| VAERS ID: |
27073 (history) |
| Form: |
Version 1.0 |
| Age: |
64.0 |
| Sex: |
Male |
| Location: |
Washington |
| Vaccinated: | 1990-11-19 |
| Onset: | 1990-11-20 |
| Days after vaccination: | 1 |
| Submitted: |
1990-11-27 |
| Days after onset: | 7 |
| Entered: |
1990-12-17 |
| Days after submission: | 20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
OJ11163 / 3 |
RA / IM |
Administered by: Other Purchased by: Public
Symptoms: Headache,
Influenza,
Neck pain,
Photophobia
SMQs:, Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Arthritis (broad), Infective pneumonia (broad), Opportunistic infections (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? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC Split Type: WA90496
Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome. |
