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From the 12/31/2003 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 27825

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Case Details

VAERS ID: 27825 (history)  
Form: Version .0  
Age: 28.2  
Sex: Female  
Location: Georgia  
Vaccinated:1990-11-05
Onset:1990-11-05
   Days after vaccination:0
Submitted: 1990-11-07
   Days after onset:2
Entered: 1991-02-13
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908212 / - A / IM

Administered by: Other       Purchased by: Unknown
Symptoms: HEADACHE, INJECT SITE REACT, MALAISE, PAIN INJECT SITE, PHARYNGITIS
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: Developed Pain & swelling @ inject site; headache; sore throat; malaise; rhinitis.


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