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This is VAERS ID 151828

Case Details

VAERS ID: 151828 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2000-01-24
Onset:2000-01-24
   Days after vaccination:0
Submitted: 2000-04-21
   Days after onset:87
Entered: 2000-05-10
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norvasc, Rebetron, Premarin, Relafen, Prilosec
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2000025711

Write-up: Injection site pain.


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