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This is VAERS ID 40947

Case Details

VAERS ID: 40947 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:1991-10-22
Onset:1991-10-31
   Days after vaccination:9
Submitted: 1992-03-11
   Days after onset:132
Entered: 1992-04-01
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918151 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hypokinesia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (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:
Current Illness: NONE
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data: x-ray pending;
CDC Split Type: MD92022

Write-up: Pt devel pain & dec ROM in arm where the vax was recvd;


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