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From the 1/7/2021 release of VAERS data:

This is VAERS ID 26941

Case Details

VAERS ID: 26941 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: Colorado  
Vaccinated:1990-10-17
Onset:1990-11-21
   Days after vaccination:35
Submitted: 1990-12-03
   Days after onset:12
Entered: 1990-12-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11210 / 3 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Headache, Hyporeflexia, Neck pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Procane, Digoxin, Tenormin
Current Illness:
Preexisting Conditions: intermittant A-Fib, CHF, NKDA
Allergies:
Diagnostic Lab Data: deceased reflexes & weakness
CDC Split Type:

Write-up: Pt c/o of hand/arm & neck pain, thought to be due to Procan intoxication , admitted to hosp. secondary to this Dx & developed progressive weakness once in hosp. Currently in ICU


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