|
VAERS ID: |
36736 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1991-11-11 |
Onset: | 1991-11-12 |
Days after vaccination: | 1 |
Submitted: |
1991-11-25 |
Days after onset: | 13 |
Entered: |
1991-12-02 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
10300080808020 / 1 |
LA / - |
Administered by: Unknown Purchased by: Private Symptoms: Facial palsy SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
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: Current Illness: ESRD Preexisting Conditions: chronic renal failure NKA Allergies: Diagnostic Lab Data: bells palsy CDC Split Type:
Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy; |
|
VAERS ID: |
37800 (history) |
Form: |
Version 1.0 |
Age: |
11.0 |
Sex: |
Male |
Location: |
Iowa |
Vaccinated: | 1991-08-27 |
Onset: | 1991-09-03 |
Days after vaccination: | 7 |
Submitted: |
1991-11-26 |
Days after onset: | 84 |
Entered: |
1991-12-06 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918122 / 1 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Brain oedema,
Confusional state,
Convulsion,
Headache,
Hypotension,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-09-04
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: UNK Current Illness: NONE Preexisting Conditions: asthma Allergies: Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing; CDC Split Type: IA910040
Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive; |
|
VAERS ID: |
37817 (history) |
Form: |
Version 1.0 |
Age: |
46.0 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: | 1991-11-18 |
Onset: | 1991-11-18 |
Days after vaccination: | 0 |
Submitted: |
1991-11-19 |
Days after onset: | 1 |
Entered: |
1991-12-09 |
Days after submission: | 20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918169 / 1 |
- / IM A |
Administered by: Public Purchased by: Public Symptoms: Anaphylactoid reaction,
Apnoea,
Asthma,
Bronchitis,
Cardiac arrest,
Condition aggravated SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1991-11-18
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: UNK Current Illness: UNK Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies; Allergies: Diagnostic Lab Data: CDC Split Type: 891325001J
Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs; |
|
VAERS ID: |
37846 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: | 1991-10-18 |
Onset: | 1991-11-14 |
Days after vaccination: | 27 |
Submitted: |
1991-12-03 |
Days after onset: | 19 |
Entered: |
1991-12-09 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21209 / 1 |
- / IM |
Administered by: Private Purchased by: Public Symptoms: Paralysis SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Procardia, Ascriptin Current Illness: NONE Preexisting Conditions: previous hx brainstomy tia w/flaccid FEB91 Allergies: Diagnostic Lab Data: MRI Scan-neg; LP-normal; NCV loss of F waves, slowing; CDC Split Type:
Write-up: 3 wks post inject pt devel paralysis; |
|
VAERS ID: |
37877 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Female |
Location: |
West Virginia |
Vaccinated: | 1991-10-25 |
Onset: | 1991-11-20 |
Days after vaccination: | 26 |
Submitted: |
1991-12-03 |
Days after onset: | 13 |
Entered: |
1991-12-11 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01071P / 2 |
LA / SC |
Administered by: Other Purchased by: Public Symptoms: Abdominal pain,
Anorexia,
Intestinal obstruction,
Vomiting SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? Yes
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, 13 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Aldactone, Edecrin, Premarin, Prednisone, Ativan Current Illness: NONE Preexisting Conditions: Alzheimer''s dementia, CHF, hypertension, chronic lymphedeme Allergies: Diagnostic Lab Data: CDC Split Type: WV9158
Write-up: 20NOV91 began vomiting @ 130AM x 2 refused to eat through the day; no audible bowel sounds @ 715PM & c/o abd tenderness & admitted to Hosp 20NOV; bowel resection completed due to volvolus of bowel; |
|
VAERS ID: |
38150 (history) |
Form: |
Version 1.0 |
Age: |
84.0 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: | 1991-12-04 |
Onset: | 1991-12-04 |
Days after vaccination: | 0 |
Submitted: |
1991-12-20 |
Days after onset: | 16 |
Entered: |
1991-12-27 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21214 / UNK |
LA / - |
Administered by: Public Purchased by: Public Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-12-04
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No~ ()~~~In patient Other Medications: Unknown; Current Illness: Chronic heart disease; Preexisting Conditions: Unknown; Allergies: Diagnostic Lab Data: NONE CDC Split Type: OK9182
Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax; |
|
VAERS ID: |
38163 (history) |
Form: |
Version 1.0 |
Age: |
59.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1991-11-06 |
Onset: | 1991-11-08 |
Days after vaccination: | 2 |
Submitted: |
1991-11-15 |
Days after onset: | 7 |
Entered: |
1991-12-30 |
Days after submission: | 45 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918136 / 6 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Apnoea,
Cardiac arrest,
Cerebral haemorrhage,
Cerebrovascular accident,
Hypertension,
Vascular anomaly SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-11-09
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Trilafor Current Illness: NONE Preexisting Conditions: Depression Allergies: Diagnostic Lab Data: CDC Split Type: GA91323
Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm; |
|
VAERS ID: |
38733 (history) |
Form: |
Version 1.0 |
Age: |
79.0 |
Sex: |
Male |
Location: |
Mississippi |
Vaccinated: | 1991-10-13 |
Onset: | 1991-10-14 |
Days after vaccination: | 1 |
Submitted: |
1991-12-05 |
Days after onset: | 52 |
Entered: |
1992-01-13 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918138 / 1 |
RA / IM |
Administered by: Other Purchased by: Other Symptoms: Malaise,
Right ventricular failure,
Somnolence,
Vomiting SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-10-17
Days after onset: 3
Permanent Disability? No
Recovered? No 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: Allergies: Diagnostic Lab Data: CDC Split Type: 891361004J
Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure; |
|
VAERS ID: |
38734 (history) |
Form: |
Version 1.0 |
Age: |
88.0 |
Sex: |
Female |
Location: |
Mississippi |
Vaccinated: | 1991-10-13 |
Onset: | 1991-10-13 |
Days after vaccination: | 0 |
Submitted: |
1991-12-05 |
Days after onset: | 53 |
Entered: |
1992-01-13 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918138 / 1 |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Chest pain,
Dyspnoea,
Haematemesis,
Hyperhidrosis,
Pallor,
Right ventricular failure,
Tremor SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-10-15
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: pt had diabetes, congestive heart failure & a peptic ulcer; Allergies: Diagnostic Lab Data: CDC Split Type: 891361005J
Write-up: w/in hrs of receiving flu vax pt began shaking & exp vomiting w/a small amount of blood noted; following morning pt exp chest pain, SOB, paleness & clamminess; pt was hospitalized & died 15OCT91; COD congestive heart failure; |
|
VAERS ID: |
38735 (history) |
Form: |
Version 1.0 |
Age: |
78.0 |
Sex: |
Female |
Location: |
Mississippi |
Vaccinated: | 1991-10-08 |
Onset: | 1991-10-13 |
Days after vaccination: | 5 |
Submitted: |
1991-12-05 |
Days after onset: | 53 |
Entered: |
1992-01-13 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918138 / 1 |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Haematuria,
Hypotension,
Pharyngitis,
Rhinitis SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-10-26
Days after onset: 13
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: 891361002J
Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax; |
|