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This is VAERS ID 26839

Case Details

VAERS ID: 26839 (history)  
Form: Version 1.0  
Age: 55.0  
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:1990-11-12
Submitted: 1990-11-16
   Days after onset:4
Entered: 1990-11-28
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Face oedema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nasalide, Zejtril
Current Illness: HTN
Preexisting Conditions: Duricef, Novacain, Feldene, Reglan
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated developed swelling-lips, face lt arm & lt hand. Seen in ER 13NOV90. Vsikeril injection in ER Hydroxyzine pam 50mg TID x 7 days. Seen in MD office 15NOV90 for f/u


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