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From the 4/30/2021 release of VAERS data:

This is VAERS ID 378027



Case Details

VAERS ID: 378027 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Virginia  
Vaccinated:2010-01-12
Onset:2010-01-15
   Days after vaccination:3
Submitted: 2010-01-21
   Days after onset:6
Entered: 2010-01-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP074AA / 1 LA / IM

Administered by: Other       Purchased by: Public
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-15
   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: Unknown
Current Illness: None reported
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: No adverse reactions within first hour after vaccination administered. Notified of client''s death on 01/15/2010.


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