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This is VAERS ID 39021

Case Details

VAERS ID: 39021 (history)  
Form: Version 1.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:1991-11-15
Onset:1991-11-16
   Days after vaccination:1
Submitted: 1992-01-09
   Days after onset:54
Entered: 1992-01-24
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC Split Type: 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


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