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This is VAERS ID 27404

Case Details

VAERS ID: 27404 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:1990-11-02
Onset:1990-11-02
   Days after vaccination:0
Submitted: 1991-01-10
   Days after onset:69
Entered: 1991-01-14
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 2 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 293978 / 3 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site reaction
SMQs:

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: OK9011

Write-up: Local reaction.


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