| VAERS ID: |
36486 (history) |
| Form: |
Version 1.0 |
| Age: |
78.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 1991-10-10 |
| Onset: | 1991-10-11 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
1991-11-19 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918170 / UNK |
- / - |
Administered by: Public Purchased by: Unknown
Symptoms: Dizziness,
Hypokinesia,
Infection,
Lung disorder,
Myalgia,
Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (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, 5 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC Split Type: CA91133
Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia; |
