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This is VAERS ID 480310

Case Details

VAERS ID: 480310 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2012-12-19
Onset:2012-12-23
   Days after vaccination:4
Submitted: 2013-01-06
   Days after onset:14
Entered: 2013-01-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Bacterial test, Death, Malaise, Pericardial haemorrhage, Viral test
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-12-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC Split Type:

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


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