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This is VAERS ID 57650

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57650
VAERS Form:
Age:70.1
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41124 / 0 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: PARALYSIS FACIAL, AMBLYOPIA, ENCEPHALOPATHY, PAIN EAR

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type': NONE

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 12/8/2009

VAERS ID: 57650 Before After
VAERS Form:
Age:70.1
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-12-03 1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F41124 / 0 LA / IM

Administered by: Unknown      Purchased by: Unknown Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy, PARALYSIS FACIAL, AMBLYOPIA, ENCEPHALOPATHY, PAIN EAR

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type': NONE (blank)

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 8/31/2010

VAERS ID: 57650 Before After
VAERS Form:
Age:70.1
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 0 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 7/7/2013

VAERS ID: 57650 Before After
VAERS Form:
Age:70.1
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 0 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 2/14/2017

VAERS ID: 57650 Before After
VAERS Form:
Age:70.1 70.0
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 0 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 5/14/2017

VAERS ID: 57650 Before After
VAERS Form:
Age:70.0
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 0 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 9/14/2017

VAERS ID: 57650 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 0 1 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 2/14/2018

VAERS ID: 57650 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 1 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 6/14/2018

VAERS ID: 57650 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 1 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 8/14/2018

VAERS ID: 57650 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 1 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 9/14/2018

VAERS ID: 57650 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 1 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


Changed on 10/14/2018

VAERS ID: 57650 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:1993-10-25
Onset:1993-10-26
Submitted:1993-11-18
Entered:1993-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 1 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC 'Split Type':

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;

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