Received Aug 6, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| FLUX | INFLUENZA (SEASONAL) (NO BRAND NAME) | UNKNOWN MANUFACTURER | UNK | — | — |
Reported Symptoms: 10002218:ANAPHYLAXIS; Narrative: An 88yo female with PMH which included hypothyroidism, HTN, HLD, chronic anxiety, chronic GERD, HX of smoking 40+ years. The patient recently moved from (withheld) and presented to clinic on March 26, 2025 to get her medication refilled (transferred from another clinic) and established care. During the visit the PCC - RN's note included "vaccine discussed and patient informed to bring in immunization status" The RN also reported the patient had a historical ADR of Influenza vaccine induced anaphylaxis. No other detailed information was provided regarding the vaccine type (mfc, lot # exp) when, where and by whom it was administered. Other Relevant HX: Other: ANAPHYLAXIS