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From the 12/31/2003 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 27738



Case Details

VAERS ID: 27738 (history)  
Form: Version .0  
Age: 74.1  
Sex: Male  
Location: Texas  
Vaccinated:1988-11-10
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED 8F91126 / - - / -

Administered by: Public       Purchased by: Unknown
Symptoms: DRY MOUTH, EDEMA FACE
SMQs:

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Gums swollen, upper lip tender & puffy & dry, causing me to constantly wet lip w/tongue same condition w/lower lip, very annoying especially at night.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27738

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