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This is VAERS ID 479777

Case Details

VAERS ID: 479777 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2012-12-14
Onset:2012-12-16
   Days after vaccination:2
Submitted: 2012-12-30
   Days after onset:14
Entered: 2012-12-31
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness, Eyelid function disorder, Vaccination complication, Viral infection
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-01-02
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACIPHEX
Current Illness: None indicated on VAR
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Beginning 12/16/12, 2 days post flu vaccine, pt complained of dizziness which became progressively more severe. It''s more of the eyelids flipping upwards/jumping movement. Per wife, hospital ruled out stroke, aneurysm and are leaning toward viral infection or flu vaccine adverse event as cause. It has not been determined.


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