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From the 11/12/2021 release of VAERS data:

This is VAERS ID 434581

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Case Details

VAERS ID: 434581 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2010-09-29
Onset:2010-10-01
   Days after vaccination:2
Submitted: 2011-09-16
   Days after onset:350
Entered: 2011-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3082CA / UNK RA / UN

Administered by: Private       Purchased by: Other
Symptoms: Amyotrophic lateral sclerosis, Death, Electromyogram abnormal, Muscle contractions involuntary
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LAMICTAL; Estradiol; Prometrium, IMITREX
Current Illness: Partial complex SZ
Preexisting Conditions: Partial complex SZ
Allergies:
Diagnostic Lab Data: Abnormal EMG; Exam
CDC Split Type:

Write-up: ADACEL vaccine administered 7/29/10 Occ Health. Fasiculations developed 2 weeks later. Diagnosed with ALS 11/10. Expired Sept 2011.


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