|
VAERS ID: |
38738 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Male |
Location: |
Mississippi |
Vaccinated: | 1991-10-22 |
Onset: | 1991-10-28 |
Days after vaccination: | 6 |
Submitted: |
1991-12-05 |
Days after onset: | 38 |
Entered: |
1992-01-13 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918138 / UNK |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Asthma,
Lung disorder SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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, 6 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: pt has Parkinson''s disease, arteriosclerotic heart disease, & COPD Allergies: Diagnostic Lab Data: CDC Split Type: 891361006J
Write-up: Pt exp wheezing & chest congestion, which began five day p/receiving flu vax; pt required hospitalization for 6 days; |
|
VAERS ID: |
38739 (history) |
Form: |
Version 1.0 |
Age: |
86.0 |
Sex: |
Female |
Location: |
Mississippi |
Vaccinated: | 1991-10-13 |
Onset: | 1991-10-28 |
Days after vaccination: | 15 |
Submitted: |
1991-12-05 |
Days after onset: | 38 |
Entered: |
1992-01-13 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918138 / UNK |
RA / IM |
Administered by: Other Purchased by: Other Symptoms: Asthma,
Confusional state,
Cough,
Mydriasis,
Pharyngitis,
Rhinitis SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, 11 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: pt has chronic renal failure & anemia Allergies: Diagnostic Lab Data: CDC Split Type: 891361003J
Write-up: Pt devel cold sx & cough w/wheezing approx 2 wks p/receiving flu vax; also exp confusion & dilation of the pupils; The pt was hospitalized @ this time for a period of 11 days; |
|
VAERS ID: |
38763 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1992-01-07 |
Entered: |
1992-01-13 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918137 / UNK |
LA / IM |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
1852S / UNK |
RA / IM |
Administered by: Private Purchased by: Unknown Symptoms: Coordination abnormal,
Dysarthria,
Gait disturbance,
Paralysis SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1992-01-02
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
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: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg; CDC Split Type:
Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis; |
|
VAERS ID: |
38764 (history) |
Form: |
Version 1.0 |
Age: |
63.0 |
Sex: |
Female |
Location: |
New Hampshire |
Vaccinated: | 1991-10-08 |
Onset: | 1991-10-09 |
Days after vaccination: | 1 |
Submitted: |
1992-01-06 |
Days after onset: | 89 |
Entered: |
1992-01-13 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21216 / UNK |
LA / IM |
Administered by: Public Purchased by: Private Symptoms: Cough,
Drug ineffective,
Dyspnoea,
Infection,
Laryngitis,
Pneumonia,
Productive cough,
Pyrexia SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes 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: NONE Preexisting Conditions: hypertension-arthritis of knees & lt ankle Allergies: Diagnostic Lab Data: 26OCT91 chest film-dx flu pneumonia; LLL-sputum & pneumococcus/streptococcus w/gram neg; CBC-smear; RADS; acid fast bacillus; CDC Split Type:
Write-up: 9OCT91 laryngitis w/dry, hacking cough, low grade temp x 1 wk; 16OCT91 productive cough, thick yellow sputum, dyspnea; 20OCT91 severe resp distress adm to hosp x 6 days sputum smear pneumococcal/strep dx flu/pneumonia; |
|
VAERS ID: |
38765 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Female |
Location: |
Iowa |
Vaccinated: | 1991-10-15 |
Onset: | 1991-10-24 |
Days after vaccination: | 9 |
Submitted: |
1992-01-02 |
Days after onset: | 70 |
Entered: |
1992-01-13 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21205 / 1 |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Confusional state,
Dizziness,
Malaise,
Myalgia,
Pharyngitis,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Pred, Florinef, Quiphite, Lasix, Colace, KCL, Tavist, Calcium, Carafate, Questran Current Illness: Preexisting Conditions: aplastic anemia orthostatic hypotension, osteoporosis; Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt is immunosuppressed w/steroids poss delayed reaction?; pt devel low grade fever, myalgia, confusion, dizziness, general malaise, sore throat; |
|
VAERS ID: |
38819 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Female |
Location: |
Oklahoma |
Vaccinated: | 1991-12-05 |
Onset: | 1991-12-06 |
Days after vaccination: | 1 |
Submitted: |
1991-12-30 |
Days after onset: | 24 |
Entered: |
1992-01-15 |
Days after submission: | 16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21215 / 2 |
LA / IM |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
297901 / 1 |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Chest pain,
Face oedema,
Tongue disorder,
Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Cardiazem Current Illness: NONE Preexisting Conditions: PCN & Sulfa-angina Allergies: Diagnostic Lab Data: CDC Split Type: OK9185
Write-up: Pt c/o sx 5DCE91 & 1130AM numbness of tongue; pt called clinic 6DEC91 c/o hives under rt breast, abdomen & groin area; also, c/o swollen lips; pt seen 6DEC91 w/edema of lips, hives & chest pain; |
|
VAERS ID: |
38871 (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? 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: UNK Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: not specified; CDC Split Type: 891360002J
Write-up: Nursing pt devel a stroke approx 1mo p/being administered flu vax; |
|
VAERS ID: |
38885 (history) |
Form: |
Version 1.0 |
Age: |
61.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1991-11-27 |
Onset: | 1991-12-04 |
Days after vaccination: | 7 |
Submitted: |
0000-00-00 |
Entered: |
1992-01-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
04161P / UNK |
- / 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: Candiac Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Guillain-Barre Synd (GBS); |
|
VAERS ID: |
38889 (history) |
Form: |
Version 1.0 |
Age: |
54.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1991-11-01 |
Onset: | 1991-11-05 |
Days after vaccination: | 4 |
Submitted: |
1991-12-09 |
Days after onset: | 34 |
Entered: |
1992-01-17 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918127 / 4 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Anorexia,
Encephalitis,
Hypokinesia,
Jaundice,
Myasthenic syndrome,
Myelitis,
Nausea,
Urinary retention SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Naprosyn, Estroderue, Seldane Current Illness: NONE Preexisting Conditions: has hayfever Allergies: Diagnostic Lab Data: LP CDC Split Type:
Write-up: Got flu shot 1NOV91 & began sx of diarrhea, fatigue, anorexia, & nausea on 5NOV91; progressed to weakness & jaundice by 10NOV91 Seen by MD got ATB starting falling down alot on 13NOV91; admitted to hosp 20NOV91 dx w/encephalomyelitis; |
|
VAERS ID: |
38963 (history) |
Form: |
Version 1.0 |
Age: |
58.0 |
Sex: |
Male |
Location: |
Indiana |
Vaccinated: | 1989-12-28 |
Onset: | 1990-01-07 |
Days after vaccination: | 10 |
Submitted: |
1992-01-02 |
Days after onset: | 725 |
Entered: |
1992-01-21 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Other Purchased by: Private Symptoms: Asthenia,
Guillain-Barre syndrome,
Hyporeflexia,
Muscle spasms,
Pain,
Paraesthesia,
Paralysis flaccid,
Peroneal nerve palsy SMQs:, Peripheral neuropathy (narrow), Dystonia (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: none Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: pt vax @ home CDC Split Type: 920000501
Write-up: several days following immin on 28Dec89, pt devel tingling in the extremities, later devel ascending flaccid motor paralysis & loss of deep tendon reflexes.Hospitalized, Guillain-Barre synd was dx & sequelae reportedly persist. |
|