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This is VAERS ID 36317

Case Details

VAERS ID: 36317 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:1991-10-18
Onset:1991-10-22
   Days after vaccination:4
Submitted: 1991-11-07
   Days after onset:16
Entered: 1991-11-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / UNK - / IM A

Administered by: Private       Purchased by: Public
Symptoms: Chest pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC Split Type:

Write-up: Chest pain, fever 100;


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