|
VAERS ID: |
62422 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 1993-10-05 |
Onset: | 1993-10-08 |
Days after vaccination: | 3 |
Submitted: |
1994-04-29 |
Days after onset: | 203 |
Entered: |
1994-05-03 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Endocarditis,
Infection,
Influenza SMQs:, 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: 1994-03-24
Days after onset: 167
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: CDC Split Type:
Write-up: began having periodic flu like dx 3 days p/vax & cont on & off until pt died; from viral endocarditis; |
|
VAERS ID: |
67959 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 1994-10-18 |
Onset: | 1994-10-19 |
Days after vaccination: | 1 |
Submitted: |
1994-10-31 |
Days after onset: | 12 |
Entered: |
1994-11-04 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
4F51155 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Arteriosclerosis,
Cardiomegaly,
Hepatomegaly,
Pulmonary embolism SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-10-19
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: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: CO5625
Write-up: died; only has rumored info, no details about incidence; |
|
VAERS ID: |
68050 (history) |
Form: |
Version 1.0 |
Age: |
86.0 |
Sex: |
Male |
Location: |
South Dakota |
Vaccinated: | 1994-10-04 |
Onset: | 1994-10-20 |
Days after vaccination: | 16 |
Submitted: |
1994-10-26 |
Days after onset: | 6 |
Entered: |
1994-11-07 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4948100 / 4 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Arteriosclerosis,
Cardiac arrest,
Chest pain,
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 (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-10-26
Days after onset: 6
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: valium; Current Illness: none; Preexisting Conditions: nka anxiety, nervousness; Allergies: Diagnostic Lab Data: cardiac work up; CDC Split Type:
Write-up: pt recvd vax; 20oct94 seen in ER for chest pain; started 7AM after eating; walked 10 blocks to hosp; admit 22oct94 expired; |
|
VAERS ID: |
68153 (history) |
Form: |
Version 1.0 |
Age: |
81.0 |
Sex: |
Unknown |
Location: |
New Hampshire |
Vaccinated: | 1994-10-10 |
Onset: | 1994-10-20 |
Days after vaccination: | 10 |
Submitted: |
0000-00-00 |
Entered: |
1994-11-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
4F51113 / 3 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Anorexia,
Asthenia,
Cough,
Pneumonia,
Pyrexia,
Thirst SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-11-05
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: Insulin, Furosemide, Capoten; Current Illness: Preexisting Conditions: IDDM, HTN, obesity Allergies: Diagnostic Lab Data: K 3.3; CDC Split Type: NH94033
Write-up: 2 wks p/vax pt became weak, tired, anorexic, devel fever, cough, pneumonia; progressing to death; |
|
VAERS ID: |
68154 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Female |
Location: |
New Hampshire |
Vaccinated: | 1994-10-14 |
Onset: | 1994-10-16 |
Days after vaccination: | 2 |
Submitted: |
1994-11-08 |
Days after onset: | 23 |
Entered: |
1994-11-09 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
4F51113 / 3 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Anorexia,
Dehydration,
Myasthenic syndrome,
Pneumonia,
Right ventricular failure SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Malignancy related conditions (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-11-04
Days after onset: 19
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: s/p CVA many yrs ago Preexisting Conditions: s/p CVA many yrs ago; Allergies: Diagnostic Lab Data: CDC Split Type: NH94034
Write-up: 2d p/vax pt became anorexic, thirsty, devel lt leg weakness; became dehydrated, was hospitalized & went into CHF- ? pneumonia; |
|
VAERS ID: |
68357 (history) |
Form: |
Version 1.0 |
Age: |
41.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1994-10-24 |
Onset: | 1994-10-28 |
Days after vaccination: | 4 |
Submitted: |
1994-11-04 |
Days after onset: | 7 |
Entered: |
1994-11-10 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
- / UNK |
- / IM |
Administered by: Public Purchased by: Private Symptoms: Aspartate aminotransferase increased,
Blood alkaline phosphatase increased,
Blood lactate dehydrogenase increased,
Condition aggravated,
Hyperbilirubinaemia,
Leukocytosis,
Pyrexia SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: prednisone; danazol; flagyl, cipro, hemaspan, diflucan, prilosec, carafate, procrit, micronase, K-dur, coumadin, maxzide, trilisate, xanax, restoril; Current Illness: chronic liver & gi tract inflammation Preexisting Conditions: cryptogenic cirrhosis, ulcerative colitis, portal vein thrombosis, autoimmune phenomena, haemolytic anaemia; Allergies: Diagnostic Lab Data: 24oct94 WBC 17.2, RBC 4.54, HGB 15.6; HCT 44.5, platelets 464, sgot 160, alk phos 199, bili 16.9, ldh 562, bun 14, creat 0.9, 28oct94 wbc 24.9, rbc 3.17, hgb 11.2, hct 31.4, platelets 366; CDC Split Type: ALI94235
Write-up: pt recvd vax;4 days after vax w/ fluvirin pt at MD ofc w/ fever of 101; blood tests revealed worsening of pre-existing haemolytic anaemia & pt hosp 28oct94;pt potential candidate for liver transplant;MD said pt condition not related to vax; |
|
VAERS ID: |
68382 (history) |
Form: |
Version 1.0 |
Age: |
85.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1994-10-17 |
Onset: | 1994-10-19 |
Days after vaccination: | 2 |
Submitted: |
1994-10-25 |
Days after onset: | 6 |
Entered: |
1994-11-14 |
Days after submission: | 20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
00474P / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Anorexia,
Asthenia,
Condition aggravated,
Dyspnoea,
Lung disorder,
Malaise,
Somnolence,
Stupor SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre 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: 1994-10-19
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: many meds (unspecified); prednisone; Current Illness: severe chest pain the day a/flu shot; Preexisting Conditions: severe chronic osteoarthritis; respiratory problems; recurrent pulmonary infections; intermittent angina w/frequent exacerbations of CHF; Parkinsons disease; HCVD; chronic bronchitis w/recurrent asthma; ASHD w/angina; Allergies: Diagnostic Lab Data: not provided; CDC Split Type: 32777
Write-up: pt recvd single dose of flu vax as a prophylaxis 17oct94; pt died 19oct94; cause of death unk; pt was recving many other meds; |
|
VAERS ID: |
68383 (history) |
Form: |
Version 1.0 |
Age: |
88.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1994-10-17 |
Onset: | 1994-10-17 |
Days after vaccination: | 0 |
Submitted: |
1994-10-25 |
Days after onset: | 8 |
Entered: |
1994-11-14 |
Days after submission: | 20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
00474P / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea,
Cardiac arrest,
Condition aggravated,
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 (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-10-20
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: many meds(unspecified); antidepressant; Current Illness: edema; severe obtundation; hypotensive; Preexisting Conditions: osteoarthritis, back & knees; arthritis large axial joints; bladder incontinent; hx of rt mastectomy 10-12 yrs ago for breast carcinoma; chronic bacteriuria; fibromyalgia; erratic appetite; depression; degenerative heart disease; Allergies: Diagnostic Lab Data: not provided; CDC Split Type: 32778
Write-up: pt recvd single dose of vax on 17oct94 as a prophylaxis; pt died 20oct94; cause of death unk; pt was receiving many oth meds; |
|
VAERS ID: |
68384 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1994-10-17 |
Onset: | 1994-10-21 |
Days after vaccination: | 4 |
Submitted: |
1994-10-24 |
Days after onset: | 3 |
Entered: |
1994-11-14 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
00474P / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Cardiovascular disorder,
Condition aggravated,
Lung disorder SMQs:, Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-10-21
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 meds (unspecified); Current Illness: Preexisting Conditions: alcohol abuse -$g progressive neuropathy, uncertain etiology; hypertension; atrial fibrillation; macular degeneration; constipation; recurrent UTI''s; hx of left ovarian cyst; COPD; rt hip fracture, intertrochanteric, s/p internal fixation; Allergies: Diagnostic Lab Data: not provided; CDC Split Type: 32779
Write-up: pt recvd single dose of flu vax as a prophylaxis 17oct94; pt died 21oct94; cause of death unk; pt was receiving many oth meds; |
|
VAERS ID: |
68505 (history) |
Form: |
Version 1.0 |
Age: |
96.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1994-10-14 |
Onset: | 1994-10-14 |
Days after vaccination: | 0 |
Submitted: |
1994-11-09 |
Days after onset: | 26 |
Entered: |
1994-11-16 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
00474P / UNK |
- / IM A |
Administered by: Private Purchased by: Private Symptoms: Blood creatine phosphokinase increased,
Cardiomegaly,
Dyspnoea,
Electrocardiogram ST segment elevation,
Pneumonia,
Pyrexia,
Renal impairment,
Shock SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1994-10-18
Days after onset: 4
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: Ampicillin, APAP #3; vit Fe, serax, Vit C Current Illness: pedal edema $g 3 wks; r hip pain recurren Preexisting Conditions: UTI; hx heart disease & heart failure Allergies: Diagnostic Lab Data: minimal urine output; good hematocrit 44; WBC count 5,000; platelet count 147,000; LDH 152; CPK 65; NA 143, K 3.7, Chloride 102, CO2 24, BUn 22, creatinine 2.6, glucose 117; PT & PTT WNL; 9AM VS BP 77/36, P162, R34, t101; lung-rhonchi; CDC Split Type:
Write-up: pt recvd vax 14OCT93 by 15OCT pt was dyspneic, had a rt middle lobe pneumonia & then cardiogenic shock; BP by EMS 80/60; pt given med; 02 sat is 84% to 86%; pt c/o chest pain; EKG showed ST segment elevation inferiorly;cardiomegaly; t101 |
|