|
VAERS ID: |
117422 (history) |
Form: |
Version 1.0 |
Age: |
61.0 |
Sex: |
Male |
Location: |
Alabama |
Vaccinated: | 1997-10-15 |
Onset: | 1997-10-16 |
Days after vaccination: | 1 |
Submitted: |
1998-12-10 |
Days after onset: | 420 |
Entered: |
1998-12-16 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Military Purchased by: Other Symptoms: Deafness permanent,
Neuropathy SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Hearing impairment (narrow), 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: Other Medications: UNK Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Pt referred to two other M.D.s (Hagood & Pappas) CDC Split Type:
Write-up: Pt recv vax on 10/15/97; on 10/16/97 pt exp unable to hear (75% loss) in left ear/ nerve damage; tx=Prednisone; Annual follow-up dated 2/21/01 provided no additional data. |
|
VAERS ID: |
118116 (history) |
Form: |
Version 1.0 |
Age: |
44.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1998-10-01 |
Onset: | 0000-00-00 |
Submitted: |
1999-01-12 |
Entered: |
1999-01-14 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E20168HC / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Mydriasis,
Retinal oedema,
Visual disturbance SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: unk Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type: MPI199900013
Write-up: pt recv vax & exp retinal edema 4-6wk p/vax;pt exp loss of vision & dilated pupils & was seen by ophthalmologist;ophthalmologist dx retinal edema;pt reports vision is getting better;MD reported adverse event has now resolved; |
|
VAERS ID: |
118329 (history) |
Form: |
Version 1.0 |
Age: |
86.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1998-11-04 |
Onset: | 1998-11-05 |
Days after vaccination: | 1 |
Submitted: |
1999-01-20 |
Days after onset: | 76 |
Entered: |
1999-01-26 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS |
02198P / UNK |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Coordination abnormal,
Guillain-Barre syndrome,
Hypertension,
Hypokinesia,
Myasthenic syndrome,
Oedema peripheral SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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: Other Medications: dyazide, premarin,ibuprofen Current Illness: None Preexisting Conditions: edema ankles, allergic codeine, episodes of weakness since 8/98 Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt exp onset of lower extremity weakness;pt could hardly walk around;very weak;balance is not good;BP 172/80;wide base gait that is unsteady;edema in ankles;possible GBS;Annual follow-up dated 10/4/00 provided no additional data. |
|
VAERS ID: |
118630 (history) |
Form: |
Version 1.0 |
Age: |
63.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 1998-10-22 |
Onset: | 1998-10-22 |
Days after vaccination: | 0 |
Submitted: |
1999-02-05 |
Days after onset: | 106 |
Entered: |
1999-02-09 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E8102EA1 / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Deafness 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Glucophage, Capoten, Deltacotril, Clarityn Current Illness: NONE Preexisting Conditions: Diabetes mellitus, Hypertension & Cystosarcoma phyllodes; Right sided hearing loss Allergies: Diagnostic Lab Data: CT brain/MRI scan-negative, Blood tests-normal CDC Split Type: MPU199900047
Write-up: Pt recv vax on 10/22/98; a few hours post vax pt exp acute onset left sided sensorineural hearing loss, Annual follow-up received on 10/2/00 provided no additional data. |
|
VAERS ID: |
118885 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1998-11-01 |
Onset: | 1998-11-02 |
Days after vaccination: | 1 |
Submitted: |
1999-02-10 |
Days after onset: | 100 |
Entered: |
1999-02-11 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
- / 1 |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Arthritis,
Asthenia,
Condition aggravated,
Granuloma,
Hypokinesia,
Laboratory test abnormal,
Myalgia,
Oedema peripheral,
Pain,
Serum sickness,
Vasculitis SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (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: Other Medications: Current Illness: Preexisting Conditions: pt has always had fibromyalgia;hayfever;allergy to ragweed,dust,trees Allergies: Diagnostic Lab Data: NONE CDC Split Type: MPI199900056
Write-up: pt exp achiness in deltoid region & groin & had no energy p/vax (date unclear);10 days p/onset pt saw MD who dx polymyalgia rheumatica & prescribed pred;approx 1mo later seen by rheumatologist who slowly took pt off med;swollen hands, tired Annual follow-up received on 10/2/00 provided no additional data. |
|
VAERS ID: |
119335 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1998-10-22 |
Onset: | 1998-10-23 |
Days after vaccination: | 1 |
Submitted: |
1999-02-19 |
Days after onset: | 119 |
Entered: |
1999-02-24 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS |
02888P / 7+ |
LA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Condition aggravated,
Myelitis,
Neuropathy,
Paraesthesia,
Salivary gland enlargement,
Skin disorder SMQs:, Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: Other Medications: arthritis Current Illness: Preexisting Conditions: arthritis;Reiter''s syndrome Allergies: Diagnostic Lab Data: MRI of spine;LP CDC Split Type:
Write-up: transverse myelitis of cervical & thoracic spinal cord; |
|
VAERS ID: |
121167 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Male |
Location: |
Kentucky |
Vaccinated: | 1996-07-01 |
Onset: | 1997-05-08 |
Days after vaccination: | 311 |
Submitted: |
1999-04-08 |
Days after onset: | 700 |
Entered: |
1999-04-13 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
6F71288 / 1 |
RA / - |
Administered by: Public Purchased by: Unknown Symptoms: Dysphagia,
Eyelid ptosis,
Guillain-Barre syndrome,
Hypokinesia,
Hypoxia,
Influenza,
Paralysis,
Pneumonia,
Respiratory disorder,
Sepsis SMQs:, Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 365 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: Preexisting Conditions: liver problems; sickle cell trait Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt got sick on 8MAY97 w/flu like sx;on 12MAY97 put in ICU for 6wk then sent to hosp for 11months;pt was paralyzed & on a respirator & blood infect & pneumonia & up in a wheel chair & a walker;GBS |
|
VAERS ID: |
121234 (history) |
Form: |
Version 1.0 |
Age: |
51.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1998-10-16 |
Onset: | 1998-12-02 |
Days after vaccination: | 47 |
Submitted: |
1999-04-01 |
Days after onset: | 120 |
Entered: |
1999-04-15 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0972870 / 4 |
LA / IM |
Administered by: Other Purchased by: Private Symptoms: Dysgeusia,
Dysphagia,
Eye disorder,
Facial palsy,
Headache,
Malaise,
Nausea SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (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: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: sulfa allergy Allergies: Diagnostic Lab Data: CBC;Chem screen; CDC Split Type:
Write-up: p/vax pt did not feel well, had waves of nausea until 2DEC lt eye weak;had difficulty w/drinking, h/a;5DEC Bell''s palsy dx, tx w/pred; as of 1APR cont w/altered taste & lt eye vague weakness; |
|
VAERS ID: |
122394 (history) |
Form: |
Version 1.0 |
Age: |
38.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 1998-10-05 |
Onset: | 1998-10-14 |
Days after vaccination: | 9 |
Submitted: |
1999-04-21 |
Days after onset: | 189 |
Entered: |
1999-05-24 |
Days after submission: | 33 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 4 |
- / - |
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 2 |
- / - |
Administered by: Military Purchased by: Military Symptoms: Deafness,
Immune system disorder,
Neuropathy,
Paraesthesia,
Tinnitus,
Vestibular disorder SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (narrow), 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: Other Medications: Current Illness: NONE Preexisting Conditions: allergy to ASA & Bees; fibromyalgia, chronic fatigue; MVA w/ L5-S1 disc protrusion (not contacting neural elements) Allergies: Diagnostic Lab Data: MRI-no abnormalities, audiogram, full ENT & Neuro exam; CDC Split Type:
Write-up: Stenger test negative 6-8000 Hz, profound high range hearing loss in lt ear; constant tinnitus; dx -immune reactive 8th nerve damage; Annual follow-up states the pt has not yet recovered. |
|
VAERS ID: |
124939 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1998-11-01 |
Onset: | 1998-11-02 |
Days after vaccination: | 1 |
Submitted: |
1999-06-14 |
Days after onset: | 223 |
Entered: |
1999-06-17 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Bone disorder,
Condition aggravated,
Gangrene,
Hyperglycaemia,
Infection,
Influenza,
Oedema SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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: Other Medications: Amaryl Current Illness: Diabetes Preexisting Conditions: pt has a 5 year hx of non-insulin dependent diabetes Allergies: Diagnostic Lab Data: bone scan positive for bone disease;later positive cult for staph CDC Split Type: U199900397
Write-up: 1 day p/vax pt exp severe flu like sx for next 6-7 days;pt notice rise in home monitored blood sugar level $g300 to 400;pt exp swelling in both great toes;saw MD & determined to have bone disease;toes damaged & gangrene;great toes amputated; |
|