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

This is VAERS ID 376990



Case Details

VAERS ID: 376990 (history)  
Form: Version 1.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2010-01-08
Onset:2010-01-10
   Days after vaccination:2
Submitted: 2010-01-14
   Days after onset:4
Entered: 2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: unknown


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=376990


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