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This is VAERS ID 479777

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2013

VAERS ID: 479777
VAERS Form:
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? No
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:     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.


Changed on 2/13/2013

VAERS ID: 479777 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2013-01-02
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: (blank) 4     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.


Changed on 7/7/2013

VAERS ID: 479777 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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.


Changed on 6/14/2014

VAERS ID: 479777 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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.


Changed on 3/14/2015

VAERS ID: 479777 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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.


Changed on 9/14/2017

VAERS ID: 479777 Before After
VAERS Form:(blank) 1
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 0 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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.


Changed on 2/14/2018

VAERS ID: 479777 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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.


Changed on 6/14/2018

VAERS ID: 479777 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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.


Changed on 8/14/2018

VAERS ID: 479777 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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.


Changed on 9/14/2018

VAERS ID: 479777 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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.


Changed on 10/14/2018

VAERS ID: 479777 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2012-12-14
Onset:2012-12-16
Submitted:2012-12-30
Entered:2012-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Dizziness, Vaccination complication, Viral infection, Eyelid function disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-02
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: 4     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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