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This is VAERS ID 26837

Case Details

VAERS ID: 26837 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Colorado  
Vaccinated:1990-10-25
Onset:1990-11-01
   Days after vaccination:7
Submitted: 1990-11-15
   Days after onset:14
Entered: 1990-11-28
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula~ ()~~~In patient
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


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