| VAERS ID: | 294221 (history) | Vaccinated: | 0000-00-00 | | Age: | 80.0 | Onset: | 2007-10-10 | | Gender: | Female | Submitted: | 2007-10-23, Days after onset: 13 | | Location: | Unknown | Entered: | 2007-10-24, Days after submission: 1 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? Yes |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: Unknown | | Current Illness: Immune system disorder | | Preexisting Conditions: | | Diagnostic Lab Data: Unknown | | CDC 'Split Type': WAES0710USA03511 | |