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This is VAERS ID 65275

Case Details

VAERS ID: 65275 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1993-11-09
Onset:1993-11-09
   Days after vaccination:0
Submitted: 1994-03-17
   Days after onset:128
Entered: 1994-05-25
   Days after submission:68
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


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