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This is VAERS ID 31633

Case Details

VAERS ID: 31633 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1990-11-12
Onset:1990-11-18
   Days after vaccination:6
Submitted: 1991-06-12
   Days after onset:205
Entered: 1991-06-21
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 5 days
   Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC Split Type:

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


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