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This is VAERS ID 132843

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 132843
VAERS Form:
Age:51.4
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1999-2000 / CONNAUGHT LABS U0186 / 5 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: DIPLOPIA

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring.

Changed on 12/8/2009

VAERS ID: 132843 Before After
VAERS Form:
Age:51.4
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1999-2000 INFLUENZA (SEASONAL) (FLUZONE 99-00) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0186 / 5 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Diplopia, DIPLOPIA

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring.

Changed on 8/31/2010

VAERS ID: 132843 Before After
VAERS Form:
Age:51.4
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 99-00) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 5 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring.

Changed on 7/7/2013

VAERS ID: 132843 Before After
VAERS Form:
Age:51.4
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 5 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 5 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring.

Changed on 2/14/2017

VAERS ID: 132843 Before After
VAERS Form:
Age:51.4 51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 5 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring.

Changed on 5/14/2017

VAERS ID: 132843 Before After
VAERS Form:
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 5 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

Changed on 9/14/2017

VAERS ID: 132843 Before After
VAERS Form:(blank) 1
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 5 6 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

Changed on 2/14/2018

VAERS ID: 132843 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 6 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

Changed on 6/14/2018

VAERS ID: 132843 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 6 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

Changed on 8/14/2018

VAERS ID: 132843 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 6 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

Changed on 9/14/2018

VAERS ID: 132843 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 6 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

Changed on 10/14/2018

VAERS ID: 132843 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 6 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

Changed on 12/24/2020

VAERS ID: 132843 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 6 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

Changed on 12/30/2020

VAERS ID: 132843 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Nebraska
Vaccinated:1999-11-03
Onset:1999-11-03
Submitted:1999-12-04
Entered:1999-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0186 / 6 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Diplopia, Influenza

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? No
Previous Vaccinations:
Other Medications:
Current Illness: double vision and flu-like symptoms
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG/ECG, MRI/brain, echo carotid, CT/head, cerv-spine obliques,mra head & neck
CDC 'Split Type':

Write-up: Received flu shot on 11/3/99 at 10:30 am and by 2:00 pm was experiencing double vision which is still occuring. Per follow-up, the pt is 95% recovered. Pt suffers from slight diplopia.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=132843&WAYBACKHISTORY=ON


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