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This is VAERS ID 94664

Case Details

VAERS ID: 94664 (history)  
Form: Version 1.0  
Age: 40.0  
Sex: Unknown  
Location: New Jersey  
Vaccinated:1996-11-18
Onset:1996-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypersensitivity, Lymphangitis, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, SMAC, LFT''s all nl;
CDC Split Type:

Write-up: pt recv vax 18NOV96 & 20NOV pt devel ipsilateral lymphangitis lasting 2 days;this was followed by an allergic rash which has been steroid resistant;


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