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From the 5/7/2021 release of VAERS data:

Found 1,944 cases where Vaccine is FLU(H1N1) or FLU3 or FLU4 or FLUA3 or FLUA4 or FLUC3 or FLUC4 or FLUN(H1N1) or FLUN3 or FLUN4 or FLUR3 or FLUR4 or FLUX or FLUX(H1N1) or H5N1 and Patient Died



Case Details (Reverse Sorted by Onset Date)

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VAERS ID: 131452 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: Louisiana  
Vaccinated:1999-11-04
Onset:1999-11-07
   Days after vaccination:3
Submitted: 1999-11-15
   Days after onset:8
Entered: 1999-11-29
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0167AA / 2 LL / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0871H / 1 RL / -

Administered by: Public       Purchased by: Unknown
Symptoms: Asphyxia, Convulsion, Injury
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: phenobarbital;
Current Illness: NONE
Preexisting Conditions: lissencephaly, microcephaly, sz disorer;
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA991103

Write-up: pt expired 11/7/99-COD accidental asphyxiation d/t lissencephaly, microcephaly;


VAERS ID: 162101 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Iowa  
Vaccinated:1999-10-14
Onset:1999-10-29
   Days after vaccination:15
Submitted: 2000-11-13
   Days after onset:381
Entered: 2000-11-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Haemoptysis
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-12-23
   Days after onset: 55
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC Split Type:

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


VAERS ID: 131449 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1999-10-11
Onset:1999-10-24
   Days after vaccination:13
Submitted: 1999-11-03
   Days after onset:10
Entered: 1999-11-29
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U011AB / 7+ LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: 2 types insulin, synthroid, antidepressants-buspar;anapheril, Ritalin, flexaril, melatonin
Current Illness: NONE; blood sugar nl 10/23, 10PM
Preexisting Conditions: diabetes (for 37 years), Graves disease (for 20yrs), diabetic depression
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA9924

Write-up: pt was found dead 12.5 days p/vax;


VAERS ID: 130028 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:1999-10-21
Onset:1999-10-22
   Days after vaccination:1
Submitted: 1999-10-22
   Days after onset:0
Entered: 1999-10-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998221 / 1 RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Cardiac arrest, Coronary artery disease, Hypertension, Lung disorder, Right ventricular failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Hypertension (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: ProAmatine, Cozaar, Dyazide; Pepcid, Carafate, Albutrol;
Current Illness: NONE
Preexisting Conditions: NKDA;CHF, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax @ clinic 10/21/99 & deceased @ home 10/22/99;


VAERS ID: 134575 (history)  
Form: Version 1.0  
Age: 50.0  
Sex: Female  
Location: Kansas  
Vaccinated:1999-10-20
Onset:1999-10-21
   Days after vaccination:1
Submitted: 2000-03-02
   Days after onset:133
Entered: 2000-03-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0155AA / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-12
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Being considered for liver transplant.
Preexisting Conditions: Hx: Hep B, Hep C, Cirrhosis of liver.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sister of pt stopped by clinic to pay for vax. Stated that flu shot caused sister''s death. Began to feel ill next day. Transported to ER on 11/12 by ambulance, died few hrs later. Stated pt didn''t see MD between 10/20 & 11/12/99.


VAERS ID: 129827 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:1999-10-20
Onset:1999-10-20
   Days after vaccination:0
Submitted: 1999-10-22
   Days after onset:2
Entered: 1999-10-26
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0096BA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: baclofen IV, morphine sulfate
Current Illness:
Preexisting Conditions: quadriplegic
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199900750

Write-up: p/vax pt was found dead by family member;exact time of death has not been established;autopsy to determine COD is being conducted 10/21/99;


VAERS ID: 129991 (history)  
Form: Version 1.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:1999-10-19
Onset:1999-10-20
   Days after vaccination:1
Submitted: 1999-10-27
   Days after onset:7
Entered: 1999-10-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0096BA / 2 - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~~In patient
Other Medications: insulin, Pepcid
Current Illness: none x/ feeling tired
Preexisting Conditions: IDDM, poorly controlled; Arteriosclerotic disease w/ angina; elev cholesterol; frequent URI & UTI; diverticulitis; hiatal hernia; breast CA s/p lumpectomy in ''92-in remission
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199900765

Write-up: p/vax pt was found dead;it it unk if an autopsy is being performed;


VAERS ID: 130869 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:1999-10-11
Onset:1999-10-20
   Days after vaccination:9
Submitted: 1999-11-05
   Days after onset:16
Entered: 1999-11-15
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0132AA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-01
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy report is pending;
CDC Split Type: U199900862

Write-up: p/vax pt dx w/pneumonia;pt expired on 11/1/99;MD does not feel what occurred is r/t vax;


VAERS ID: 130318 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:1999-10-12
Onset:1999-10-19
   Days after vaccination:7
Submitted: 1999-10-28
   Days after onset:9
Entered: 1999-11-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998212 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 3030320OCT199

Write-up: p/vax pt devel resp arrest & died;it was reported that medical director felt there was no connection between vax & events;


VAERS ID: 131045 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:1999-10-05
Onset:1999-10-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1999-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 49998293 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Coagulopathy, Hypoxia, Infection, Pneumonia, Pyrexia, Respiratory disorder
SMQs:, Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-10-25
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: chronic vertigo
Preexisting Conditions: HTN;Hypothyroidism;Iron def anemia;
Allergies:
Diagnostic Lab Data: 10/25/99 positive viral cult for influenza A from a bronchial washing;
CDC Split Type:

Write-up: p/vax pt c/o T103.8 & shaking chills;refused hosp adm;T104.6 R;adm to hosp;10/14/99 CXR showed ARDS & pneumonia;pt placed on ventilator;devel DIC;pt expired 10/25/99;


VAERS ID: 130605 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1999-10-07
Onset:1999-10-08
   Days after vaccination:1
Submitted: 1999-11-03
   Days after onset:26
Entered: 1999-11-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0065AA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypoxia, Pharyngitis, Pulmonary fibrosis, Pulmonary oedema, Respiratory disorder
SMQs:, Cardiac failure (narrow), Agranulocytosis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-11-18
   Days after onset: 41
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:
Other Medications: Celestone, Ceftin, Proventil HAM, histex HC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: surgical pathology from lt lung biopsy on 10/28/99-diffuse alveolar damage w/acute & chronic penumonitis, hyaline membrane formation, interstitial edema & early organization;
CDC Split Type: U199900836

Write-up: p/vax pt exp a severe sore throat that became worse p/ATB;CXR revealed bilat pulmonary infiltrates;pt put on ventilator;pt had an open lung biopsy on10/28''/99;tissue samples show diffuse alveolar damage w/acute & chronic pneumonitis;60 day follow up states the pt died.


VAERS ID: 132243 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1999-10-05
Onset:1999-10-08
   Days after vaccination:3
Submitted: 1999-11-13
   Days after onset:36
Entered: 1999-12-07
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0063AA / UNK LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Condition aggravated, Hypoxia, Lung disorder, Respiratory disorder, Right ventricular failure, Sepsis, Shock, Urinary tract disorder
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (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), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-12-09
   Days after onset: 62
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: polyarythemia/myclofibrodysplastia;cardiomyopathy
Allergies:
Diagnostic Lab Data: extemsive
CDC Split Type:

Write-up: resp failure-ventilator support;aspiration;prob septic shock;CHF;60 day follow-up / states the pt died. The pt developed renal and pulmonary disorders and had to be intubated, was dialyzed before he died.


VAERS ID: 129826 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1999-10-06
Onset:1999-10-07
   Days after vaccination:1
Submitted: 1999-10-25
   Days after onset:18
Entered: 1999-10-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0126FA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Lung disorder, Myocardial infarction, Right ventricular failure
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199900751

Write-up: p/vax pt found dead by husband on 10/7/99;it was reported by pt husband that on 10/6/99 pt had a cough & chest congestion;pt was never seen by MD not in whole life;pt always treated self w/all kinds of herbs & vitamins;


VAERS ID: 151799 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Male  
Location: Oregon  
Vaccinated:1999-10-01
Onset:1999-10-05
   Days after vaccination:4
Submitted: 2000-04-28
   Days after onset:206
Entered: 2000-05-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Neoplasm, Quadriplegia, Respiratory arrest, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow), Non-haematological tumours of unspecified malignancy (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Other Medications: Carboplatin, etoposide phosphate, cyclophosphamide.
Current Illness:
Preexisting Conditions: glioblastoma multiforme located in occipital region
Allergies:
Diagnostic Lab Data: probable cause of death-progression of tumor and respiratory failure
CDC Split Type: MPU2000002450

Write-up: This case concerns male who had had influenza vax 48 hours prior to chemotherapy. On day 3, after the carboplatin based tridrug chemotherapy with blood brain-barrier disruption (vertebral artery), he experienced respiratory arrest and rapid progression of quadriparesis. The pt remained quadriparetic and ventilator dependent and died 75 days after chemotherapy treatment. The authors conclude that the pathophysiology of the complication seen in the 7 pts is multi-factorial but may be related to vascular streaming and an atypical inflammatory toxic reaction to carboplatin or etoposide. The complication has not recurred during a 6 month period following modification of the protocol. Date of vax and onset not specified and therefore assumed to be associated with the 1999/1999 influenza season.


VAERS ID: 150250 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Foreign  
Vaccinated:1999-09-09
Onset:1999-10-04
   Days after vaccination:25
Submitted: 2000-03-15
   Days after onset:163
Entered: 2000-03-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Aplastic anaemia, Bone marrow depression, Bronchitis, Cerebral atrophy, Emphysema, Epistaxis, Hypotension, Mouth haemorrhage, Petechiae, Pulmonary hypertension, Respiratory failure, Thrombocytopenia
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-09
   Days after onset: 5
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:
Other Medications: Therapy with platelet concentrates and corticosteroids
Current Illness: Relapsing thrombocytompenic purpura, compensated renal insufficiency, senile dementia.
Preexisting Conditions: Relapsing thrombocytopenic purpura since 1994, compensated renal insufficiency, senile dementia, and history of cerebra infarction.
Allergies:
Diagnostic Lab Data: Thrombocyte count - 3 giga/l. Maximum platelet after substitution was 22 giga/l. Normal lab findings: leukocytes, hemoglobin, differential blood count, PTT. HGB - 7.1 g/dl. Bone marrow biopsy showed hypoplastic myelodysplastic syndrome with differential dx of aplastic anemia/toxic marrow lesion. EEG-nml. Chest x-ray showed emphysema, bronchitis, pulmonary hypertension signs and aortic sclerosis. Cranial CT revealed cerebral atrophy with no hemorrhage.
CDC Split Type: WAES00031015

Write-up: Information has been received from a health care professional concerning an 82 year old male pt who on 9/9/1999 was vaccinated and on 10/4/1999, the pt presented with oral bleeding and petechia of both forelegs. It was noted thrombocyte count was 3 giga/1. The pt was admitted to the hospital. It was noted that he suffered from epistaxis for several months before this incident. Inspite of therapy with platelet concentration and corticosteroids, the pt''s condition worsened and he died on 10/9/1999 due to respiratory failure and hypotension. An autopsy was refused by the relatives. (It was noted that the maximum count after platelet substitution was 22 giga/1.)


VAERS ID: 130280 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Female  
Location: Foreign  
Vaccinated:1999-10-01
Onset:1999-10-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1999-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Brain stem syndrome, Coma, Encephalitis, Headache, Somnolence
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Neoral, Azathioprine, Pred, septrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MPU199900466

Write-up: p/vax pt hosp & died;pt recv vax 2 days prior to adm to hosp;pt reported to have felt unwell w/h/a & drowsiness;adm to hosp in coma & progressed to brain stem death;no post mortem performed & poss COD encephalitis;


VAERS ID: 740185 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:1999-09-20
Onset:1999-09-01
Submitted: 0000-00-00
Entered: 2018-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Adenocarcinoma, Antibody test positive, Arrhythmia, Bradycardia, Condition aggravated, Coxsackie virus test positive, Death, Diarrhoea, Electromyogram abnormal, Endoscopy upper gastrointestinal tract abnormal, Endotracheal intubation, Gastrointestinal haemorrhage, Guillain-Barre syndrome, HIV test negative, Malaise, Mechanical ventilation, Neuropathy peripheral, Pneumonia, Sinus node dysfunction, Staphylococcal infection, Staphylococcus test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Angioedema (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vasculitis (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-12-12
   Days after onset: 102
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol abuse; Arrhythmia; Bronchitis chronic; Chronic obstructive pulmonary disease; Common cold syndrome; Diabetes mellitus; Hepatic cirrhosis; Liver disorder; Prophylaxis; Sick sinus syndrome
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DE00950751399120245

Write-up: Information has been received from a health care professional concerning a 66-year-old male patient. The patient''s concurrent condition included cirrhosis of the liver, alcohol abuse, hepatic disorder, diabetes mellitus (treated with insulin), chronic obstructive pulmonary disease, chronic bronchitis, arrhythmia and sick sinus syndrome. Concomitant therapy included influenza virus vaccine (unspecified). On 20-SEP-1999, the patient was vaccinated with PNEUMOVAX 23 (dose 1, 0.5 ml, intramuscular, frequency, lot# and expiration date were unknown) for prophylaxis. In 1999, he developed progressive ascending incomplete paralysis necessitating mechanical ventilation. The presumptive diagnosis was Guillain-Barre syndrome, however, the cerebrospinal fluid culture (CSF) examination did not reveal an increase in protein content. At the time of reporting, the patient had not yet recovered. The patient''s conditions were considered serious because of a life-threatening event, the admission to hospital and possibly permanent damage. Upon internal review, the event Guillain-Barre syndrome considered to be medically significant. Follow-up information received indicated that on 25-SEP-1999 the patient was hospitalized because he had suffered for several days from diarrhea and from a deterioration of his general condition. First a pneumonia of the right was diagnosed. In the further course the patient developed a progressive ascending paralysis without sensory deficit which led to intubation on 6-OCT-1999. That day a respiratory therapy was started. At that time the treating physicians assumed a Guillain-Barre syndrome (GBS) caused by the given vaccinations. A significant albumin increase was not found in several CSF''s. Repeated electromyography (EMG) and National Lawyers Guild (NLG) investigations indicated a polyradiculoneuropathy. No hints were given for multiple sclerosis, Borrelia, Epstein-Barr, varicella, Enteric cytopathic human orphan (ECHO), poliomyelitis or TBC. Human immunodeficiency virus (HIV) was negative. Investigations showed a slightly increased titer for Coxsackie virus and antibodies against Campylobacter. A gastroscopy at gastrointestinal bleeding showed a hardly differentiated adeno carcinoma in the esophagus and cardia area. Therefore, a paraneoplastic GBS was discussed as well. The patient developed repeated bronchopulmonary infections, finally with Methicillin-resistant Staphylococcus aureus (MRSA) positive staph. Aureus. For a short time the patient''s clinical condition had significantly improved but deteriorated dramatically in the end. The patient had to be supplied with oxygen again under permanent control. The patient died due to bradycardia arrhythmia with sick sinus syndrome on 12-DEC-1999 at 3:30 am. It was unknown if the autopsy was done. As agreed by the patient''s family, no resuscitation was performed. The reporter considered the event "Sinus arrhythmia", "neuropathy peripheral" and "respiratory disorder" to be life-threatening. Upon internal review, the event "pneumonia" considered to be medically significant. This is an amended report. The reporter indicated "yes" for alcohol abuse involving the patient. In addition the reaction onset date has been changed from 1999 to September 1999. Follow up information has been received on 04-MAR-2018, the patient concurrent condition also included common cold. The concomitant therapy was updated to INFLUVAC (previously reported as influenza virus vaccine (unspecified). It has been determined that case # 99120262 is a duplicate of case # 99120245 Therefore, case # 99120262 is being deleted from our files and the cases are consolidated into case 99120245. Sender''s Comments: MERCK 99120245: Mfr number; Reported Cause(s) of Death: Guillain-Barre Syndrome; susp. of polyradiculoneuropathy; Ascending Paralysis; bradycardia arrhythmia w/ sick sinus syndrome.


VAERS ID: 182271 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:1998-10-23
Onset:1999-05-29
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2002-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pneumonia, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PJP200200177

Write-up: The pt received a Fluvirin vaccination on 10/23/98 and on 5/29/99 experienced pneumonia and respiratory failure and subsequently died, as a result the adverse event was considered serious. The reporter assessed the causality as possibly related. No more information has been provided.


VAERS ID: 124694 (history)  
Form: Version 1.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:1998-11-01
Onset:1999-02-20
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 1999-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0973930 / UNK - / -

Administered by: Other       Purchased by: Public
Symptoms: Drug ineffective, Hypoxia, Infection, Lung disorder, Pneumonia, Pyrexia, Respiratory disorder, Shock
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-21
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD influenza complicated by pneumococcal pneumonia;2/23/99 WBC 6.4, 19% bands;2/24/99 WBC 7.3, 18% bands;CXR showed hazy lt lower lung base;3/17/99 tracheostomy performed;
CDC Split Type: TX99112

Write-up: fever & mild upper airway sx, then lower resp problems w/dec 02;dx influenza, r/o pneumonia;deteriorated;required intubation, ventilation support;dx pneumococcal pneumonia;devel shock, father req no aggressive tx-pt died; father ref autopsy


VAERS ID: 165979 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:1998-10-21
Onset:1999-01-01
   Days after vaccination:72
Submitted: 2001-02-15
   Days after onset:776
Entered: 2001-02-20
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975770 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Amnesia, Confusional state, Mental impairment, Neoplasm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U2001004120

Write-up: Following vaccination the pt''s family noticed a sudden onset of confusion and mental deterioration in 1/99. A rapid progression from short-term memory loss to death in March 2000. A diagnosis of paraneoplastic disorder was given. Further information is requested.


VAERS ID: 117906 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Male  
Location: Utah  
Vaccinated:1998-11-30
Onset:1998-12-01
   Days after vaccination:1
Submitted: 1998-12-23
   Days after onset:22
Entered: 1999-01-05
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 498819 / UNK LA / -

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Pyrexia, Shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cordarone
Current Illness: NONE
Preexisting Conditions: Allergic to PCN, Irregular heart beat, ventricular arrhythmia(declined implantable defibrillator, CABG x3 in 1995, ischemic cardiomyapathy, heavy drinker, hearing aid
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: UT981825

Write-up: Pt recv vax on 11/30/98; on 12/1/98 pt exp coldness, fever; on 12/2/98 pt exp hotness; collapsed; pt died


VAERS ID: 118500 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Male  
Location: Foreign  
Vaccinated:1998-11-05
Onset:1998-11-19
   Days after vaccination:14
Submitted: 1999-01-25
   Days after onset:67
Entered: 1999-01-28
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Infection, Malaise, Pneumonia, Respiratory disorder
SMQs:, Lack of efficacy/effect (narrow), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-12-12
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WAES99011244

Write-up: pt recv vax & 30NOV98 pt was adm to hosp where on 12DEC98 pt died of pneumonia;pt was in good health @ time of vax;


VAERS ID: 223808 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Texas  
Vaccinated:1998-11-03
Onset:1998-11-17
   Days after vaccination:14
Submitted: 2004-07-09
   Days after onset:2060
Entered: 2004-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 0980530 / 4 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Acute respiratory distress syndrome, Atrial fibrillation, Guillain-Barre syndrome, Hypotension, Laboratory test abnormal, Leukocytosis, Multi-organ failure, Pneumonia, Renal failure, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-22
   Days after onset: 66
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 60 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: decadron,mannitol
Current Illness: Vaccine given at pre-op physical for meningioma resection. Afebrile and well at time of exam except for headache and irritibility/personality changed referable to right frontal meningioma.
Preexisting Conditions: none except meningioma
Allergies:
Diagnostic Lab Data: EMG consistent with G-B syndrome. Two neurologists agreed with diagnosis. Sputum culture from admission positive beta-hemolytic strep, not group A. WBCs at presentation 48,000 with a left shift.
CDC Split Type:

Write-up: Adverse event: Guillain-Barre syndrome presenting on 11/18/2004 in conjunction with Beta-hemolytic streptococcal pneumonia. Individual was also post-op from craniotomy for meningioma on 11/09/1998 and had been continuously treated with IV Decadron and Mannitol since that procedure for ongoing cerebral edema. Yeast was also present in tracheal aspirates at presentation; not cultured for campylobacter yersenia nor tested for CMV. He developed ARDS and sepsis and despite treatment with plasmapheresis and IVIG died 66 days after presentation with multiple organ failure. Manufacturer of vaccine was Connaught, lot 0980530 or possibly 0986530. Influenza vaccine givne IM left deltoid. Exp 06/99. He had had influenza vaccine for at least the preceeding 3 years. Nurse follow up on 07/26/04 states: "atrial fib, renal failure, hypotension."


VAERS ID: 117068 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Male  
Location: California  
Vaccinated:1998-11-13
Onset:1998-11-14
   Days after vaccination:1
Submitted: 1998-11-16
   Days after onset:2
Entered: 1998-12-04
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 7+ - / -

Administered by: Other       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Dyspnoea, Lung disorder, Right ventricular failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE frail-depressed
Preexisting Conditions: 18OCT98 resp infect-sx free 28OCT98
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COPD w/exacerbation;resp distress;expired 15NOV98 @ hosp;adm to hosp 14NOV98;


VAERS ID: 117066 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Male  
Location: Foreign  
Vaccinated:1998-11-10
Onset:1998-11-14
   Days after vaccination:4
Submitted: 1998-12-02
   Days after onset:18
Entered: 1998-12-04
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest, Cardiovascular disorder, Pneumonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, blind
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800857

Write-up: pt recv vax 10NOV98 & was taken to hospital by amb 4AM on 14NOV98 & died 1hr later;COD pneumonia & was told that the pneumonia brought on a heart attack;


VAERS ID: 117908 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Female  
Location: California  
Vaccinated:1998-10-27
Onset:1998-11-10
   Days after vaccination:14
Submitted: 1998-12-28
   Days after onset:48
Entered: 1999-01-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988202 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood urea increased, Brain oedema, Coma, Diabetes mellitus, Gastroenteritis, Hyperglycaemia, Hyponatraemia, Infection, Ketosis, Vomiting, Weight decreased
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-12
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Beclovent inhaler
Current Illness:
Preexisting Conditions: asthma, rt lower lobe infiltrate, innocent murmur
Allergies:
Diagnostic Lab Data: glucose on admission 1310;NA 124;BUN 31;SGPT 26;CREAT 0.3;SGOT 42;
CDC Split Type:

Write-up: pt recv vax 27OCT98 & 10NOV severe vomiting, glucose 92, felt prob viral age;25NOV seen for OM;29NOV cranky, some vomiting w/nl exam;sl weight loss;3DEC vomited againx2;dx DKA w/glucose 1310;


VAERS ID: 118271 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Foreign  
Vaccinated:1998-10-22
Onset:1998-11-02
   Days after vaccination:11
Submitted: 1999-01-19
   Days after onset:78
Entered: 1999-01-22
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Anorexia, Asthenia, Diarrhoea, Pharyngitis, Pneumonia, Rhinitis, Sepsis
SMQs:, Agranulocytosis (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness:
Preexisting Conditions: severe COPD, severe oxygen dependent, chronic dementia
Allergies:
Diagnostic Lab Data: WBC-increased; Blood culture-positive pneumcoccus; Chest X-ray; EKG
CDC Split Type: U199900043

Write-up: Pt recv vax on 10/22/98; on 11/2/98 pt exp a cold, not eating, diarrhea, weakness; pt to hosp 11/3;dx=acute left lobar pneumonia; tx=IV antibiotics; pt expired on unspecified day


VAERS ID: 115910 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Male  
Location: Virginia  
Vaccinated:1998-10-29
Onset:1998-10-29
   Days after vaccination:0
Submitted: 1998-11-04
   Days after onset:6
Entered: 1998-11-06
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


VAERS ID: 115912 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Female  
Location: Ohio  
Vaccinated:1998-10-28
Onset:1998-10-28
   Days after vaccination:0
Submitted: 1998-10-30
   Days after onset:2
Entered: 1998-11-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 02298P / UNK RA / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Chest pain
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: FLU89161098

Write-up: pt recv vax 28OCT98 4PM;taken to Er @ approx 6Pm w/sudden onset of chest discomfort;


VAERS ID: 115913 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Female  
Location: Missouri  
Vaccinated:1998-10-28
Onset:1998-10-28
   Days after vaccination:0
Submitted: 1998-10-30
   Days after onset:2
Entered: 1998-11-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 021198P / 2 - / IM

Administered by: Other       Purchased by: Private
Symptoms: Apnoea, Malaise, Myocarditis, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unk
Preexisting Conditions: allergic to PCN
Allergies:
Diagnostic Lab Data: drug toxicology drawn in ER;
CDC Split Type: FLU89171098

Write-up: pt recv vax 6-8AM & on 28OCT98 pt vomited 10min later felt bad;went home & cont c/o not feeling well next day;drove husband to work & when arrived in parking lot lost consciousness & stopped breathing;


VAERS ID: 116465 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Ohio  
Vaccinated:1998-10-16
Onset:1998-10-25
   Days after vaccination:9
Submitted: 1998-11-12
   Days after onset:18
Entered: 1998-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20228KC / 1 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 455382 / 1 - / IM

Administered by: Other       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Accolate, Aerobid, albuterol, Isonizid, Zoloft, Pyridoxine, Ritalin, Theophyline;
Current Illness: COPD, ASHD, CHF, HTN, resp failure, PRD
Preexisting Conditions: NKA;COPD, ASHD, CHF, HTN, resp failure, PRD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: no immed rxn, no adverse rxn @ site;no elevated pulse, temp;


VAERS ID: 118502 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Iowa  
Vaccinated:1998-10-15
Onset:1998-10-24
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1999-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Condition aggravated, Influenza, Lung disorder, Pneumonia, Pneumonia aspiration, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-05
   Days after onset: 12
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:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, IDDM, Smoker, Aspiration pnuemonia, depression, thyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: adm w/flu-like sx flu shot 9 days earlier;pt w/underlying COPD went on to devel pneumonia & renal failure & resp failure, died 5NOV;


VAERS ID: 182147 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:1998-10-20
Onset:1998-10-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2002-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Tracheobronchitis
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PJP200200178

Write-up: A report received on 2/28/02, is concerning a 73 year old male pt who experienced life-threatening tracheobronchitis, for which he was hospitalized, 3 days after receiving Fluvirin vaccine, on 10/20/1998. The pt died subsequently. It is unclear from the report what the cause of death was. The causality was stated to be possibly related. No further information was provided.


VAERS ID: 115260 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1998-10-21
Onset:1998-10-22
   Days after vaccination:1
Submitted: 1998-10-23
   Days after onset:1
Entered: 1998-10-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC Split Type:

Write-up: c/o vague sx of not feeling well;T102.4;


VAERS ID: 116466 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Ohio  
Vaccinated:1998-10-14
Onset:1998-10-20
   Days after vaccination:6
Submitted: 1998-11-12
   Days after onset:23
Entered: 1998-11-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20228KC / 1 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 454382 / 1 - / IM

Administered by: Other       Purchased by: Public
Symptoms: Cardiac arrest, Hypotension
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zestril, Norvasc, Lasix, Ritalin, Pepcid, ensure per tube
Current Illness: CVA, CHF, NIDDM, ASHD, HTN, VHD, CAF, PVD, renal insufficiency, COPD
Preexisting Conditions: PCN, cephalosporins;CVA, NIDDM, ASHD, HTN, VHD, CAF, PVD, renal insufficiency, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: no immediate rxn, no adverse rxn @ site, no acute distress resident found w/no BP, no pulse initiated CPR;


VAERS ID: 116385 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Foreign  
Vaccinated:1998-10-19
Onset:1998-10-20
   Days after vaccination:1
Submitted: 1998-11-13
   Days after onset:24
Entered: 1998-11-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: EML981919

Write-up: pt recv vax & died suddenly the day p/vax 19OCT98;


VAERS ID: 115514 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1998-10-19
Onset:1998-10-19
   Days after vaccination:0
Submitted: 1998-10-21
   Days after onset:2
Entered: 1998-11-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


VAERS ID: 116801 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-11-09
   Days after onset:23
Entered: 1998-11-25
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0978660 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0871H / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Coronary artery disease, Diabetes mellitus, Unevaluable event
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Other ischaemic heart disease (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec, lanoxin, coumadin, immodium PRN;insulin
Current Illness: NONE
Preexisting Conditions: CAD/diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: NJ9827

Write-up: pt expired w/in 24h of vax;no apparent allergic response;


VAERS ID: 115255 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:1998-10-13
Onset:1998-10-14
   Days after vaccination:1
Submitted: 1998-10-20
   Days after onset:6
Entered: 1998-10-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981800 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800667

Write-up: pt recv vax 13OCT98 & 14OCT98 pt committed suicide gun shot wound to head;


VAERS ID: 115054 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1998-10-08
Onset:1998-10-08
   Days after vaccination:0
Submitted: 1998-10-14
   Days after onset:6
Entered: 1998-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800624

Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;


VAERS ID: 115695 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Foreign  
Vaccinated:1998-10-01
Onset:1998-10-01
   Days after vaccination:0
Submitted: 1998-11-01
   Days after onset:31
Entered: 1998-11-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20188HE / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ?cardiac disorder
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MPI981933

Write-up: pt recv vax & died 10hr post vax;date of vax not specified, but batch number quoted is a current season''s batch;


VAERS ID: 116127 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: New York  
Vaccinated:1998-09-29
Onset:1998-09-30
   Days after vaccination:1
Submitted: 1998-11-06
   Days after onset:37
Entered: 1998-11-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988207 / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Blood amylase increased, Infection, Laboratory test abnormal, Pancreatitis haemorrhagic, Somnolence, Stupor, Vomiting
SMQs:, Acute pancreatitis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Stavudine;Videx liquid
Current Illness:
Preexisting Conditions: cogenital HIV+ from mother @ birth;never developed AIDS fefining illness;NKDA;followed by immunologist;
Allergies:
Diagnostic Lab Data: SEP98 CD4 count 1400 & viral load test of approx 8000;amylase 2125;blood lipase $g8000;autopsy included extensive microscopic studies;tissue stains yielded no organisms;brain examined by neuropathologist & found to be free of any AIDS;
CDC Split Type:

Write-up: 30SEP98 exp malaise, abd complaints, sleepiness;taken to ER dx benign rxn to flu vax;taken home later devel vomiting;mom found child unresponsive taken back to ER;child pronounced in ER;autopsy had acute hemorrhagic pancreatitis;


VAERS ID: 117527 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:1998-09-11
Onset:1998-09-24
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 1998-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cachexia, Condition aggravated, Diarrhoea, Dyspepsia, Dyspnoea, Hypotension, Hypothermia, Lung disorder, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Accidents and injuries (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-11-20
   Days after onset: 57
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur;Pred;Xanas;Azmacort;Synthroid;Aldactone;Lasix;KDUR;albuterol;atrovent;loxanol;
Current Illness: no acute illness afeb;end state COPD;
Preexisting Conditions: End Stage COPD; corpulmonale;HTN;Heart Failure
Allergies:
Diagnostic Lab Data: BP 104/70;T97.9;pulse 96;resp 20;
CDC Split Type:

Write-up: pt exp diarrhea 24SEp;8hr later upset stomach;7hr later dyspnea;


VAERS ID: 105745 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Maryland  
Vaccinated:1997-11-21
Onset:1997-11-22
   Days after vaccination:1
Submitted: 1997-12-11
   Days after onset:19
Entered: 1997-12-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC Split Type: MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


VAERS ID: 105197 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:1997-10-23
Onset:1997-11-17
   Days after vaccination:25
Submitted: 1997-11-18
   Days after onset:1
Entered: 1997-11-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 4 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


VAERS ID: 105194 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: New York  
Vaccinated:1997-11-06
Onset:1997-11-09
   Days after vaccination:3
Submitted: 1997-11-21
   Days after onset:12
Entered: 1997-11-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978218 / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: hydroencephaly, shunted hydrocephalis, cerebral palsy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: severely delayed child became lethargic;48hr p/vax brought to ED, expired during CT scan to evaluate shunt status;


VAERS ID: 106152 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1997-11-06
Onset:1997-11-06
   Days after vaccination:0
Submitted: 1997-12-04
   Days after onset:28
Entered: 1998-01-07
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978172 / UNK LA / -

Administered by: Public       Purchased by: Unknown
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax @ work place a/2:15;did not report any s/s of feeling ill either before or p/inj;lt for break 330PM & had MI during break;


VAERS ID: 106323 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
Vaccinated:1997-11-02
Onset:1997-11-06
   Days after vaccination:4
Submitted: 1998-01-07
   Days after onset:62
Entered: 1998-01-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypoxia, Paralysis
SMQs:, Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dilantin, decadron 9started in JUL post op brain surg)
Current Illness: glioblastoma
Preexisting Conditions: before dx glioblasma, excellent health before & ater;
Allergies:
Diagnostic Lab Data: several CT scans, MRI, blood work, etc;refused to test for GBS;
CDC Split Type:

Write-up: quadriplegia & 100% vent assisted;pt too weakened to cont w/chemotherapy;prognosis is less than 2mo;


VAERS ID: 105296 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:1997-10-21
Onset:1997-11-01
   Days after vaccination:11
Submitted: 1997-11-24
   Days after onset:23
Entered: 1997-12-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Asthenia, CSF test abnormal, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-21
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC Split Type:

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


VAERS ID: 104094 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: Connecticut  
Vaccinated:1997-10-28
Onset:1997-10-28
   Days after vaccination:0
Submitted: 1997-10-30
   Days after onset:2
Entered: 1997-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3337GB / 3 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cardiac arrest, Malaise
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: diabetes, others not known
Allergies:
Diagnostic Lab Data: BP was taken @ clu clinic as a routine service offered to pt 130/66;
CDC Split Type: CT9711

Write-up: pt c/o not feeling well while in car w/wife;EMS was called when arrived pt was in cardiac arrest;attempts to revive failed was transported to hosp ER states COD listed on ER record as cardiac arrest;


VAERS ID: 104253 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Maryland  
Vaccinated:1997-10-28
Onset:1997-10-28
   Days after vaccination:0
Submitted: 1997-11-04
   Days after onset:7
Entered: 1997-11-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HC / UNK - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 441214 / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Cyanosis, Dyspnoea, Hypothermia, Oedema peripheral, Pallor
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-04
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx ETOH, tobacco use;
Allergies:
Diagnostic Lab Data: refused lab work
CDC Split Type:

Write-up: presented on 4NOV @ 926AM immed care w/ SOB, weakness, cyanotic, pallor, swelling lt arm-lateral forearm to hand;swollen since inj;T96.8;expired 4NOV97 @ home;


VAERS ID: 105125 (history)  
Form: Version 1.0  
Age: 100.0  
Sex: Female  
Location: New York  
Vaccinated:1997-10-27
Onset:1997-10-27
   Days after vaccination:0
Submitted: 1997-11-17
   Days after onset:21
Entered: 1997-11-25
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-30
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


VAERS ID: 104878 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Foreign  
Vaccinated:1997-10-26
Onset:1997-10-27
   Days after vaccination:1
Submitted: 1997-11-20
   Days after onset:24
Entered: 1997-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E71009BC1 / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Laboratory test abnormal, Leukopenia, Pyrexia
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-30
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Aspegic/acetylsalicylic acid;Digoxine/DIgoxin;Glyceryltrintrate/glyceryl;Nootropyl/piracetam
Current Illness: immun against influenza;14OCT97 WBC 7460 (70% neutrophils);
Preexisting Conditions: cardiovascular disease, unspecified
Allergies:
Diagnostic Lab Data: 14OCT97 p/vax WBC 7460 (70% neutrophils);WBC p/vax 2370 (17% neutrophils); next day WBC 790 (8% neutrophils);
CDC Split Type: EMF97853

Write-up: pt recv vax 26OCT97 & next day devel a fever adm to hosp when WBC was found to be 2370 (17% neutrophils) & next day this had dropped to 790 (8% neutrophils);tx w/ringer lactate, ATB & neupogen but pt died on 30OCT97;


VAERS ID: 108923 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1997-10-06
Onset:1997-10-22
   Days after vaccination:16
Submitted: 1997-11-12
   Days after onset:21
Entered: 1998-03-26
   Days after submission:134
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978172 / 2 RA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 444071 / 1 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Asthenia, Chills, Condition aggravated, Constipation, Cough, Diarrhoea, Dizziness, Dyspepsia, Dyspnoea, Fatigue, Feeling cold, Headache, Influenza, Influenza like illness, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-31
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dyazide-water pill
Current Illness: NONE
Preexisting Conditions: HTN, dizziness;
Allergies:
Diagnostic Lab Data: 2wk later on 22OCT97 felt resp diff breathing merthiolate, thimerosal rxn;
CDC Split Type:

Write-up: extreme fatigue, muscles/joint pain, h/a, gastrointestinal upset, constipation, diarrhea, chills-feeling cold, dry cough, fever;22OCT97 exp extreme diff breathing & dizziness;pt felt had the flu;. All these symptoms started on Oct 6, 1997 when the influenza, pneumococcal vaccines were administered. Her health continued to deteriorate and on Oct 22, 1997 in the evening she experienced extreme difficulty breathing and then later dizziness. At this point she was taken to the Emergency room of hospital. Felt nauseated at home- threw up at hospital. Asthenia, headache, diarrhea, no dyspnea, myalgia, dyspepsia, chills fever, flu symd, arthralgia, constipation, cough inc, reaction aggrav.


VAERS ID: 105806 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: Foreign  
Vaccinated:1997-10-15
Onset:1997-10-18
   Days after vaccination:3
Submitted: 1997-12-22
   Days after onset:65
Entered: 1997-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E71009BD1 / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Anorexia, Asthenia, Malaise
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-03
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amitriptyline/amitripyline;Bendrofluazide/bendroflumsthia;co-proxamol/co-proxamol;omeprazole/omeprazole;pred, quinine sulphate, warfarin
Current Illness: immun against influenza
Preexisting Conditions: 4DEC97 carcinoma in situ stomach; osteoporosis;HTN;angina pectoris;emphysema;obstructive airway dis;alveolitis;resp failure;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: EML971025H

Write-up: pt recv vax & had sx of gen malaise, weakness & anorexia;3 days p/vax pt died about 2wk later;reporter did not indicate whether had been adm to hosp or that an autopsy had been undertaken;


VAERS ID: 103592 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1997-10-16
Onset:1997-10-17
   Days after vaccination:1
Submitted: 1997-10-22
   Days after onset:5
Entered: 1997-10-24
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


VAERS ID: 107856 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:1997-10-15
Onset:1997-10-16
   Days after vaccination:1
Submitted: 1998-02-21
   Days after onset:128
Entered: 1998-02-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK LA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 39 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


VAERS ID: 104095 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1997-10-15
Onset:1997-10-15
   Days after vaccination:0
Submitted: 1997-10-16
   Days after onset:1
Entered: 1997-11-03
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3287GB / 1 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: GLynase, Corzide
Current Illness:
Preexisting Conditions: HTN, diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS97040

Write-up: pt recv vax 15OCT97 830 to 930AM & same day died;corner states COD massive MI;


VAERS ID: 104634 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Maine  
Vaccinated:1997-09-18
Onset:1997-10-14
   Days after vaccination:26
Submitted: 1997-11-11
   Days after onset:28
Entered: 1997-11-13
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


VAERS ID: 106403 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Male  
Location: Minnesota  
Vaccinated:1997-10-13
Onset:1997-10-13
   Days after vaccination:0
Submitted: 1997-10-20
   Days after onset:7
Entered: 1998-01-15
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin;lasix;K-Dur;Allopurinol;
Current Illness: metastatic melanoma;
Preexisting Conditions: hx of CHF;metastatic melanoma;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt followed for metastatic melanoma recv flu vax & apparently had sudden death approx 45min later;no prev rxn to flu vax;


VAERS ID: 103878 (history)  
Form: Version 1.0  
Age: 57.0  
Sex: Male  
Location: Michigan  
Vaccinated:1997-09-11
Onset:1997-09-22
   Days after vaccination:11
Submitted: 1997-10-09
   Days after onset:17
Entered: 1997-10-28
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978168 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, Pneumonia, Respiratory disorder
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-07
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: allergies PCN;LBBB;
Allergies:
Diagnostic Lab Data: neuro consult suggested;polyneuropathy D/T GBS
CDC Split Type:

Write-up: pt recv vax 11SEP97 & came in 22SEP97 w/GBS expired 7OCT97 d/t ARDS secondary to pneumonia secondary to GBS;polyneuropathy d/t GBS;


VAERS ID: 177955 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Male  
Location: New York  
Vaccinated:1995-01-01
Onset:1997-04-01
   Days after vaccination:821
Submitted: 2001-11-16
   Days after onset:1690
Entered: 2001-11-20
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Ascites, Cardiomegaly, Chest pain, Chills, Dehydration, Dyspnoea, HIV test positive, Haemoptysis, Heart rate increased, Hepatic cirrhosis, Hepatomegaly, Hyperventilation, Hypotension, Hypoxia, Malaise, Meningitis, Night sweats, Oliguria, Pallor, Pleural effusion, Pneumonia, Sepsis, Splenomegaly, Varices oesophageal, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lamivudine; sulfamethoxazole (+) zidovudine
Current Illness: Cirrhosis; human immunodeficiency virus antigen positive; hepatitis C; drug abuse
Preexisting Conditions: Chronic sinusitis; hepatitis B
Allergies:
Diagnostic Lab Data: RR-40/min; BP-91/60 mmHg; HR-114/min; breath sounds over his right lung field were decreased; CXR-showed an infiltrate of the entire right lung; Autopsy-showed lobar pneumonia, pleural effusion, ascites, cardiomegaly with unremarkable valves, esophageal varices, splenomegaly and hepatomegaly with liver cirrhosis. Histopathology of the lungs revealed sheets of acute and chronic inflammatory cells diffusely filling the alveolar spaces, intra-alveolar edema and capillary congestion. Histopathology of the liver revealed cirrhotic micronodules surrounded by bridging bands of fibrosis with portal ductular proliferation and moderately periductual lymphocytic infiltrate. Histopathology of the spleen showed marked sinusoidal congestion with mild depletion of the white pulp. Lymph nodes showed mild follicular depletion. Isotyping confirmed S. pneumonia, strain type 3.
CDC Split Type: WAES01110449

Write-up: It was reported that a 44 year old white male was vaccinated in 1995 with a dose of pneumococcal vaccine 23 polyvalent and a dose of influenza virus vaccine. At the time of vaccination, the pt''s CD4 count was 250 cells/microL (19%) and he was prescribed concomitantly zidovudine, lamivudine and sulfamethoxazole/trimethoprim. It was noted that over the subsequent 2 years, there was a transient increase of his CD4 count to a maximum of 370 cells/microL and then a slow decline. The pt presented in 4/97 to the ER with a 6 day history of violent shaking chills, night sweat and malaise. The pt reported shortness of breath, occasional blood-tinged sputum and pleuritic chest pain for 3 days. The pt was known to have been HIV (+) for 8 years, with risk factors including IV drug abuse. It was noted that the pt had received medical care at the infectious disease clinic at the same hospital. It was noted that at his last appointment, 3 months prior to his presentation to the ER, the pt had a CD4 cell count of 216 cells/microL (16%) and his viral load was 1270 copies/mL. It was reported that the pt completely recovered from a hepatitis b infection, but hat a history of chronic sinusitis and hepatitis C. The pt had never suffered from the opportunistic infections common in AIDS. It was reported that in the ER, the pt was poorly cooperative, appeared pale and coughed occasionally. He was afebrile, hypoxemic and had oliguria. Septic shock with severe bacterial pneumonia was dx''d. Ceftazidime, erythromycin, sulfamethoxazole/trimethoprim and IV hydration were administered. It was reported that the pt required orotracheal intubation and mechanical ventilation. About 11 hours after presenting to the ER, the pt developed recurrent ventricular tachycardia and expired. It was noted that with the exception of minimal aseptic leptomeningitis, the neuropathological findings were unremarkable. There was no evidence that the pt had a concurrent influenza infection. It was reported that Streptococcus pneumoniae was cultured from various blood samples. The organism was sensitive to penicillin, chloramphenicol, vancomycin and erythromycin. It was noted that the pneumococcal vaccine 23 polyvalent included isotype 3.


VAERS ID: 94662 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: South Carolina  
Vaccinated:1996-12-20
Onset:1996-12-20
   Days after vaccination:0
Submitted: 1996-12-31
   Days after onset:11
Entered: 1997-02-06
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 2 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


VAERS ID: 93698 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-12-18
   Days after vaccination:51
Submitted: 1997-01-02
   Days after onset:15
Entered: 1997-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 00696P / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Cough, Hypotension, Infection, Pneumonia, Pyrexia, Rhinitis, Sepsis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, irritable bowel synd, legally blind, diverticulitis, anemia
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC Split Type: 0010150970009

Write-up: pt recv vax 28OCT96 & 18DEC96 pt devel cough, congestion, elevated temp of 99.8, anorexia;2 days later 20DEC96 pt expired-cause unk;


VAERS ID: 93696 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-12-15
   Days after vaccination:48
Submitted: 1997-01-02
   Days after onset:18
Entered: 1997-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 00696P / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Coronary artery disease, Dementia, Hypertension, Infection, Lung disorder, Malaise, Pneumonia
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (narrow), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-18
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE REPORTED
Preexisting Conditions: hx of dementia, CAD, HTN, COPD, hiatal hernia, osteoarthritis, angina, hypokalemia
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC Split Type: 0010150970007

Write-up: pt recv vax 28OCT96 & 15DC96 pt devel a cough, restlessness, malaise, anorexia & elevated temp of 102;APAP & symmetrel prescribed;2 days later 17DEC96 pt was afeb but cough worsened;pt on ATB following day 18DEC96 pt expired-cause unk;


VAERS ID: 93695 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-12-14
   Days after vaccination:47
Submitted: 1997-01-02
   Days after onset:19
Entered: 1997-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00696P / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cough, Infection, Pneumonia, Pyrexia, Respiratory disorder, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, Cytotec, Voltaren, synthroid
Current Illness: NONE REPORTED
Preexisting Conditions: hx of hypothyroidism, pre renal azotemia, CVA (old) - lt hemiparesis, CHF, HTN, osteoarthritis, intermittent atrial fibrillation, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type: 0010150970006

Write-up: pt recv vax 28OCT96 & 14DEC96 pt devel a cough & rhinitis;symmetrel was prescribed; 2 days later 16DEC96 pt t103 & put on APAP & ATB;temp down to 99.8 w/in 4 hr;pt expired that day cause unk. The death certificate states aspiration.


VAERS ID: 94611 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1996-11-21
Onset:1996-11-23
   Days after vaccination:2
Submitted: 1997-01-29
   Days after onset:67
Entered: 1997-01-31
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Dysphagia, Haemorrhage, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (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), Gastrointestinal ulceration (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-17
   Days after onset: 55
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 56 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


VAERS ID: 105293 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Oregon  
Vaccinated:1996-11-12
Onset:1996-11-12
   Days after vaccination:0
Submitted: 1997-11-24
   Days after onset:377
Entered: 1997-12-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 1 LA / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 92054 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:1996-11-05
Onset:1996-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00276P / UNK - / A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 92136 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Female  
Location: Kansas  
Vaccinated:1996-11-05
Onset:1996-11-05
   Days after vaccination:0
Submitted: 1996-11-11
   Days after onset:6
Entered: 1996-11-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00276P / 1 - / IM A

Administered by: Private       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of heart disease?NKDA/no allergy to eggs;not taking coumadin/prev recv flu vax w/o rxn;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 0010150960083

Write-up: pt recv vax 5NOV96 & that evening pt died;pt had a hx of heart disease;pt was not allergic to eggs & had prev recv the flu vax w/o rxn;pt was not taking Coumadin;responsible MD does not think the death was r/t vax;


VAERS ID: 107361 (history)  
Form: Version 1.0  
Age: 40.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1996-10-31
Onset:1996-11-05
   Days after vaccination:5
Submitted: 1998-01-26
   Days after onset:447
Entered: 1998-02-10
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Coma, Diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


VAERS ID: 93697 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-11-04
   Days after vaccination:7
Submitted: 1997-01-02
   Days after onset:59
Entered: 1997-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00696P / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Anorexia, Cardiac arrest, Cough, Dementia, Malaise, Pneumonia, Pyrexia, Rhinitis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (narrow), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-23
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec, Antivert, Multivitamni, TUMS, Vitamin C
Current Illness: NONE
Preexisting Conditions: hx of dementia, postional vertigo, HTN, mild renal failure, multiple allergies;
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC Split Type: 0010150970008

Write-up: pt recv vax 28OCT96 & 4NOV96 pt devel a cough & congestion & was treated w/med;pt devel t99.0, anorexia & malaise;5 days later 23DEC96 pt expired-cause unk;


VAERS ID: 92652 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-10-01
Onset:1996-11-02
   Days after vaccination:32
Submitted: 1996-11-28
   Days after onset:26
Entered: 1996-12-11
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Cardiac arrest, Guillain-Barre syndrome, Hypoxia, Quadriplegia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Cardiomyopathy (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-17
   Days after onset: 15
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: inhaler for COPD (identity unk)
Current Illness:
Preexisting Conditions: COPD, Crohn''s disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: adm on 2NOV96 w/weakness, progressing to quadraparesis;GBS dx;required intubation & ventilation;tx w/immunoglobulin, & then plasamaphoresis w/no improvement;cardiac arrest on 17NOV96;could not be resuscitated;


VAERS ID: 92463 (history)  
Form: Version 1.0  
Age: 95.0  
Sex: Male  
Location: Arizona  
Vaccinated:1996-10-27
Onset:1996-10-31
   Days after vaccination:4
Submitted: 1996-11-01
   Days after onset:1
Entered: 1996-11-29
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


VAERS ID: 92464 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Female  
Location: Arizona  
Vaccinated:1996-10-23
Onset:1996-10-30
   Days after vaccination:7
Submitted: 1996-11-01
   Days after onset:2
Entered: 1996-11-29
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Peripheral vascular disorder, Pupillary disorder, Speech disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-31
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: TYPE II DIABETES, CHF,SCHIZOPHRENIA, UTI
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896309012L

Write-up: 1 of 2 pt from a long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following receipt of flu vax;


VAERS ID: 92505 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1996-10-22
Onset:1996-10-29
   Days after vaccination:7
Submitted: 1996-11-22
   Days after onset:24
Entered: 1996-12-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00586P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Diarrhoea, Haematemesis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-17
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theophylline, Lanoxin, Lasix, Multiple vitamins, Synthroid, Maalox, Prevacid, Compazine, Propulsid, Capoten, Potassium, Lactulose;
Current Illness: unk
Preexisting Conditions: peptic ulcer disease, COPD, atrial fibrillation, hypothyroidism, pacemaker, mitral valve replacement;
Allergies:
Diagnostic Lab Data: emesis positive for occult blood
CDC Split Type: 0010150960057

Write-up: pt recv vax 22OCT96 & 29OCT96 exp n/v, vomiting blood, & diarrhea w/o fever;pt hosp & condition has been described as grave;pt has not yet recovered;


VAERS ID: 91441 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1996-10-28
Onset:1996-10-28
   Days after vaccination:0
Submitted: 1996-10-28
   Days after onset:0
Entered: 1996-11-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968202 / UNK RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Dizziness, Dyspnoea, Hyperhidrosis, Hypoxia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HTN
Allergies:
Diagnostic Lab Data: EKG-nl sinus thythm-nl ECG;
CDC Split Type:

Write-up: pt became diaphoretic, lightheaded, dizzy w/soreness in joints, sl heaviness in chest & SOB relieved w/02, ntg, IV NS;


VAERS ID: 96949 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-10-28
Onset:1996-10-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Conduction defects (narrow), Embolic and thrombotic events, arterial (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-05
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


VAERS ID: 93968 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1996-10-24
Onset:1996-10-25
   Days after vaccination:1
Submitted: 1996-11-01
   Days after onset:7
Entered: 1997-01-23
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


VAERS ID: 92612 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Louisiana  
Vaccinated:1996-10-21
Onset:1996-10-21
   Days after vaccination:0
Submitted: 1996-11-13
   Days after onset:23
Entered: 1996-12-09
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968175 / UNK RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1626B / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypertension, Myelitis, Paralysis, Quadriplegia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
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: unk
Current Illness: NONE
Preexisting Conditions: hypertension, hyperlipidemia, hypercholesterolemia and smoking 1.5 packs per day for 13 years
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896323001L

Write-up: pt recv vax & devel transverse myelitis, & was hosp, & is a quadriplegic;reporter was notified of this event as part of litigation proceedings;


VAERS ID: 97164 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Foreign  
Vaccinated:1996-10-08
Onset:1996-10-19
   Days after vaccination:11
Submitted: 1997-04-24
   Days after onset:187
Entered: 1997-04-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71251 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Herpes simplex, Infection, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7196

Write-up: pt recv vax 8OCT96 & 19OCT96 pt was found in a state of collapse;adm to hosp into ICU w/dx of herpes simplex encephalitis;tx w/Acyclovir & supportive care & remains hosp as of the initial report date 7JAN97;


VAERS ID: 91623 (history)  
Form: Version 1.0  
Age: 96.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:1996-10-16
Onset:1996-10-18
   Days after vaccination:2
Submitted: 1996-10-24
   Days after onset:6
Entered: 1996-11-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00986P / 1 - / IM A

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1996-10-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC Split Type: 0010150960037

Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;pt died on 19OCT96;reporter states pt health had been


VAERS ID: 91791 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Utah  
Vaccinated:1996-10-15
Onset:1996-10-17
   Days after vaccination:2
Submitted: 1996-10-22
   Days after onset:5
Entered: 1996-11-08
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


VAERS ID: 92804 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:1996-10-16
Onset:1996-10-17
   Days after vaccination:1
Submitted: 1996-11-25
   Days after onset:39
Entered: 1996-12-13
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71212 / UNK - / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Guillain-Barre syndrome, Hypokinesia, Influenza, Myalgia, Neuropathy, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Cardiomyopathy (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-31
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA960127

Write-up: pt started having flu-like sx day p/vax including fever, malaise, gen aching;seen in ER several days later exp peripheral neuropathy of arms & legs;unable to stand;hosp;dx GBS;severe autonomic collapse unable to resuscitate;pt died 31OCT96;


VAERS ID: 93595 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:1996-10-09
Onset:1996-10-15
   Days after vaccination:6
Submitted: 1997-01-02
   Days after onset:79
Entered: 1997-01-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71212 / UNK - / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: many
Current Illness: endstage CHF
Preexisting Conditions: ASA; novocaine; CHF terminal
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 19oct96; pt died 15oct96, not necessarily related, pt had terminal CHF disease


VAERS ID: 96948 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-10-02
Onset:1996-10-03
   Days after vaccination:1
Submitted: 1996-11-18
   Days after onset:46
Entered: 1997-04-16
   Days after submission:148
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Procardia XL 30mg
Current Illness:
Preexisting Conditions: HTN, coronary artery disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax and shortly p/vax died;MD does not feel that the shot contributed to death;pt recv flu vax in past w/no adverse effects;COD MI;


VAERS ID: 90265 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:1996-09-18
Onset:1996-09-22
   Days after vaccination:4
Submitted: 1996-09-27
   Days after onset:5
Entered: 1996-09-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6786

Write-up: death, flu-like sx 3 days p/shot;


VAERS ID: 82670 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: New York  
Vaccinated:1995-10-18
Onset:1996-02-07
   Days after vaccination:112
Submitted: 1996-02-12
   Days after onset:5
Entered: 1996-02-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 5F61134 / UNK LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Asthenia, Guillain-Barre syndrome, Malaise, Paraesthesia, Rhinitis
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Respiratory failure (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3FEB96 rhinitis x 3 days;7FEB96 numbness in hands & feet;seen in ER inc numbness & fatigue,malaise-presently dx w/GBS on a ventilator;


VAERS ID: 86285 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:1995-12-18
Onset:1995-12-19
   Days after vaccination:1
Submitted: 1996-01-02
   Days after onset:14
Entered: 1996-05-23
   Days after submission:141
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-12-23
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure


VAERS ID: 86649 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Maryland  
Vaccinated:1995-11-27
Onset:1995-11-29
   Days after vaccination:2
Submitted: 1996-02-05
   Days after onset:68
Entered: 1996-06-03
   Days after submission:118
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


VAERS ID: 83031 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: Foreign  
Vaccinated:1995-11-21
Onset:1995-11-26
   Days after vaccination:5
Submitted: 1996-02-20
   Days after onset:86
Entered: 1996-02-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Bronchitis, Cardiovascular disorder, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-11-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: atrovent, digoxin dak tabs;capoten, seroxat
Current Illness:
Preexisting Conditions: cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6464

Write-up: resp insufficiency & bronchitis w/cardiac disease;died-unrelated to drug;


VAERS ID: 81461 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Connecticut  
Vaccinated:1995-11-16
Onset:1995-11-19
   Days after vaccination:3
Submitted: 1996-01-16
   Days after onset:58
Entered: 1996-01-30
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Mouth ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-11-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: urinary tract infect
Preexisting Conditions: pt may have been taking Macrodantin for a urinary tract infect @ the time of death
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896017020L

Write-up: pt recvd vax 16NOV95;19NOV95 noted general weakness & canker sore in mouth;notified MD but declined to go to office because of weakness;next day husband found pt dead;


VAERS ID: 80847 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Male  
Location: Kansas  
Vaccinated:1995-11-01
Onset:1995-11-01
   Days after vaccination:0
Submitted: 1995-11-01
   Days after onset:0
Entered: 1996-01-16
   Days after submission:76
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 5F61162 / UNK LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthma, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-11-10
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: pcn, demedrol, codeine,tape, beesting
Allergies:
Diagnostic Lab Data:
CDC Split Type: KS95057

Write-up: pt recvd vax;T 100; wheezing 3nov95; emesis; apap given; to er;


VAERS ID: 83553 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Georgia  
Vaccinated:1995-10-27
Onset:1995-10-29
   Days after vaccination:2
Submitted: 1995-11-01
   Days after onset:3
Entered: 1996-03-11
   Days after submission:131
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 3 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-10-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: arhtritis
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA96001

Write-up: deceased 28OCT95


VAERS ID: 79660 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:1995-10-26
Onset:1995-10-27
   Days after vaccination:1
Submitted: 1995-11-09
   Days after onset:13
Entered: 1995-11-27
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / 2 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Aspartate aminotransferase increased, Blood lactate dehydrogenase increased, Coma, Hepatic failure, Hepatic steatosis, Hyperglycaemia, Laboratory test abnormal, Right ventricular failure
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-11-02
   Days after onset: 6
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: Insulin, Accupril, APAP
Current Illness: none other than hypertension & diabetes
Preexisting Conditions: HTN, IDDM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax 26OCT95;fever 102 27OCT followed by abd pain, vomiting, sweating;28OCT hosp ER T102;adm for hydration; BX 305; progressive liver failure, SGOT 544, LDH 5099; congestive heart failure, coma;autopsy massive faulty degen of liver


VAERS ID: 79864 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: Foreign  
Vaccinated:1995-10-23
Onset:1995-10-24
   Days after vaccination:1
Submitted: 1995-11-23
   Days after onset:30
Entered: 1995-12-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E527AC1 / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-10-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Warfarin, Metformin, Iburpofen, Digoxin, Hypovase, Gilbenclamide
Current Illness: unreported
Preexisting Conditions: unreported
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: REG95474

Write-up: pt recvd vax & had a sudden unexplained death one day p/vax; a post mortem was not carried out;reporter does not think the flu vax contributed to death;


VAERS ID: 80176 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Foreign  
Vaccinated:1995-10-12
Onset:1995-10-20
   Days after vaccination:8
Submitted: 1995-12-14
   Days after onset:55
Entered: 1995-12-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 2 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac failure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: vasotec, frusemide
Current Illness:
Preexisting Conditions: no relevant hx
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95115097

Write-up: pt recvd vax;on 20oct95 pt collapsed & died;COD was lt ventricular failure;reporting MD did not give causalty statement;


VAERS ID: 78518 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: South Dakota  
Vaccinated:0000-00-00
Onset:1995-10-19
Submitted: 1995-10-27
   Days after onset:8
Entered: 1995-10-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958112 / UNK LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: IHSS, Bipolar disorder, Dementia
Preexisting Conditions: IHSS, Bipolar disorder, Dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death (pt was found dead in the bathroom by husband, prev to this no complaints) no tx; no evaluation post mortem, data gather from conversation w/husband


VAERS ID: 79260 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:1995-10-16
Onset:1995-10-17
   Days after vaccination:1
Submitted: 1995-10-18
   Days after onset:1
Entered: 1995-11-20
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 5F61148 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 390968 / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Cardiovascular disorder, Convulsion, Insomnia, Pain
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-10-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: died @ heart of Florida hosp
CDC Split Type: FL95079

Write-up: heart attack, ate dinner, rode bike on 16OCT95 p/vax; aching & diff sleeping noc of 16OCT95;sz on 17OCT95 to ER per ambulance


VAERS ID: 80174 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Female  
Location: Illinois  
Vaccinated:1995-10-11
Onset:1995-10-15
   Days after vaccination:4
Submitted: 1995-12-18
   Days after onset:64
Entered: 1995-12-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 5F61099 / 2 - / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Pneumonia
SMQs:, Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-10-31
   Days after onset: 16
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: pneumonia 1 wk p/ 1994 flu vax;~ ()~~~In patient
Other Medications: numerous
Current Illness:
Preexisting Conditions: 5 yr hx of fibrotic lung disease,arteriosclrosis w/ renal angioplasy,carotid enarterectomy,stroke;living w/ husband as care giver;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6416

Write-up: pt recvd vax; devel pneumonia & was hosp on ventilator assistance;died 31oct95;no autopsy performed;COD pneumonia & resp arrest;


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