| VAERS ID: |
44800 (history) |
| Form: |
Version .0 |
| Age: |
40.3 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 1991-11-21 |
| Onset: | 1991-12-01 |
| Days after vaccination: | 10 |
| Submitted: |
1992-09-06 |
| Days after onset: | 279 |
| Entered: |
1992-09-10 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918152 / 0 |
A / IM |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
0M21074 / 0 |
A / SC |
Administered by: Private Purchased by: Private
Symptoms: Chorioretinitis,
Conjunctivitis,
Optic neuritis,
Photophobia,
Pupillary disorder,
Retinal detachment,
Retinal disorder,
Visual field defect
SMQs:, Severe cutaneous adverse reactions (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Accidents and injuries (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Corneal disorders (broad), Retinal disorders (narrow), Conjunctival disorders (narrow), Ocular infections (narrow), Hypersensitivity (broad)
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, 3 days
Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE prior to onset began Nafaralin 1DEc & 14DEc d/c
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: inflammation resolved showed multiple bilat retinal defects;
CDC Split Type:
Write-up: 1DEC91 h/a, photophobia; 7DEC91 paralysis of rt pupil, adie''s pupil; pt seen in ER for unequal pupils to r/o aneurysm; inc chemosis; 20DEC91 impaired central vision, bilat, retinas showed mutiple serous detachments, bilat opic disc edema; |
