|
VAERS ID: |
131045 (history) |
Form: |
Version 1.0 |
Age: |
85.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1999-10-05 |
Onset: | 1999-10-12 |
Days after vaccination: | 7 |
Submitted: |
0000-00-00 |
Entered: |
1999-11-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
49998293 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Coagulopathy,
Hypoxia,
Infection,
Pneumonia,
Pyrexia,
Respiratory disorder SMQs:, Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1999-10-25
Days after onset: 13
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Current Illness: chronic vertigo Preexisting Conditions: HTN;Hypothyroidism;Iron def anemia; Allergies: Diagnostic Lab Data: 10/25/99 positive viral cult for influenza A from a bronchial washing; CDC Split Type:
Write-up: p/vax pt c/o T103.8 & shaking chills;refused hosp adm;T104.6 R;adm to hosp;10/14/99 CXR showed ARDS & pneumonia;pt placed on ventilator;devel DIC;pt expired 10/25/99; |
|
VAERS ID: |
131449 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: | 1999-10-11 |
Onset: | 1999-10-24 |
Days after vaccination: | 13 |
Submitted: |
1999-11-03 |
Days after onset: | 10 |
Entered: |
1999-11-29 |
Days after submission: | 26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U011AB / 7+ |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1999-10-24
Days after onset: 0
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: 2 types insulin, synthroid, antidepressants-buspar;anapheril, Ritalin, flexaril, melatonin Current Illness: NONE; blood sugar nl 10/23, 10PM Preexisting Conditions: diabetes (for 37 years), Graves disease (for 20yrs), diabetic depression Allergies: Diagnostic Lab Data: CDC Split Type: MA9924
Write-up: pt was found dead 12.5 days p/vax; |
|
VAERS ID: |
131452 (history) |
Form: |
Version 1.0 |
Age: |
7.0 |
Sex: |
Female |
Location: |
Louisiana |
Vaccinated: | 1999-11-04 |
Onset: | 1999-11-07 |
Days after vaccination: | 3 |
Submitted: |
1999-11-15 |
Days after onset: | 8 |
Entered: |
1999-11-29 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U0167AA / 2 |
LL / - |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
0871H / 1 |
RL / - |
Administered by: Public Purchased by: Unknown Symptoms: Asphyxia,
Convulsion,
Injury SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1999-11-07
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: phenobarbital; Current Illness: NONE Preexisting Conditions: lissencephaly, microcephaly, sz disorer; Allergies: Diagnostic Lab Data: CDC Split Type: LA991103
Write-up: pt expired 11/7/99-COD accidental asphyxiation d/t lissencephaly, microcephaly; |
|
VAERS ID: |
131642 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 1999-10-26 |
Onset: | 1999-11-12 |
Days after vaccination: | 17 |
Submitted: |
1999-11-15 |
Days after onset: | 3 |
Entered: |
1999-12-02 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U1032AA / 5 |
LL / IM |
Administered by: Private Purchased by: Private Symptoms: Brain oedema,
Convulsion,
Encephalitis,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (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: 1999-11-15
Days after onset: 3
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: APAP, carbamazepine Current Illness: Preexisting Conditions: 30wk prematurity, triplet, mild BPD-resolved; hx of seizures, hx of encephalitis, bronchitis Allergies: Diagnostic Lab Data: nasopharyngeal culture 11/14/99: parainfluenzavirus type I CDC Split Type:
Write-up: brainstem & cerebellar edema leading to brain death adm 11/12/99 w/nl LP, MRI;f/u MRI 11/14/ brainstem, cerebellar edema prior hx of CNS problems p/last year''s vax also;acute demyelinating encephalomyelitis 10/98 w/bilat temporal lobe; Autopsy stated final diagnosis of seizure and fever, |
|
VAERS ID: |
132243 (history) |
Form: |
Version 1.0 |
Age: |
72.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 1999-10-05 |
Onset: | 1999-10-08 |
Days after vaccination: | 3 |
Submitted: |
1999-11-13 |
Days after onset: | 36 |
Entered: |
1999-12-07 |
Days after submission: | 24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U0063AA / UNK |
LA / IM |
Administered by: Private Purchased by: Unknown Symptoms: Apnoea,
Condition aggravated,
Hypoxia,
Lung disorder,
Respiratory disorder,
Right ventricular failure,
Sepsis,
Shock,
Urinary tract disorder SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (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), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1999-12-09
Days after onset: 62
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: polyarythemia/myclofibrodysplastia;cardiomyopathy Allergies: Diagnostic Lab Data: extemsive CDC Split Type:
Write-up: resp failure-ventilator support;aspiration;prob septic shock;CHF;60 day follow-up / states the pt died. The pt developed renal and pulmonary disorders and had to be intubated, was dialyzed before he died. |
|
VAERS ID: |
132417 (history) |
Form: |
Version 1.0 |
Age: |
73.0 |
Sex: |
Male |
Location: |
Kentucky |
Vaccinated: | 1999-10-18 |
Onset: | 0000-00-00 |
Submitted: |
1999-11-29 |
Entered: |
2000-01-06 |
Days after submission: | 38 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS |
031779P / UNK |
RA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Right ventricular failure SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1999-10-22
Permanent Disability? No
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: KY990062
Write-up: Death due to CHF, no autopsy. |
|
VAERS ID: |
133836 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1999-11-29 |
Onset: | 1999-12-24 |
Days after vaccination: | 25 |
Submitted: |
2000-01-28 |
Days after onset: | 35 |
Entered: |
2000-02-09 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U0104AA / UNK |
RA / IM |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
0043J / UNK |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Cardiac arrest,
Guillain-Barre syndrome SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Cardiomyopathy (broad), Demyelination (narrow), Respiratory failure (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2000-05-22
Days after onset: 149
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Norvase, Dilantin Current Illness: NONE Preexisting Conditions: Seizure disorder, HTP Allergies: Diagnostic Lab Data: + CP and FMG CDC Split Type:
Write-up: Pt was dx w/ Guillian-Barre. Cause of death given as cardiac arrest. |
|
VAERS ID: |
134575 (history) |
Form: |
Version 1.0 |
Age: |
50.0 |
Sex: |
Female |
Location: |
Kansas |
Vaccinated: | 1999-10-20 |
Onset: | 1999-10-21 |
Days after vaccination: | 1 |
Submitted: |
2000-03-02 |
Days after onset: | 133 |
Entered: |
2000-03-07 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U0155AA / UNK |
- / IM A |
Administered by: Public Purchased by: Public Symptoms: Malaise SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1999-11-12
Days after onset: 22
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Being considered for liver transplant. Preexisting Conditions: Hx: Hep B, Hep C, Cirrhosis of liver. Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Sister of pt stopped by clinic to pay for vax. Stated that flu shot caused sister''s death. Began to feel ill next day. Transported to ER on 11/12 by ambulance, died few hrs later. Stated pt didn''t see MD between 10/20 & 11/12/99. |
|
VAERS ID: |
150155 (history) |
Form: |
Version 1.0 |
Age: |
74.0 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: | 1999-11-15 |
Onset: | 1999-11-20 |
Days after vaccination: | 5 |
Submitted: |
2000-03-08 |
Days after onset: | 109 |
Entered: |
2000-03-17 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U0163AA / UNK |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Hallucination,
Headache SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
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: Other Medications: B12 shot Current Illness: NONE Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided. |
|
VAERS ID: |
151799 (history) |
Form: |
Version 1.0 |
Age: |
44.0 |
Sex: |
Male |
Location: |
Oregon |
Vaccinated: | 1999-10-01 |
Onset: | 1999-10-05 |
Days after vaccination: | 4 |
Submitted: |
2000-04-28 |
Days after onset: | 206 |
Entered: |
2000-05-10 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Neoplasm,
Quadriplegia,
Respiratory arrest,
Respiratory failure SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow), Non-haematological tumours of unspecified malignancy (narrow), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
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: Other Medications: Carboplatin, etoposide phosphate, cyclophosphamide. Current Illness: Preexisting Conditions: glioblastoma multiforme located in occipital region Allergies: Diagnostic Lab Data: probable cause of death-progression of tumor and respiratory failure CDC Split Type: MPU2000002450
Write-up: This case concerns male who had had influenza vax 48 hours prior to chemotherapy. On day 3, after the carboplatin based tridrug chemotherapy with blood brain-barrier disruption (vertebral artery), he experienced respiratory arrest and rapid progression of quadriparesis. The pt remained quadriparetic and ventilator dependent and died 75 days after chemotherapy treatment. The authors conclude that the pathophysiology of the complication seen in the 7 pts is multi-factorial but may be related to vascular streaming and an atypical inflammatory toxic reaction to carboplatin or etoposide. The complication has not recurred during a 6 month period following modification of the protocol. Date of vax and onset not specified and therefore assumed to be associated with the 1999/1999 influenza season. |
|