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This is VAERS ID 27529

Case Details

VAERS ID: 27529 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:1990-11-06
Onset:1990-11-07
   Days after vaccination:1
Submitted: 1991-01-18
   Days after onset:72
Entered: 1991-01-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Right ventricular failure
SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-10
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


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