|
VAERS ID: |
115912 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 1998-10-28 |
Onset: | 1998-10-28 |
Days after vaccination: | 0 |
Submitted: |
1998-10-30 |
Days after onset: | 2 |
Entered: |
1998-11-06 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS |
02298P / UNK |
RA / - |
Administered by: Public Purchased by: Public Symptoms: Apnoea,
Cardiac arrest,
Chest pain SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-10-29
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient Other Medications: Current Illness: unk Preexisting Conditions: unk Allergies: Diagnostic Lab Data: unk CDC Split Type: FLU89161098
Write-up: pt recv vax 28OCT98 4PM;taken to Er @ approx 6Pm w/sudden onset of chest discomfort; |
|
VAERS ID: |
115913 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 1998-10-28 |
Onset: | 1998-10-28 |
Days after vaccination: | 0 |
Submitted: |
1998-10-30 |
Days after onset: | 2 |
Entered: |
1998-11-06 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS |
021198P / 2 |
- / IM |
Administered by: Other Purchased by: Private Symptoms: Apnoea,
Malaise,
Myocarditis,
Syncope,
Vomiting SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-10-29
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: unk Preexisting Conditions: allergic to PCN Allergies: Diagnostic Lab Data: drug toxicology drawn in ER; CDC Split Type: FLU89171098
Write-up: pt recv vax 6-8AM & on 28OCT98 pt vomited 10min later felt bad;went home & cont c/o not feeling well next day;drove husband to work & when arrived in parking lot lost consciousness & stopped breathing; |
|
VAERS ID: |
116127 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1998-09-29 |
Onset: | 1998-09-30 |
Days after vaccination: | 1 |
Submitted: |
1998-11-06 |
Days after onset: | 37 |
Entered: |
1998-11-10 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4988207 / 2 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Abdominal pain,
Blood amylase increased,
Infection,
Laboratory test abnormal,
Pancreatitis haemorrhagic,
Somnolence,
Stupor,
Vomiting SMQs:, Acute pancreatitis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-10-01
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: Stavudine;Videx liquid Current Illness: Preexisting Conditions: cogenital HIV+ from mother @ birth;never developed AIDS fefining illness;NKDA;followed by immunologist; Allergies: Diagnostic Lab Data: SEP98 CD4 count 1400 & viral load test of approx 8000;amylase 2125;blood lipase $g8000;autopsy included extensive microscopic studies;tissue stains yielded no organisms;brain examined by neuropathologist & found to be free of any AIDS; CDC Split Type:
Write-up: 30SEP98 exp malaise, abd complaints, sleepiness;taken to ER dx benign rxn to flu vax;taken home later devel vomiting;mom found child unresponsive taken back to ER;child pronounced in ER;autopsy had acute hemorrhagic pancreatitis; |
|
VAERS ID: |
116465 (history) |
Form: |
Version 1.0 |
Age: |
78.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1998-10-16 |
Onset: | 1998-10-25 |
Days after vaccination: | 9 |
Submitted: |
1998-11-12 |
Days after onset: | 18 |
Entered: |
1998-11-18 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E20228KC / 1 |
- / IM |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
455382 / 1 |
- / IM |
Administered by: Other Purchased by: Public Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-10-25
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: Accolate, Aerobid, albuterol, Isonizid, Zoloft, Pyridoxine, Ritalin, Theophyline; Current Illness: COPD, ASHD, CHF, HTN, resp failure, PRD Preexisting Conditions: NKA;COPD, ASHD, CHF, HTN, resp failure, PRD Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: no immed rxn, no adverse rxn @ site;no elevated pulse, temp; |
|
VAERS ID: |
116466 (history) |
Form: |
Version 1.0 |
Age: |
79.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1998-10-14 |
Onset: | 1998-10-20 |
Days after vaccination: | 6 |
Submitted: |
1998-11-12 |
Days after onset: | 23 |
Entered: |
1998-11-18 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E20228KC / 1 |
- / IM |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
454382 / 1 |
- / IM |
Administered by: Other Purchased by: Public Symptoms: Cardiac arrest,
Hypotension SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-10-20
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: Zestril, Norvasc, Lasix, Ritalin, Pepcid, ensure per tube Current Illness: CVA, CHF, NIDDM, ASHD, HTN, VHD, CAF, PVD, renal insufficiency, COPD Preexisting Conditions: PCN, cephalosporins;CVA, NIDDM, ASHD, HTN, VHD, CAF, PVD, renal insufficiency, COPD Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: no immediate rxn, no adverse rxn @ site, no acute distress resident found w/no BP, no pulse initiated CPR; |
|
VAERS ID: |
116744 (history) |
Form: |
Version 1.0 |
Age: |
47.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1998-10-20 |
Onset: | 0000-00-00 |
Submitted: |
1998-10-27 |
Entered: |
1998-11-24 |
Days after submission: | 28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0975790 / UNK |
RA / IM |
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0924000 / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Stupor,
Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-10-20
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient Other Medications: unk Current Illness: NONE Preexisting Conditions: schizophrenia;pt brother states pt stated had been advised to have heart surgery; Allergies: Diagnostic Lab Data: CDC Split Type: TX98164
Write-up: arrived @ ER via ambulance CPR in progress reported unconscious, unresponsive by family who called ambulance;CPR discontinued 815AM;no post mortem exam done; |
|
VAERS ID: |
116801 (history) |
Form: |
Version 1.0 |
Age: |
67.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1998-10-16 |
Onset: | 1998-10-17 |
Days after vaccination: | 1 |
Submitted: |
1998-11-09 |
Days after onset: | 23 |
Entered: |
1998-11-25 |
Days after submission: | 16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0978660 / UNK |
LA / IM |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
0871H / 1 |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Coronary artery disease,
Diabetes mellitus,
Unevaluable event SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Other ischaemic heart disease (narrow), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-10-17
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: Vasotec, lanoxin, coumadin, immodium PRN;insulin Current Illness: NONE Preexisting Conditions: CAD/diabetes Allergies: Diagnostic Lab Data: CDC Split Type: NJ9827
Write-up: pt expired w/in 24h of vax;no apparent allergic response; |
|
VAERS ID: |
117068 (history) |
Form: |
Version 1.0 |
Age: |
87.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1998-11-13 |
Onset: | 1998-11-14 |
Days after vaccination: | 1 |
Submitted: |
1998-11-16 |
Days after onset: | 2 |
Entered: |
1998-12-04 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 7+ |
- / - |
Administered by: Other Purchased by: Private Symptoms: Apnoea,
Cardiac arrest,
Dyspnoea,
Lung disorder,
Right ventricular failure SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-11-16
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Current Illness: NONE frail-depressed Preexisting Conditions: 18OCT98 resp infect-sx free 28OCT98 Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: COPD w/exacerbation;resp distress;expired 15NOV98 @ hosp;adm to hosp 14NOV98; |
|
VAERS ID: |
117527 (history) |
Form: |
Version 1.0 |
Age: |
61.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1998-09-11 |
Onset: | 1998-09-24 |
Days after vaccination: | 13 |
Submitted: |
0000-00-00 |
Entered: |
1998-12-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Apnoea,
Cachexia,
Condition aggravated,
Diarrhoea,
Dyspepsia,
Dyspnoea,
Hypotension,
Hypothermia,
Lung disorder,
Tachycardia SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Accidents and injuries (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-11-20
Days after onset: 57
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Theodur;Pred;Xanas;Azmacort;Synthroid;Aldactone;Lasix;KDUR;albuterol;atrovent;loxanol; Current Illness: no acute illness afeb;end state COPD; Preexisting Conditions: End Stage COPD; corpulmonale;HTN;Heart Failure Allergies: Diagnostic Lab Data: BP 104/70;T97.9;pulse 96;resp 20; CDC Split Type:
Write-up: pt exp diarrhea 24SEp;8hr later upset stomach;7hr later dyspnea; |
|
VAERS ID: |
117906 (history) |
Form: |
Version 1.0 |
Age: |
75.0 |
Sex: |
Male |
Location: |
Utah |
Vaccinated: | 1998-11-30 |
Onset: | 1998-12-01 |
Days after vaccination: | 1 |
Submitted: |
1998-12-23 |
Days after onset: | 22 |
Entered: |
1999-01-05 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
498819 / UNK |
LA / - |
Administered by: Private Purchased by: Public Symptoms: Condition aggravated,
Pyrexia,
Shock SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-12-02
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient Other Medications: Cordarone Current Illness: NONE Preexisting Conditions: Allergic to PCN, Irregular heart beat, ventricular arrhythmia(declined implantable defibrillator, CABG x3 in 1995, ischemic cardiomyapathy, heavy drinker, hearing aid Allergies: Diagnostic Lab Data: UNK CDC Split Type: UT981825
Write-up: Pt recv vax on 11/30/98; on 12/1/98 pt exp coldness, fever; on 12/2/98 pt exp hotness; collapsed; pt died |
|