| VAERS ID: |
28835 (history) |
| Form: |
Version 1.0 |
| Age: |
70.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 1990-10-02 |
| Onset: | 1990-10-24 |
| Days after vaccination: | 22 |
| Submitted: |
1990-11-07 |
| Days after onset: | 14 |
| Entered: |
1991-03-06 |
| Days after submission: | 119 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
02580P / UNK |
LA / IM |
Administered by: Public Purchased by: Public
Symptoms: Arthralgia,
Arthritis,
Chills,
Coma,
Dehydration,
Injection site reaction,
Palpitations,
Pyrexia,
Rash,
Syncope,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)
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, 5 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC Split Type: MD91006
Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug |
