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From the 8/14/2018 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 413868

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Case Details

VAERS ID: 413868 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: New York  
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted: 2010-12-28
Entered: 2011-01-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-12-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC Split Type:

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


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