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From the 9/17/2021 release of VAERS data:

This is VAERS ID 376969



Case Details

VAERS ID: 376969 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Virginia  
Vaccinated:2010-01-06
Onset:2010-01-09
   Days after vaccination:3
Submitted: 2010-01-14
   Days after onset:5
Entered: 2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-11
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC Split Type:

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


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