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This is VAERS ID 27391

Case Details

VAERS ID: 27391 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Female  
Location: Missouri  
Vaccinated:1990-11-06
Onset:1990-11-28
   Days after vaccination:22
Submitted: 1990-12-18
   Days after onset:20
Entered: 1991-01-14
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Back pain, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Syntroid for thyroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO901

Write-up: Developed backache & headache, 100.6, no appetite. Wife & son had aches-pains mostly bronchial.


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