| 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), Immune-mediated/autoimmune disorders (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, 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 |
