Adverse Event Report

Field Content
VAERS_ID 0610831
RECVDATE 2015-11-19
STATE CA
AGE_YRS 42
CAGE_YR 42
CAGE_MO
SEX F
RPT_DATE 2015-11-19
SYMPTOM_TEXT PT STATES HAD PAIN RIGHT AWAY X2 DAYS . FOLLOWED BY RASH & ITCHING STARTING SUNDAY 11/15/15 UNTIL PRESENT DAY.
DIED
DATEDIED
L_THREAT
ER_VISIT Y
HOSPITAL
HOSPDAYS
X_STAY
DISABLE
RECOVD U
VAX_DATE 2015-11-12
ONSET_DATE 2015-11-12
NUMDAYS 0
LAB_DATA PT WAS EVALUATED TODAY 11/19/15 BY DR. RX WAS GIVEN FOR BENADRYL AND PT WAS ADVISED ON COMFORT MEASURES AND TO FOLLOW UP AS NEEDED IF NOT IMPROVING OR GETTING WORSE.
V_ADMINBY UNK
V_FUNDBY PVT
OTHER_MEDS LISINOPRIL 25MG PO QD, HCTZ 25MG 1POQD
CUR_ILL NO
HISTORY DIABETES AND HYPERTENTION
PRIOR_VAX
SPLTTYPE
FORM_VERS 1
TODAYS_DATE
BIRTH_DEFECT
OFC_VISIT
ER_ED_VISIT
ALLERGIES
SYMPTOMS
  • Pain
  • Pruritus
  • Rash

Vaccines

INFLUENZA (SEASONAL) (FLUVIRIN)
Field Content
VAERS_ID 0610831
VAX_TYPE FLU3
VAX_MANU NOVARTIS VACCINES AND DIAGNOSTICS
VAX_LOT 1515701
VAX_DOSE_SERIES UNK
VAX_ROUTE IM
VAX_SITE LA
VAX_NAME INFLUENZA (SEASONAL) (FLUVIRIN)
PNEUMO (PNEUMOVAX)
Field Content
VAERS_ID 0610831
VAX_TYPE PPV
VAX_MANU MERCK & CO. INC.
VAX_LOT K021881
VAX_DOSE_SERIES UNK
VAX_ROUTE IM
VAX_SITE LA
VAX_NAME PNEUMO (PNEUMOVAX)
Virtual Assistant