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This is VAERS ID 31993

Case Details

VAERS ID: 31993 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1989-11-27
Onset:1989-12-10
   Days after vaccination:13
Submitted: 1991-06-19
   Days after onset:555
Entered: 1991-07-01
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (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, 24 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


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