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This is VAERS ID 100801

Case Details

VAERS ID: 100801 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1993-10-15
Onset:1993-11-04
   Days after vaccination:20
Submitted: 1997-07-25
   Days after onset:1358
Entered: 1997-07-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Amblyopia, Eye disorder, Eye haemorrhage, Hypertension, Laboratory test abnormal, Neuropathy, Visual disturbance, Visual field defect
SMQs:, Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: no history of ocular pain, cephalgia, jaw cladication, or preceding illness;NKA;no hx of cat bite, or exposure to cats;no family hx of impaired vision;
Allergies:
Diagnostic Lab Data: The following tests were neg or nl: bilat temporal artery biopsy, MRI of brain & orbits w/ & w/o gadoliniu, lytes, BUN, creatine, alk phos, LDH, SOGT< GGT, SGTP, ESR< CBC, PT, PTT< lupus anticoagulant, Lyme titer, B-12, folate, flucose;
CDC Split Type: 010150970125000

Write-up: pt devel visual loss in both eyes 3wk p/vax;4NOV93 noted blurring of both eyes rt $g lt;BP 130/100;pupillary defect;visual field testing revealed upper nasal island of vision;optic disc swollen & peripapillary hem;allerg react;neuropathy;


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