First Appeared on 12/8/2009 |
| VAERS ID: |
342656
|
Vaccinated: |
2009-02-09 |
| Age: |
59.0 |
Onset: |
2009-03-01 |
| Gender: |
Female |
Submitted: |
2009-03-25 |
| Location: |
North Carolina |
Entered: |
2009-03-25 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? No |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
| Previous Vaccinations: |
| Other Medications: Current meds: 1. Toprol XL 200 mg po daily 2. Aspirin 81 mg po daily 3. Plavix 75 mg po daily 4. Quinapril 80 mg po daily 5. Hydrochlorothiazide 25 mg po daily 6. Levemir insulin 32 units SubQ bid 7. Novolog insulin 16 units tid ac 8. Amlod |
| Current Illness: none |
| Preexisting Conditions: PMH: DMII, HL, HTN, CAD, Gout, Status post multiple lacunar CVA with residual left side coordination deficit |
| Diagnostic Lab Data: |
| CDC 'Split Type': |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| FLU: INFLUENZA (SEASONAL) (NO BRAND NAME - BRAND NAME UNKNOWN) |
SANOFI PASTEUR |
U2849AC |
|
IM |
RA |
| HEP: HEP B (RECOMBIVAX HB) |
MERCK & CO. INC. |
0398X |
|
IM |
RA |
|
| Administered by: Unknown
Purchased by: Unknown |
| Symptoms: Paraesthesia |
| Write-up: 59 yo BF presented to clinic 3/24/09 with c/o pins and needles and tingling in right arm x ~ 3.5 weeks. Onset was weeks following 02/09/2009 vaccination with Hepatitis B vaccine and influenza IM injections in the right arm. MD will continue to monitor. Unclear association at this time. Pt will return to clinic for f/u in ~1 month. |
|
|
Changed on 12/7/2010 |
| VAERS ID: |
342656 Before
After
|
Vaccinated: |
2009-02-09 |
| Age: |
59.0 |
Onset: |
2009-03-01 |
| Gender: |
Female |
Submitted: |
2009-03-25 |
| Location: |
North Carolina |
Entered: |
2009-03-25 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? No |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
| Previous Vaccinations: |
| Other Medications: Current meds: 1. Toprol XL 200 mg po daily 2. Aspirin 81 mg po daily 3. Plavix 75 mg po daily 4. Quinapril 80 mg po daily 5. Hydrochlorothiazide 25 mg po daily 6. Levemir insulin 32 units SubQ bid 7. Novolog insulin 16 units tid ac 8. Amlod |
| Current Illness: none |
| Preexisting Conditions: PMH: DMII, HL, HTN, CAD, Gout, Status post multiple lacunar CVA with residual left side coordination deficit |
| Diagnostic Lab Data: |
| CDC 'Split Type': |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| FLU: INFLUENZA (SEASONAL) (NO BRAND NAME - BRAND NAME UNKNOWN)/INFLUENZA (SEASONAL) (NO BRAND NAME) |
SANOFI PASTEUR |
U2849AC |
|
IM |
RA |
| HEP: HEP B (RECOMBIVAX HB) |
MERCK & CO. INC. |
0398X |
|
IM |
RA |
|
| Administered by: Unknown
Purchased by: Unknown |
| Symptoms: Paraesthesia |
| Write-up: 59 yo BF presented to clinic 3/24/09 with c/o pins and needles and tingling in right arm x ~ 3.5 weeks. Onset was weeks following 02/09/2009 vaccination with Hepatitis B vaccine and influenza IM injections in the right arm. MD will continue to monitor. Unclear association at this time. Pt will return to clinic for f/u in ~1 month. |
|
|
