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This is VAERS ID 26880

Case Details

VAERS ID: 26880 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:1990-11-19
Onset:1990-11-19
   Days after vaccination:0
Submitted: 1990-11-24
   Days after onset:5
Entered: 1990-12-03
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 1 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Chest pain, Chills, Cough, Dyspnoea, Headache, Injection site pain, Neck pain, Paraesthesia, Rhinitis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (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: Coumadin, Premarin, Ativan, Emycin,Ampicillin
Current Illness:
Preexisting Conditions: Codeine, open heart surgery for dysfunctional aortic valve 3/90
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza lt arm felt sore & noted headache in the region & bilateral neck pain posterior. Also noted chills - did not take temp pt woke up feeling as if couldn''t breathe & had a cement block on chest.


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