|
VAERS ID: |
104721 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
Indiana |
Vaccinated: | 1995-10-11 |
Onset: | 0000-00-00 |
Submitted: |
1997-10-23 |
Entered: |
1997-11-14 |
Days after submission: | 22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Eye disorder,
Visual disturbance,
Visual field defect SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (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: 897309005L
Write-up: this plaintiff allegedly sustained permanent eye damage & was otherwise injured p/vax; |
|
VAERS ID: |
104866 (history) |
Form: |
Version 1.0 |
Age: |
64.0 |
Sex: |
Female |
Location: |
South Carolina |
Vaccinated: | 1996-11-07 |
Onset: | 1996-11-08 |
Days after vaccination: | 1 |
Submitted: |
1997-10-31 |
Days after onset: | 357 |
Entered: |
1997-11-19 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / 1 |
- / SC A |
Administered by: Public Purchased by: Other Symptoms: Guillain-Barre syndrome,
Hypokinesia,
Myalgia,
Paraesthesia,
Tenosynovitis,
Vomiting SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Dyazide, premarin, hysterectomy 1980;poss allergy to APAP #3; Current Illness: NONE Preexisting Conditions: borderline HTN; Allergies: Diagnostic Lab Data: nerve conduction test indicated severe carpal tunnel synd testing for rheumatoid arthritis was negative; CDC Split Type: 10150970130000
Write-up: pt recv vax 7NOV96 & 8NOV96 pt exp v;13NOV96 pt exp muscle pain in legs, back, shoulder, hands & fingers;exp numbness & tingling in fingertips only;pt dx w/severe CTS;diff performing daily activities;tested for GBS; |
|
VAERS ID: |
104867 (history) |
Form: |
Version 1.0 |
Age: |
38.0 |
Sex: |
Male |
Location: |
Missouri |
Vaccinated: | 1997-10-27 |
Onset: | 1997-10-27 |
Days after vaccination: | 0 |
Submitted: |
1997-11-02 |
Days after onset: | 6 |
Entered: |
1997-11-19 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
7F81755 / 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? 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: Pneumovax; Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level; CDC Split Type:
Write-up: Guillain-Barre synd; |
|
VAERS ID: |
105113 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1993-11-25 |
Onset: | 0000-00-00 |
Submitted: |
1997-11-03 |
Entered: |
1997-11-25 |
Days after submission: | 22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E2253HA / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Condition aggravated,
Coordination abnormal,
Guillain-Barre syndrome,
Personality disorder SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Demyelination (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? No
ER or Doctor Visit? No
Hospitalized? Yes, 90 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: unk Current Illness: unk Preexisting Conditions: this plaintiff may have had a prev episode of GBS Allergies: Diagnostic Lab Data: CDC Split Type: 897308014L
Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work |
|
VAERS ID: |
105336 (history) |
Form: |
Version 1.0 |
Age: |
85.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1997-09-16 |
Onset: | 1997-09-17 |
Days after vaccination: | 1 |
Submitted: |
1997-11-28 |
Days after onset: | 72 |
Entered: |
1997-12-03 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
7F81840 / 1 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Deafness transitory SMQs:, Hearing impairment (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: NONE~ ()~~~In patient Other Medications: Synthroid once/day Current Illness: NONE Preexisting Conditions: hypothyroid condition Allergies: Diagnostic Lab Data: both tests indicated significant hearing loss bilat;standard hearing test X3;BAER test brain stem auditory response test; CDC Split Type:
Write-up: w/in 24hr of vax pt exp hearing related sx in both ears;voices are heard @ two distinct pitches @ the same time-a nl pitch & a very low pitch;marked hearing loss;inability to recognize familiar voices;singing voices sound off key; |
|
VAERS ID: |
105440 (history) |
Form: |
Version 1.0 |
Age: |
34.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1997-10-29 |
Onset: | 1997-11-04 |
Days after vaccination: | 6 |
Submitted: |
0000-00-00 |
Entered: |
1997-12-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
306423 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Facial palsy SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: NONE Allergies: Diagnostic Lab Data: SMAC/CBC/sed rate WNL; CDC Split Type:
Write-up: development of lt facial nerve paralysis/palsy; |
|
VAERS ID: |
105543 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Male |
Location: |
Indiana |
Vaccinated: | 1996-11-12 |
Onset: | 1996-11-18 |
Days after vaccination: | 6 |
Submitted: |
1997-12-02 |
Days after onset: | 379 |
Entered: |
1997-12-09 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
7F71277 / 1 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Hypotension,
Hypoxia,
Infection,
Influenza,
Neck pain,
Paralysis,
Pneumonia,
Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 35 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: ASA;Valium, Vicodin, Procan, Daypro Current Illness: Preexisting Conditions: SDMA coumpound, nalfon;degenerative disc disease lumars Allergies: Diagnostic Lab Data: blood test, spinal tap, MRI, NCV, EMG, EKG CDC Split Type:
Write-up: flu like sx wk of 17NOV96 & again wk of 8DEC96;pain in neck & shoulders 23DEC96;weakness 24DEC96;collapsed in floor 26DEC96;hosp 27DEC97 transferred to rehab ctr 31JAN97;totally paralyzed staph pneumonia;T107.4; |
|
VAERS ID: |
105612 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1997-10-21 |
Onset: | 1997-10-21 |
Days after vaccination: | 0 |
Submitted: |
1997-12-10 |
Days after onset: | 50 |
Entered: |
1997-12-11 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
- / UNK |
RA / - |
Administered by: Other Purchased by: Other Symptoms: Asthma,
Condition aggravated,
Dizziness,
Nausea SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (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: Provex CV Current Illness: Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem; Allergies: Diagnostic Lab Data: NONE CDC Split Type: MPI971030
Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking; |
|
VAERS ID: |
105751 (history) |
Form: |
Version 1.0 |
Age: |
34.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1995-10-03 |
Onset: | 1995-10-04 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1997-12-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
5F61113 / 3 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Condition aggravated,
Laboratory test abnormal,
Malaise,
Myasthenic syndrome,
Paraesthesia,
Rheumatoid arthritis,
Tenosynovitis,
Thrombocytopenia SMQs:, Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Arthritis (narrow), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: rheumatoid arthritis; Allergies: Diagnostic Lab Data: low blood platelets;elevated rheumatoid factor;carpal tunnel synd CDC Split Type:
Write-up: muscle fatigue/overall malaise poss rheumatoid arthritis recently dx; |
|
VAERS ID: |
105810 (history) |
Form: |
Version 1.0 |
Age: |
44.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1997-11-02 |
Onset: | 1997-11-06 |
Days after vaccination: | 4 |
Submitted: |
1997-12-16 |
Days after onset: | 40 |
Entered: |
1997-12-22 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Depressed level of consciousness,
Dyspnoea,
Hypoxia,
Neuropathy,
Oedema,
Paraplegia,
Sarcoma SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: NKA; Allergies: Diagnostic Lab Data: oncologists, radiologists stated nothing went wrong during chemo w/either doses or type of administration;MRI revealed swelling around spinal cord; CDC Split Type:
Write-up: 2NOV97 pt recv vax & pre-adm to hosp for chemo;6NOV97 d/c in AM general weakness, SOB, neuropathy;by 930PM 100% vent dependent, paralysis, tetra plegic;dx & tx for neuroblastoma; |
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