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

This is VAERS ID 73464

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Case Details

VAERS ID: 73464 (history)  
Form: Version .0  
Age: 48.3  
Sex: Female  
Location: Illinois  
Vaccinated:1995-04-13
Onset:1995-04-13
   Days after vaccination:0
Submitted: 1995-04-18
   Days after onset:5
Entered: 1995-04-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA424A6 / - LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: DIARRHEA, DIZZINESS, HEADACHE, HYPERTENS, PALLOR
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: NONE
Current Illness: NONE
Preexisting Conditions: PCN & shellfish
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt recvd vax 13APR95 1115AM & 15-20mins later could taste it describing it as a bitter taste;asked if has any tightness in throat or SOB; stated felt lightheaded & looked pale; observed 10 mins; BP 174/90; exp diarrhea & h/a


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