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This is VAERS ID 36727

Case Details

VAERS ID: 36727 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:1991-11-06
Onset:1991-11-14
   Days after vaccination:8
Submitted: 1991-11-25
   Days after onset:11
Entered: 1991-12-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC Split Type:

Write-up: vertigo, nausea, emesis, confusion, disorientation;


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