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This is VAERS ID 37808

Case Details

VAERS ID: 37808 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:1991-11-21
Onset:1991-11-21
   Days after vaccination:0
Submitted: 1991-11-26
   Days after onset:5
Entered: 1991-12-09
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Alkalosis, Diarrhoea, Oliguria, Pyrexia, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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, 6 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: AZT (Retrovin), Bactrim, Diflucan
Current Illness: Pt is HIV pos
Preexisting Conditions: Pt has had crytococcal meningitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: 914091068

Write-up: Shock, metabolic alkalosis, high fever & diarrhea are reported p/recvd flu vax 21NOV91; pt has had cryptococcal meningitis & is HIV positive; Seen in ER t106.7F in shock & diarrhea admitted to hosp & found to be oliguric;


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