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This is VAERS ID 35721

Case Details

VAERS ID: 35721 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1991-10-03
Onset:1991-10-03
   Days after vaccination:0
Submitted: 1991-10-07
   Days after onset:4
Entered: 1991-10-22
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, 1 days
   Extended hospital stay? No
Previous Vaccinations: No;~ ()~~~In patient
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC Split Type: OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


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