|
VAERS ID: |
28571 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11206 / UNK |
- / A |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Myalgia,
Pain,
Pharyngitis,
Pyrexia,
Rash SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: not available Allergies: Diagnostic Lab Data: not available CDC Split Type: CO3721
Write-up: Prolonged intermittant fever, myalgias, fatiguing; Initial rash, especially inject arm; Pharyngitis/pleuritic discomfort; |
|
VAERS ID: |
28572 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Female |
Location: |
Montana |
Vaccinated: | 0000-00-00 |
Onset: | 1990-11-14 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0J11163 / UNK |
- / A |
Administered by: Unknown Purchased by: Unknown Symptoms: Hypertonia,
Oedema,
Vasodilatation SMQs:, Cardiac failure (broad), Anaphylactic reaction (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), Cardiomyopathy (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: not available Allergies: Diagnostic Lab Data: not available CDC Split Type: CO3723
Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year; |
|
VAERS ID: |
28573 (history) |
Form: |
Version 1.0 |
Age: |
46.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Dermatitis bullous,
Necrosis SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: not available Allergies: Diagnostic Lab Data: not available CDC Split Type: CO3724
Write-up: Diffuse rash w/bullae 7 days post inject; Area around umbilicus showing early signs of necrosis; |
|
VAERS ID: |
28575 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 1989-09-18 |
Onset: | 1989-09-21 |
Days after vaccination: | 3 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Eczema SMQs:, Hypersensitivity (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Guarem, Atenol, Digoxin, Euglucon N, Diformin retard Current Illness: Preexisting Conditions: not available Allergies: Diagnostic Lab Data: not available CDC Split Type: CO3375
Write-up: Ezema allergicum; No known egg allergy; Previous vaccinations w/Fluzone 2x in''86, 1x in ''87, 1x in"88; |
|
VAERS ID: |
28576 (history) |
Form: |
Version 1.0 |
Age: |
72.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 1989-09-26 |
Onset: | 1989-09-28 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site hypersensitivity,
Injection site oedema,
Injection site reaction,
Pruritus SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: NA Allergies: Diagnostic Lab Data: not available CDC Split Type: CO3376
Write-up: Erythematous area of 10cm @ inject site w/intact skin, burning, itchy & slightly swollen; |
|
VAERS ID: |
28577 (history) |
Form: |
Version 1.0 |
Age: |
30.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 1989-10-16 |
Onset: | 1989-10-17 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Diarrhoea,
Headache,
Hyperhidrosis,
Injection site pain,
Nausea SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: NA Allergies: Diagnostic Lab Data: NA CDC Split Type: CO3679
Write-up: Diaphoresis, nausea, h/a upon awakening; Headache all day & p/dinner, diarrhea; pain @ inject site, unable to sleep on her arm; |
|
VAERS ID: |
28578 (history) |
Form: |
Version 1.0 |
Age: |
10.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 1989-10-17 |
Onset: | 1989-10-17 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
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: NA Allergies: Diagnostic Lab Data: NA CDC Split Type: CO3680
Write-up: Urticaria, mild, less tha 6 hrs duration; |
|
VAERS ID: |
28340 (history) |
Form: |
Version 1.0 |
Age: |
58.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 1990-11-09 |
Onset: | 1990-11-20 |
Days after vaccination: | 11 |
Submitted: |
1991-02-14 |
Days after onset: | 86 |
Entered: |
1991-02-18 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
PD02680P / UNK |
LA / IM |
Administered by: Other Purchased by: Public Symptoms: Asthenia,
Back pain,
Guillain-Barre syndrome,
Paralysis SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
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: ~ ()~~~In patient Other Medications: Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: Information from hosp. has not yet been received. CDC Split Type:
Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91 |
|
VAERS ID: |
28359 (history) |
Form: |
Version 1.0 |
Age: |
47.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1990-10-31 |
Onset: | 1990-12-10 |
Days after vaccination: | 40 |
Submitted: |
1991-02-15 |
Days after onset: | 67 |
Entered: |
1991-02-18 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908205 / 2 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Facial palsy,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Prednisone, Lopressor, Lasix, Vasotec Current Illness: Preexisting Conditions: Lupus, hypertension Allergies: Diagnostic Lab Data: EMG-polyneuropathy, EEG-normal CDC Split Type:
Write-up: Numbness, tingling, face hands, feet. Paralysis, face. Weakness, upper & lower extremities |
|
VAERS ID: |
28362 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-11-08 |
Onset: | 1990-11-18 |
Days after vaccination: | 10 |
Submitted: |
1991-01-25 |
Days after onset: | 68 |
Entered: |
1991-02-18 |
Days after submission: | 24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11203 / 1 |
LA / IM |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
285909 / 1 |
RA / SC |
Administered by: Public Purchased by: Public Symptoms: Arthralgia,
Cough,
Gait disturbance,
Headache,
Influenza,
Pain,
Pharyngitis,
Rhinitis SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient Other Medications: none Current Illness: none Preexisting Conditions: hx of prostate CA Allergies: Diagnostic Lab Data: xray hip-showed arthritis CDC Split Type: CA9118
Write-up: 8-10 days /p vax pt felt cold sxss, sneezing,"sick all over",10 days /p that aching in lt arm &rt hip.2 wks later aching in lt hip &rt arm, ache cont''s, difficult to raise arm &walk, Seen by MD TX:Cortisone & meds, Still has cold |
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