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This is VAERS ID 57404

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 57404 (history)  
Form: Version .0  
Age: 8.2  
Sex: Female  
Location: Illinois  
Vaccinated:1993-10-01
Onset:1993-10-18
   Days after vaccination:17
Submitted: 1993-11-09
   Days after onset:22
Entered: 1993-11-22
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
M: ATTENUVAX / MSD 1117W / 2 LA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: BLIND, HEADACHE, NEURITIS OPTIC
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx cleft lip repaired (2o old) NKA;
Allergies:
Diagnostic Lab Data: MRI (Brain, orbits, optical nerve & ?);
CDC Split Type:

Write-up: pt recvd vax 1OCT93 & c/o h/a; 18NOV loss of vision; seen by MD 20OCT03; hospitalized 23OCT93 for optic neuritis;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=57404


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