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This is VAERS ID 58363

Case Details

VAERS ID: 58363 (history)  
Form: Version 1.0  
Age: 28.0  
Sex: Female  
Location: Ohio  
Vaccinated:1991-12-06
Onset:1991-12-18
   Days after vaccination:12
Submitted: 1993-11-23
   Days after onset:706
Entered: 1993-12-22
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Deafness
SMQs:, Hearing impairment (narrow)

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: UNK
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893336014J

Write-up: pt recvd vax 6DEC91 & 18DEC91 devel hearing loss in lt ear; 27JAN93 dx w/profound sensorineural hearing loss of the lt ear; hearing loss cont to the date of this report;


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