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This is VAERS ID 38737

Case Details

VAERS ID: 38737 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1991-10-28
Onset:1991-10-28
   Days after vaccination:0
Submitted: 1991-12-10
   Days after onset:43
Entered: 1992-01-13
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


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