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This is VAERS ID 161041

Case Details

VAERS ID: 161041 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Ohio  
Vaccinated:2000-10-19
Onset:2000-10-20
   Days after vaccination:1
Submitted: 2000-10-23
   Days after onset:3
Entered: 2000-10-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 2 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.


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