|
VAERS ID: |
36912 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1991-11-29 |
Onset: | 1991-11-29 |
Days after vaccination: | 0 |
Submitted: |
1991-12-03 |
Days after onset: | 4 |
Entered: |
1992-04-08 |
Days after submission: | 126 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918140 / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Dyspnoea,
Hypersensitivity,
Urticaria SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (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? 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: UNK Current Illness: UNK Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 891364002J
Write-up: Pt exp an allergic rxn p/receiving flu vax; addtl info has been requested; |
|
VAERS ID: |
41492 (history) |
Form: |
Version 1.0 |
Age: |
37.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1991-10-25 |
Onset: | 1991-10-25 |
Days after vaccination: | 0 |
Submitted: |
1992-03-25 |
Days after onset: | 152 |
Entered: |
1992-04-24 |
Days after submission: | 29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21216 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Dizziness,
Headache,
Hypoventilation,
Somnolence SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (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, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Blood work/cultures-WNL CDC Split Type: CO4035
Write-up: Hospitalized for dizziness, slowed respiration, somnolence & h/a; tx w/Adrenlin & sterioids in low doses, then DPH; |
|
VAERS ID: |
41509 (history) |
Form: |
Version 1.0 |
Age: |
64.0 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1991-12-19 |
Onset: | 1991-12-24 |
Days after vaccination: | 5 |
Submitted: |
1992-04-22 |
Days after onset: | 119 |
Entered: |
1992-04-24 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918123 / 1 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Anxiety,
Asthenia,
Atrial fibrillation,
Chills,
Guillain-Barre syndrome,
Hyporeflexia,
Insomnia,
Paralysis SMQs:, Peripheral neuropathy (narrow), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (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, 12 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Cardizem, Lanoxin, Tetracycline, Voltaren, Quindex Current Illness: Preexisting Conditions: PCN Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: 24DEC91 devel vigors & chills, felt anxious & weak; 25DEC91 rigors & chill & diaphoretic; unable to sleep; 30DEC91 EKG-atrial fibrillation; 4JAN92 very weak, seen in ER, arreflexia of legs & followed by neurologist for GBS; |
|
VAERS ID: |
41591 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 1991-09-10 |
Onset: | 1991-10-09 |
Days after vaccination: | 29 |
Submitted: |
1992-04-16 |
Days after onset: | 190 |
Entered: |
1992-04-29 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / 6 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Arthritis bacterial,
Guillain-Barre syndrome 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? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient Other Medications: diabetic on insulin Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: GBS hospitalized 9OCT91 eval & dx; tx plasmapheresis-responded well, but complicated by septic arthritis of rt knee; |
|
VAERS ID: |
41594 (history) |
Form: |
Version 1.0 |
Age: |
67.0 |
Sex: |
Female |
Location: |
Oregon |
Vaccinated: | 1991-11-21 |
Onset: | 1991-12-01 |
Days after vaccination: | 10 |
Submitted: |
1992-04-22 |
Days after onset: | 142 |
Entered: |
1992-04-29 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01481P / 1 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Dysphagia,
Guillain-Barre syndrome,
Paralysis SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: GBS-plasmapharesis; |
|
VAERS ID: |
41862 (history) |
Form: |
Version 1.0 |
Age: |
68.0 |
Sex: |
Male |
Location: |
Nebraska |
Vaccinated: | 1991-12-12 |
Onset: | 1991-12-22 |
Days after vaccination: | 10 |
Submitted: |
1992-04-30 |
Days after onset: | 129 |
Entered: |
1992-05-11 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21216 / 7+ |
LA / IM |
Administered by: Public Purchased by: Private Symptoms: Anaemia,
Asthenia,
Malaise,
Myelofibrosis,
Oedema peripheral,
Otitis media SMQs:, Cardiac failure (broad), Angioedema (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Blood premalignant disorders (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
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: NONE Allergies: Diagnostic Lab Data: CDC Split Type: NE9212
Write-up: 10 days p/flu vax felt poorly-tired; MD tests done found to be very anemic; dx rare acute myleofibrosis of the bone; gets blood transfusions every 2 wks; has also had ear infects & now swelling of the feet is very weak; |
|
VAERS ID: |
37209 (history) |
Form: |
Version 1.0 |
Age: |
20.0 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: | 1992-02-17 |
Onset: | 1992-02-18 |
Days after vaccination: | 1 |
Submitted: |
1992-02-19 |
Days after onset: | 1 |
Entered: |
1992-05-20 |
Days after submission: | 90 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
- / UNK |
- / - |
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Military Purchased by: Military Symptoms: Paraesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: UNK Current Illness: NONE Preexisting Conditions: pt had surgery on rt hip related to chondromalacia @ age of 9; Allergies: Diagnostic Lab Data: CDC Split Type: 892051005L
Write-up: pt devel numbness on rt side of body 24 hrs p/flu vax/DT/Meningococcal vax; pt was hospitalized due to adverse effect & was noted to be improving w/numbness currently localized to the rt leg; |
|
VAERS ID: |
37210 (history) |
Form: |
Version 1.0 |
Age: |
68.0 |
Sex: |
Female |
Location: |
Kansas |
Vaccinated: | 1991-10-01 |
Onset: | 1991-10-01 |
Days after vaccination: | 0 |
Submitted: |
1992-02-19 |
Days after onset: | 141 |
Entered: |
1992-05-20 |
Days after submission: | 90 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918139 / 1 |
- / IM A |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
297900 / 1 |
- / IM A |
Administered by: Private Purchased by: Other Symptoms: Abdominal pain,
Anaphylactoid reaction,
Dizziness SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: UNK Current Illness: UNK Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: CDC Split Type: 892078006L
Write-up: pt exp severe abd pain, dizziness & acute distress w/in 2 hrs recvd flu/pne-imune vax; adm to hosp w/dx of anaphylactoid reaction; |
|
VAERS ID: |
37229 (history) |
Form: |
Version 1.0 |
Age: |
82.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1991-10-23 |
Onset: | 1991-10-30 |
Days after vaccination: | 7 |
Submitted: |
1991-11-20 |
Days after onset: | 21 |
Entered: |
1992-05-28 |
Days after submission: | 189 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
312973 / UNK |
- / IM |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
298962 / 2 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Arthritis,
Condition aggravated,
Hyperglycaemia,
Oedema,
Osteoarthritis,
Pain,
Red blood cell sedimentation rate increased,
Vasodilatation SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (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, 6 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NA Current Illness: erythema & edema of hand, PIP, joint kne Preexisting Conditions: chronic atrial fibrillation; hiatus hernia w/gastroesophageal reflux; degenerative LS disease; Allergies: Diagnostic Lab Data: Chem-nl CBC- high sed rate 45 otherwise nl glucose 186; ANA pending; lyme test neg; mono test neg; RA neg; RPR non reactive; CDC Split Type: 910224401
Write-up: Approx 1 wk p/flu vax/pnu imune, pt exp redness swelling of hands, wrist, knees; dx acute polyarthritis; seen in ER 13NOV91; ESR 45; tx w/Clinoral; 19NOV still having pain, clinoral discontinued, txthen w/Darvocet & Ansaid; hospitalized; |
|
VAERS ID: |
42853 (history) |
Form: |
Version 1.0 |
Age: |
45.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 1991-11-08 |
Onset: | 1991-11-10 |
Days after vaccination: | 2 |
Submitted: |
1992-06-05 |
Days after onset: | 207 |
Entered: |
1992-06-15 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
1F21206 / UNK |
- / - |
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH |
4918050 / UNK |
- / - |
Administered by: Other Purchased by: Private Symptoms: Condition aggravated SMQs:
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, ? days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: pt has med hx of asthma attacks Allergies: Diagnostic Lab Data: EEG; Brain scan; LP; CDC Split Type:
Write-up: 2 days p/recd Td/flu shot had an asthma attack on 10NOV91 & was hospitalized; |
|