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This is VAERS ID 26864

Case Details

VAERS ID: 26864 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:1990-11-01
Onset:1990-11-10
   Days after vaccination:9
Submitted: 1990-11-15
   Days after onset:5
Entered: 1990-11-30
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious diarrhoea (broad), 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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


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