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This is VAERS ID 36651

Case Details

VAERS ID: 36651 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: Utah  
Vaccinated:1991-10-16
Onset:1991-10-16
   Days after vaccination:0
Submitted: 1991-11-01
   Days after onset:16
Entered: 1991-11-26
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC Split Type: UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


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