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From the 6/11/2021 release of VAERS data:

This is VAERS ID 407287



Case Details

VAERS ID: 407287 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2010-10-22
Onset:2010-10-25
   Days after vaccination:3
Submitted: 2010-11-08
   Days after onset:14
Entered: 2010-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFUA602AB / UNK LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Back pain, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-11-11
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated on 10/22/10. Reports back pain and muscle weakness increasing through weekend. Admitted on 10/27/10.


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