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This is VAERS ID 195704

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 195704
VAERS Form:
Age:61.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, 40956AA / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: HEM EYE

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recov"ered.


Changed on 12/8/2009

VAERS ID: 195704 Before After
VAERS Form:
Age:61.0 62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR, AVENTIS PASTEUR 40956AA / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage, HEM EYE

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recov"ered. recovered.


Changed on 7/7/2013

VAERS ID: 195704 Before After
VAERS Form:
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR 40956AA / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR 40956AA / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 5/14/2017

VAERS ID: 195704 Before After
VAERS Form:
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR 40956AA / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 9/14/2017

VAERS ID: 195704 Before After
VAERS Form:(blank) 1
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 2/14/2018

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 6/14/2018

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 8/14/2018

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 9/14/2018

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 10/14/2018

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 12/10/2020

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Unknown New York
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 12/24/2020

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:New York
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 12/30/2020

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:New York
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 5/7/2021

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:New York
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.


Changed on 5/21/2021

VAERS ID: 195704 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:New York
Vaccinated:2002-11-25
Onset:2002-11-25
Submitted:2002-12-19
Entered:2003-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 40956AA / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Conjunctival haemorrhage

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: NONE
Current Illness:
Preexisting Conditions: Hearing loss October 2002. Otherwise reportedly healthy male. No allergies reported. Social history unavailable.
Allergies:
Diagnostic Lab Data: Patient was told to report to eye clinic for evaluation on 11/27/02 but lost to follow up.
CDC 'Split Type':

Write-up: Patient developed right subconjuctival hemorrhage 3 hours after receiving vaccine. Patient reportedly received no other medication prior to event. Patient was given artificial tears to keep eyes moist. 60 day follwow up states assume yes that pt has recovered.

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