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This is VAERS ID 175831

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 175831
VAERS Form:
Age:1.3
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABS - / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABS 5E61006 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 0623B / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MSD 0430B / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: DEAF, SPEECH DIS, DIARRHEA, EYE DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 12/8/2009

VAERS ID: 175831 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-02 2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES - / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 5E61006 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0623B / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0430B / 0 LL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired, DEAF, SPEECH DIS, DIARRHEA, EYE DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 10/14/2012

VAERS ID: 175831 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE (blank)

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 2/14/2017

VAERS ID: 175831 Before After
VAERS Form:
Age:1.3 1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 5/14/2017

VAERS ID: 175831 Before After
VAERS Form:
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 9/14/2017

VAERS ID: 175831 Before After
VAERS Form:(blank) 1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 3 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 3 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 0 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 0 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 2/14/2018

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 6/14/2018

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 8/14/2018

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 9/14/2018

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 10/14/2018

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 12/24/2020

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 12/30/2020

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 5/7/2021

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.


Changed on 5/14/2021

VAERS ID: 175831 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Minnesota
Vaccinated:1995-09-25
Onset:1995-09-25
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / 4 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61006 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0623B / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0430B / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Aphasia, Diarrhoea, Eye disorder, Hearing impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: diarrhea, rash~Measles + Mumps + Rubella (no brand name)~2~5.00~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt developed permanent chronic diarrhea, arersion to eye contact, change in hearing and stopped speaking. Diarrhea and loss of speech were immediate others were gradual onset approximately 1 month.

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