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This is VAERS ID 29510

Case Details

VAERS ID: 29510 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:1990-12-15
Onset:1990-12-16
   Days after vaccination:1
Submitted: 1991-03-26
   Days after onset:100
Entered: 1991-04-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Anorexia, Asthenia, Atelectasis, Chills, Cough, Headache, Myalgia, Paraesthesia, Pharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: ASA
Current Illness: NONE
Preexisting Conditions: No egg allergy
Allergies:
Diagnostic Lab Data: CBC, Sed RAT, Cold agglutinins, chemistry profile, CT scan of head & abdomin, Legionella titer - all WNL; CXR mild basilar; atelectasis during acute phase;
CDC Split Type: 914090005

Write-up: Polymyalgia rheumatica reported in MD receiving FLUOGEN 1st shot 15DEC90; sx of URI, fevers to 101, chills w/rigors, myalgia, headache, fatigue, anorexia, non productive cough & dysesthesias of scalp; Atelectasis on CXR;


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