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This is VAERS ID 27393

Case Details

VAERS ID: 27393 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Missouri  
Vaccinated:1990-11-06
Onset:1990-11-27
   Days after vaccination:21
Submitted: 1990-12-18
   Days after onset:21
Entered: 1991-01-14
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Back pain, Chills, Diarrhoea, Nausea, Pyrexia, Somnolence
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: arthritic medication
Current Illness:
Preexisting Conditions: Stroke 89 - compressed disc in spine column area - arthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO902

Write-up: 3 wks after FLU vaccine, developed backache, diarrhea, chills, drank lots of fluid, temp 104.2, nausea, tired & sleepy. Four other members of family had flu-like symptoms at same time.


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