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This is VAERS ID 26822

Case Details

VAERS ID: 26822 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:1990-10-29
Onset:1990-10-30
   Days after vaccination:1
Submitted: 1990-11-19
   Days after onset:20
Entered: 1990-11-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / UNK - / A

Administered by: Public       Purchased by: Private
Symptoms: Face oedema, Nuchal rigidity, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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:

Write-up: Pt vaccinated with Fluogen/Engerix developed puffy below eyes, blotchy patches on shoulder & legs, felt like fever, stiff neck started morning after & lasted 1 wk red color around neck


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