|
VAERS ID: |
39899 (history) |
Form: |
Version 1.0 |
Age: |
50.0 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 1989-10-15 |
Onset: | 1989-10-25 |
Days after vaccination: | 10 |
Submitted: |
0000-00-00 |
Entered: |
1992-03-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01209P / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Guillain-Barre syndrome,
Hypertonia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Calan, Zantac, Zestril, & HCTZ & KCL; Current Illness: Preexisting Conditions: Diet controlled NIDDM prior to GBS, now on insulin; flu shot in past w/out sequelae; Allergies: Diagnostic Lab Data: CDC Split Type: 914090006
Write-up: GBS reported in pt who recvd flu vax & 10 days p/flu shot pt was hospitalized for rapid progression of weakness; CT scan suggested surgical etiology for GBS; pt still exp muscle spasms; |
|
VAERS ID: |
39900 (history) |
Form: |
Version 1.0 |
Age: |
70.0 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 1991-09-10 |
Onset: | 1991-10-07 |
Days after vaccination: | 27 |
Submitted: |
0000-00-00 |
Entered: |
1992-03-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Arthritis bacterial,
Guillain-Barre syndrome,
Infection SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Arthritis (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: Insulin Current Illness: Preexisting Conditions: pt is diabetic & taking insulin Allergies: Diagnostic Lab Data: CDC Split Type: 914091001
Write-up: GBS reported in a pt who recvd flu vax on 10SEP91 & on 7OCT91 was admitted to hosp w/dx of GBS; tx meds sx improved but still devel septic arthritis (staphylococcal); |
|
VAERS ID: |
40120 (history) |
Form: |
Version 1.0 |
Age: |
33.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1991-11-25 |
Onset: | 1991-12-17 |
Days after vaccination: | 22 |
Submitted: |
1992-03-03 |
Days after onset: | 77 |
Entered: |
1992-03-09 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Public Purchased by: Other Symptoms: Asthenia,
Headache,
Hepatitis B surface antigen,
Immunoglobulins increased,
Nausea,
Paraesthesia SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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, 7 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: Preexisting Conditions: apply fractures Allergies: Diagnostic Lab Data: EMG, LP CDC Split Type:
Write-up: Pt recvd flu vax 25NOV91 & exp nausea, h/a early DEC, progressive paresthesias, weakness; pt hospitalized 27DEC91; pos Hep B surface core AB; |
|
VAERS ID: |
40121 (history) |
Form: |
Version 1.0 |
Age: |
31.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1991-11-01 |
Onset: | 1991-12-14 |
Days after vaccination: | 43 |
Submitted: |
1992-03-03 |
Days after onset: | 80 |
Entered: |
1992-03-09 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Apnoea,
Quadriplegia SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (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, 60 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Tranyene, Carafate, Prilosec, Darvocet Current Illness: Preexisting Conditions: Ulcers, migraines, rt bell''s palsey, situational depression Allergies: Diagnostic Lab Data: EMG, LP CDC Split Type:
Write-up: quadriparesis, resp failure; |
|
VAERS ID: |
41008 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Unknown |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1990-11-30 |
Entered: |
1992-03-12 |
Days after submission: | 468 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
4918P2 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Chills,
Condition aggravated,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), 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? 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: NA CDC Split Type: CO3707I
Write-up: Temp not recorded, but believed to be over 37, chills, weakness, asthma worsened; |
|
VAERS ID: |
40380 (history) |
Form: |
Version 1.0 |
Age: |
31.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1991-11-02 |
Onset: | 1991-11-03 |
Days after vaccination: | 1 |
Submitted: |
1992-02-18 |
Days after onset: | 107 |
Entered: |
1992-03-19 |
Days after submission: | 30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918138 / UNK |
- / IM |
Administered by: Public Purchased by: Private Symptoms: Antinuclear antibody,
Arthralgia,
Asthenia,
Immune system disorder,
Myalgia,
Osteoarthritis,
Systemic lupus erythematosus,
Vertigo SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (narrow), Arthritis (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? Yes
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: pt has hx of asthma Allergies: Diagnostic Lab Data: CDC Split Type: 892050001B
Write-up: Pt devel chills, low-grade fever, muscle pain, joint swelling hands, fatigue soon p/recvd flu vax; pt exp weakness, fatigue, & joint pain, devel autoimmun response; vertigo; pt antinuclear antibody titer was elevated; |
|
VAERS ID: |
40387 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1991-11-06 |
Onset: | 1991-11-06 |
Days after vaccination: | 0 |
Submitted: |
1991-11-20 |
Days after onset: | 14 |
Entered: |
1992-03-19 |
Days after submission: | 120 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918202 / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Delirium,
Dizziness,
Hypokinesia,
Vestibular disorder,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Dehydration (broad)
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, 10 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: NONE CDC Split Type: MD92016
Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder; |
|
VAERS ID: |
40944 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 1991-11-21 |
Onset: | 1991-12-02 |
Days after vaccination: | 11 |
Submitted: |
1991-12-05 |
Days after onset: | 3 |
Entered: |
1992-04-01 |
Days after submission: | 118 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918202 / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Dizziness,
Hyperhidrosis,
Nausea SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Brain Scan, EKG, ultra-sound-neck; ecchocardiogram, EEG, heart monitor, blood tests; CDC Split Type: MD92013
Write-up: Dizziness, nausea, perspiring on forehead during night; Seen by MD AM 3DEC91 admitted to hosp 3DEC91 having multiple tests; |
|
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: |
41088 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1991-11-26 |
Onset: | 1991-11-28 |
Days after vaccination: | 2 |
Submitted: |
1991-12-02 |
Days after onset: | 4 |
Entered: |
1992-04-06 |
Days after submission: | 125 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918170 / 7+ |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Arthralgia,
Asthma,
Deafness,
Depression,
Facial palsy,
Injection site mass,
Osteoarthritis,
Tremor SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow), Hypersensitivity (broad), Arthritis (narrow), Hypoglycaemia (broad)
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, 2 days
Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: NONE CDC Split Type: CA9235
Write-up: 28NOV91 pain, swelling, inc warmth & lump on LA @ site of shot; c/o pain, swelling & tenderness in joints; c/o wheezing; Seen by MD x 2; hospitalized x 2 days; dx w/Bell''s palsey; c/o hearing loss 1 ear; tremors, nervous, depressed & teary; |
|