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From the 11/19/2021 release of VAERS data:

This is VAERS ID 416456

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Case Details

VAERS ID: 416456 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2010-10-18
Onset:2010-11-20
   Days after vaccination:33
Submitted: 2011-02-09
   Days after onset:81
Entered: 2011-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3579BA / UNK LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Abasia, Electromyogram, Hypoaesthesia, Laboratory test, Lumbar puncture, Muscular weakness, Nuclear magnetic resonance imaging, Scan, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fish oil, Centrum silver, Baby aspirin, Decadron, Testosterone, folic acid, lasix, Nexium, Toprol-XL, Zocor, Ambien, Levaquin, Neurontin, Rephresh eyedrops, Colace Lortab, coumadin, IVIG
Current Illness: peripheral vascular disease
Preexisting Conditions: colon polyps, Benign prostatic hyperplasia, osteoarthritis, atherosclerotic peripheral vascular disease, history CVA, pituitary adenoma with right partial third nerve palsy, hyperlipidemia, hypertension, peripheral neuropathy, organic health disease with atrial fibrillation and cardiomegaly
Allergies:
Diagnostic Lab Data: Was sent to Nursing Home after discharge from hospital. MRI, scans, lumbar puncture, EMG, xray, lab
CDC Split Type:

Write-up: 6 wks after receiving the vaccine began having progressive weakness and numbness in legs and fingertips. Few days prior to admission to hosptial 1/26/2011 unable to walk.


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