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This is VAERS ID 57404

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57404
VAERS Form:
Age:8.2
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
M: ATTENUVAX / MSD 1117W / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
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;


Changed on 12/8/2009

VAERS ID: 57404 Before After
VAERS Form:
Age:8.2
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-22 1993-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
M: ATTENUVAX / MSD 1117W / 2 LA / SC
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 1117W / 2 LA / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Blindness, Headache, Optic neuritis, HEADACHE, NEURITIS OPTIC, BLIND

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
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': (blank) IL93122

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


Changed on 2/14/2017

VAERS ID: 57404 Before After
VAERS Form:
Age:8.2 8.0
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 1117W / 2 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Blindness, Headache, Optic neuritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
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': IL93122

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


Changed on 5/14/2017

VAERS ID: 57404 Before After
VAERS Form:
Age:8.0
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 1117W / 2 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Blindness, Headache, Optic neuritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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
Current Illness: NONE
Preexisting Conditions: hx cleft of clef lip repaired (2o (2 mos old) NKA; no known allergies;
Allergies:
Diagnostic Lab Data: MRI (Brain, orbits, optical (Brian, oribts, optic nerve & ?); 7 chasm);
CDC 'Split Type': IL93122 (blank)

Write-up: pt recvd vax 1OCT93 & on 16OCT93 c/o sl h/a; 18NOV loss 18OCT93 had sudden lost of vision; seen by MD 20OCT03; 20OCT93; hospitalized on 23OCT93 for optic neuritis;


Changed on 9/14/2017

VAERS ID: 57404 Before After
VAERS Form:(blank) 1
Age:8.0
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 1117W / 2 3 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Blindness, Headache, Optic neuritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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
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;


Changed on 2/14/2018

VAERS ID: 57404 Before After
VAERS Form:1
Age:8.0
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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
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;


Changed on 6/14/2018

VAERS ID: 57404 Before After
VAERS Form:1
Age:8.0
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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
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;


Changed on 8/14/2018

VAERS ID: 57404 Before After
VAERS Form:1
Age:8.0
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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
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;


Changed on 9/14/2018

VAERS ID: 57404 Before After
VAERS Form:1
Age:8.0
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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
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;


Changed on 10/14/2018

VAERS ID: 57404 Before After
VAERS Form:1
Age:8.0
Sex:Female
Location:Illinois
Vaccinated:1993-10-01
Onset:1993-10-18
Submitted:1993-11-09
Entered:1993-11-15
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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
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;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=57404&WAYBACKHISTORY=ON


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