|
VAERS ID: |
109033 (history) |
Form: |
Version 1.0 |
Age: |
76.0 |
Sex: |
Female |
Location: |
Louisiana |
Vaccinated: | 1997-10-20 |
Onset: | 1997-11-03 |
Days after vaccination: | 14 |
Submitted: |
1998-03-31 |
Days after onset: | 148 |
Entered: |
1998-04-01 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
LA / - |
Administered by: Public Purchased by: Other Symptoms: Hypokinesia,
Muscle twitching,
Paraesthesia,
Skin nodule SMQs:, Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: high BP Allergies: Diagnostic Lab Data: NOEN CDC Split Type:
Write-up: bumping, muscle twitching & numbness in arm, arm can hardly be used; |
|
VAERS ID: |
110508 (history) |
Form: |
Version 1.0 |
Age: |
57.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1996-11-19 |
Onset: | 1996-12-02 |
Days after vaccination: | 13 |
Submitted: |
1998-04-27 |
Days after onset: | 510 |
Entered: |
1998-04-30 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
6F71226 / UNK |
- / A |
Administered by: Private Purchased by: Public 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: glyburide Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: studies performed @ hosp CDC Split Type:
Write-up: pt devel sx consistent w/GBS w/in 1 2k of vax;as a result pt sought ER care;pt later adm to rehab on 26DEC96 for 37 days of in-patient care;pt resulting dx is GBS; |
|
VAERS ID: |
111667 (history) |
Form: |
Version 1.0 |
Age: |
28.0 |
Sex: |
Female |
Location: |
Kentucky |
Vaccinated: | 1997-10-25 |
Onset: | 1997-12-20 |
Days after vaccination: | 56 |
Submitted: |
1998-06-05 |
Days after onset: | 166 |
Entered: |
1998-06-10 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Public Purchased by: Private Symptoms: Convulsion,
Hypertonia,
Multiple sclerosis,
Muscle spasms,
Paraesthesia,
Speech disorder,
Thinking abnormal SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Hypokalaemia (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: MRI X 2; CDC Split Type:
Write-up: pt became numb, spasms, sent to neurologist, dx multiple sclerosis; |
|
VAERS ID: |
111958 (history) |
Form: |
Version 1.0 |
Age: |
36.0 |
Sex: |
Female |
Location: |
North Carolina |
Vaccinated: | 1991-11-01 |
Onset: | 1991-11-27 |
Days after vaccination: | 26 |
Submitted: |
1998-06-16 |
Days after onset: | 2392 |
Entered: |
1998-06-18 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 2 |
UN / UN |
Administered by: Private Purchased by: Private Symptoms: Activities of daily living impaired,
Arthralgia,
Cognitive disorder,
Disorientation,
Food allergy,
Fungal infection,
Immune system disorder,
Memory impairment,
Multiple chemical sensitivity,
Muscular weakness,
Speech disorder,
Thinking abnormal SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Hypoglycaemia (broad), Dehydration (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? No
Previous Vaccinations: Other Medications: Trazodone Current Illness: NONE; Depression; Anxiety Preexisting Conditions: Depression Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt recv vax & devel chronic fatigue immune dysfunction synd;pt out of work x 5yr;pt was working full time a/the vax; 3/6/08 Reviewed outpatient clinic records of 8/2006-1/2008. Clinic states only records available. These records indicated chronic fatigue syndrome initially diagnosed 11/1991 s/p flu shot. Moved to MH group home 4/2007. Several ER visits for UTI & asthma. PMH: atopic dermatitis/ateatotic dermatitis; rosacea; skin tags; depression; chronic dysthymia disorder w/insomnia & anxiety; alcohol abuse; migraines; asthma; genital herpes; seasonal allergies; GERD; IBS; impaired fasting glucose; family hx of diabetes; umbilical hernia repair w/mesh; obesity; uterine fibroids; pre-glaucoma; ALLERGIES: PCN, sulfa, vaccines Per 60 day follow up: Residual symptoms are chronic fatigue, cognitive function problems, calculation difficulties, memory disturbance, spatial disorientation, frequently saying the wrong word, depression, insomnia, migrane, muscular weakness, severe allergies & asthma, joint pain, IBS, multiple sensitivities to chemicals, meds & food, recurring yeast bacterial infections. It is required by law that a doctor report vaccine reactions, did they? I have been son sick since Nov. 1991 that I have not even been able to get help and no money to get it. I have to live off of $356.00 a month. Are they going to help me. Follow-up: I do not have the information you requested. I have not been able to work since the flu shot in November 91. (I think it was the day before Thanksgiving I can''t think of anything more cruel than to not help someone after they have a reaction. I was to sick to do anything but go to doctors. 02/05/2010 Follow up: Fatigue, cognitive function problems and calculation difficultiesm memory problems, depression, anxiety, insomnia, can''t work anymore, myalgic encephalomyelitis (chronic). |
|
VAERS ID: |
113259 (history) |
Form: |
Version 1.0 |
Age: |
51.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 1994-10-01 |
Onset: | 0000-00-00 |
Submitted: |
1998-08-03 |
Entered: |
1998-08-06 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Amblyopia,
Ear pain,
Eye disorder,
Headache,
Myalgia,
Pyrexia,
Visual disturbance,
Visual field defect SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: MPI981625B
Write-up: pt recv influenza vax became febrile with chills and myalgias. 4 wk later devel ear pain, h/a, blurry vision (both eyes). Eye exam acuity of 25/50 OD-20/25 OS visual field defect OD and super nasal defect OS, both optic disc edematous; |
|
VAERS ID: |
113260 (history) |
Form: |
Version 1.0 |
Age: |
47.0 |
Sex: |
Female |
Location: |
Indiana |
Vaccinated: | 1994-10-01 |
Onset: | 0000-00-00 |
Submitted: |
1998-08-03 |
Entered: |
1998-08-06 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Amblyopia,
Eye disorder,
Eye pain,
Immunoglobulins increased,
Optic atrophy,
Red blood cell sedimentation rate increased,
Visual disturbance,
Visual field defect SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (narrow), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (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: Current Illness: Preexisting Conditions: Mild strabismic amblyopia in right eye. Allergies: Diagnostic Lab Data: serum protein electrophoresis w/immunofixation showed a nonspecific polyclonal hypergammglobulinemia;westergren test indicated sed rate midly elevated @ 44; CDC Split Type: MPI981625A
Write-up: pt exp decrease vision OD & transient eye pain. Later devel blurriness in left eye, superior accurate defect OD, inferior latitudinal defect OS. Both optic discs moderately edematous w/ splinter hemorrhages & couon-wool spots;atrophy disc |
|
VAERS ID: |
113466 (history) |
Form: |
Version 1.0 |
Age: |
51.0 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: | 1997-10-18 |
Onset: | 0000-00-00 |
Submitted: |
1998-05-29 |
Entered: |
1998-08-11 |
Days after submission: | 74 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4978150 / 3 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Amblyopia,
Eye disorder,
Infection,
Optic neuritis,
Visual disturbance SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Ocular infections (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: unk Current Illness: NONE Preexisting Conditions: newly diagnosed diabetic Allergies: Diagnostic Lab Data: CDC Split Type: 898154004A
Write-up: pt recv vax 18OCT97 & pt devel a blind spot in the lt eye & was seen by ophthalmologist;pt reported this event to primary MD in APR98; |
|
VAERS ID: |
114199 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1998-01-06 |
Entered: |
1998-09-18 |
Days after submission: | 254 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / 2 |
- / - |
Administered by: Other Purchased by: Other Symptoms: Optic neuritis,
Visual disturbance SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Ocular infections (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: pt devel bilat optic neuritis p/vax;~ ()~~~In patient Other Medications: unk Current Illness: unk Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 898245018A
Write-up: pt devel acute loss of vision in both eyes 17 days p/vax;dx bilat optic neuritis made & pt treated w/IV corticosteriods;hosp is presumed, although not documented;visual acuity in rt eye returned to 20/30;only able to perceive light in lt ey |
|
VAERS ID: |
114487 (history) |
Form: |
Version 1.0 |
Age: |
81.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1997-10-27 |
Onset: | 1997-10-28 |
Days after vaccination: | 1 |
Submitted: |
1998-09-24 |
Days after onset: | 330 |
Entered: |
1998-09-29 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Other Symptoms: Deafness permanent SMQs:, Hearing impairment (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: Elthyroxin;Calan Current Illness: unk Preexisting Conditions: unk Allergies: Diagnostic Lab Data: MRI CDC Split Type: FLU86220998
Write-up: partial deafness |
|
VAERS ID: |
114731 (history) |
Form: |
Version 1.0 |
Age: |
47.0 |
Sex: |
Female |
Location: |
Alabama |
Vaccinated: | 1997-11-12 |
Onset: | 1998-03-01 |
Days after vaccination: | 109 |
Submitted: |
1998-10-02 |
Days after onset: | 214 |
Entered: |
1998-10-05 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E20067KF / 1 |
RA / - |
Administered by: Other Purchased by: Private Symptoms: Anorexia,
Asthenia,
Delirium,
Depressed level of consciousness,
Diarrhoea,
Dizziness,
Hypokinesia,
Myelitis,
Neuropathy,
Paraesthesia SMQs:, Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (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 (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (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, 5 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: transverse myelitis CDC Split Type: AL9811
Write-up: numbness in body, dizzy, extreme weakness, hard to walk;inflammation in brain & spinal cord;no cure only tx is steroids; transverse myelitis; |
|