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This is VAERS ID 28474

Case Details

VAERS ID: 28474 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Washington  
Vaccinated:1991-01-25
Onset:1991-01-31
   Days after vaccination:6
Submitted: 1991-02-01
   Days after onset:1
Entered: 1991-02-25
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 3 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Other ischaemic heart disease (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC Split Type: WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


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