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This is VAERS ID 311987

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311987
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating pro"cess as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on b


Changed on 12/8/2009

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUVIRIN) INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, C-reactive protein normal, Cerebral atrophy, Death, Dysphagia, Eye pain, Full blood count normal, Hypoxia, Intensive care, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Optic neuritis retrobulbar, Papilloedema, Plasmapheresis, Pneumonia, Posturing, Pyrexia, Viral infection, Vision blurred, Mental status changes, Brain oedema, Leukoencephalomyelitis, Red blood cell sedimentation rate normal, General physical health deterioration, Central nervous system lesion, Febrile infection, Musculoskeletal stiffness, Staphylococcal infection, Escherichia infection, Steroid therapy, Oral intake reduced, Staphylococcus identification test positive, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating pro"cess process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on b bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty


Changed on 3/2/2010

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, C-reactive protein normal, Cerebral atrophy, Death, Dysphagia, Eye pain, Full blood count normal, Hypoxia, Intensive care, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Optic neuritis retrobulbar, Papilloedema, Plasmapheresis, Pneumonia, Posturing, Pyrexia, Viral infection, Vision blurred, Mental status changes, Brain oedema, Leukoencephalomyelitis, Red blood cell sedimentation rate normal, General physical health deterioration, Central nervous system lesion, Febrile infection, Musculoskeletal stiffness, Staphylococcal infection, Escherichia infection, Steroid therapy, Oral intake reduced, Staphylococcus identification test positive, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty


Changed on 8/31/2010

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Biopsy brain abnormal, Blindness, Death, Papilloedema, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty


Changed on 1/4/2011

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Biopsy brain abnormal, Blindness, Death, Papilloedema, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 4/13/2011

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, C-reactive protein normal, Cerebral atrophy, Death, Dysphagia, Eye pain, Full blood count normal, Hypoxia, Intensive care, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Optic neuritis retrobulbar, Papilloedema, Plasmapheresis, Pneumonia, Posturing, Pyrexia, Viral infection, Vision blurred, Mental status changes, Brain oedema, Leukoencephalomyelitis, Red blood cell sedimentation rate normal, General physical health deterioration, Central nervous system lesion, Febrile infection, Musculoskeletal stiffness, Staphylococcal infection, Escherichia infection, Oral intake reduced, Staphylococcus identification test positive, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 5/13/2011

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, C-reactive protein normal, Cerebral atrophy, Death, Dysphagia, Eye pain, Full blood count normal, Hypoxia, Intensive care, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Optic neuritis retrobulbar, Papilloedema, Plasmapheresis, Pneumonia, Posturing, Pyrexia, Viral infection, Vision blurred, Mental status changes, Brain oedema, Leukoencephalomyelitis, Red blood cell sedimentation rate normal, General physical health deterioration, Central nervous system lesion, Febrile infection, Musculoskeletal stiffness, Staphylococcal infection, Escherichia infection, Oral intake reduced, Staphylococcus identification test positive, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 6/11/2011

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, C-reactive protein normal, Cerebral atrophy, Death, Dysphagia, Eye pain, Full blood count normal, Hypoxia, Intensive care, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Optic neuritis retrobulbar, Papilloedema, Plasmapheresis, Pneumonia, Posturing, Pyrexia, Viral infection, Vision blurred, Mental status changes, Brain oedema, Leukoencephalomyelitis, Red blood cell sedimentation rate normal, General physical health deterioration, Central nervous system lesion, Febrile infection, Musculoskeletal stiffness, Staphylococcal infection, Escherichia infection, Oral intake reduced, Staphylococcus identification test positive, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 7/7/2013

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, C-reactive protein normal, Cerebral atrophy, Death, Dysphagia, Eye pain, Full blood count normal, Hypoxia, Intensive care, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Optic neuritis retrobulbar, Papilloedema, Plasmapheresis, Pneumonia, Posturing, Pyrexia, Viral infection, Vision blurred, Mental status changes, Brain oedema, Leukoencephalomyelitis, Red blood cell sedimentation rate normal, General physical health deterioration, Central nervous system lesion, Febrile infection, Musculoskeletal stiffness, Staphylococcal infection, Escherichia infection, Oral intake reduced, Staphylococcus identification test positive, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 6/14/2014

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, C-reactive protein normal, Cerebral atrophy, Death, Dysphagia, Eye pain, Full blood count normal, Hypoxia, Intensive care, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Optic neuritis retrobulbar, Papilloedema, Plasmapheresis, Pneumonia, Posturing, Pyrexia, Viral infection, Vision blurred, Mental status changes, Brain oedema, Leukoencephalomyelitis, Red blood cell sedimentation rate normal, General physical health deterioration, Central nervous system lesion, Febrile infection, Musculoskeletal stiffness, Staphylococcal infection, Escherichia infection, Oral intake reduced, Staphylococcus identification test positive, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 4/14/2017

VAERS ID: 311987 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, C-reactive protein normal, Cerebral atrophy, Death, Dysphagia, Eye pain, Full blood count normal, Hypoxia, Intensive care, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging abnormal, Optic neuritis, Optic neuritis retrobulbar, Papilloedema, Plasmapheresis, Pneumonia, Posturing, Pyrexia, Viral infection, Vision blurred, Mental status changes, Brain oedema, Leukoencephalomyelitis, Red blood cell sedimentation rate normal, General physical health deterioration, Central nervous system lesion, Febrile infection, Musculoskeletal stiffness, Staphylococcal infection, Escherichia infection, Oral intake reduced, Staphylococcus identification test positive, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 9/14/2017

VAERS ID: 311987 Before After
VAERS Form:(blank) 1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 2 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 2/14/2018

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 6/14/2018

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 8/14/2018

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 9/14/2018

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 10/14/2018

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 12/24/2020

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 12/30/2020

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 5/7/2021

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis


Changed on 5/14/2021

VAERS ID: 311987 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Minnesota
Vaccinated:2007-10-16
Onset:2007-11-18
Submitted:2008-05-09
Entered:2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 80685 / 3 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blindness, Death, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Allergies:
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC 'Split Type':

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating process as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on bronchoalveolar lavage 1/14/08. Other contributing conditions included: acute aggressive multifocal demyelinating disease w/white matter lesions multiple areas of the brain including previous biopsy sites & cervical spinal cord; cerebral atrophy & edema. 9/26/08 Reviewed hospital medical records of 1/3-/-19/2008. FINAL DX: multiple CNS lesions w/gadolinium-enhancing CNS lesions; myalgia; hypoxic respiratory failure; dysphagia; poor oral intake; nutrition; possible pneumonia; prophylaxis. Records reveal patient experienced re-admission for brain biopsy which revealed acute demyelinating process. Failed high dose steroids & plasma exchange. Tx w/mitoxantrone treatment & second course of high dose steroids in ICU. Mental & respiratory status deteriorated, significant muscle spasms & pain. Mechanical ventilation. Brain lesions continued to grow & new lesions appeared. Developed decerebrate posturing. Comfort care only decided & transferred to hospital closer to family home. 5/23/08 Reviewed initial eye clinic records of 11/29-11/30/2007 FINAL DX: probable retrobulbar ischemic ACON. Records reveal patient experienced HA x 3 days & blurred vision x 1 day. Patient had viral infection w/fever approx 10 days prior & still has sore eyes & stiff neck. Referred to neuro-ophthal. 6/6/08 Reviewed neuro-optho medical records for 11/30-12/2/2007. FINAL DX: bilateral optic neuritis Records reveal patient seen in clinic 11/30 emergently & admitted to hospital same day. Had used Cialis & noted difficulty reading next AM w/HA. Then developed blurry vision, decreased vision & pain over 3 days. Exam revealed visual acuity hand motion in right eye & 4/200 left eye, IOP WNL, no ptosis, slit lamp WNL, fundus w/1(+) edema of right optic nerve & trace edema left optic nerve. Admitted for stat MRI & IV steroids. No improvement & D/C to home on continued tapering steroids. 7/4/08 Reviewed hospital medical records of 11/30-12/02/2007 which were previously included in clinic records. FINAL DX: bilateral optic neuritis

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