|
VAERS ID: |
81459 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Female |
Location: |
Arkansas |
Vaccinated: | 1995-10-28 |
Onset: | 1995-10-31 |
Days after vaccination: | 3 |
Submitted: |
1996-01-30 |
Days after onset: | 91 |
Entered: |
1996-01-30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4858102 / UNK |
- / - |
Administered by: Public Purchased by: Other Symptoms: Coma,
Convulsion,
Delirium,
Diarrhoea,
Hyponatraemia,
Lung disorder,
Pyrexia,
Respiratory disorder SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 86 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: unk Current Illness: febrile Preexisting Conditions: premature birth w/trachial tube in place Allergies: Diagnostic Lab Data: NONE CDC Split Type: ALI96031
Write-up: pt recvd vax & exp febrile convuls leading to brain damage p/vax;OCT95 pt exp sz d/t dehydration & low sodium & was adm to hosp x3-4days;28OCT95 exp diarrhea & resp illness including fever;t106;pt exp sz & coma resulted in 3/4 brain damage; |
|
VAERS ID: |
82317 (history) |
Form: |
Version 1.0 |
Age: |
32.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1988-11-01 |
Onset: | 1988-11-01 |
Days after vaccination: | 0 |
Submitted: |
1996-02-05 |
Days after onset: | 2652 |
Entered: |
1996-02-12 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Amnesia,
Asthenia,
Myalgia SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Current Illness: CFS-chronic fatigue synd Preexisting Conditions: childhood asthma, endometriosis Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: CFS-chronic fatigue synd;extreme fatigue, memory impairment, extreme muscle pain |
|
VAERS ID: |
84195 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
South Carolina |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1995-11-28 |
Entered: |
1996-02-26 |
Days after submission: | 90 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Deafness,
Myalgia,
Tinnitus SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Allergies: Diagnostic Lab Data: CDC Split Type: 895347004L
Write-up: pt recv vax & devel tinnitus & unilateral sudden hearing loss that was classified as profound; |
|
VAERS ID: |
83517 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: | 1995-10-27 |
Onset: | 1995-10-31 |
Days after vaccination: | 4 |
Submitted: |
1996-02-21 |
Days after onset: | 113 |
Entered: |
1996-03-08 |
Days after submission: | 16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4958102 / UNK |
- / IM |
Administered by: Private Purchased by: Other Symptoms: Brain oedema,
Coma,
Delirium,
Drug ineffective,
Encephalopathy,
Grand mal convulsion,
Hydrocephalus,
Infection SMQs:, Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 82 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: URI, d; fever Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever; Allergies: Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus; CDC Split Type: 896052006L
Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD; |
|
VAERS ID: |
83619 (history) |
Form: |
Version 1.0 |
Age: |
39.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 1995-10-18 |
Onset: | 1995-10-18 |
Days after vaccination: | 0 |
Submitted: |
1996-03-04 |
Days after onset: | 138 |
Entered: |
1996-03-12 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
5F61123 / 1 |
LA / - |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
1541A / 1 |
LA / - |
Administered by: Private Purchased by: Other Symptoms: Convulsion,
Ear pain,
Gait disturbance,
Myasthenic syndrome,
Paraesthesia,
Paraesthesia oral,
Speech disorder,
Visual disturbance SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Malignancy related conditions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NA Current Illness: NONE Preexisting Conditions: asthma Allergies: Diagnostic Lab Data: blood tests, MRI, spinal tap etc CDC Split Type:
Write-up: 7 1/2 hrs p/vax numbness in lips on lt side;progressed to numbness & tingling in entire lt side of body;pain in lt ear,weakness on entire lt side;effected vision on lt side;2 sz,effected speech & walking ability,muscle control |
|
VAERS ID: |
83648 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1995-03-07 |
Entered: |
1996-03-13 |
Days after submission: | 372 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Neuropathy SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: no relevant data CDC Split Type: WAES96021959
Write-up: pt recvd vax; devel brachial plexus neuropathy; |
|
VAERS ID: |
84327 (history) |
Form: |
Version 1.0 |
Age: |
54.0 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 1989-10-02 |
Onset: | 1989-10-08 |
Days after vaccination: | 6 |
Submitted: |
1995-11-01 |
Days after onset: | 2215 |
Entered: |
1996-04-02 |
Days after submission: | 153 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01209P / 2 |
- / A |
Administered by: Private Purchased by: Other Symptoms: Diabetes mellitus,
Guillain-Barre syndrome,
Hypertonia,
Hypokinesia,
Myasthenic syndrome,
Nail disorder,
Neuropathy,
Pain SMQs:, Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
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: Zestril, Calan, Zantac & hydrochlorothiazide Current Illness: NONE Preexisting Conditions: HTN Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: GBS,muscle weakness & spasms insulin dependent diabetes (caused from medication given for GBS);muscle relaxants,physical therapy,pain med,antihypertensive,insulin,nerve medication;left w/nerve & muscle damage to legs & side |
|
VAERS ID: |
84798 (history) |
Form: |
Version 1.0 |
Age: |
42.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1992-10-01 |
Onset: | 1992-10-01 |
Days after vaccination: | 0 |
Submitted: |
1996-04-09 |
Days after onset: | 1286 |
Entered: |
1996-04-15 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
RA / - |
Administered by: Public Purchased by: Other Symptoms: Arthralgia,
Arthropathy,
Extrapyramidal disorder,
Hypokinesia,
Myalgia,
Oedema peripheral,
Pain SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CT scan & MRI both of head were neg; CDC Split Type:
Write-up: flu shot given OCT92 in rt arm;pt had intermittent pain in muscle for about 1yr;during that time rt arm, hand & shoulder deteriorated to point of diminished functioning;pt had Physical therapy & occupational therapy;lost use of arm and hand |
|
VAERS ID: |
85292 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: | 1995-10-18 |
Onset: | 1995-11-14 |
Days after vaccination: | 27 |
Submitted: |
1996-04-05 |
Days after onset: | 143 |
Entered: |
1996-04-25 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
5F61134 / 2 |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Guillain-Barre syndrome,
Hypokinesia,
Laboratory test abnormal,
Myasthenic syndrome,
Neuropathy,
Paraesthesia SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Digoxin;ASA Current Illness: NONE Preexisting Conditions: had hernia operation 31OCT95, rx for arrhythmia w/digoxin Allergies: Diagnostic Lab Data: dx paraproteinemic demyelination neuroapthy; CDC Split Type: MA9607
Write-up: pt recv vax & started to notice a funny feeling & numbness that started in lt leg & progressed to rt leg;pt exp bilat leg weakness & was having diff walking;MD felt d/t rxn to flu shot;dx GBS & hosp;had extensive testing & underwent plasma |
|
VAERS ID: |
85375 (history) |
Form: |
Version 1.0 |
Age: |
42.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1992-11-17 |
Onset: | 1992-11-17 |
Days after vaccination: | 0 |
Submitted: |
1996-04-06 |
Days after onset: | 1236 |
Entered: |
1996-04-29 |
Days after submission: | 22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
4928266 / 1 |
RA / IM |
Administered by: Other Purchased by: Public Symptoms: Hypokinesia,
Injection site pain,
Muscle atrophy SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: uses inhaler PRN Current Illness: NONE Preexisting Conditions: asthma-allergic to dogs & cats Allergies: Diagnostic Lab Data: x-ray of rt arm; MRI & CAT scan of brain CDC Split Type:
Write-up: hurt @ site of inj,pain of&on from 1st day to present;rt arm felt like it atrophied,was unaware of extent until tried to type;had physical therapy&occupational therapy;felt some results-did not cont,financial problems; |
|