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This is VAERS ID 69841

Case Details

VAERS ID: 69841 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: Georgia  
Vaccinated:1994-10-13
Onset:1994-11-20
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 1 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Nephritis, Sepsis
SMQs:, Acute renal failure (broad), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

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: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC Split Type: PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


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