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This is VAERS ID 36577

Case Details

VAERS ID: 36577 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Female  
Location: Alabama  
Vaccinated:1991-10-15
Onset:1991-10-28
   Days after vaccination:13
Submitted: 1991-11-14
   Days after onset:17
Entered: 1991-11-22
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Condition aggravated
SMQs:

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, 8 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic medical condition but stable
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL91033

Write-up: Pt is known to have COPD; had excerbation needing hospitalization from 28OCT91 to 5NOV91;


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