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This is VAERS ID 480995

Case Details

VAERS ID: 480995 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2012-10-03
Onset:2012-10-07
   Days after vaccination:4
Submitted: 2013-01-10
   Days after onset:95
Entered: 2013-01-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / UNK LA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-10-18
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.


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