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This is VAERS ID 56991

Case Details

VAERS ID: 56991 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:1993-10-18
Onset:1993-10-19
   Days after vaccination:1
Submitted: 1993-10-22
   Days after onset:3
Entered: 1993-11-03
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


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