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This is VAERS ID 473170

Case Details

VAERS ID: 473170 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2012-08-01
Onset:2012-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Optic nerve disorders (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-10-10
   Days after onset: 70
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC Split Type: HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


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