VAERS ID: |
57404 (history) |
Form: |
Version 1.0 |
Age: |
8.0 |
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: |
1993-11-15 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
1117W / 3 |
LA / SC |
Administered by: Private Purchased by: Public Symptoms: Blindness,
Headache,
Optic neuritis SMQs:, Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Retinal disorders (broad), Ocular infections (broad)
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: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: hx of clef lip repaired (2 mos old) no known allergies; Allergies: Diagnostic Lab Data: MRI (Brian, oribts, optic nerve 7 chasm); CDC Split Type:
Write-up: pt recvd vax 1OCT93 & on 16OCT93 c/o sl h/a; 18OCT93 had sudden lost of vision; seen by MD 20OCT93; hospitalized on 23OCT93 for optic neuritis; |