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This is VAERS ID 26838

Case Details

VAERS ID: 26838 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Arizona  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1990-11-15
Entered: 1990-11-28
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC Split Type: 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


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