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This is VAERS ID 36485

Case Details

VAERS ID: 36485 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:1991-10-24
Onset:1991-10-28
   Days after vaccination:4
Submitted: 1991-11-05
   Days after onset:8
Entered: 1991-11-19
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 2 - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 302959 / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


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