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This is VAERS ID 26722

Case Details

VAERS ID: 26722 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Male  
Location: Colorado  
Vaccinated:1990-10-17
Onset:1990-10-17
   Days after vaccination:0
Submitted: 1990-10-30
   Days after onset:13
Entered: 1990-11-26
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11210 / 1 LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Dizziness, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Pt vaccinated with Influenza, fainting, BP 56/30, pulse weak thready 96. No redness swelling at site of injection. Given Epinephrine.


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