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From the 10/8/2021 release of VAERS data:

This is VAERS ID 413215



Case Details

VAERS ID: 413215 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Virginia  
Vaccinated:2010-11-01
Onset:2010-12-06
   Days after vaccination:35
Submitted: 2010-12-20
   Days after onset:14
Entered: 2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public       Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2010-12-16
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=413215

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