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From the 12/31/2003 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 100801



Case Details

VAERS ID: 100801 (history)  
Form: Version .0  
Age: 61.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1993-10-15
Onset:1993-11-04
   Days after vaccination:20
Submitted: 1997-07-25
   Days after onset:1358
Entered: 1997-07-30
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 / PARKE-DAVIS - / - - / IM

Administered by: Other       Purchased by: Unknown
Symptoms: AMBLYOPIA, EYE DIS, HEM EYE, HYPERTENS, LAB TEST ABNORM
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: no history of ocular pain, cephalgia, jaw cladication, or preceding illness;NKA;no hx of cat bite, or exposure to cats;no family hx of impaired vision;
Allergies:
Diagnostic Lab Data: The following tests were neg or nl: bilat temporal artery biopsy, MRI of brain & orbits w/ & w/o gadoliniu, lytes, BUN, creatine, alk phos, LDH, SOGT< GGT, SGTP, ESR< CBC, PT, PTT< lupus anticoagulant, Lyme titer, B-12, folate, flucose;
CDC Split Type:

Write-up: pt devel visual loss in both eyes 3wk p/vax;4NOV93 noted blurring of both eyes rt $g lt;BP 130/100;pupillary defect;visual field testing revealed upper nasal island of vision;optic disc swollen & peripapillary hem;allerg react;neuropathy;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=100801

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