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This is VAERS ID 36710

Case Details

VAERS ID: 36710 (history)  
Form: Version 1.0  
Age: 39.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:1991-11-07
Onset:1991-11-11
   Days after vaccination:4
Submitted: 1991-11-20
   Days after onset:9
Entered: 1991-12-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Pharyngitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

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, 4 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: X-ray gallbladder & kidney for stones-normal; upper GI-normal; Ultra sound on stomach, gallbladder & liver-normal;
CDC Split Type: OK9177

Write-up: Vomiting, diarrhea, dehydration, fever, sore throat treatment @ hosp-Tagamet, Glucose/dextrose, Amoxillin;


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