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This is VAERS ID 27386

Case Details

VAERS ID: 27386 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:1990-11-07
Onset:1990-11-11
   Days after vaccination:4
Submitted: 1991-01-02
   Days after onset:52
Entered: 1991-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 0190P / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Rash
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Alopurinol
Current Illness:
Preexisting Conditions: Gout
Allergies:
Diagnostic Lab Data:
CDC Split Type: FL9008

Write-up: Approx 4 wks after imm. developed severe weakness lasting 3-4 wks; rash on chest and buttocks & fingers; inject site red with white eruptions. Did not see a MD.


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