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This is VAERS ID 29955

Case Details

VAERS ID: 29955 (history)  
Form: Version 1.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:1990-10-31
Onset:1990-11-15
   Days after vaccination:15
Submitted: 1990-11-29
   Days after onset:14
Entered: 1991-04-18
   Days after submission:139
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908204 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Asthenia, Chest pain, Cough, Hyperhidrosis, Hypertension, Influenza, Paraesthesia, Pharyngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cardizem 30 mg tid, Presantine 50 mg tid
Current Illness: none
Preexisting Conditions: angio-plasty
Allergies:
Diagnostic Lab Data: Neurological evaluation
CDC Split Type: CA9139

Write-up: Recvd injection 31Oct90- 15Nov90 numbness in lt arm-hand-went to ER-Adm for observation over night. DX virus-infection-still very tired. Had neurological evaluation.


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