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This is VAERS ID 37877

Case Details

VAERS ID: 37877 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1991-10-25
Onset:1991-11-20
   Days after vaccination:26
Submitted: 1991-12-03
   Days after onset:13
Entered: 1991-12-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01071P / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Anorexia, Intestinal obstruction, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Aldactone, Edecrin, Premarin, Prednisone, Ativan
Current Illness: NONE
Preexisting Conditions: Alzheimer''s dementia, CHF, hypertension, chronic lymphedeme
Allergies:
Diagnostic Lab Data:
CDC Split Type: WV9158

Write-up: 20NOV91 began vomiting @ 130AM x 2 refused to eat through the day; no audible bowel sounds @ 715PM & c/o abd tenderness & admitted to Hosp 20NOV; bowel resection completed due to volvolus of bowel;


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