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This is VAERS ID 27338

Case Details

VAERS ID: 27338 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:1990-10-19
Onset:1990-10-20
   Days after vaccination:1
Submitted: 1990-11-30
   Days after onset:41
Entered: 1991-01-08
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Sepsis (narrow), 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, 8 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


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