|
VAERS ID: |
36656 (history) |
Form: |
Version 1.0 |
Age: |
70.0 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1991-11-07 |
Onset: | 1991-11-07 |
Days after vaccination: | 0 |
Submitted: |
1991-11-21 |
Days after onset: | 14 |
Entered: |
1991-11-26 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Bradycardia,
Dizziness,
Dyspnoea,
Hypotonia,
Nausea SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Atenolol, Norpace, synthroid Current Illness: Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress; |
|
VAERS ID: |
36657 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 1991-11-18 |
Onset: | 1991-11-18 |
Days after vaccination: | 0 |
Submitted: |
1991-11-22 |
Days after onset: | 4 |
Entered: |
1991-11-26 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
04161P / 1 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Apnoea,
Cyanosis,
Dyspnoea SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase; Current Illness: NONE Preexisting Conditions: environmental allergies, asthma Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02; |
|
VAERS ID: |
36702 (history) |
Form: |
Version 1.0 |
Age: |
91.0 |
Sex: |
Male |
Location: |
Missouri |
Vaccinated: | 1991-11-08 |
Onset: | 1991-11-09 |
Days after vaccination: | 1 |
Submitted: |
1991-11-18 |
Days after onset: | 9 |
Entered: |
1991-12-02 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918146 / 5 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Anorexia,
Asthenia,
Pyrexia,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: Allergic to penicillin; Allergies: Diagnostic Lab Data: CDC Split Type: MO9191
Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week; |
|
VAERS ID: |
36710 (history) |
Form: |
Version 1.0 |
Age: |
39.0 |
Sex: |
Female |
Location: |
Oklahoma |
Vaccinated: | 1991-11-07 |
Onset: | 1991-11-11 |
Days after vaccination: | 4 |
Submitted: |
1991-11-20 |
Days after onset: | 9 |
Entered: |
1991-12-02 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918169 / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Dehydration,
Diarrhoea,
Pharyngitis,
Pyrexia,
Vomiting SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: X-ray gallbladder & kidney for stones-normal; upper GI-normal; Ultra sound on stomach, gallbladder & liver-normal; CDC Split Type: OK9177
Write-up: Vomiting, diarrhea, dehydration, fever, sore throat treatment @ hosp-Tagamet, Glucose/dextrose, Amoxillin; |
|
VAERS ID: |
36727 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1991-11-06 |
Onset: | 1991-11-14 |
Days after vaccination: | 8 |
Submitted: |
1991-11-25 |
Days after onset: | 11 |
Entered: |
1991-12-02 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21209 / 1 |
LA / IM |
Administered by: Private Purchased by: Public Symptoms: Confusional state,
Nausea,
Vertigo,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Naprosyn, Zestaril, Premarin Current Illness: NONE Preexisting Conditions: PCN, Hypertensive Allergies: Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal; CDC Split Type:
Write-up: vertigo, nausea, emesis, confusion, disorientation; |
|
VAERS ID: |
36763 (history) |
Form: |
Version 1.0 |
Age: |
54.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 1991-10-30 |
Onset: | 1991-11-04 |
Days after vaccination: | 5 |
Submitted: |
1991-11-21 |
Days after onset: | 17 |
Entered: |
1991-12-03 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918146 / UNK |
- / IM A |
Administered by: Other Purchased by: Private Symptoms: Asthenia,
Hypokinesia,
Pain,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever; Allergies: Diagnostic Lab Data: CDC Split Type: CO9193
Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis; |
|
VAERS ID: |
37791 (history) |
Form: |
Version 1.0 |
Age: |
33.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1991-10-18 |
Onset: | 0000-00-00 |
Submitted: |
1991-10-28 |
Entered: |
1991-12-06 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / 1 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Headache,
Pleocytosis,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: None Current Illness: Sxs of URI; Preexisting Conditions: Pt has a hx of mild asthma; Allergies: Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg; CDC Split Type: 891310001J
Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae; |
|
VAERS ID: |
37802 (history) |
Form: |
Version 1.0 |
Age: |
82.0 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 1991-11-08 |
Onset: | 1991-11-21 |
Days after vaccination: | 13 |
Submitted: |
1991-11-27 |
Days after onset: | 6 |
Entered: |
1991-12-06 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918146 / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Asthenia,
Chills,
Cough,
Pyrexia SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Thyroid Current Illness: NONE Preexisting Conditions: mold, grasses, tres, flower, house dust; thyroid deficiency Allergies: Diagnostic Lab Data: Pneumonia-CXR; CDC Split Type: MO9194
Write-up: 21NOV91 coughing, fever, chills, fatigue, weakness; hospitalized 24NOV91 MD does not feel condition is assoc w/flu shot; |
|
VAERS ID: |
37808 (history) |
Form: |
Version 1.0 |
Age: |
49.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1991-11-21 |
Onset: | 1991-11-21 |
Days after vaccination: | 0 |
Submitted: |
1991-11-26 |
Days after onset: | 5 |
Entered: |
1991-12-09 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / 1 |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Alkalosis,
Diarrhoea,
Oliguria,
Pyrexia,
Shock SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: AZT (Retrovin), Bactrim, Diflucan Current Illness: Pt is HIV pos Preexisting Conditions: Pt has had crytococcal meningitis Allergies: Diagnostic Lab Data: CDC Split Type: 914091068
Write-up: Shock, metabolic alkalosis, high fever & diarrhea are reported p/recvd flu vax 21NOV91; pt has had cryptococcal meningitis & is HIV positive; Seen in ER t106.7F in shock & diarrhea admitted to hosp & found to be oliguric; |
|
VAERS ID: |
37809 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
Nevada |
Vaccinated: | 1991-10-07 |
Onset: | 1991-10-13 |
Days after vaccination: | 6 |
Submitted: |
1991-12-02 |
Days after onset: | 50 |
Entered: |
1991-12-09 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1J21107 / UNK |
- / IM |
Administered by: Other Purchased by: Public Symptoms: Guillain-Barre syndrome,
Paraesthesia SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: assume well @ time of vax Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: CO4030
Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax; |
|