|
VAERS ID: |
38153 (history) |
Form: |
Version 1.0 |
Age: |
72.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1991-11-07 |
Onset: | 1991-11-10 |
Days after vaccination: | 3 |
Submitted: |
1991-12-01 |
Days after onset: | 21 |
Entered: |
1991-12-27 |
Days after submission: | 26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / 1 |
- / IM A |
Administered by: Private Purchased by: Public Symptoms: Aspartate aminotransferase increased,
Blood lactate dehydrogenase increased,
Hepatitis,
Hyperbilirubinaemia,
Infection,
Jaundice,
Leukocytosis,
Pyrexia SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (narrow), 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), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: N/A Preexisting Conditions: No known allergies; Allergies: Diagnostic Lab Data: Bilirubin 2.4; LDH 548; SGOT 98; CDC Split Type:
Write-up: Pt became ill 3 days p/flu shot; rt upper outer abdominal pain, fever, chills, jaundice, elevated white blood count 14,000; elevated liver function tests; hepatitis; |
|
VAERS ID: |
38176 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 1991-10-31 |
Onset: | 1991-11-14 |
Days after vaccination: | 14 |
Submitted: |
0000-00-00 |
Entered: |
1991-12-30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / 1 |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Guillain-Barre syndrome SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? 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: Vitamin C, Tenormin, Amitriptyline; Current Illness: Preexisting Conditions: Hx of sensory nerve disorder & hypertension; Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Guillain-Barre Syndrome; hospitalized 16NOV91; plasma replacement was carried out; |
|
VAERS ID: |
38490 (history) |
Form: |
Version 1.0 |
Age: |
48.0 |
Sex: |
Female |
Location: |
D.C. |
Vaccinated: | 1991-12-06 |
Onset: | 1991-12-06 |
Days after vaccination: | 0 |
Submitted: |
1991-12-16 |
Days after onset: | 10 |
Entered: |
1992-01-08 |
Days after submission: | 23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Headache,
Nausea,
Pharyngitis,
Pyrexia,
Shock,
Vomiting SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: UNK Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 891353001J
Write-up: Pt devel fever, sore throat, h/a & severe nausea & vomiting p/receiving flu vax; 4 days later, pt devel shock & was hospitalized; pt condition subsequently improved; Reporter was not aware of any allergies in pt; |
|
VAERS ID: |
38491 (history) |
Form: |
Version 1.0 |
Age: |
73.0 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: | 1991-09-27 |
Onset: | 1991-10-01 |
Days after vaccination: | 4 |
Submitted: |
1991-10-22 |
Days after onset: | 21 |
Entered: |
1992-01-08 |
Days after submission: | 78 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918140 / 2 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Hypersensitivity,
Infection,
Injection site hypersensitivity,
Pruritus,
Pyrexia,
Rash,
Sepsis SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Vasotec tabs; Ecotrin tabs, Lasix tabs; Current Illness: NONE Preexisting Conditions: Pt has non-insulin dependent diabetes, hypertension, & arteriosclerotic heart disease; pt recvd flu vax 29OCT90; Allergies: Diagnostic Lab Data: Immune Complex 44.5; Blood Cultures showed Staphylococcus species; coagulase negative in one bottle only; CDC Split Type: 891316018L
Write-up: Pt devel a rash, itching, & loss of energy w/in 12 days of flu vax; rash began @ the inject site approx 1 wk p/vax; 9OCT91 pt was seen @ MD office w/a generalized rash & t101.6; Seen in ER t103 admitted; dx hypersensitivity rxn; |
|
VAERS ID: |
38712 (history) |
Form: |
Version 1.0 |
Age: |
51.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1991-11-21 |
Onset: | 1991-11-27 |
Days after vaccination: | 6 |
Submitted: |
1991-12-16 |
Days after onset: | 19 |
Entered: |
1992-01-10 |
Days after submission: | 25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21219 / 2 |
- / SC |
Administered by: Private Purchased by: Private Symptoms: Guillain-Barre syndrome SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Multiple tests in hosp CDC Split Type: CO9201
Write-up: probable GBS synd; |
|
VAERS ID: |
38715 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 1991-12-11 |
Onset: | 1991-12-26 |
Days after vaccination: | 15 |
Submitted: |
1992-01-08 |
Days after onset: | 13 |
Entered: |
1992-01-10 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / 1 |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Facial palsy,
Guillain-Barre syndrome,
Headache,
Myalgia,
Paraesthesia,
Vertigo SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Hearing impairment (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: UNK Current Illness: NONE Preexisting Conditions: hypertension, hypercholesterolemia Allergies: Diagnostic Lab Data: CT Scan of brain-normal; Lumbar Puncture-normal; CDC Split Type:
Write-up: Devel tingling, mild vertigo, myalgias, & h/a 15 day post vax; on day of admission devel lt peripheral facial paresis w/difficulty closing lt eye & droop of lt side of mouth; probable GBS: |
|
VAERS ID: |
38716 (history) |
Form: |
Version 1.0 |
Age: |
61.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1991-10-04 |
Onset: | 1991-10-12 |
Days after vaccination: | 8 |
Submitted: |
1991-12-30 |
Days after onset: | 79 |
Entered: |
1992-01-10 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918181 / UNK |
LA / - |
Administered by: Public Purchased by: Private Symptoms: Eye disorder,
Headache,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Corneal disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CT Scan; CDC Split Type: PA91390
Write-up: Severe h/a steady & pounding seen by MD 14OCT91; slight temp adm to hosp 16OCT91 when rt eye drooped; seen by neurologist while admitted; |
|
VAERS ID: |
38717 (history) |
Form: |
Version 1.0 |
Age: |
61.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1991-09-19 |
Onset: | 1991-09-19 |
Days after vaccination: | 0 |
Submitted: |
1991-12-30 |
Days after onset: | 102 |
Entered: |
1992-01-10 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21209 / UNK |
LA / - |
Administered by: Private Purchased by: Public Symptoms: Chest pain,
Dyspepsia,
Dyspnoea,
Headache,
Pharyngitis,
Right ventricular failure SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: PA91394
Write-up: Terrible pain in temple, throat & chest; initially MD prescribed DPH pills but these made her sick to stomach; had difficult breathing & chest hurt; To ER @ hosp 21SEp91; poss congestive heart failure admitted; |
|
VAERS ID: |
38734 (history) |
Form: |
Version 1.0 |
Age: |
88.0 |
Sex: |
Female |
Location: |
Mississippi |
Vaccinated: | 1991-10-13 |
Onset: | 1991-10-13 |
Days after vaccination: | 0 |
Submitted: |
1991-12-05 |
Days after onset: | 53 |
Entered: |
1992-01-13 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918138 / 1 |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Chest pain,
Dyspnoea,
Haematemesis,
Hyperhidrosis,
Pallor,
Right ventricular failure,
Tremor SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-10-15
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: pt had diabetes, congestive heart failure & a peptic ulcer; Allergies: Diagnostic Lab Data: CDC Split Type: 891361005J
Write-up: w/in hrs of receiving flu vax pt began shaking & exp vomiting w/a small amount of blood noted; following morning pt exp chest pain, SOB, paleness & clamminess; pt was hospitalized & died 15OCT91; COD congestive heart failure; |
|
VAERS ID: |
38735 (history) |
Form: |
Version 1.0 |
Age: |
78.0 |
Sex: |
Female |
Location: |
Mississippi |
Vaccinated: | 1991-10-08 |
Onset: | 1991-10-13 |
Days after vaccination: | 5 |
Submitted: |
1991-12-05 |
Days after onset: | 53 |
Entered: |
1992-01-13 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918138 / 1 |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Haematuria,
Hypotension,
Pharyngitis,
Rhinitis SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-10-26
Days after onset: 13
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: 891361002J
Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax; |
|