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This is VAERS ID 40946

Case Details

VAERS ID: 40946 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Maryland  
Vaccinated:1991-10-22
Onset:1991-10-25
   Days after vaccination:3
Submitted: 1992-03-11
   Days after onset:138
Entered: 1992-04-01
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918151 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: bladder cancer
Preexisting Conditions: bladder cancer
Allergies:
Diagnostic Lab Data: x-ray of arm; no fracture 3FEB92;
CDC Split Type: MD92021

Write-up: Pt c/o onset of continuous pain in arm @ site of inject;


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