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This is VAERS ID 26861

Case Details

VAERS ID: 26861 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:1990-11-06
Onset:1990-11-06
   Days after vaccination:0
Submitted: 1990-11-16
   Days after onset:10
Entered: 1990-11-30
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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:
Other Medications: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


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