|
VAERS ID: |
27290 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 1990-10-30 |
Onset: | 1990-11-15 |
Days after vaccination: | 16 |
Submitted: |
1990-12-05 |
Days after onset: | 20 |
Entered: |
1991-01-04 |
Days after submission: | 30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11222 / UNK |
- / - |
Administered by: Public Purchased by: Public Symptoms: Diarrhoea,
Vomiting SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: In pt; aching; 70yrold; Flu vax;~ ()~~~In patient Other Medications: Capoten Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: kidney infection CDC Split Type: OH9055
Write-up: Pt vaccinated with FLU experienced vomiting (forceful); Diarrhea. |
|
VAERS ID: |
27302 (history) |
Form: |
Version 1.0 |
Age: |
66.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1988-10-27 |
Onset: | 1988-11-14 |
Days after vaccination: | 18 |
Submitted: |
1990-12-06 |
Days after onset: | 752 |
Entered: |
1991-01-04 |
Days after submission: | 29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Public Purchased by: Unknown Symptoms: Myalgia,
Myasthenic syndrome,
Pain SMQs:, Rhabdomyolysis/myopathy (broad), Malignancy related conditions (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Polymyalgia Rehumatica Preexisting Conditions: Polymyalgia Rheumatica Allergies: Diagnostic Lab Data: chest x-ray - Normal, no malignancy; Breast Exam: no malignancy; Sed rate: 75 (NL = 0-20 MM/1HR.) Nomocytic Anemia (MCHC):11.5 gms CDC Split Type: 890341001B
Write-up: Pt vaccinated w/Influenza developed aggravation reaction. This involved exacerbation of her polymyalgia rheumatica. Admitted to hosp w/severe painful weakness in her proximal muscles. Given steroidal therapy approx six months later, weaned. |
|
VAERS ID: |
27303 (history) |
Form: |
Version 1.0 |
Age: |
74.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1990-12-11 |
Entered: |
1991-01-04 |
Days after submission: | 24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Neoplasm skin SMQs:, Skin tumours of unspecified malignancy (narrow), Non-haematological tumours of unspecified malignancy (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 890346008B
Write-up: Pt vaccinated with Influenza developed keratoacanthoma at the site of injection four wks after receiving influenza vaccine. Hospitalized and the lesion was surgically removed. |
|
VAERS ID: |
27304 (history) |
Form: |
Version 1.0 |
Age: |
82.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1990-10-30 |
Onset: | 1990-11-09 |
Days after vaccination: | 10 |
Submitted: |
0000-00-00 |
Entered: |
1991-01-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Brain stem syndrome,
Dysphagia,
Eyelid ptosis,
Hyperglycaemia,
Hypertension,
Speech disorder SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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), Hypertension (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Catapres, Tambocor, Digoxin, ASA, Clonidine Current Illness: Preexisting Conditions: A CVA & Myasthenia gravis have been ruled out. Allergies: Diagnostic Lab Data: Spinal Tap & Ct head Scan WNL; Tensilon test - Negative. CSF = wnl, EMG - planned. CDC Split Type: 904090014
Write-up: Pt vac w/FLUOGEN developed brain stem disorder, weakness of extremities & hypertension, bilat ptosis, difficulty speaking & swallowing. Admitted to Hosp BP 217/87, P 70min, R 20min, BS 225 mg/DL. Botulism suspected. Tensilon test neg. |
|
VAERS ID: |
27338 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-10-19 |
Onset: | 1990-10-20 |
Days after vaccination: | 1 |
Submitted: |
1990-11-30 |
Days after onset: | 41 |
Entered: |
1991-01-08 |
Days after submission: | 39 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11203 / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Abdominal pain,
Asthenia,
Asthma,
Myalgia,
Rhinitis,
Sepsis SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: during hospitalization: Theodur, Prednisone, Ventolin Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: CA9026
Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect. |
|
VAERS ID: |
27543 (history) |
Form: |
Version 1.0 |
Age: |
85.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1990-11-19 |
Onset: | 1990-11-19 |
Days after vaccination: | 0 |
Submitted: |
1990-11-21 |
Days after onset: | 2 |
Entered: |
1991-01-25 |
Days after submission: | 65 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
06580P / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Asthenia,
Gait disturbance,
Hyperhidrosis,
Hypoglycaemia,
Tremor SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes 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: Procardia, Micronase, Ativan Current Illness: Preexisting Conditions: Diabetes Allergies: Diagnostic Lab Data: Blood Sugar Test - 21 CDC Split Type: GA9025
Write-up: Pt vaccinated w/FLU developed difficulty walking out to the car, BP & Pulse normal. Felt clammy & blood sugar was 21. Also difficulty getting 1/2 cup coke swallowed was shaking & moaning,took to Hosp treated & observed in ER,admit for 1 day |
|
VAERS ID: |
27634 (history) |
Form: |
Version 1.0 |
Age: |
31.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1973-02-01 |
Onset: | 1973-03-01 |
Days after vaccination: | 28 |
Submitted: |
1991-01-09 |
Days after onset: | 6523 |
Entered: |
1991-01-29 |
Days after submission: | 20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Military Purchased by: Other Symptoms: Guillain-Barre syndrome SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 180 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 910006401
Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist. |
|
VAERS ID: |
27639 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1990-12-26 |
Entered: |
1991-01-29 |
Days after submission: | 34 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Dyspnoea,
Pyrexia SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Bronchiectasis Allergies: Diagnostic Lab Data: CDC Split Type: 910003501
Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days. |
|
VAERS ID: |
27752 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1990-11-20 |
Onset: | 1990-11-27 |
Days after vaccination: | 7 |
Submitted: |
1991-01-25 |
Days after onset: | 59 |
Entered: |
1991-02-05 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
02780P / UNK |
- / - |
Administered by: Public Purchased by: Private Symptoms: Back pain,
Guillain-Barre syndrome,
Paraesthesia SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 35 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Approx 7d, pain lower back, tingling hands. Approx 14d, severe back pain & pain shooting up arms & legs & numbness in trunk & same area of pain. Hosp 5 wks-Therapy; Meds at home.unk when reflexs, nerves heal or numbness subsides. + GBS. |
|
VAERS ID: |
27816 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1990-10-30 |
Onset: | 1990-11-12 |
Days after vaccination: | 13 |
Submitted: |
1991-01-28 |
Days after onset: | 77 |
Entered: |
1991-02-08 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
287973 / 1 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea,
Muscle atrophy,
Paralysis,
Pyrexia SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
Extended hospital stay? Yes
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: neck & back sprain (auto accident) Allergies: Diagnostic Lab Data: See hospital records; See treating physicians. CDC Split Type:
Write-up: Fever, respiratory paralysis, etc. Admitted for about 2 wks. Under care of neurologists including automatic respirator. |
|