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This is VAERS ID 57465

Case Details

VAERS ID: 57465 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:1993-10-28
Onset:1993-10-28
   Days after vaccination:0
Submitted: 1993-11-03
   Days after onset:6
Entered: 1993-11-17
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 358957 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


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