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This is VAERS ID 53151

Case Details

VAERS ID: 53151 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:1992-10-10
Submitted: 1993-05-11
   Days after onset:213
Entered: 1993-05-24
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01772P / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Hypokinesia, Insomnia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 23591

Write-up: Chronic intense pain from shoulder to 7-8" down arm; This was the 1st time pt has been vaxed for influenza; pt stated that the pain started immed p/receiving the shot; pt exp limited movement in that arm, difficulty lifting arm overhead;


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