|
VAERS ID: |
161766 (history) |
Form: |
Version 1.0 |
Age: |
72.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 2000-10-12 |
Onset: | 2000-10-12 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2000-11-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E62700HA / UNK |
- / IM |
Administered by: Public Purchased by: Other Symptoms: Eye disorder,
Eyelid ptosis SMQs:, Corneal disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility 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: NONE Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: MPI2000048370
Write-up: Post vax, the pt has experienced lack of normal eye movements in her left eye and a staring right eye. It was also reported that the pt has experienced drooping of both eyelids. The pt has been evaluated by a physician and is receiving treatment with eye drops of unknown name or dosage. Attempts have been initiated to obtain further information. |
|
VAERS ID: |
162595 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 1999-10-12 |
Onset: | 1999-10-12 |
Days after vaccination: | 0 |
Submitted: |
2000-11-20 |
Days after onset: | 405 |
Entered: |
2000-11-27 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
2597A2 / 3 |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Arthralgia,
Asthenia,
Cataract,
Difficulty in walking,
Hypokinesia,
Nerve injury,
Vision blurred SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Lens disorders (narrow), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (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? No
Previous Vaccinations: Other Medications: Vasotec, Lipitor, Inderal Current Illness: NONE Preexisting Conditions: Hypertension and high cholesterol Allergies: Diagnostic Lab Data: X-rays, EMG''s, MRI, blood testing and monitoring of kidney and liver functions CDC Split Type:
Write-up: Post vax, the pt developed lack of mobility in extremities, loss of muscular nerve functions, blurred vision, cataracts, and pain in all joints. Treatment included medication. Follow up information received 09/18/02 states "Pain in all joints of body (ie- neck, arms, legs(Knees), Difficulty in walking, getting up from sitting positions, Sleep is affected, fatigue, general weakness over entire body, conditions gets worst each month.". |
|
VAERS ID: |
162760 (history) |
Form: |
Version 1.0 |
Age: |
63.0 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: | 1999-10-01 |
Onset: | 2000-02-01 |
Days after vaccination: | 123 |
Submitted: |
2000-11-20 |
Days after onset: | 293 |
Entered: |
2000-11-29 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
- / 1 |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Bronchitis,
Cough,
Dyspnoea,
Pneumonia SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
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: Other Medications: aspirin, Zocor Current Illness: Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: CXR-2/1/00 CDC Split Type: WAES00100269
Write-up: In February-March 2000, the pt developed pneumonia. The pt sought unspecified medical attention. Follow-up information received from the pharmacist on 11/6/00 indicated that in 2/00 and 3/00 the pt was sick with pneumonia. It was reported that the pt had chest x-rays, several doctor visits, and was treated with three different antibiotics. As of 10/00, it was reported that the pt "partially recovered" but still had a persistent cough and shortness of breath. The pharmacist indicated that the pneumonia resulted in a persistent or significant disability/incapacity for the pt. Additional information has been requested. Followup received from RN at doctor''s office indicates pt vaccinated in October of 1998 (although initially reported in 1999) and has had intermittent difficulties with cough and was last seen in January 2001 with a 1 day history of cough. Pt diagnosed with bronchitis and antibiotics were ordered. Pt instructed to return if did not improve and he has not returned. No further info is expected. |
|
VAERS ID: |
163950 (history) |
Form: |
Version 1.0 |
Age: |
51.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1999-11-04 |
Onset: | 1999-11-04 |
Days after vaccination: | 0 |
Submitted: |
2000-10-18 |
Days after onset: | 348 |
Entered: |
2000-12-20 |
Days after submission: | 63 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH |
FAV024 / 4 |
LA / IM |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
LA / IM |
Administered by: Military Purchased by: Military Symptoms: Asthenia,
Hypokinesia,
Immune system disorder,
Laboratory test abnormal,
Neuralgia,
Neuropathy,
Pain SMQs:, Peripheral neuropathy (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (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: Other Medications: Mevacor Current Illness: NONE Preexisting Conditions: hypercholesterolemia Allergies: Diagnostic Lab Data: EMG - abnormal CDC Split Type:
Write-up: The pt experienced an improperly placed Anthrax injection. The vax was injected into the ulnar nerve and the subcutaneous nerve. The event triggered immune response in/on both nerves. At the time extreme neuropathic pain which subsided to moderate, loss of strength, and motion. Treated with steroids with little improvement. Symptoms still persist. On 60 Day FU: same symptoms as previously reported are still relevant and related to this adverse event, there has been no change. |
|
VAERS ID: |
164451 (history) |
Form: |
Version 1.0 |
Age: |
57.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 2000-11-18 |
Onset: | 0000-00-00 |
Submitted: |
2002-11-07 |
Entered: |
2001-01-04 |
Days after submission: | 672 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Brain oedema,
Coma,
Convulsion,
Disorientation,
Dizziness,
Facial palsy,
Malaise,
Nausea,
Syncope,
Vomiting SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), 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), Cardiomyopathy (broad), Hearing impairment (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (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: Baycol, Sudafed Current Illness: UNK Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: brain scan - swelling of both sides of the brain, MRI - swelling of both sides of brain, no tumors or infection CDC Split Type: HQ5383229DEC2000
Write-up: A nurse reported that her 56 year old aunt received an injection of Flu-Shield (2000-2001 Formula) in 12/00. Two days, post vax, she collapsed and developed nausea, vomiting and dizziness. She was seen in the ER where they reportedly could find nothing wrong and was sent home. Afterwards, she was weak and did not feel well. On 12/25/00, she awoke with right-sided facial paralysis and "dropping", was disoriented and did not feel well. She was taken to ER where they reportedly could find nothing wrong and was again sent home. On the way home, she seized in the car and was taken to the hospital where she was admitted into the ICU. The swelling of the brain from the tests, was undeterminable. She was unresponsive until 12/28/00; however, the reporter noted that the pt was very sedated. She developed a fever and was opening her eye briefly and was able to move her legs as of the date of this report. |
|
VAERS ID: |
164505 (history) |
Form: |
Version 1.0 |
Age: |
74.0 |
Sex: |
Male |
Location: |
Kentucky |
Vaccinated: | 2000-12-09 |
Onset: | 2000-12-16 |
Days after vaccination: | 7 |
Submitted: |
2001-01-04 |
Days after onset: | 19 |
Entered: |
2001-01-09 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
Administered by: Public Purchased by: Unknown Symptoms: Asthenia,
Blood creatinine increased,
Blood urea increased,
Bone disorder,
CSF test abnormal,
Guillain-Barre syndrome,
Hypertension,
Lung disorder,
Nuclear magnetic resonance imaging brain abnormal,
Pain,
Renal failure acute SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Demyelination (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Arm swelling~Pneumo (no brand name)~1~74.00~In Patient Other Medications: Cozaar, Lopid, Procardia XL, Lasix, potassium ibuprofen Current Illness: NONE Preexisting Conditions: Hypertension Allergies: Diagnostic Lab Data: MRI cervical spine-shows mild accentuation of cervical lordotic curve; MRI of thoric spine as well as the lumbosacral spine were nml; Cat Scan of brain-showed a small focus of low denisity signal in the posterior limb of the right internal coccal, consistent with an old lunar infarction; CT scan chest-showed 1cm in the terminate area of ill-defined density or infiltrate in the right upper lobe and another 3 to 4mm circumscribed nodule in the lingular segment of the left upper lobe; attempts to do the LP on 12/26/00 were unsuccesssful. With fluorscopic guidance, an LP was performed by the radiologist-slight elevation of the spinal fluid protein which was 4 to 7, spinal fluid chloride was 115, which were wnl; Gram stain, as well as, a smear for fungus-wnl. CDC Split Type:
Write-up: Guillain-Barre Syndrome and later developed acute renal failure; started as pain in feet and legs. Admitted to the hospital on 12/26/00. Received IVIG and IV contrast which may be related to acute renal failure. Per F/U 5/1/01: BP 220/100. During her stay in the hospital, she gradually became weak and worse. Attempts to insert an IV line were made, but it was unsuccessful anf for this reason, we had asked MD to see her to insert a Port-A-Cath which was performed on 12/27/00. The pt was then given 8mg of Globulin, immunogloblin, 17 grams daily for 5 days over 16 hours. However, this was discontinued on 12/30/00 after 4 dosages, after she developed an elevated BUN and creatininie who had a history of was felt to be secondary to the immunoglobulin. Because of this, we had asked MD to see her who then started her on short-term dialysis. Slowly and gradually the rhythm failure improved. She remained stable and was then transferred to the skilled nursing facility on 1/16/01. Impression: Guillain-Barre syndrome, improving; Acute renal failure, transient secondary to the immunoglobulin therapy; hypertension. |
|
VAERS ID: |
164716 (history) |
Form: |
Version 1.0 |
Age: |
76.0 |
Sex: |
Unknown |
Location: |
California |
Vaccinated: | 2000-11-25 |
Onset: | 2000-11-26 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2001-01-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E71790LA / UNK |
- / IM |
Administered by: Military Purchased by: Other Symptoms: Asthenia,
Dizziness,
Joint stiffness,
Oedema peripheral,
Pain,
Rhinorrhoea SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament 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: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Dizziness, ache, weakness, hands swelling, feels sandy, fingers locking on right hand, runny nose, allergic to flu shot. |
|
VAERS ID: |
166324 (history) |
Form: |
Version 1.0 |
Age: |
54.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2000-11-28 |
Onset: | 2000-12-15 |
Days after vaccination: | 17 |
Submitted: |
2001-02-19 |
Days after onset: | 66 |
Entered: |
2001-03-02 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
345 / UNK |
- / IM |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
0690K / UNK |
- / IM |
Administered by: Public Purchased by: Other Symptoms: Arthritis,
Connective tissue disorder,
Oedema peripheral,
Pain,
Paraesthesia,
Pyrexia SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: Other Medications: Humalog, Premarin, Flovent, Plaquenil, Naproxen, Cortisone Current Illness: NONE Preexisting Conditions: Diabetes Type I, Hashimoto''s Syndrome, asthma Allergies: Diagnostic Lab Data: In pt''s file CDC Split Type:
Write-up: One day of fever to 101.5F; onset mid-December of tingling in hand, arm pain on total body involvement by latter January. On February 12, dx''d with Sjogren''s Syndrome. 60 day follow-up states that there is a new diagnosis of MCTD (Standford) not Sjogrens as previously reported. Doc 210790, annual follow up states the following: swelling (hands, legs, feet) athritis pain. Also states that patient was type I diabetic, had asthma and had thyroid. |
|
VAERS ID: |
166735 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 2000-12-08 |
Onset: | 2001-01-12 |
Days after vaccination: | 35 |
Submitted: |
2001-03-01 |
Days after onset: | 48 |
Entered: |
2001-03-08 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4008217 / 1 |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Encephalitis,
Gait disturbance,
Laboratory test abnormal,
Loss of consciousness,
Memory impairment,
Urinary incontinence SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 9 days
Extended hospital stay? Yes
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: High cholesterol,hypertension, hypercholesterolemia Allergies: Diagnostic Lab Data: Lyme disease and MS ruled out. MRI-abnormal CDC Split Type:
Write-up: Notified by parent on 2/26/01 that on 1/12/01, daughter admitted to hospital after found unconscious at home. Lyme and MS ruled out by Neuro MD. Dx''d with ADEM related to pt receiving flu vaccine. Abnormal gait; incontinence and no short term memory. |
|
VAERS ID: |
166737 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
2001-03-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
Administered by: Military Purchased by: Military Symptoms: Headache,
Neck pain,
Pain SMQs:, 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: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Body aching, neck pain, headache treated with Motrin. I believe vaccinated in 1979-1980. |
|