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This is VAERS ID 36523

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36523
VAERS Form:
Age:39.1
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1991-1992 EVANS MED & LEDERLE / LEDERLE 310974 / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: NEURITIS OPTIC

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
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': fuch''s heterochromic iridocyclitis-both eyes

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


Changed on 12/8/2009

VAERS ID: 36523 Before After
VAERS Form:
Age:39.1
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-26 1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1991-1992 EVANS MED & LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE 91-92) / LEDERLE LEDERLE LABORATORIES 310974 / - LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Optic neuritis, NEURITIS OPTIC

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
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': fuch''s heterochromic iridocyclitis-both eyes (blank)

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


Changed on 8/31/2010

VAERS ID: 36523 Before After
VAERS Form:
Age:39.1
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE 91-92) INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 310974 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Optic neuritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
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;


Changed on 7/7/2013

VAERS ID: 36523 Before After
VAERS Form:
Age:39.1
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 310974 / - LA / -
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 310974 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Optic neuritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
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;


Changed on 2/14/2017

VAERS ID: 36523 Before After
VAERS Form:
Age:39.1 39.0
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 310974 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Optic neuritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
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;


Changed on 5/14/2017

VAERS ID: 36523 Before After
VAERS Form:
Age:39.0
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 310974 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Optic neuritis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE 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;


Changed on 9/14/2017

VAERS ID: 36523 Before After
VAERS Form:(blank) 1
Age:39.0
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: 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;


Changed on 2/14/2018

VAERS ID: 36523 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: 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;


Changed on 6/14/2018

VAERS ID: 36523 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: 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;


Changed on 8/14/2018

VAERS ID: 36523 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: 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;


Changed on 9/14/2018

VAERS ID: 36523 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: 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;


Changed on 10/14/2018

VAERS ID: 36523 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Utah
Vaccinated:1991-10-18
Onset:1991-10-19
Submitted:1991-10-31
Entered:1991-11-19
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: 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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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36523&WAYBACKHISTORY=ON


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