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This is VAERS ID 26711

Case Details

VAERS ID: 26711 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:1990-10-18
Onset:1990-10-18
   Days after vaccination:0
Submitted: 1990-11-09
   Days after onset:22
Entered: 1990-11-21
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 2 - / -

Administered by: Public       Purchased by: Public
Symptoms: Face oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA901

Write-up: Pt vaccinated with Fluzone developed facial swelling seen on 19OCT90 face was red with periorbital swelling. Benadryl 25 mg 1 or 2 caps every 8 hours.


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