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This is VAERS ID 603499

Case Details

VAERS ID: 603499 (history)  
Form: Version 1.0  
Age: 75.0  
Gender: Female  
Location: Vermont  
Vaccinated:2015-10-02
Onset:2015-10-02
   Days after vaccination:0
Submitted: 2015-10-20
   Days after onset:18
Entered: 2015-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS L94EX / 3 UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Dyspnoea, Muscular weakness, Pain in extremity, Restless legs syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Leg pain, restless legs, progressive weakness of extremities, neck, difficulty breathing.


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