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This is VAERS ID 26844

Case Details

VAERS ID: 26844 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Washington  
Vaccinated:1990-09-01
Onset:1990-09-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Stevens-Johnson syndrome
SMQs:, Severe cutaneous adverse reactions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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:
Diagnostic Lab Data:
CDC Split Type: 904090004

Write-up: Pt vaccinated with FLUOGEN developed Stevens-Johnson Synd. No other details known.


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