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This is VAERS ID 27388

Case Details

VAERS ID: 27388 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: Georgia  
Vaccinated:1990-11-28
Onset:1990-12-06
   Days after vaccination:8
Submitted: 1990-12-27
   Days after onset:21
Entered: 1991-01-14
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cough, Pharyngitis, Pyrexia, Rhinitis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Folic acid, Pencillin
Current Illness:
Preexisting Conditions: Sickle Cell
Allergies:
Diagnostic Lab Data: blood work, chest x-ray (MCCG)
CDC Split Type: GA9018

Write-up: Pt vaccinated with FLU developed fever 102, vomiting, sore throat, red, mattered eyes, runny nose, cough.


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