|
VAERS ID: |
130885 (history) |
Form: |
Version 1.0 |
Age: |
49.0 |
Sex: |
Unknown |
Location: |
California |
Vaccinated: | 1999-10-11 |
Onset: | 1999-10-30 |
Days after vaccination: | 19 |
Submitted: |
1999-11-17 |
Days after onset: | 18 |
Entered: |
1999-11-18 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U0109CA / UNK |
LA / IM |
Administered by: Other Purchased by: Private Symptoms: Back pain,
Myelitis,
Pain,
Paralysis SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: NONE Current Illness: NONE Preexisting Conditions: tetanus vax-rash & puffiness occured; Allergies: Diagnostic Lab Data: MRI, CT Scan, Lumbar Puncture, EKG, CT scan of pelvis, abd, lumbar spine, all relevant blood work & various tests; CDC Split Type:
Write-up: p/vax exp acute lower back & leg pain;onset occurred p/20min;to ER, able to walk w/ one assist; within one hour paralyzed from waist down; tests reveal healthy, normal person w/ no apparent cause. Annual FU: transverse myelitis at T8/9 level. Paralysis is permanent. |
|
VAERS ID: |
130972 (history) |
Form: |
Version 1.0 |
Age: |
47.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1999-10-13 |
Onset: | 1999-10-13 |
Days after vaccination: | 0 |
Submitted: |
1999-11-10 |
Days after onset: | 28 |
Entered: |
1999-11-22 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS |
03179P / 1 |
LA / - |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
1339H / 1 |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Headache,
Injection site hypersensitivity,
Myasthenic syndrome,
Nausea,
Pain,
Pyrexia,
Somnolence,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Verpamil, Prozac, Premarin; Current Illness: NONE Preexisting Conditions: hayfever, migraines; Allergies: Diagnostic Lab Data: NONE CDC Split Type: FLU2031199
Write-up: 10/13/99 nausea, lethargic, h/a, tired;T102;vomiting;3 episodes & red raised site 7-8inches long, 5-6 inches across oval shaped under arm & whole upper arm tend to touch w/heaviness & major discomfort;could not work for 2 days d/t rxn; |
|
VAERS ID: |
131448 (history) |
Form: |
Version 1.0 |
Age: |
33.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1999-10-28 |
Onset: | 1999-10-30 |
Days after vaccination: | 2 |
Submitted: |
1999-11-11 |
Days after onset: | 12 |
Entered: |
1999-11-29 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U0169AB / UNK |
RA / IM |
Administered by: Other Purchased by: Private Symptoms: Hypertonia,
Multiple sclerosis,
Myasthenic syndrome,
Myopathy,
Neuropathy,
Paraesthesia SMQs:, Rhabdomyolysis/myopathy (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: MRI, Neuro MD CDC Split Type:
Write-up: muscle spasms, weakness in rt leg; noticed sx worsened; numbness, tingling on both legs;dx myopathy, MS; 60 day follow-up dated 11/6/00 provided no additional data. Annual follow-up dated 1/24/01 states the pt is being treated for demyelination of the spine that was due to the vaccine. |
|
VAERS ID: |
131601 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
South Carolina |
Vaccinated: | 1996-11-14 |
Onset: | 1996-11-15 |
Days after vaccination: | 1 |
Submitted: |
1999-11-25 |
Days after onset: | 1105 |
Entered: |
1999-12-01 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E30966B / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Back pain,
Hypotonia,
Myelitis,
Pain,
Paraesthesia,
Paralysis SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: NONE Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: PE-revealed decreased sensation w/paralysis at about T7; CDC Split Type: MPU199900536
Write-up: p/vax pt awoke w/pain rt leg;tried to stand both legs weak & could not move w/o assistance;1hr later to ER c/o numbness in legs & aching in mid/lower back;PE revealed dec sensation w/paralysis @ T7;dx post vaccinal transverse myelitis; 60 day follow-up received on 10/2/00 provided no additional data. |
|
VAERS ID: |
131626 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1999-10-25 |
Onset: | 1999-10-30 |
Days after vaccination: | 5 |
Submitted: |
1999-11-15 |
Days after onset: | 16 |
Entered: |
1999-12-02 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS |
00499P / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Injection site pain,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (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: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NO MD Allergies: Diagnostic Lab Data: NONE CDC Split Type: WI99043
Write-up: p/vax states could "feel it" when recv vax then pain devel about 5 days p/vax;now whenever uses arm knows it''s there; actually hurts when raises lt arm or does something unusual w/lt arm;vax site has no swelling or redness |
|
VAERS ID: |
131646 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1999-11-24 |
Entered: |
1999-12-02 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Public Symptoms: Asthenia,
Immune system disorder,
Pain SMQs:, Guillain-Barre syndrome (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: ? Preexisting Conditions: Allergies: Diagnostic Lab Data: although extensive, invasive & debilitating tests were performed, unable to get the data; CDC Split Type:
Write-up: severe, chronic autoimmune problems throughout life;tx w/steroids, ATB & surgery;ASA now;60 day follow-up states the pt still has severe pain and weakness resemblin flu-like symptoms. |
|
VAERS ID: |
132107 (history) |
Form: |
Version 1.0 |
Age: |
51.0 |
Sex: |
Male |
Location: |
Missouri |
Vaccinated: | 1999-11-03 |
Onset: | 1999-11-03 |
Days after vaccination: | 0 |
Submitted: |
1999-11-29 |
Days after onset: | 26 |
Entered: |
1999-12-06 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
U0155AA / 1 |
- / - |
Administered by: Other Purchased by: Private Symptoms: Visual disturbance,
Visual field defect SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (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: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: MRI/MRA, reflex tests, VER test, numerous blood tests; CDC Split Type:
Write-up: approx 4hr p/vax vision narrowed & loss of vision lt half of both eyes;dx from ER w/subsequent test w/o stroke or MS poss;tx w/ASA & pred;vision problems started 11/3/99, partial vision recovered;60 day follow-up / no additional data. |
|
VAERS ID: |
132833 (history) |
Form: |
Version 1.0 |
Age: |
45.0 |
Sex: |
Male |
Location: |
Kentucky |
Vaccinated: | 1999-11-03 |
Onset: | 1999-11-13 |
Days after vaccination: | 10 |
Submitted: |
1999-12-06 |
Days after onset: | 23 |
Entered: |
1999-12-27 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Guillain-Barre syndrome,
Myasthenic syndrome,
Neuropathy SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: IV Ig. Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: EMG-neuropathy/LP-protein=75 CDC Split Type:
Write-up: Guillain Barre syndrom 10 days after influenza vaccine.Pt. had distal limb weakness,decreased DTR.Pt had coughing & sore throat prior to developing GBS. |
|
VAERS ID: |
132835 (history) |
Form: |
Version 1.0 |
Age: |
45.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1999-10-28 |
Onset: | 1999-11-03 |
Days after vaccination: | 6 |
Submitted: |
1999-12-09 |
Days after onset: | 36 |
Entered: |
1999-12-27 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
4998226 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Condition aggravated,
Dysarthria,
Multiple sclerosis,
Visual disturbance SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Multiple Sclerosis Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt received flu shot and developed MS flare,visual disturbance, & dysarthria. |
|
VAERS ID: |
132836 (history) |
Form: |
Version 1.0 |
Age: |
29.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1999-10-20 |
Onset: | 1999-10-27 |
Days after vaccination: | 7 |
Submitted: |
1999-12-09 |
Days after onset: | 43 |
Entered: |
1999-12-27 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
4998226 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Condition aggravated,
Hemiplegia,
Multiple sclerosis SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Optic nerve disorders (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), 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: Solumedrol, prednisone Current Illness: Preexisting Conditions: pregnant, Multiple Sclerosis Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt. received flu shot and developed MS flare while pregnant.Pt. hemiparetic with residual after IV Solumedrol.60 day follow-up states it is unknown if the pt recovered. |
|