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This is VAERS ID 413215

History of Changes from the VAERS Wayback Machine

First Appeared on 1/4/2011

VAERS ID: 413215
VAERS Form:
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN(10-11): INFLUENZA (SEASONAL) (FLUMIST 10-11) / MEDIMMUNE VACCINES, INC. 501049P / 1 - / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 4/13/2011

VAERS ID: 413215 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN(10-11): INFLUENZA (SEASONAL) (FLUMIST 10-11) / MEDIMMUNE VACCINES, INC. 501049P / 1 - / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Blood albumin decreased, Blood chloride decreased, Blood gases abnormal, Blood potassium decreased, Blood sodium decreased, C-reactive protein increased, Computerised tomogram abnormal, CSF glucose decreased, CSF lymphocyte count abnormal, CSF pressure increased, CSF protein increased, Death, Echocardiogram normal, Febrile convulsion, Haematocrit decreased, Haemoglobin decreased, Headache, Hydrocephalus, Intensive care, Lumbar puncture, Meningitis bacterial, Nuclear magnetic resonance imaging brain abnormal, Otitis media, Pupillary reflex impaired, Pupils unequal, Pyrexia, Red blood cells CSF positive, Unresponsive to stimuli, Vomiting, White blood cell count increased, Mental status changes, Brain oedema, Brain death, CSF monocyte count decreased, CSF neutrophil count increased, CSF white blood cell count increased, Scan brain, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 5/13/2011

VAERS ID: 413215 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN(10-11): INFLUENZA (SEASONAL) (FLUMIST 10-11) / MEDIMMUNE VACCINES, INC. 501049P / 1 - / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Blood albumin decreased, Blood chloride decreased, Blood gases abnormal, Blood potassium decreased, Blood sodium decreased, C-reactive protein increased, Computerised tomogram abnormal, CSF glucose decreased, CSF lymphocyte count abnormal, CSF pressure increased, CSF protein increased, Death, Echocardiogram normal, Febrile convulsion, Haematocrit decreased, Haemoglobin decreased, Headache, Hydrocephalus, Intensive care, Lumbar puncture, Meningitis bacterial, Nuclear magnetic resonance imaging brain abnormal, Otitis media, Pupillary reflex impaired, Pupils unequal, Pyrexia, Red blood cells CSF positive, Unresponsive to stimuli, Vomiting, White blood cell count increased, Mental status changes, Brain oedema, Brain death, CSF monocyte count decreased, CSF neutrophil count increased, CSF white blood cell count increased, Scan brain, Endotracheal intubation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 7/12/2011

VAERS ID: 413215 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 1 - / IN
FLUN(10-11): INFLUENZA (SEASONAL) (FLUMIST 10-11) / MEDIMMUNE VACCINES, INC. 501049P / 1 - / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 7/7/2013

VAERS ID: 413215 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 1 - / IN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 1 - / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 9/14/2017

VAERS ID: 413215 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 1 2 - NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 2/14/2018

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 6/14/2018

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 8/14/2018

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 9/14/2018

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 10/14/2018

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 12/24/2020

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 12/30/2020

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 5/7/2021

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.


Changed on 5/14/2021

VAERS ID: 413215 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Virginia
Vaccinated:2010-11-01
Onset:2010-12-06
Submitted:2010-12-20
Entered:2010-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / 2 NS / IN

Administered by: Public      Purchased by: Public
Symptoms: Blindness, Death, Headache, Intensive care, Pyrexia, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2010-12-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA10020

Write-up: On 12/6/10, developed fever & headache. Treated with Advil until 12/9/10; went to PMD; patient vomiting, 12/10/10, vision loss, adm. to E.R. 12/11/10, transferred to PICU. Expired 12/16/10.

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