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This is VAERS ID 37802

Case Details

VAERS ID: 37802 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Missouri  
Vaccinated:1991-11-08
Onset:1991-11-21
   Days after vaccination:13
Submitted: 1991-11-27
   Days after onset:6
Entered: 1991-12-06
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Chills, Cough, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Thyroid
Current Illness: NONE
Preexisting Conditions: mold, grasses, tres, flower, house dust; thyroid deficiency
Allergies:
Diagnostic Lab Data: Pneumonia-CXR;
CDC Split Type: MO9194

Write-up: 21NOV91 coughing, fever, chills, fatigue, weakness; hospitalized 24NOV91 MD does not feel condition is assoc w/flu shot;


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