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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 26703

Case Details

VAERS ID: 26703 (history)  
Form: Version .0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:1990-10-31
Onset:1990-11-02
   Days after vaccination:2
Submitted: 1990-11-06
   Days after onset:4
Entered: 1990-11-26
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11221 / 0 A / -

Administered by: Private       Purchased by: Unknown
Symptoms: ASTHENIA, DIARRHEA, FEVER, FLU SYND, NAUSEA
SMQs:

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

Write-up: Pt vaccinated with Influenza vaccine developed diarrhea, flu-like symptoms, rash, fatigue, nausea, fever.


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