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This is VAERS ID 26729

Case Details

VAERS ID: 26729 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1990-11-02
Onset:1990-11-02
   Days after vaccination:0
Submitted: 1990-11-05
   Days after onset:3
Entered: 1990-11-26
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01770P / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Hyperhidrosis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (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:
Other Medications: Cardizem, Axid, Carafate
Current Illness:
Preexisting Conditions: HTN, Cardiovascular
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS901

Write-up: Pt vaccinated with Fluogen approx 15 min after receiving vaccine pt c/o dizziness, weakness, excessive perspiring, nausea. vomited X 2; BP 140/80, P80 Reg, BS 150.


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