| VAERS ID: |
29822 (history) |
| Form: |
Version 1.0 |
| Age: |
61.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 1990-11-14 |
| Onset: | 1990-11-16 |
| Days after vaccination: | 2 |
| Submitted: |
1991-02-06 |
| Days after onset: | 82 |
| Entered: |
1991-04-09 |
| Days after submission: | 61 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
0097S / 1 |
LA / IM |
Administered by: Other Purchased by: Unknown
Symptoms: Chest pain,
Eczema,
Pruritus,
Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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, ? days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Cardiozen, Hydrochlorathiazide, Potassium, ASA, Proventyl, Thyroid, Persantine
Current Illness: NONE
Preexisting Conditions: 2 CVA''s (1986 & 87), asthma, hypertension, Atrial Fibrillation; Boarderline diabetic;
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: 16NOV90 pt had urticaria x/soles of feet, breasts & face; By 19NOV90 pt report entire body covered w/eczema, pruritus, burning & sensation of needles pricking the skin was described by pt; Admitted to Hosp 19NOV90 w/chest pains; |
