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This is VAERS ID 572584

Case Details

VAERS ID: 572584 (history)  
Form: Version 1.0  
Age: 65.0  
Gender: Female  
Location: Vermont  
Vaccinated:2015-03-28
Onset:0000-00-00
Submitted: 2015-03-31
Entered: 2015-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L13518 / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Erythema, Injection site pain, Injection site swelling, Peripheral swelling, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy: MOTRIN, Balsam, Nickel, Naproxen; DM; HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm erythemic, swollen 5cm around vaccine site, extending past elbow, tender. Rx: BENADRYL 25mg 1-2 PO Q 6 hours prn, return prn.


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