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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: 78297 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Male  
Location: Minnesota  
Vaccinated:1995-10-02
Onset:1995-10-13
   Days after vaccination:11
Submitted: 1995-10-16
   Days after onset:3
Entered: 1995-10-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958074 / UNK RA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 390928 / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Guillain-Barre syndrome, Hypokalaemia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypokalaemia (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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: guillain-Barre synd-hypokalemia


VAERS ID: 78092 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: New York  
Vaccinated:1995-09-27
Onset:1995-09-28
   Days after vaccination:1
Submitted: 1995-10-04
   Days after onset:6
Entered: 1995-10-13
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958109 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest, Coronary artery disease
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), Other ischaemic heart disease (narrow), 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:
Other Medications: Micronase
Current Illness:
Preexisting Conditions: no noted symptomatic heart disease-did have poorly controlled DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had coronary event 12 hrs p/vax autopsy showed only CAD-pt had sudden death clinically


VAERS ID: 79863 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1995-09-24
Onset:1995-09-25
   Days after vaccination:1
Submitted: 1995-12-01
   Days after onset:67
Entered: 1995-12-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2835HA / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Malaise, Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-09-25
   Days after onset: 0
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: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: ALI95493

Write-up: pt recvd flu vax & was observed x 30mins then sent home;@ the time of vax pt denied allergies;later that noc felt distressed & went to the ER dx sepsis was made;reporter states pt died that day p/being seen in ER;


VAERS ID: 78870 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1995-09-24
Onset:1995-09-24
   Days after vaccination:0
Submitted: 1995-11-04
   Days after onset:41
Entered: 1995-11-13
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2835HA / 1 - / IM

Administered by: Other       Purchased by: Private
Symptoms: Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-09-25
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted w/sepsis synd 24 hrs pos vax cultures neg;pt expired;no autopsy;acute sepsis synd poss d/t vax


VAERS ID: 71370 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Female  
Location: Indiana  
Vaccinated:1994-09-29
Onset:1994-12-31
   Days after vaccination:93
Submitted: 1995-01-25
   Days after onset:25
Entered: 1995-02-08
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Thrombotic thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, arterial (narrow), Renovascular disorders (broad), Immune-mediated/autoimmune disorders (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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 34483

Write-up: pt recvd vax; devel thrombocytopenia purpura the day p/ vax; pt died at end of dec94 or beginning of jan;MD does not know how thrombocytopenia presented;pt''s daughter said,it was cause of death;


VAERS ID: 69952 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: Alabama  
Vaccinated:1994-12-15
Onset:1994-12-15
   Days after vaccination:0
Submitted: 1994-12-21
   Days after onset:6
Entered: 1994-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-15
   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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL9445

Write-up: pt recvd vax; found dead by his wife approx 2 hrs p/ vax;


VAERS ID: 69733 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Ohio  
Vaccinated:1994-12-12
Onset:1994-12-12
   Days after vaccination:0
Submitted: 1994-12-16
   Days after onset:4
Entered: 1994-12-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51146 / UNK - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51023 / UNK - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61023 / 3 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-12
   Days after onset: 0
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: Lasix, Digoxin, Ferinsol
Current Illness: rt hypoplastic ventricle
Preexisting Conditions: congenital heart defect; scheduled for surgery in JAN95
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5748

Write-up: found not breathing by grandmother; taken to ER & revived; airlifted to hosp expired 12DEC94;


VAERS ID: 72314 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-10-13
Onset:1994-11-18
   Days after vaccination:36
Submitted: 1994-11-30
   Days after onset:12
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Hypoxia, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (broad), Oropharyngeal infections (narrow), 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 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-19
   Days after onset: 1
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: COPD, diabetes, hypertension, emphysema;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343012S

Write-up: pt recvd vax & devel upper-respiratory symptoms with cough & congestion; oxygen was continued;


VAERS ID: 68944 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1994-11-16
Onset:1994-11-17
   Days after vaccination:1
Submitted: 1994-11-21
   Days after onset:4
Entered: 1994-11-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51010 / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Shock, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Ventricular tachyarrhythmias (narrow), 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Coumadin; Maxzide
Current Illness: NONE
Preexisting Conditions: NKDA; DMII, CHF, hypertension, Hypertriglyceridonic
Allergies:
Diagnostic Lab Data: rhythm strip-Vf
CDC Split Type:

Write-up: pt collapsed in kitchen-ambulance arrived pt in vent fib-coded-died; flu vax given 16NOV & pt died 17NOV;


VAERS ID: 70240 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:1994-11-10
Onset:1994-11-17
   Days after vaccination:7
Submitted: 1994-12-15
   Days after onset:28
Entered: 1995-01-09
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51025 / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Influenza, Myocardial infarction, Nausea, Pericardial effusion, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), 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: 1994-12-04
   Days after onset: 17
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: unk
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA94160

Write-up: pt recvd vax;began to exp n & v along w/ sxs of the flu;sxs cont until death;pt did not seek med help;cause of death cardiac tamponade due to ruptured myocardial infarction & coronary atherosclerosis;


VAERS ID: 72312 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-11-05
Onset:1994-11-15
   Days after vaccination:10
Submitted: 1994-11-30
   Days after onset:15
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-15
   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: Alzheimer''s disease;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343010S

Write-up: pt recvd vax & devel upper-resp symptoms with congestion, elevated temp, & cough; pt went on to be treated w/ATB;


VAERS ID: 69183 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Florida  
Vaccinated:1994-11-14
Onset:1994-11-14
   Days after vaccination:0
Submitted: 1994-11-15
   Days after onset:1
Entered: 1994-12-02
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00774P / 3 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   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: capoten, ativan, nitrodur patch, micro K; reg ASA; bumex; nitrostat;
Current Illness: none;
Preexisting Conditions: calan sr, severe cardiomyopathy;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt came to ofc for lab work;wife requested he have flu vax;given in am, approx 15 min after leaving,wife called from hosp er,stated after getting into car pt Lt arm began twitching & head fell over to side;


VAERS ID: 72315 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-11-08
Onset:1994-11-14
   Days after vaccination:6
Submitted: 1994-11-30
   Days after onset:16
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Angina pectoris, Asthma, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (narrow), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   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: Arteriosclerotic heart disease, COPD, hypertension, CVA, glaucoma;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343013S

Write-up: pt recvd vax & devel upper-respiratory symptoms with congestion & wheezing; oxygen was continued; cause of death was acute coronary insufficiency;


VAERS ID: 72313 (history)  
Form: Version 1.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-10-27
Onset:1994-11-13
   Days after vaccination:17
Submitted: 1994-11-30
   Days after onset:17
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Dyspnoea, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   Days after onset: 1
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: Congestive heart failure, anemia, atrial fibrillation;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343011S

Write-up: pt recvd vax & devel upper resp symptoms w/congestion, cough, elevated temp, & shortness of breath; x-ray showed congestive heart failure; Rocephin IM was given;


VAERS ID: 68571 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1994-11-04
Onset:1994-11-04
   Days after vaccination:0
Submitted: 1994-11-10
   Days after onset:6
Entered: 1994-11-18
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948032 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Coma, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax; cardiac arrest w/ VF several hrs later; in hosp pt unconscious;


VAERS ID: 70705 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:1994-11-04
Onset:1994-11-04
   Days after vaccination:0
Submitted: 1995-01-18
   Days after onset:75
Entered: 1995-01-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51165 / 2 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Convulsion, Headache, Intracranial aneurysm, Malaise, Subarachnoid haemorrhage, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-17
   Days after onset: 13
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: heart condition not requiring medication
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5678

Write-up: h/a; severe enough that needed to lie down in the evening of 7NOV994; also had general malaise; c/o h/a started the same day of vax 4NOV94; 10NOV94 pt exp sz, then passed out; sx ruptured cerebral aneurysm; pt had surgery 11NOV94 & died;


VAERS ID: 71426 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: Utah  
Vaccinated:1994-10-28
Onset:1994-11-03
   Days after vaccination:6
Submitted: 1995-01-27
   Days after onset:85
Entered: 1995-02-13
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51072 / UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1474W / 1 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Condition aggravated, Deep vein thrombosis, Hyperkalaemia, Lung neoplasm malignant, Pleural effusion, Pneumonia, Renal failure, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Systemic lupus erythematosus (broad), 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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-05
   Days after onset: 32
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: Tenex, Procardia, Furosemide, Aludent-Furoxaline
Current Illness: kidney failure, hip replace SEP94
Preexisting Conditions: Kidney failure, hip replacement SEP94, HTN, bilateral pulmonary emboli, mononeuritis multiplex w/muscle atrophy, mesangioglomerulonephritis 2ndary to IgM nephropathy, chronic leukocytosis & elevated creatinine; degenerative joint disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type: UT952703

Write-up: wife says flu like sx & SOB hospitalized for pneumonia 22NOV94 x 8 days; readmitted 04DEC94-expired 05DEC94; says had been on meds for kidney failure, HTN-autopsy revealed lung cancer;


VAERS ID: 69159 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1994-10-31
Onset:1994-10-31
   Days after vaccination:0
Submitted: 1994-11-23
   Days after onset:23
Entered: 1994-12-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51129 / 2 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Hypernatraemia, Hyperventilation, Hypotension, Hypothermia, Infection, Pneumonia, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-09
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: pt exp flu-like s/s @ 77yrs w/flu #1~ ()~~~In patient
Other Medications: Lanoxin, Calan, nitropatch; Haldol; Zantac
Current Illness: NONE
Preexisting Conditions: hx of CVA, organic brain synd, UTI, hypertension, UGI bleed, CAD, allergies Tetrapline, PCN, Prunes, coffee, cream, jello
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax 31OCT94 1030AM & 1PM devel cold, clammy skin w/t97.2 ax; 2PM t103.3 R; 250PM T102.6R; Epi given-to ER dx febrile illness-poss viral synd, hypernatremia/chloremia, d/c ed on 1NOV; died 9NOV94;


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: 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: 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: 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: 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: 71272 (history)  
Form: Version 1.0  
Age: 57.0  
Sex: Male  
Location: Colorado  
Vaccinated:1994-10-19
Onset:1994-10-19
   Days after vaccination:0
Submitted: 1994-12-05
   Days after onset:47
Entered: 1995-02-03
   Days after submission:60
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01764P / 1 - / A

Administered by: Other       Purchased by: Other
Symptoms: Blood creatinine increased, Blood fibrinogen decreased, Blood urea increased, Coagulopathy, Hypotension, Infection, Leukocytosis, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-26
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Feeling slightly ill;
Preexisting Conditions: No spleen; hx of asthma, hx of positive HIV test; hypertension; gout;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax in the AM & reportedly devel fever that evening; was admitted to hosp during the next week & died exactly 1 wk from the vax date reportedly of a bacterial infect in blood;


VAERS ID: 74952 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: Foreign  
Vaccinated:1994-10-19
Onset:1994-10-19
   Days after vaccination:0
Submitted: 1995-06-13
   Days after onset:237
Entered: 1995-06-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Cerebral haemorrhage, Paralysis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (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:
Current Illness:
Preexisting Conditions: Hx of minor cerebral hem 2 yr. prior.
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5955

Write-up: pt recv vax; devel apoplexia cerebri & died 1 hr later;


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: 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: 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


VAERS ID: 58871 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:1993-09-28
Onset:1993-12-18
   Days after vaccination:81
Submitted: 1994-01-03
   Days after onset:16
Entered: 1994-01-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private       Purchased by: Other
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: 1993-12-18
   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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC Split Type:

Write-up: respiratory failure, usual interstital pneumonia, death;


VAERS ID: 58410 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:1993-12-14
Onset:1993-12-14
   Days after vaccination:0
Submitted: 1993-12-15
   Days after onset:1
Entered: 1993-12-27
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private       Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-14
   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: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


VAERS ID: 59120 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Arizona  
Vaccinated:1993-11-28
Onset:1993-12-11
   Days after vaccination:13
Submitted: 1993-12-21
   Days after onset:10
Entered: 1994-01-18
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938278 / UNK - / IM A

Administered by: Other       Purchased by: Private
Symptoms: Asthenia, Cardiovascular disorder, Dysphagia, Dyspnoea, Guillain-Barre syndrome, Neck pain, Neuropathy, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Demyelination (narrow), Arthritis (broad), Immune-mediated/autoimmune disorders (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: unk
Current Illness: unk
Preexisting Conditions: hx of labile hypertension, uterine cancer--rx''d in 1975, hysterectomy, osteoporosis, acute herniated disc--rx''d w/epidural blocks; allergic to sulfa drugs & possibly Demerol;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893357001J

Write-up: pt recvd flu vax 28NOV93 & approx 14DEC93 began to devel sx of GBS; remains hospitalized as the date of this report in stable condition;


VAERS ID: 58384 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:1993-10-13
Onset:1993-11-29
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41148 / UNK - / IM

Administered by: Military       Purchased by: Military
Symptoms: Endocarditis, Haematemesis, Haemorrhage, Infection, Leukopenia, Lymphadenopathy, Necrosis, Pneumonia
SMQs:, Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-29
   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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: waiting on drug screen
CDC Split Type: CO5196

Write-up: found dead in apartment, no suspicious circumstances. Autopsy results: lymphoma; no known cause of death.


VAERS ID: 58319 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Female  
Location: Missouri  
Vaccinated:1993-10-22
Onset:1993-11-26
   Days after vaccination:35
Submitted: 1993-12-11
   Days after onset:15
Entered: 1993-12-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK RA / -

Administered by: Private       Purchased by: Other
Symptoms: Hepatic failure
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: acute hepatocellular failure;


VAERS ID: 58302 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Female  
Location: Foreign  
Vaccinated:1993-11-08
Onset:1993-11-12
   Days after vaccination:4
Submitted: 1993-11-23
   Days after onset:11
Entered: 1993-12-20
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Bronchitis, Condition aggravated
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-12
   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: Amoxycillin
Current Illness: Bronchopneumonia
Preexisting Conditions: senile dementia MFR Senile Dementia;
Allergies:
Diagnostic Lab Data: autopsy: acute purulent bronchitis/bronchopnemonia;
CDC Split Type: 930248901

Write-up: pt vaxed 8NOV93 & died 4 days later 12NOV93; autopsy; acute purulent bronchitis/bronchopneumonia;


VAERS ID: 58089 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-10-25
Onset:1993-11-06
   Days after vaccination:12
Submitted: 1993-11-12
   Days after onset:6
Entered: 1993-12-09
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   Days after onset: 2
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;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


VAERS ID: 60715 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Virginia  
Vaccinated:1993-10-08
Onset:1993-11-04
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 1994-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, CSF test abnormal, Guillain-Barre syndrome, Pain
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: 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: ~ ()~~~In patient
Other Medications: HCTZ
Current Illness:
Preexisting Conditions: large cell lymphoma of abdo; dx SEP93 treated w/ 3 cycles of meds; ASCVD, MI
Allergies:
Diagnostic Lab Data: CSF protein inc @ 155;
CDC Split Type:

Write-up: Pt exp GBS secondary to flu vax given 8OCT93; since the vax pt had exp 2-3 wks of upper body discomfort & weakness;


VAERS ID: 58095 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: South Carolina  
Vaccinated:1993-11-02
Onset:1993-11-03
   Days after vaccination:1
Submitted: 1993-11-24
   Days after onset:21
Entered: 1993-12-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Infection, Malaise, 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: 1993-11-15
   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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


VAERS ID: 56851 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Male  
Location: Maryland  
Vaccinated:1993-10-28
Onset:1993-10-29
   Days after vaccination:1
Submitted: 1993-10-29
   Days after onset:0
Entered: 1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), 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), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-29
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


VAERS ID: 58132 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Virginia  
Vaccinated:1993-10-08
Onset:1993-10-28
   Days after vaccination:20
Submitted: 1993-11-16
   Days after onset:19
Entered: 1993-12-13
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, CSF test abnormal, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy
SMQs:, Rhabdomyolysis/myopathy (narrow), Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC Split Type: 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;


VAERS ID: 58884 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-10-14
Onset:1993-10-28
   Days after vaccination:14
Submitted: 1993-12-29
   Days after onset:62
Entered: 1994-01-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock
SMQs:, Acute renal failure (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (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), Chronic kidney disease (broad), Hypersensitivity (narrow), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-11-27
   Days after onset: 30
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: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


VAERS ID: 59281 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: Alabama  
Vaccinated:1993-10-28
Onset:1993-10-28
   Days after vaccination:0
Submitted: 1993-11-15
   Days after onset:18
Entered: 1994-01-26
   Days after submission:72
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938149 / 1 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Arrhythmia, Cardiac arrest, Cerebrovascular accident, Dyspnoea, Hypokalaemia, Hypoxia, Malaise
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), 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), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-28
   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:
Current Illness: diabetes, hypokalema, COPD, old CVA
Preexisting Conditions: diabetes, hypokalemia, COPD, old CVA;
Allergies:
Diagnostic Lab Data: COD cardiorespiratory arrest secondary dx CVA, arrythmia; K-3.3; Creat 0.5; WBC 9.6; HCT 39.0; PO2 48.8; PC02 46.0;
CDC Split Type: AL9353

Write-up: pt recvd vax & pt did not feel well; denies chest pain; phone call from family @ 345; pt having trouble breathing; instructed to call 911 or transport to ER arrived ER 444PM; PO2 48.8, Co2 46.0; K 3.3; creact 5; resp sx cont to worsen;


VAERS ID: 61105 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: Foreign  
Vaccinated:1993-10-13
Onset:1993-10-25
   Days after vaccination:12
Submitted: 1994-03-16
   Days after onset:142
Entered: 1994-03-30
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH E3232CC1 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Arteritis, Dyspnoea, Guillain-Barre syndrome, Paralysis, Renal failure acute, Vasculitis, Visual disturbance
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (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 (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vasculitis (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-11
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 31 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaler for asthma
Current Illness: hx of asthma since 1958
Preexisting Conditions: hx of asthma since 1958
Allergies:
Diagnostic Lab Data: autopsy recorded acute renal failure, hypersensitivity angitis (microscopic polyarteritis) & influenza vax as COD;
CDC Split Type: 940053901

Write-up: pt vaxed 13OCT93-25OCT vision impaired, paralysis in hands then limbs; hospitalized 11NOV; dx GBS; hospital transfer-had breathing difficulty & acute renal failure died 11DEC93; autopsy dx acute renal failure, hypersensitivity angitis flu


VAERS ID: 57612 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:1993-10-23
Onset:1993-10-23
   Days after vaccination:0
Submitted: 1993-11-10
   Days after onset:18
Entered: 1993-11-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-23
   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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


VAERS ID: 58157 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:1993-10-15
Onset:1993-10-23
   Days after vaccination:8
Submitted: 1993-11-29
   Days after onset:37
Entered: 1993-12-13
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / UNK LA / IM

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: 1993-10-23
   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: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


VAERS ID: 58231 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Female  
Location: Foreign  
Vaccinated:1993-10-20
Onset:1993-10-23
   Days after vaccination:3
Submitted: 1993-10-27
   Days after onset:4
Entered: 1993-12-14
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH - / UNK - / IM

Administered by: Public       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: 1993-10-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt had recvd fluvirin in previous years w/no problem;~ ()~~~In patient
Other Medications: Tamoxifen, Paracetamol PRN;
Current Illness: Carcinoma breast, angina;
Preexisting Conditions: carcinoma breast, angina;
Allergies:
Diagnostic Lab Data: Autopsy results: acute myocardial infarction was COD:
CDC Split Type: 930230002

Write-up: pt vaxed 20OCT93 & died 23OCT: autopsy results indicate that acute myocardial infarction was COD;


VAERS ID: 59828 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Male  
Location: Georgia  
Vaccinated:1993-10-07
Onset:1993-10-21
   Days after vaccination:14
Submitted: 1993-11-19
   Days after onset:29
Entered: 1994-02-14
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Guillain-Barre syndrome, 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: 1993-11-09
   Days after onset: 19
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: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


VAERS ID: 58230 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Foreign  
Vaccinated:1993-10-18
Onset:1993-10-20
   Days after vaccination:2
Submitted: 1993-10-27
   Days after onset:7
Entered: 1993-12-14
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt had recvd fluvirin in prev years w/no problems;~ ()~~~In patient
Other Medications: Spironolactone/Prostap/Maxolon; Temazepam/frusemide/ASA
Current Illness: carcinoma of prostate, diabetes;
Preexisting Conditions: carcinoma of prostate, diabetes, congestive cardiac failure, asthma;
Allergies:
Diagnostic Lab Data: autopsy results: coronary Thrombosis was COD;
CDC Split Type: 930230001

Write-up: 1 of 2 cancer pts who had been vaxed w/flu vax & recently died; pt vaxed 18OCT & died 20OCT; autopsy result indicated coronary thrombosis was COD;


VAERS ID: 57470 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:1993-10-01
Onset:1993-10-17
   Days after vaccination:16
Submitted: 1993-11-10
   Days after onset:24
Entered: 1993-11-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Myelitis, Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
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, 25 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC Split Type:

Write-up: poss transverse myelitis w/paralysis from chest down;


VAERS ID: 58359 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Male  
Location: Virginia  
Vaccinated:1993-10-04
Onset:1993-10-15
   Days after vaccination:11
Submitted: 1993-11-24
   Days after onset:40
Entered: 1993-12-22
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Non-haematological malignant tumours (narrow), Immune-mediated/autoimmune disorders (narrow)

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: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


VAERS ID: 58137 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Male  
Location: Maryland  
Vaccinated:1993-10-12
Onset:1993-10-14
   Days after vaccination:2
Submitted: 1993-12-07
   Days after onset:54
Entered: 1993-12-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor
SMQs:, Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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: 0000-00-00
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:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


VAERS ID: 58061 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: West Virginia  
Vaccinated:1993-10-07
Onset:1993-10-12
   Days after vaccination:5
Submitted: 1993-11-16
   Days after onset:35
Entered: 1993-12-09
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 3 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (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 (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC Split Type: MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


VAERS ID: 56832 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:1993-10-01
Onset:1993-10-11
   Days after vaccination:10
Submitted: 1993-10-20
   Days after onset:9
Entered: 1993-10-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-14
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide-Micro K; Ventolin-Aero Bid uniphyl;
Current Illness: NONE
Preexisting Conditions: bronchial asthma, hypertensive cardio vascular disease;
Allergies:
Diagnostic Lab Data: LP-nl; EMG-nl; consistant w/GBS:
CDC Split Type:

Write-up: ascending paralysis, w/resp failure, consistant w/GBS;


VAERS ID: 56721 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:1993-10-09
Onset:1993-10-10
   Days after vaccination:1
Submitted: 1993-10-12
   Days after onset:2
Entered: 1993-10-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / UNK - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Deep vein thrombosis, Nausea, Pulmonary embolism, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-10
   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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


VAERS ID: 57347 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: Foreign  
Vaccinated:1993-10-07
Onset:1993-10-10
   Days after vaccination:3
Submitted: 1993-10-21
   Days after onset:11
Entered: 1993-11-15
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH E3232DA / UNK - / IM

Administered by: Public       Purchased by: Other
Symptoms: Endocarditis, Infection, Sepsis
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-16
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: unk
Preexisting Conditions: Hx of angina & hypertension;
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 930222401

Write-up: pt devel septicemia following vax;


VAERS ID: 57611 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:1993-10-07
Onset:1993-10-08
   Days after vaccination:1
Submitted: 1993-11-10
   Days after onset:33
Entered: 1993-11-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Arrhythmia
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-08
   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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


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: 56467 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:1993-09-30
Onset:1993-10-01
   Days after vaccination:1
Submitted: 1993-10-02
   Days after onset:1
Entered: 1993-10-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938137 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 340938 / 1 RA / -

Administered by: Private       Purchased by: Private
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: 1993-10-01
   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: Sinemet; Parlodel, Xanax, Doxepin, Furosemide, ASA, Paxil
Current Illness: parkinsons, skin (contact derm);
Preexisting Conditions: sulfa/motrin advanced parkinsons disease;
Allergies:
Diagnostic Lab Data: last labs 20AUG93 Serum NA 127; serum CA+ 8.5; chlorids 88;
CDC Split Type:

Write-up: resp/cardiac arrest;


VAERS ID: 57008 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Arizona  
Vaccinated:1993-09-30
Onset:1993-10-01
   Days after vaccination:1
Submitted: 1993-10-18
   Days after onset:17
Entered: 1993-11-05
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / 4 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Hyperventilation, Hypocalcaemia, Leukocytosis, Pneumonia, Pyrexia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-08
   Days after onset: 7
Permanent Disability? No
Recovered? No
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: Prednisone; Methotrexate;
Current Illness:
Preexisting Conditions: pulmonary fibrosis, past hx TB, theumatoid arthritis;
Allergies:
Diagnostic Lab Data: family refused autopsy;
CDC Split Type: CO5040

Write-up: died p/being hospitalized for interstitial pneumonia; day p/vax felt SOB & started to cough; 5OCt admitted;


VAERS ID: 59156 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:1993-10-01
Onset:1993-10-01
   Days after vaccination:0
Submitted: 1994-01-04
   Days after onset:95
Entered: 1994-01-18
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis
SMQs:, Peripheral neuropathy (narrow), Conduction defects (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


VAERS ID: 56603 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: California  
Vaccinated:1993-09-30
Onset:1993-09-30
   Days after vaccination:0
Submitted: 1993-10-01
   Days after onset:1
Entered: 1993-10-15
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

Administered by: Private       Purchased by: Other
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: 1993-09-30
   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: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


VAERS ID: 56919 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1993-09-29
Onset:1993-09-30
   Days after vaccination:1
Submitted: 1993-10-27
   Days after onset:27
Entered: 1993-11-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-01
   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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


VAERS ID: 64533 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:1993-09-20
Onset:1993-09-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), 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 (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-11-05
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 47 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC Split Type: 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


VAERS ID: 57323 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:1993-09-13
Onset:1993-09-14
   Days after vaccination:1
Submitted: 1993-10-29
   Days after onset:45
Entered: 1993-11-12
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 493814 / UNK - / A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Blood thromboplastin decreased, Confusional state, Dementia, Encephalitis, Leukopenia, Pyrexia, Red blood cell sedimentation rate increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: remains hospitalized on ventilator; outcome remains guarded;
Allergies:
Diagnostic Lab Data: WBC 2.3; nl 4-11; sed rate 36; Ptt 5; CSF WNL; Bl no grwoth; titer for EEE, california E, st louis E pending; Enterovirus & Herpes cultures being done on CSF;;
CDC Split Type:

Write-up: rapid progressive dementia ventilation for respiratory failure, t105; family states confusion started about 16 hrs p/vax; post flu vax encephalitis;


VAERS ID: 48672 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1992-10-29
Onset:1992-11-22
   Days after vaccination:24
Submitted: 1992-11-30
   Days after onset:8
Entered: 1993-01-04
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928217 / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Anxiety, Cardiac arrest, Condition aggravated, Dyspnoea, Hypertension, Hyperventilation, Myocardial infarction, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, Lanoxin, Calan SR, Humulin, Axid, Nitrobid, Elavil, Nifedipineoth
Current Illness: NONE
Preexisting Conditions: CAD, IDDM, Hypertension, chronic CHF, cardiomegaly;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WV9242

Write-up: dyspnea, anxiety, P56, R36, BP 200/90, 02 on transferred to hosp; causes of death-cardiac failure, CHF, Ischemic cardiomyopathy, COPD; also exp discomfort & tingling in arms; R36 shallow & labored;


VAERS ID: 61058 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:1992-10-12
Onset:1992-11-12
   Days after vaccination:31
Submitted: 1994-03-09
   Days after onset:482
Entered: 1994-03-28
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Nuchal rigidity, Peroneal nerve palsy, Pruritus, Speech disorder
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dementia (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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, 7 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC Split Type:

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


VAERS ID: 49057 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:1992-10-21
Onset:1992-11-07
   Days after vaccination:17
Submitted: 1992-11-23
   Days after onset:16
Entered: 1993-01-14
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Haemorrhage, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC Split Type: 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


VAERS ID: 47857 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-11-05
Onset:1992-11-05
   Days after vaccination:0
Submitted: 1992-12-07
   Days after onset:32
Entered: 1992-12-09
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 335914 / 1 - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0100V / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Cardiovascular disorder, Hyperhidrosis, Hypertrophy, Malaise, Myocardial infarction, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-05
   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:
Current Illness:
Preexisting Conditions: COPD, end stage; hyperlimpidemia; hypertension
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES92111093

Write-up: pt recvd vax & approx 9 hrs following vax pt devel sweating & did not feel well; pts husband suggested ER but pt did not; pt died @ home;


VAERS ID: 47189 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:1992-10-28
Onset:1992-11-03
   Days after vaccination:6
Submitted: 1992-11-09
   Days after onset:6
Entered: 1992-11-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928217 / 1 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Cough, Hypertension, Hypotension, Malaise, Muscle twitching, Respiratory disorder, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Prozac, Synthroid, Trental, Tylenol, ASA, Senokot, Mult vit, Dulcolax;
Current Illness: NONE
Preexisting Conditions: no allergies-CVA rt hemopoisis, mild depression, plural effusions''
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: laughing, talking & eating well 2NOV92; 3NOV92 wake & vomited BP 180/110, P 100; 550 became listless, BP 75/50, P diff to count; twitching


VAERS ID: 47310 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1992-11-02
Onset:1992-11-03
   Days after vaccination:1
Submitted: 1992-11-04
   Days after onset:1
Entered: 1992-11-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2F311704 / UNK - / IM

Administered by: Private       Purchased by: Private
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: 1992-11-03
   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: Insulin, Clinoril med, for hypertension;
Current Illness: diabetes/hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found on floor @ home in full arrest;


VAERS ID: 47309 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-11-02
Onset:1992-11-02
   Days after vaccination:0
Submitted: 1992-11-04
   Days after onset:2
Entered: 1992-11-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military       Purchased by: Military
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: 1992-11-02
   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: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: could not breath went into full arrest;


VAERS ID: 47268 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Missouri  
Vaccinated:1992-10-23
Onset:1992-10-25
   Days after vaccination:2
Submitted: 1992-10-29
   Days after onset:4
Entered: 1992-11-16
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928215 / UNK LA / IM

Administered by: Unknown       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: 1992-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of CAD & chronic debilitation;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had an acute myocardial infarction on 25OCT92; pt did not recover; long hx of cornary artery disease & chronic debilitation;


VAERS ID: 47149 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1992-10-13
Onset:1992-10-24
   Days after vaccination:11
Submitted: 1992-10-30
   Days after onset:6
Entered: 1992-11-12
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928223 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-26
   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: Trazadone, Tedrol, Prosom, Buspar
Current Illness: chronic bronchitis-alzheimers
Preexisting Conditions: PCN, Novacaine-alzheimers
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 57496 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Texas  
Vaccinated:1992-10-10
Onset:1992-10-23
   Days after vaccination:13
Submitted: 1993-09-14
   Days after onset:326
Entered: 1993-09-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (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? No
Previous Vaccinations: pt exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


VAERS ID: 96748 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: Foreign  
Vaccinated:1992-10-22
Onset:1992-10-22
   Days after vaccination:0
Submitted: 1997-04-08
   Days after onset:1629
Entered: 1997-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER E2216FA / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthma, Depressed level of consciousness, Hypertension, Myelitis, Myocardial infarction, Paraesthesia, Pneumonia, Sepsis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-07-09
   Days after onset: 1356
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: HTN status:ongoing 18MAR97;18MAR97 asthma-fairly severe;18MAR97 acute myocardial infarction;
Allergies:
Diagnostic Lab Data: NONE reported;
CDC Split Type: EML97178

Write-up: pt recv vax devel paresthesia & weakness of the legs, w/unsteadiness;no specific dx found poss post vax transverse myelitis which affect spinal cord;COD septicemia, bronchopneumonia & infected trophic ulcer;spinal cord damage, influenza vax


VAERS ID: 47668 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1992-10-09
Onset:1992-10-21
   Days after vaccination:12
Submitted: 1992-10-26
   Days after onset:5
Entered: 1992-12-03
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

Administered by: Public       Purchased by: Public
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: 1992-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS9256

Write-up: pt had massive coronary & died on 21OCT92;


VAERS ID: 47308 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Illinois  
Vaccinated:1992-10-16
Onset:1992-10-17
   Days after vaccination:1
Submitted: 1992-11-13
   Days after onset:27
Entered: 1992-11-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928226 / UNK RA / IM

Administered by: Private       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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, K-tab, Hydralazme
Current Illness:
Preexisting Conditions: hypertension, moderate carotid artery stenosis, lt venous insufficiency;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up:


VAERS ID: 46526 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:1992-10-12
Onset:1992-10-14
   Days after vaccination:2
Submitted: 1992-10-16
   Days after onset:2
Entered: 1992-10-28
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928234 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Cardiomegaly, Confusional state, Hypotension, Leukocytosis, Myocardial infarction, Pulmonary oedema, Vascular occlusion
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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: 1992-10-16
   Days after onset: 2
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:
Current Illness: following Hemodialysis
Preexisting Conditions: pt had chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: 892293001E

Write-up: pt recvd flu vax & devel sudden onset of hypotension, hypoglycemia & chills; pt suffered a cardiac arrest & was hospitalized & died;


VAERS ID: 48415 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:1992-10-08
Onset:1992-10-12
   Days after vaccination:4
Submitted: 1992-10-15
   Days after onset:3
Entered: 1992-12-23
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928243 / 3 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Cardiovascular disorder, Myocardial infarction, Nausea, Shock
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Myocardial infarction (narrow), 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), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-12
   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: hx of coronary problems
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA92210

Write-up: 930AM 12OCT92 MD office w/nausea, weak; hx of heart disease; BP 162/50-sent ot ER expired 1152 12OCT92 w/prob dx of myocardial infarction;


VAERS ID: 46276 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Female  
Location: Texas  
Vaccinated:1992-10-07
Onset:1992-10-08
   Days after vaccination:1
Submitted: 1992-10-14
   Days after onset:6
Entered: 1992-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 338971 / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Aphasia, Encephalopathy, Grand mal convulsion, Paralysis
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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, 6 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nasalide, Megace, Theophyllin, Digoxin, K Ce, Lasix, Coumadin, Iron, ALbuterol inhaler, Atrovent;
Current Illness: breast cancer w/metasitasis, CHF
Preexisting Conditions: organic brain synd, recurrent deep vein thrombosis & pulmonar-embolism;
Allergies:
Diagnostic Lab Data: neg head CT x 2; neg LP; THeophylline level + digoxin levels non toxic;
CDC Split Type:

Write-up: seizures, grand mal w/in 12 hrs of vax; diffuse encephalopathy w/bilateral lower extremities & rt upper extremities paresis, aphasia;


VAERS ID: 46528 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Female  
Location: Michigan  
Vaccinated:1992-10-06
Onset:1992-10-07
   Days after vaccination:1
Submitted: 1992-10-13
   Days after onset:6
Entered: 1992-10-28
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Atrial fibrillation, Dermatitis bullous, Hallucination, Herpes zoster, Hypertension, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 892289001E

Write-up: Pt recvd flu vax the next evening devel a rash & some blisters on breasts & back; dx w/herpes zoster; tx Zovirax & DPH; also exp inc BP & hallucinations; adm to hosp 12OCT92;


VAERS ID: 46705 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-05
   Days after vaccination:3
Submitted: 1992-10-08
   Days after onset:3
Entered: 1992-11-05
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public       Purchased by: Other
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-05
   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: n/s
Current Illness: n/s
Preexisting Conditions: surgery on facial sinus; brain stem infarct
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 924092015

Write-up: death is reported in a pt who recvd flu vax on 2OCT; pt died on 5OCT92 w/no final cause of death given; an autopsy was performed; coroner believed that pt died of CVA; pt had undergone facial sinus surgery 2 wks prior to death;


VAERS ID: 46704 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-10-08
   Days after onset:5
Entered: 1992-11-05
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public       Purchased by: Other
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: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


VAERS ID: 46787 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-10-08
   Days after onset:5
Entered: 1992-11-09
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public       Purchased by: Other
Symptoms: Cardiovascular disorder, Electrocardiogram abnormal, Malaise, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (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: n/s
Current Illness: n/s
Preexisting Conditions: h/o heart disease
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 924092016

Write-up: Death & myocardial infarction are reported in pt who recvd flu vax on 2OCT92; 3OCT92 was not feeling well & went to ER; had MI (full EKG changes); pt had a classical heart attack & died;


VAERS ID: 47492 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-11-12
   Days after onset:40
Entered: 1992-11-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: PA92327

Write-up: 3OCT92 seen in Er admitted to hosp;


VAERS ID: 47493 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-11-12
   Days after onset:40
Entered: 1992-11-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: PA92328

Write-up: pt seen in ER where died 3OCT92;


VAERS ID: 40951 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-12-19
Onset:1991-12-27
   Days after vaccination:8
Submitted: 1992-03-24
   Days after onset:88
Entered: 1992-04-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21215 / UNK - / IM A

Administered by: Private       Purchased by: Public
Symptoms: Cardiac arrest, Coagulopathy, Dyspnoea, Lactic acidosis, Pharyngitis, Pneumonia, Respiratory disorder, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-01-05
   Days after onset: 9
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: NONE~ ()~~~In patient
Other Medications: Chemotherapy w/Cytoxan, Vincristine, Procarbazine, Pred, & Bleomycin
Current Illness: Lymphoma
Preexisting Conditions: lymphoma, leukemia
Allergies:
Diagnostic Lab Data: CXR
CDC Split Type: PA9280

Write-up: 27DEC91 fever, fatigue, weak; 28DEC91 t102, ATB recvd; 31DEC91 fever, cough worse to hosp ER; cxr done; not admitted; 1JAN92 to hosp ER was admitted; heart stopped in ICU died 5JAN92;


VAERS ID: 41862 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Nebraska  
Vaccinated:1991-12-12
Onset:1991-12-22
   Days after vaccination:10
Submitted: 1992-04-30
   Days after onset:129
Entered: 1992-05-11
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / 7+ LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Anaemia, Asthenia, Malaise, Myelofibrosis, Oedema peripheral, Otitis media
SMQs:, Cardiac failure (broad), Angioedema (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Blood premalignant disorders (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
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, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NE9212

Write-up: 10 days p/flu vax felt poorly-tired; MD tests done found to be very anemic; dx rare acute myleofibrosis of the bone; gets blood transfusions every 2 wks; has also had ear infects & now swelling of the feet is very weak;


VAERS ID: 38816 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: Nevada  
Vaccinated:1991-11-26
Onset:1991-12-18
   Days after vaccination:22
Submitted: 1992-01-07
   Days after onset:20
Entered: 1992-01-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (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), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-18
   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: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


VAERS ID: 39455 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:1991-12-14
Onset:1991-12-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


VAERS ID: 39014 (history)  
Form: Version 1.0  
Age: 95.0  
Sex: Female  
Location: Illinois  
Vaccinated:1991-11-12
Onset:1991-12-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-15
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


VAERS ID: 38150 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1991-12-04
Onset:1991-12-04
   Days after vaccination:0
Submitted: 1991-12-20
   Days after onset:16
Entered: 1991-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


VAERS ID: 38869 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Illinois  
Vaccinated:1991-11-01
Onset:1991-12-01
   Days after vaccination:30
Submitted: 1991-12-19
   Days after onset:18
Entered: 1992-01-17
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Not specified;
CDC Split Type: 891360001J

Write-up: Nursing home pt devel a stroke approx 1 month p/being administered flu vax, pt subsequently expired;


VAERS ID: 40513 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Foreign  
Vaccinated:1991-11-13
Onset:1991-11-27
   Days after vaccination:14
Submitted: 1992-02-20
   Days after onset:85
Entered: 1992-03-23
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
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: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4140

Write-up: Died of cardio-respiratory arrest;


VAERS ID: 40512 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: Foreign  
Vaccinated:1991-10-11
Onset:1991-11-25
   Days after vaccination:45
Submitted: 1992-02-20
   Days after onset:87
Entered: 1992-03-23
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pulmonary infiltration "inactive" lymphoma type II diabetes;
Allergies:
Diagnostic Lab Data: No autopsy was performed;
CDC Split Type: CO4139

Write-up: Pt had a hx of chronic pulmonary problems; pt died;


VAERS ID: 44074 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Female  
Location: California  
Vaccinated:1991-11-14
Onset:1991-11-21
   Days after vaccination:7
Submitted: 1992-02-19
   Days after onset:90
Entered: 1992-08-10
   Days after submission:172
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: CA9277

Write-up: pt had a massive heart attack;


VAERS ID: 37877 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1991-10-25
Onset:1991-11-20
   Days after vaccination:26
Submitted: 1991-12-03
   Days after onset:13
Entered: 1991-12-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01071P / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Anorexia, Intestinal obstruction, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 13 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Aldactone, Edecrin, Premarin, Prednisone, Ativan
Current Illness: NONE
Preexisting Conditions: Alzheimer''s dementia, CHF, hypertension, chronic lymphedeme
Allergies:
Diagnostic Lab Data:
CDC Split Type: WV9158

Write-up: 20NOV91 began vomiting @ 130AM x 2 refused to eat through the day; no audible bowel sounds @ 715PM & c/o abd tenderness & admitted to Hosp 20NOV; bowel resection completed due to volvolus of bowel;


VAERS ID: 39077 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-11-20
Onset:1991-11-20
   Days after vaccination:0
Submitted: 1992-01-20
   Days after onset:61
Entered: 1992-01-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Myocardial infarction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-20
   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: Calan, Synthroid, Feldene
Current Illness: NONE
Preexisting Conditions: No known allergies; hypertension, hypothyroidism, arthritis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt was administered flu vax @ approx 1215 PM 20NOV91 VS-nl; pt had taken flu vax previously remained in the clinic for 15 to 20mins p/inject; pt passed out on the golf course @ approx 2PM to ER dx MI; no evidence of allergic rxn;


VAERS ID: 37817 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Male  
Location: Connecticut  
Vaccinated:1991-11-18
Onset:1991-11-18
   Days after vaccination:0
Submitted: 1991-11-19
   Days after onset:1
Entered: 1991-12-09
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / IM A

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-11-18
   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: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


VAERS ID: 39281 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1991-11-13
Onset:1991-11-18
   Days after vaccination:5
Submitted: 1992-01-16
   Days after onset:59
Entered: 1992-01-31
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia
SMQs:, Agranulocytosis (broad), Gastrointestinal perforation (narrow), Oropharyngeal infections (narrow), Ischaemic colitis (broad), 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: 1991-11-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


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