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This is VAERS ID 26819

Case Details

VAERS ID: 26819 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:1990-11-12
Onset:1990-11-13
   Days after vaccination:1
Submitted: 1990-11-13
   Days after onset:0
Entered: 1990-11-27
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site reaction
SMQs:

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

Write-up: Reporter is MD states would have required Dr visit if wasn''t an MD. Vaccinated with Influenza developed slight soreness at site 6 hrs later. 24hrs later mild swelling, erythema 3" diameter & pruritis.


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