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This is VAERS ID 104721

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 104721
VAERS Form:
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: EYE DIS, VISION ABNORM, VISUAL FIELD DEFECT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 12/8/2009

VAERS ID: 104721 Before After
VAERS Form:
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-18 1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 INFLUENZA (SEASONAL) (FLUSHIELD 95-96) / WYETH WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect, EYE DIS, VISION ABNORM, VISUAL FIELD DEFECT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 8/31/2010

VAERS ID: 104721 Before After
VAERS Form:
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 95-96) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 7/7/2013

VAERS ID: 104721 Before After
VAERS Form:
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 5/14/2017

VAERS ID: 104721 Before After
VAERS Form:
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 9/14/2017

VAERS ID: 104721 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 2/14/2018

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 6/14/2018

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 8/14/2018

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 9/14/2018

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 10/14/2018

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 12/24/2020

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 12/30/2020

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 5/7/2021

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;


Changed on 5/14/2021

VAERS ID: 104721 Before After
VAERS Form:1
Age:
Sex:Male
Location:Indiana
Vaccinated:1995-10-11
Onset:0000-00-00
Submitted:1997-10-23
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Visual disturbance, Visual field defect

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897309005L

Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=104721&WAYBACKHISTORY=ON


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