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This is VAERS ID 670730

Case Details

VAERS ID: 670730 (history)  
Form: Version 1.0  
Age: 58.0  
Gender: Female  
Location: Vermont  
Vaccinated:2016-11-21
Onset:2016-11-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2016-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5S349 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~Influenza (Seasonal) (no brand name)~UN~56.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None pertinent to reaction
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 16 x 7 cm area with erythema and warmth.


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