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This is VAERS ID 61371

Case Details

VAERS ID: 61371 (history)  
Form: Version 1.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:1993-11-01
Onset:1993-11-01
   Days after vaccination:0
Submitted: 1994-02-02
   Days after onset:93
Entered: 1994-03-31
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Back pain, Injection site inflammation, Pain
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (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:

Write-up: pt recvd vax & exp pain in back & lt arm has been considerable; became inflamed immed that day & have been taking anti-inflamatorys & muscle relaxants ever since; I also have been to physical therapy;


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