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This is VAERS ID 95639

Case Details

VAERS ID: 95639 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Female  
Location: Georgia  
Vaccinated:1996-09-01
Onset:1996-12-01
   Days after vaccination:91
Submitted: 1997-03-06
   Days after onset:95
Entered: 1997-03-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (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: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


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