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This is VAERS ID 30243

Case Details

VAERS ID: 30243 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: Colorado  
Vaccinated:1990-10-25
Onset:1990-11-01
   Days after vaccination:7
Submitted: 1991-04-05
   Days after onset:155
Entered: 1991-04-29
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: ~ ()~~~In patient
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


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