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This is VAERS ID 26863

Case Details

VAERS ID: 26863 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1990-10-31
Onset:1990-11-07
   Days after vaccination:7
Submitted: 1990-11-26
   Days after onset:19
Entered: 1990-11-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 3 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chest pain, Gastroenteritis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Noninfectious diarrhoea (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC Split Type: MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


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