|
VAERS ID: |
78518 (history) |
Form: |
Version 1.0 |
Age: |
79.0 |
Sex: |
Female |
Location: |
South Dakota |
Vaccinated: | 0000-00-00 |
Onset: | 1995-10-19 |
Submitted: |
1995-10-27 |
Days after onset: | 8 |
Entered: |
1995-10-31 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4958112 / UNK |
LA / IM |
Administered by: Other 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: 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: IHSS, Bipolar disorder, Dementia Preexisting Conditions: IHSS, Bipolar disorder, Dementia Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: death (pt was found dead in the bathroom by husband, prev to this no complaints) no tx; no evaluation post mortem, data gather from conversation w/husband |
|
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: |
79260 (history) |
Form: |
Version 1.0 |
Age: |
75.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1995-10-16 |
Onset: | 1995-10-17 |
Days after vaccination: | 1 |
Submitted: |
1995-10-18 |
Days after onset: | 1 |
Entered: |
1995-11-20 |
Days after submission: | 33 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
5F61148 / 1 |
LA / - |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
390968 / 1 |
RA / - |
Administered by: Public Purchased by: Public Symptoms: Cardiovascular disorder,
Convulsion,
Insomnia,
Pain SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1995-10-17
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: died @ heart of Florida hosp CDC Split Type: FL95079
Write-up: heart attack, ate dinner, rode bike on 16OCT95 p/vax; aching & diff sleeping noc of 16OCT95;sz on 17OCT95 to ER per ambulance |
|
VAERS ID: |
79660 (history) |
Form: |
Version 1.0 |
Age: |
61.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1995-10-26 |
Onset: | 1995-10-27 |
Days after vaccination: | 1 |
Submitted: |
1995-11-09 |
Days after onset: | 13 |
Entered: |
1995-11-27 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / 2 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Aspartate aminotransferase increased,
Blood lactate dehydrogenase increased,
Coma,
Hepatic failure,
Hepatic steatosis,
Hyperglycaemia,
Laboratory test abnormal,
Right ventricular failure SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1995-11-02
Days after onset: 6
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: Insulin, Accupril, APAP Current Illness: none other than hypertension & diabetes Preexisting Conditions: HTN, IDDM Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt recvd vax 26OCT95;fever 102 27OCT followed by abd pain, vomiting, sweating;28OCT hosp ER T102;adm for hydration; BX 305; progressive liver failure, SGOT 544, LDH 5099; congestive heart failure, coma;autopsy massive faulty degen of liver |
|
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: |
80174 (history) |
Form: |
Version 1.0 |
Age: |
73.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1995-10-11 |
Onset: | 1995-10-15 |
Days after vaccination: | 4 |
Submitted: |
1995-12-18 |
Days after onset: | 64 |
Entered: |
1995-12-20 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
5F61099 / 2 |
- / - |
Administered by: Private Purchased by: Private 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: 1995-10-31
Days after onset: 16
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: pneumonia 1 wk p/ 1994 flu vax;~ ()~~~In patient Other Medications: numerous Current Illness: Preexisting Conditions: 5 yr hx of fibrotic lung disease,arteriosclrosis w/ renal angioplasy,carotid enarterectomy,stroke;living w/ husband as care giver; Allergies: Diagnostic Lab Data: CDC Split Type: CO6416
Write-up: pt recvd vax; devel pneumonia & was hosp on ventilator assistance;died 31oct95;no autopsy performed;COD pneumonia & resp arrest; |
|
VAERS ID: |
80766 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Pennsylvania |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1996-01-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E2715HA / 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: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt recvd vax; supposed death; |
|
VAERS ID: |
80847 (history) |
Form: |
Version 1.0 |
Age: |
85.0 |
Sex: |
Male |
Location: |
Kansas |
Vaccinated: | 1995-11-01 |
Onset: | 1995-11-01 |
Days after vaccination: | 0 |
Submitted: |
1995-11-01 |
Days after onset: | 0 |
Entered: |
1996-01-16 |
Days after submission: | 76 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
5F61162 / UNK |
LA / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthma,
Pyrexia,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1995-11-10
Days after onset: 9
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: pcn, demedrol, codeine,tape, beesting Allergies: Diagnostic Lab Data: CDC Split Type: KS95057
Write-up: pt recvd vax;T 100; wheezing 3nov95; emesis; apap given; to er; |
|
VAERS ID: |
81461 (history) |
Form: |
Version 1.0 |
Age: |
74.0 |
Sex: |
Female |
Location: |
Connecticut |
Vaccinated: | 1995-11-16 |
Onset: | 1995-11-19 |
Days after vaccination: | 3 |
Submitted: |
1996-01-16 |
Days after onset: | 58 |
Entered: |
1996-01-30 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Mouth ulceration SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1995-11-20
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: unk Current Illness: urinary tract infect Preexisting Conditions: pt may have been taking Macrodantin for a urinary tract infect @ the time of death Allergies: Diagnostic Lab Data: CDC Split Type: 896017020L
Write-up: pt recvd vax 16NOV95;19NOV95 noted general weakness & canker sore in mouth;notified MD but declined to go to office because of weakness;next day husband found pt dead; |
|
VAERS ID: |
82670 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1995-10-18 |
Onset: | 1996-02-07 |
Days after vaccination: | 112 |
Submitted: |
1996-02-12 |
Days after onset: | 5 |
Entered: |
1996-02-16 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
5F61134 / UNK |
LA / IM |
Administered by: Private Purchased by: Public Symptoms: Apnoea,
Asthenia,
Guillain-Barre syndrome,
Malaise,
Paraesthesia,
Rhinitis SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Respiratory failure (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: Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: 3FEB96 rhinitis x 3 days;7FEB96 numbness in hands & feet;seen in ER inc numbness & fatigue,malaise-presently dx w/GBS on a ventilator; |
|