National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 36612

Case Details

VAERS ID: 36612 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-11-06
Onset:1991-11-06
   Days after vaccination:0
Submitted: 1991-11-07
   Days after onset:1
Entered: 1991-11-25
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918153 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chills, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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:
Current Illness: pt stated was healthy @ time;
Preexisting Conditions: had rt breast & lymph nodes removed p/each breast was dx;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS9151

Write-up: Pt states approx 2 hrs p/vax was given, pt began having a fever of 101 to103 & a chill & aching severly; pt was taken to Hosp ER & admitted; This was pts 1st flu immun;


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36612


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166