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This is VAERS ID 31712

Case Details

VAERS ID: 31712 (history)  
Form: Version 1.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:1990-07-01
Onset:1990-07-09
   Days after vaccination:8
Submitted: 1991-06-17
   Days after onset:343
Entered: 1991-06-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Affect lability, Arthralgia, Dizziness, Ear pain, Pain
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Branchial Nueroplexy
CDC Split Type:

Write-up: Pain in arm (not in the one where the shot was administered), dizziness, earache, feeling out-of-it, felt would lose contol of arms, achiness in joints;


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