|
VAERS ID: |
37900 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1991-11-01 |
Onset: | 0000-00-00 |
Submitted: |
1991-11-20 |
Entered: |
1991-12-13 |
Days after submission: | 23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
- / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Hypoxia,
Pneumonia SMQs:, Asthma/bronchospasm (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? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient Other Medications: NA Current Illness: NA Preexisting Conditions: NA Allergies: Diagnostic Lab Data: Legionella & ANA-neg; Mycoplasma-neg; Biopsy lung-interstitial pneumonitis; neg gallium scan of lungs; CDC Split Type: 910219201
Write-up: 1 wk p/receiving flu vax, 60 yo pt presented to hosp w/ PO2 50 & bilateral interstitial pneumonitis; sxs began w/in 24 hrs p/vax; pt had neg gallium scan of lungs & is responding to Prednisone; pt improved & was discharged; |
|
VAERS ID: |
37918 (history) |
Form: |
Version 1.0 |
Age: |
85.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1991-11-12 |
Onset: | 1991-11-13 |
Days after vaccination: | 1 |
Submitted: |
1991-12-10 |
Days after onset: | 27 |
Entered: |
1991-12-16 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Lung neoplasm malignant,
Neuropathy peripheral SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Non-haematological malignant tumours (narrow), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: UNK Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CXR-lung mass CDC Split Type: 914091069
Write-up: Peripheral neuropathy reported in pt who recvd flu vax 12NOV91; pt admitted to hosp w/lower extremity weakness; discovered to have adenocarcinoma of lung; MD wonders if lower extremity weakness is part of a neoplastic synd re: CA or ADR vax |
|
VAERS ID: |
37926 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1991-10-24 |
Onset: | 1991-10-30 |
Days after vaccination: | 6 |
Submitted: |
1991-11-08 |
Days after onset: | 9 |
Entered: |
1991-12-16 |
Days after submission: | 38 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918169 / 2 |
LA / - |
Administered by: Public Purchased by: Public Symptoms: Asthenia,
Convulsion,
Infection,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: Chronic renal failure; septic hip Allergies: Diagnostic Lab Data: CSF-Scantgroup; Staph Aureus bld-steph aureus; CSF-WBC-820, RBC 107 Protein 268, FR stain 0; CDC Split Type: CA91150
Write-up: Pt recvd flu vax on 24OCT91 & presented to ER on 3NOV91 w/ a 4 day hx of fever, lower extremity weakness; generalized weakness & questionable seizure activity; |
|
VAERS ID: |
37952 (history) |
Form: |
Version 1.0 |
Age: |
75.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1991-11-08 |
Onset: | 1991-11-13 |
Days after vaccination: | 5 |
Submitted: |
1991-11-13 |
Days after onset: | 0 |
Entered: |
1991-12-16 |
Days after submission: | 33 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918169 / UNK |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Injection site pain,
Lung disorder,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Blackadrene Current Illness: Denies Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Blood cultures-neg; Echocardigram; CDC Split Type: CA91176
Write-up: C/o fever 101 w/sl tenderness @ inject site; fever became progressively higher; fluid detected in lungs; admitted & released p/ 3 days; dx uncertain; |
|
VAERS ID: |
37960 (history) |
Form: |
Version 1.0 |
Age: |
39.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1991-10-24 |
Onset: | 1991-11-05 |
Days after vaccination: | 12 |
Submitted: |
1991-11-22 |
Days after onset: | 17 |
Entered: |
1991-12-16 |
Days after submission: | 24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01381P / UNK |
RA / IM |
Administered by: Public Purchased by: Private Symptoms: Asthenia,
Myelitis,
Pain,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: MRI, Myelogram w/ CT cuts; CDC Split Type: CO9192
Write-up: rt leg pain, weakness, numbness; lt leg numbness; dx transverse myelitis; |
|
VAERS ID: |
38035 (history) |
Form: |
Version 1.0 |
Age: |
74.0 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 1991-11-15 |
Onset: | 1991-11-17 |
Days after vaccination: | 2 |
Submitted: |
1991-11-25 |
Days after onset: | 8 |
Entered: |
1991-12-19 |
Days after submission: | 24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21216 / 2 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Confusional state,
Encephalitis,
Encephalopathy,
Haematuria,
Leukocytosis,
Malaise,
Pyrexia,
Urinary tract disorder SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: UNK Current Illness: denied any illness Preexisting Conditions: prev hx urinary tract problems/penial implant x 2 yrs; Allergies: Diagnostic Lab Data: CBC showed WBC 15,000; UA showed hematuria-LP-neg; CDC Split Type: TN91223
Write-up: Pt recd vax @ clinic 15NOV91 became ill on 17NOV91 w/fever 102 & confusion taken to ER admitted while hospitalized discovered urinary tract tumor; p/4 days hospitalized discharged by MD; dx encephalopathy/post influenza vax-encephalitis; |
|
VAERS ID: |
38085 (history) |
Form: |
Version 1.0 |
Age: |
73.0 |
Sex: |
Male |
Location: |
Missouri |
Vaccinated: | 1991-11-04 |
Onset: | 1991-11-08 |
Days after vaccination: | 4 |
Submitted: |
1991-12-11 |
Days after onset: | 33 |
Entered: |
1991-12-20 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918146 / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Bronchitis,
Cough,
Hallucination,
Productive cough,
Pyrexia SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient Other Medications: Theodur, Quine, Organibin, Calciumsupplement; Current Illness: Known chronic COPD; Preexisting Conditions: COPD, emphysema Allergies: Diagnostic Lab Data: None revealed by hospital or physicians office CDC Split Type: MO91100
Write-up: 8NOV91 began coughing productively (green & yellow sputum);11NOV91 @ MDs office for cough; temp was elevated inc 100 admitted directly to hosp; was on med/surg floor; exp drug induced hallucinations; dx emphysema & chronic bronchitis; |
|
VAERS ID: |
38092 (history) |
Form: |
Version 1.0 |
Age: |
44.0 |
Sex: |
Female |
Location: |
Montana |
Vaccinated: | 1991-10-31 |
Onset: | 1991-11-05 |
Days after vaccination: | 5 |
Submitted: |
1991-11-26 |
Days after onset: | 21 |
Entered: |
1991-12-23 |
Days after submission: | 27 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918147 / 1 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Guillain-Barre syndrome,
Myasthenic syndrome,
Peroneal nerve palsy SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: UNK Current Illness: UNK Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: CDC Split Type: 891331002J
Write-up: Pt devel GBS 5 days p/receiving flu vax; additional info has been requested; |
|
VAERS ID: |
38094 (history) |
Form: |
Version 1.0 |
Age: |
70.0 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: | 1991-11-07 |
Onset: | 1991-12-11 |
Days after vaccination: | 34 |
Submitted: |
1991-12-11 |
Days after onset: | 0 |
Entered: |
1991-12-23 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21218 / 1 |
LA / IM |
Administered by: Public Purchased by: Unknown Symptoms: Hyperhidrosis,
Pneumonia,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Fansidor Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: ? done in s. Africa; CDC Split Type: AZ9129
Write-up: Fever, sweats; hospitalized in S. Africa 15NOV-22NOV; dx pneumonia; no cough; |
|
VAERS ID: |
38114 (history) |
Form: |
Version 1.0 |
Age: |
67.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 1991-11-22 |
Onset: | 1991-11-30 |
Days after vaccination: | 8 |
Submitted: |
1991-12-06 |
Days after onset: | 6 |
Entered: |
1991-12-23 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01481P / 1 |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: 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? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Trinsicon Q day Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis CDC Split Type:
Write-up: Guillian Barre Synd |
|