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This is VAERS ID 44800

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 44800
VAERS Form:
Age:40.3
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918152 / 0 A / IM
IPV: IPV / MERIEUX INST C1150 / 0 A / SC
MEN: MENOMUNE A/C/Y/W / CONNAUGHT LABS 0M21074 / 0 A / SC

Administered by: Private      Purchased by: Unknown
Symptoms: NEURITIS OPTIC, CONJUNCTIVITIS, PHOTOPHOBIA, PUPIL DIS, CHORIORETINITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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': NONE

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;

Changed on 12/8/2009

VAERS ID: 44800 Before After
VAERS Form:
Age:40.3
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-14 1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918152 / 0 A / IM
IPV: IPV / MERIEUX INST C1150 / 0 A / SC
MEN: MENOMUNE A/C/Y/W MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0M21074 / 0 A / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect, NEURITIS OPTIC, CONJUNCTIVITIS, PHOTOPHOBIA, PUPIL DIS, CHORIORETINITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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': NONE (blank)

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;

Changed on 8/31/2010

VAERS ID: 44800 Before After
VAERS Form:
Age:40.3
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC 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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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;

Changed on 7/7/2013

VAERS ID: 44800 Before After
VAERS Form:
Age:40.3
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 0 A / IM
FLU3: 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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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;

Changed on 12/14/2016

VAERS ID: 44800 Before After
VAERS Form:
Age:40.3
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 0 A / IM
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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;

Changed on 2/14/2017

VAERS ID: 44800 Before After
VAERS Form:
Age:40.3 40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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;

Changed on 5/14/2017

VAERS ID: 44800 Before After
VAERS Form:
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 0 A - / IM IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 0 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 0 A - / SC SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
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;

Changed on 9/14/2017

VAERS ID: 44800 Before After
VAERS Form:(blank) 1
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 0 1 - / IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 0 1 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 0 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
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;

Changed on 2/14/2018

VAERS ID: 44800 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 1 - / IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 1 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
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;

Changed on 6/14/2018

VAERS ID: 44800 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 1 - / IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 1 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
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;

Changed on 8/14/2018

VAERS ID: 44800 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 1 - / IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 1 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
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;

Changed on 9/14/2018

VAERS ID: 44800 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 1 - / IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 1 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
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;

Changed on 10/14/2018

VAERS ID: 44800 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 1 - / IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 1 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
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;

Changed on 12/24/2020

VAERS ID: 44800 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 1 - / IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 1 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
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;

Changed on 12/30/2020

VAERS ID: 44800 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:Massachusetts
Vaccinated:1991-11-21
Onset:1991-12-01
Submitted:1992-09-06
Entered:1992-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918152 / 1 - / IM A
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. C1150 / 1 - / SC A
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 0M21074 / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Chorioretinitis, Conjunctivitis, Optic neuritis, Photophobia, Pupillary disorder, Retinal detachment, Retinal disorder, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
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;

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