|
VAERS ID: |
125165 (history) |
Form: |
Version 1.0 |
Age: |
74.0 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: | 1997-10-24 |
Onset: | 1997-11-01 |
Days after vaccination: | 8 |
Submitted: |
1999-06-07 |
Days after onset: | 582 |
Entered: |
1999-06-25 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
7F81829 / UNK |
- / - |
Administered by: Private Purchased by: Other Symptoms: Asthenia,
Bone disorder,
Dysphagia,
Hypokinesia,
Myasthenic syndrome,
Myopathy,
Osteonecrosis,
Respiratory disorder,
Speech disorder SMQs:, Rhabdomyolysis/myopathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Osteonecrosis (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Other Medications: unk Current Illness: unk Preexisting Conditions: hypothroidism, dyspepsia w/intermittent gastroesophageal reflux, cardiomyopathy, CHF, chronic atrial fib w/ atrial thrombus Allergies: Diagnostic Lab Data: myasthenia panel: "borderline''''; Electrophysiological studies: "could not be confirmatory'''' CDC Split Type: 899159114A
Write-up: p/vax pt devel difficulty swallowing, and progressive weakness, could not walk;exp acute flu like sx;Dx=myasthenia gravis;devel steroid myopathy & aseptic necrosis of hips;pred d/c & difficulty speaking, swallowing & walking Doc # 197836 states that report was cancelled based on correspondance received from the vaccine provider. |
|
VAERS ID: |
125328 (history) |
Form: |
Version 1.0 |
Age: |
50.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1998-10-09 |
Onset: | 1998-10-10 |
Days after vaccination: | 1 |
Submitted: |
1999-07-01 |
Days after onset: | 264 |
Entered: |
1999-07-06 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4988224 / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Arthropathy,
Hypokinesia,
Injection site oedema,
Injection site pain,
Oedema peripheral SMQs:, Cardiac failure (broad), Angioedema (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (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: Lopressor, Premarin Current Illness: NONE Preexisting Conditions: MVP Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: severe soreness @ inj site w/in 1st 6-8hr;severe swelling lt upper arm, pain @ site w/in 48hr;unable to lift lt arm;swelling increased;w/in 1 wk could not lift lt arm, became frozen shoulder; now in P.T., still w/pain, prognosis fair |
|
VAERS ID: |
126433 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1998-11-05 |
Onset: | 1998-11-05 |
Days after vaccination: | 0 |
Submitted: |
1999-07-21 |
Days after onset: | 257 |
Entered: |
1999-07-29 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Public Purchased by: Public Symptoms: Asthenia,
Condition aggravated,
Dizziness,
Dyspnoea,
Ear disorder,
Gastrointestinal disorder,
Headache,
Influenza,
Neuropathy,
Pain,
Tinnitus SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic 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 mild rxn to vax in past~ ()~~~In patient Other Medications: NONE Current Illness: 85lbs @ time, wasn''t feeling well Preexisting Conditions: recovery from mild pancreatitis, sensitive to chemicals, digestive disorder; Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: weakness, buzzing in head,faintness-dec in 1/2hr;next AM, strong neurological rxn in head, trunk & arm pain, difficulty breathing, head squeezed, ears clogged w/ringing;weakness & fatigue;flu like sx;faint, body pain, intestinal problems; |
|
VAERS ID: |
126932 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Pennsylvania |
Vaccinated: | 1998-11-18 |
Onset: | 1999-03-01 |
Days after vaccination: | 103 |
Submitted: |
0000-00-00 |
Entered: |
1999-08-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0966960 / 1 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Gait disturbance,
Gastrointestinal disorder,
Neoplasm,
Paraesthesia,
Urine analysis abnormal SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: none Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: 8/99 MRI-fatty mass, angiolipoma in back; had surgery 8/7/99 to remove mass & is now recovered; CDC Split Type:
Write-up: p/recv flu vax & pt was dx w/ transverse myelitis; sx did not appear until spring. pt has extreme fatigue, feels nothing below the waist, gait significantly impaired; slight urine & bowel difficulties |
|
VAERS ID: |
127881 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 1996-10-07 |
Onset: | 1996-10-27 |
Days after vaccination: | 20 |
Submitted: |
1999-09-01 |
Days after onset: | 1039 |
Entered: |
1999-09-03 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Public Symptoms: Arthropathy,
Guillain-Barre syndrome,
Myelitis,
Neuropathy SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Arthritis (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 120 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Ecotrin;Cardura;Lotrel;Kadur; Current Illness: NONE Preexisting Conditions: HTN, mild diabetes; cerebrovascular disease;benign prostatic hypertrophy Allergies: Diagnostic Lab Data: MRI, CAT Scan, blood work-up CDC Split Type:
Write-up: GBS; |
|
VAERS ID: |
128329 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1998-10-14 |
Onset: | 1998-10-14 |
Days after vaccination: | 0 |
Submitted: |
1999-09-15 |
Days after onset: | 336 |
Entered: |
1999-09-17 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
- / 6 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Back pain,
Eye pain,
Faecal incontinence,
Hypokinesia,
Myelitis,
Neuralgia,
Neuropathy,
Oedema peripheral,
Pain,
Paraesthesia,
Paralysis,
Thrombosis,
Tremor,
Urinary incontinence,
Urinary retention SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: irritable bowel syndrome Allergies: Diagnostic Lab Data: Doppler ultrasound-DVT (deep vein thrombosis);10/20/99 lumbar puncture,brain scan,two MRI''s CDC Split Type: U199900673
Write-up: pt exp burning sensation eyes;pt exp lower back pain;rt leg shaky & both legs hurting;took motrin;saw MD-poss pinched nerve;med given;could not stand or void;Dx transverse myelitis;disch w/cane & catheter;legs swollen; blood clot;Dx DVT |
|
VAERS ID: |
129685 (history) |
Form: |
Version 1.0 |
Age: |
39.0 |
Sex: |
Female |
Location: |
North Carolina |
Vaccinated: | 1992-10-01 |
Onset: | 1993-02-01 |
Days after vaccination: | 123 |
Submitted: |
1999-10-18 |
Days after onset: | 2449 |
Entered: |
1999-10-22 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Public Symptoms: Anxiety,
Asthenia,
Hypoglycaemia,
Hypokinesia,
Somnolence SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: pt exp rxn @ age 39 w/flu dose 1;~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: allergies: eggs, chocolate, cheese, peanuts, milk; Allergies: Diagnostic Lab Data: Glucometer readings p/the fact CDC Split Type:
Write-up: weakness-so severe pt could only ambulate w/help-total lethargy, amorphous anxiety later; proven to be blood sugars 19-50;6-8wk bedridden;other pt known to have same rxn;extreme weight loss;blood sugars problem; |
|
VAERS ID: |
129839 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Female |
Location: |
Louisiana |
Vaccinated: | 1998-10-04 |
Onset: | 1998-11-03 |
Days after vaccination: | 30 |
Submitted: |
1999-10-02 |
Days after onset: | 332 |
Entered: |
1999-10-26 |
Days after submission: | 24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 6 |
RA / SC |
Administered by: Private Purchased by: Other Symptoms: Cardiac failure,
Hypertonia,
Hypokinesia,
Hypotonia,
Injury,
Paralysis SMQs:, Cardiac failure (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypokalaemia (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, 5 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: K-dur;lasix;glucotrol;imdur;zantac;& other meds Current Illness: NONE Preexisting Conditions: CHF w/MI & TAP 2 vagal by pass, diabetes, dec BP, arttrition, cathetes for kidney control, bilat leg paralysis, chronephritis; Allergies: Diagnostic Lab Data: extensive lab tests, mylogram, MRI''s, Spinal tap x 2; biopsy of vertebrae & spinal fluid, EMG all neg or WNL CDC Split Type:
Write-up: p/vax pt fell for no reason;rt leg became stiff & wouldn''t hold pt up even w/cane or walker;then couldn''t move other leg; told all muscle tone was gone from both 12/12/00 states the pt remains wheel chair bound due to the paralysis of legs. A Foley catheter in place due to excessive accumulation of fluid and congestive heart failure. |
|
VAERS ID: |
130026 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: | 1998-11-02 |
Onset: | 1998-11-15 |
Days after vaccination: | 13 |
Submitted: |
1999-10-25 |
Days after onset: | 343 |
Entered: |
1999-10-29 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0980530 / 1 |
- / IM A |
Administered by: Private Purchased by: Private Symptoms: Albuminuria,
Anaemia,
Blood urea increased,
Hypochloraemia,
Hyponatraemia,
Hypoproteinaemia,
Laboratory test abnormal,
Nephrotic syndrome,
Thrombocythaemia SMQs:, Acute renal failure (broad), Haematopoietic erythropenia (broad), Retroperitoneal fibrosis (broad), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
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: NONE Allergies: Diagnostic Lab Data: urine protein $g2000 on dip UA;BUN 34, Cr 0.5;NA 127;Cl 92;Platelets 675K;albumin2.1;C3 260.6, C4 91.2, Hgb 9.7;BUN/Cr ratio 110; CDC Split Type:
Write-up: nephrotic synd devel w/in 6wk of vax; |
|
VAERS ID: |
130741 (history) |
Form: |
Version 1.0 |
Age: |
70.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1999-10-01 |
Onset: | 1999-10-02 |
Days after vaccination: | 1 |
Submitted: |
1999-11-12 |
Days after onset: | 41 |
Entered: |
1999-11-15 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
- / 1 |
- / - |
Administered by: Other Purchased by: Other Symptoms: Abdominal pain,
Epididymitis,
Haematuria,
Orchitis,
Pain,
Pelvic pain,
Prostatic disorder,
Pyrexia,
Scrotal oedema SMQs:, Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No Relevant Data~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: allergic rhinitis Allergies: Diagnostic Lab Data: 10/1/99 unspecified blood work-nl;urine culture-nl; CDC Split Type: WAES99100392
Write-up: p/vax pt devel fever of 100.5, chills, groin pain & severe pain to lower abd to lt testicle;pt exp hematuria;pt devel orchitis, prostatitis, epididymitis;poss d/t vax; |
|