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This is VAERS ID 36523

Case Details

VAERS ID: 36523 (history)  
Form: Version 1.0  
Age: 39.0  
Sex: Female  
Location: Utah  
Vaccinated:1991-10-18
Onset:1991-10-19
   Days after vaccination:1
Submitted: 1991-10-31
   Days after onset:12
Entered: 1991-11-19
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 310974 / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Optic neuritis
SMQs:, Optic nerve disorders (narrow), Demyelination (narrow), Ocular infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: fuch''s heterochromic iridocyclitis-both eyes
Allergies:
Diagnostic Lab Data: Orbital CT scan-normal;
CDC Split Type:

Write-up: Optic neuritis lt eye onset on awakening 0800 19OCT91;


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