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This is VAERS ID 42008

Case Details

VAERS ID: 42008 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:1991-10-29
Onset:1991-10-30
   Days after vaccination:1
Submitted: 1992-05-04
   Days after onset:186
Entered: 1992-05-15
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Hypokinesia, Injection site pain, Myalgia, Oedema, Pain, Tendon disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (narrow)

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? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Levathroid; Anacin
Current Illness:
Preexisting Conditions: Hypothyroidism offset by Levathroid & rxn to antib''s given for recurring bladder infects; hypereosinophilia w/tx for hypothyroidism EOS levels went back to nl
Allergies:
Diagnostic Lab Data: MRI
CDC Split Type:

Write-up: Extreme tenderness in area of flu shot; soreness & tenderness & later sweling by 11JAN92 arm mobility way down & discomfort very high; pt went to MD then referred to specialist 29JAN92 w/same sx as 11JAN92 & in between; tedonitis;


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