|
VAERS ID: |
105846 (history) |
Form: |
Version 1.0 |
Age: |
67.0 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1997-12-01 |
Entered: |
1997-12-23 |
Days after submission: | 22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / 3 |
- / - |
Administered by: Private Purchased by: Other Symptoms: Cough,
Deafness,
Ear disorder,
Haemorrhage,
Influenza,
Visual disturbance SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: unk; Current Illness: none; Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 897338015L
Write-up: exp flu like sx w/ heavy cough; cough was described as "an explosion w/in the body disrupting the nl function". pt stated that as result of coughing, he exp "degradation of sight",bleeding "into the ear";as result of bleeding, lost hearing |
|
VAERS ID: |
105847 (history) |
Form: |
Version 1.0 |
Age: |
68.0 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 1997-10-04 |
Onset: | 0000-00-00 |
Submitted: |
1997-12-01 |
Entered: |
1997-12-23 |
Days after submission: | 22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / 4 |
- / - |
Administered by: Private Purchased by: Other Symptoms: Cough,
Visual disturbance SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: exp flu like sx and coughing following vax;degradation of sight, hearing loss;~ ()~~~In patient Other Medications: unk; Current Illness: none; Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 897338016L
Write-up: devel "bout of coughing" described as "an explosion w/in the body disrupting the nl function". exp "degradation of sight" as a result of coughing; prior to oct 04, he only required reading glasses; |
|
VAERS ID: |
105857 (history) |
Form: |
Version 1.0 |
Age: |
10.0 |
Sex: |
Male |
Location: |
Utah |
Vaccinated: | 1997-11-03 |
Onset: | 1997-11-04 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1997-12-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4178150 / 1 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Hypertonia,
Laboratory test abnormal,
Oedema peripheral,
Pain,
Peripheral vascular disorder SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypokalaemia (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: ADHD on Ritalin Allergies: Diagnostic Lab Data: CBC and sed rate nl; doppler flow study abnl; CDC Split Type:
Write-up: pain and swelling in lt hand 1 day after getting shot, lasted 5 days then devel pain and swelling in lt foot which persisted for 1month; foot cold; |
|
VAERS ID: |
105910 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1997-10-24 |
Onset: | 1997-11-19 |
Days after vaccination: | 26 |
Submitted: |
1997-12-08 |
Days after onset: | 19 |
Entered: |
1997-12-30 |
Days after submission: | 22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Atrioventricular block,
Coordination abnormal,
Myelitis,
Paraesthesia,
Paraplegia SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Conduction defects (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Prinvil;Estrace;ASA Current Illness: unk Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 897343012L
Write-up: 24 days p/vax pt devel ataxia & tingling in legs;dx of transverse myelitis made & pt was hosp; |
|
VAERS ID: |
105940 (history) |
Form: |
Version 1.0 |
Age: |
39.0 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: | 1997-11-13 |
Onset: | 1997-11-18 |
Days after vaccination: | 5 |
Submitted: |
1997-12-26 |
Days after onset: | 38 |
Entered: |
1998-01-05 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
7F81863 / 4 |
LA / - |
Administered by: Other Purchased by: Unknown Symptoms: Optic neuritis SMQs:, Optic nerve disorders (narrow), Demyelination (narrow), Ocular infections (broad), Immune-mediated/autoimmune disorders (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? No
Previous Vaccinations: pt exp optic neuritis @ 38yr old;~ ()~~~In patient Other Medications: Zoloft Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: optic neuritis 6 days post vax; |
|
VAERS ID: |
106149 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Female |
Location: |
North Dakota |
Vaccinated: | 1994-10-04 |
Onset: | 0000-00-00 |
Submitted: |
1997-12-28 |
Entered: |
1998-01-07 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4948108 / UNK |
LA / - |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
378977 / UNK |
RA / - |
Administered by: Private Purchased by: Private Symptoms: Back pain,
Dysphagia,
Facial palsy,
Guillain-Barre syndrome,
Hypokinesia,
Muscle spasms,
Myasthenic syndrome,
Paraesthesia SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related conditions (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Demyelination (narrow), Hearing impairment (broad), Hypotonic-hyporesponsive episode (broad), Immune-mediated/autoimmune disorders (narrow)
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, 60 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Glynaise;Lotensin Current Illness: newly dx diabetes;hypertension, hiatal hernia, glaucoma Preexisting Conditions: newly dx diabetes, HTN, hiatal hernia, glaucoma; Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: GBS;severe back pain, leg cramps/fingers & toes numb;finally couldn''t walk, facial paralysis, half smile;couldn''t roll over w/o help;hard time swallowing couldn''t close eyes;p/2mo in hosp had to learn to walk again but legs feel heavy; |
|
VAERS ID: |
106310 (history) |
Form: |
Version 1.0 |
Age: |
90.0 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 1995-10-18 |
Onset: | 1995-10-18 |
Days after vaccination: | 0 |
Submitted: |
1995-10-27 |
Days after onset: | 9 |
Entered: |
1998-01-12 |
Days after submission: | 808 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4958126 / 5 |
LA / IM |
Administered by: Private Purchased by: Unknown Symptoms: Cerebral haemorrhage,
Confusional state,
Headache SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (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, 6 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Ibuprofen Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CT Scan & MRI-intracranial hemorrhage; CDC Split Type: WA971413
Write-up: 45min post inj devel h/a & confusion found shortly thereafter to have had in intracranial hemorrhage; |
|
VAERS ID: |
106323 (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: |
1998-01-07 |
Days after onset: | 62 |
Entered: |
1998-01-13 |
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: Asthenia,
Guillain-Barre syndrome,
Hypoxia,
Paralysis SMQs:, Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Dilantin, decadron 9started in JUL post op brain surg) Current Illness: glioblastoma Preexisting Conditions: before dx glioblasma, excellent health before & ater; Allergies: Diagnostic Lab Data: several CT scans, MRI, blood work, etc;refused to test for GBS; CDC Split Type:
Write-up: quadriplegia & 100% vent assisted;pt too weakened to cont w/chemotherapy;prognosis is less than 2mo; |
|
VAERS ID: |
107033 (history) |
Form: |
Version 1.0 |
Age: |
61.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 1997-11-07 |
Onset: | 1997-11-09 |
Days after vaccination: | 2 |
Submitted: |
1998-01-16 |
Days after onset: | 68 |
Entered: |
1998-01-28 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
7F81719 / 2 |
- / IM |
Administered by: Unknown Purchased by: Public Symptoms: Diplopia,
Eye disorder,
Gait disturbance,
Headache,
Neuropathy,
Vomiting SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: GLucophage;Glyburide;Prevacid;Norvasc;HCTZ;Cardura;Lotension;baby ASA Current Illness: NONE Preexisting Conditions: diabetes/hypertension/NKDA Allergies: Diagnostic Lab Data: EEG, head scan, brain stem study-MRI/enhanced-echogram CDC Split Type:
Write-up: n/v, h/a (double vision, unable to focus, staggering gait;eye movement rt dec 80degree out to rt;has improved 95%;3rd cranial nerve +; |
|
VAERS ID: |
107091 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Female |
Location: |
Iowa |
Vaccinated: | 1995-10-26 |
Onset: | 1995-10-26 |
Days after vaccination: | 0 |
Submitted: |
1998-01-22 |
Days after onset: | 819 |
Entered: |
1998-01-30 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
5F61126 / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Confusional state,
Gait disturbance,
Nausea,
Neuropathy,
Pain,
Paraesthesia SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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, 7 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Furosomide;Spironolactone:Atenolol;Cardizem CD;Synthroid;Premarin;Zocor;HumulinN;Humulin R;Multivitamin; Vitamin E;Calcium; Current Illness: Preexisting Conditions: diabetes; Allergies: Diagnostic Lab Data: CAT Scan, MRI, Spinal Tap, Brain Function Testing, Daily Blood Testing for 7 days in hosp, Muscle Testing w/needles, etc; CDC Split Type:
Write-up: pt disoriented, nauseous & felt ill;pt exp no feeling on rt side of body;body totally affected w/paralysis;lt leg numb;walks w/sl limp-rt leg very painful diff & painful to walk;legs stiff;no energy;dx diabetic neuropathy; |
|