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From the 1/14/2022 release of VAERS data:

Found 4,229 cases where Vaccine targets Influenza (FLU(H1N1) or FLU3 or FLU4 or FLUA3 or FLUA4 or FLUC3 or FLUC4 or FLUN(H1N1) or FLUN3 or FLUN4 or FLUR3 or FLUR4 or FLUX or FLUX(H1N1) or H5N1) and Disabled

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Case Details

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VAERS ID: 227344 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2002-08-29
Submitted: 2004-10-01
   Days after onset:764
Entered: 2004-10-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Private
Symptoms: Apnoea, Asthenia, Constipation, Coordination abnormal, Dyspnoea, Electrocardiogram abnormal, Eye disorder, Facial palsy, Guillain-Barre syndrome, Infection, Laboratory test abnormal, Pneumonia, Sepsis, Thinking abnormal, Venous thrombosis
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Demyelination (narrow), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (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? Yes, 360 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE Medical records state hypertension, diabetes mellitus, disc disease and hypercholesteremia. msv
Allergies:
Diagnostic Lab Data: GBS Medical records state abnormal EKG, abnormal lab tests. msv
CDC Split Type:

Write-up: I got GBS on 8/29/02. Diagnosed as GBS in hospital. Now in a rental assisted living home. Hope to be walking soon. Follow up 01/20/05: Still under on going medical care, has not recovered. I'' good as I can be. I fell good, no aches or pains. The only thing to complain about I gues is that I can''t make the right knee do what its supposed to do. I can''t get either leg to pull up like their supposed to do. Neith leg hurts, I just can''t lift both of them as far or as high as I should. The left one is nealy normal but not so for the right. I can''t get either leg to lift up as far as it should in a single step. On I can get the left on up pretty good but the right one is hard. Also, I can''t get them up on the second step very easily. I guess I could get it up a second step but boy what a task. My back is ok, arms ok, breathing ok and talking seems to be ok. I am having soem trouble with my eyes. My right eye might as well be blind as I can only see everything as a blear. Stuff just wont focus in the right eye. The left eye is pretty much ok. I need my old glasses to make out stuff, but I can read the newspaper with my glasses in the left eye if I''m careful and try hard. In the right eye I''m having troube, it just doesn''t focus good. Rougly speaking however it''s functioning pretty well. I have to have drops in bother eyes to see fairly well. When I look at airplanes in the sky, there are two airplaines separated by a bit of space. I guess that''s double vision. I can make a airplane disappear however by blocking the vision to the right eye!!! Lets see you do that!! I am walking down and back 150 foot corridor with my walker all by myself. I can get in and out of the car without any help, but I''m not sure how much more I can do. Information from Discharge summary states respiratory failure, ataxia, infection, dyspnea, weak, eye disorder and venous thrombophlebitis. Medical records state sepsis, constipation, bells palsy, abnormal thinking, pneumonia. msv


VAERS ID: 227788 (history)  
Form: Version 1.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2004-09-28
Onset:2004-09-29
   Days after vaccination:1
Submitted: 2004-10-08
   Days after onset:9
Entered: 2004-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0740N / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0410USA00906

Write-up: Information has been received from a health care worker concerning a 54 year old female who on 9/28/04 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N). Concomitant therapy included influenza virus vaccine, it was unknown when the flu shot was given. On 9/30/04, the patient developed lymph node swelling and fever. The patient was seen in the emergency room. It was also noted that the patient was hospitalized. At the time of the report, the patient had not recovered. The reporter expressed concern with lot 0740N. The reporter also mentioned 4 other female patients who were also vaccinated with a dose of pneumococcal 23v polysaccharide vaccine and developed similar reactions. No product quality complaint was involved. Lymph node swelling and fever were considered to be immediately life-threatening and disabling. Additional information has been requested. Follow up 03/03/05: Patient has not recovered from the adverse event(s).


VAERS ID: 227789 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2004-09-28
Onset:2004-09-30
   Days after vaccination:2
Submitted: 2004-10-08
   Days after onset:8
Entered: 2004-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0740N / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0410USA00907

Write-up: Information has been received from a health care worker concerning a 67 year old female who on 9/28/04 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N). Concomitant therapy included influenza virus vaccine (unspecified), it was unknown when the flu shot was given. On 9/30/04, the patient developed lymph node swelling and fever. It was noted that one patient had gone to the emergency room. It was also noted that the patient was hospitalized. The outcome was not recovered. The reporter also mentioned 4 other female patients who were also vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N) and developed similar reactions. No product quality complaint was involved. Lymph node swelling and fever were considered to be immediately life-threatening and disabling. Additional information has been requested. Follow up on 10/18/04 states: "Information has been received from a health care worker concerning a 67 year old female who on 09/28/04 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N). Suspect concomitant therapy included influenza virus vaccine (Fluzone), on the same arm, which was administered on the same day. On 09/29/04, the pt developed lymph node swelling and fever. The pt was seen in the ER. It was also noted that the pt was hospitalized. At the time of the report, the pt had not recovered. The reporter expressed concern with Lot 0740N. Lymph node swelling and fever were considered to be immediately life-threatening and disabling. Additional information has been requested." Follow up 03/03/05: Patient has not recovered from the adverse event(s).


VAERS ID: 227790 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2004-09-28
Onset:2004-09-30
   Days after vaccination:2
Submitted: 2004-10-08
   Days after onset:8
Entered: 2004-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0740N / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0410USA00909

Write-up: Information has been received from a health care worker concerning a female patient in her late 60''s who on 9/28/04 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N). Concomitant therapy included influenza virus vaccine (unspecified), it was unknown when the flu shot was given. On 9/30/04, the patient developed lymph node swelling and fever. It was noted that one patient had gone to the emergency room. It was also noted that the patient was hospitalized. The outcome was not recovered. The reporter also mentioned 4 other female patients who were also vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N) and developed similar reactions. No product quality complaint was involved. Lymph node swelling and fever were considered to be immediately life threatening and disabling. Additional information has been requested. Follow up on 10/18/04 states: "Information has been received from a health care worker concerning a female pt in her late 60''s who on 09/28/04 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N). Suspect concomitant therapy included influenza virus vaccine (Fluzone), in the same arm, which was administered on the same day. On 09/29/04 the pt developed lymph node swelling and fever. The pt was seen in the ER. It was noted that the pt was hospitalized. At the time of the report, the pt had not recovered. The reporter expressed concern with Lot 0740N. Lymph node swelling and fever were considered to be immediately life-threatening and disabling. Additional information has been requested." Follow up 03/03/05: Patient has not recovered from the adverse event(s).


VAERS ID: 227791 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2004-09-28
Onset:2004-09-30
   Days after vaccination:2
Submitted: 2004-10-08
   Days after onset:8
Entered: 2004-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0740N / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0410USA00908

Write-up: Information has been received from a health care worker concerning a 68 year old female who on 9/28/04 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N). Concomitant therapy included influenza virus vaccine (unspecified), it was unknown when the flu shot was given. On 9/30/04, the patient developed lymph node swelling and fever. It was noted that one patient had gone to the emergency room. It was also noted that the patient was hospitalized. The outcome was not recovered. The reporter also mentioned 4 other female patients who were also vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N) and developed similar reactions. No product quality complaint was involved. Lymph node swelling and fever were considered to be immediately life-threatening and disabling. Additional information has been requested. Follow up on 10/18/04 states: "Information has been received from a health care worker concerning a 68 year old female who on 09/28/04 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N). Suspect concomitant therapy included influenza virus vaccine (Fluzone), in the same arm, which was administered on the same day. On 09/29/04 the pt developed lymph node swelling and fever. The pt was seen in the ER. It was noted that the pt was hospitalized. At the time of the report, the pt had not recovered. The reporter expressed concern with Lot 0740N. Lymph node swelling and fever were considered to be immediately life-threatening and disabling. Additional information has been requested." Follow up 03/03/05: Patient has not recovered from the adverse event(s).


VAERS ID: 227792 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2004-09-28
Onset:2004-09-30
   Days after vaccination:2
Submitted: 2004-10-08
   Days after onset:8
Entered: 2004-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0740N / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0410USA00063

Write-up: Information has been received from a health care worker concerning a 70 year old female who on 9/28/04 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine (647359/0740N). Concomitant therapy included influenza virus vaccine (unspecified), it was unknown when the flu shot was given. On 9/30/04, the patient developed lymph node swelling and fever. It was noted that one patient had gone to the emergency room. It was also noted that the patient was hospitalized. The outcome was not recovered. The reporter also mentioned 4 other female patients who were also vaccinated with a dose of pneumococcal 23v polysaccharide vaccine and developed similar reactions. No product quality complaint was involved. Lymph node swelling and fever were considered to be immediately life threatening and disabling. Additional information has been requested. Follow up on 10/18/04 states: "The pt was seen in the ER. It was also noted that the pt was hospitalized. At the time of the report, the pt had not recovered. The reporter expressed concern with Lot # 0740N. Lymph node swelling and fever were considered to be immediately life-threatening and disabling. Additional information has been requested." Follow up 03/03/05: Patient has not recovered from the adverse event(s).


VAERS ID: 227897 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Female  
Location: Alabama  
Vaccinated:2004-10-15
Onset:2004-10-15
   Days after vaccination:0
Submitted: 2005-05-23
   Days after onset:220
Entered: 2004-10-18
   Days after submission:217
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 41455EA / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Fatigue, Joint stiffness, Muscle contractions involuntary, Muscle twitching, Muscular weakness, Paraesthesia, Sleep disorder, Stomach discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: arm swelling/pain/dev. flu symptoms - age given is est.~Influenza (Seasonal) (no brand name)~~0.00~In Patient
Other Medications: Ortho Novum 1-35/28 day. Ibuprofen began after the vaccine. No other the week before or day of or days after.
Current Illness: NONE
Preexisting Conditions: None. I was hit in the back by a chiropractor 2+ yr. ago and have had some back pain - releived with rest & heat pad, but tests show no problems. Otherwise - healthy - exercise 5-6 days per week at least 30-45 min. each time, perfect weight also. No use of tobacco either.
Allergies:
Diagnostic Lab Data: None taken yet - waiting to see if the symptoms improve. If not I will go to a neurologist within a couple of weeks. Hoping for a natural resolution without intervention. Will watch for life threatening signs that occur w/ Guillain-Barre''. Multiple blood test by Dr. also nerve/sensory condition & EMG. DR reports symptoms appear to be directly related to the influenza vaccine. Other then symptoms no underlying illness.
CDC Split Type:

Write-up: When I went to go to sleep, I laid down as usual, but I couldn''t relax. My legs felt tingly. I only slept 1 hour the entire night. Legs kept feeling like there was vibration under the skin on both legs (beginning at the hips & moving down) all night. I would get up, walk around, but the instant I would try to relax it would begin. Also, I developed muscle twitching. I could actually visually see tiny muscles jumping at various places all over my legs. ALL NIGHT (still occurring 10/18/04 - & some on my body). Next day, felt tired, slight stomach upset. Muscles felt weak. By 10/16 night I was exhausted and slept but felt the tingling as I fell asleep. Felt slight tingling all day when at rest. 10/17/04 Sunday - felt the tingling when at rest. Now my upper body (arms) felt weak and began to experience a slight vibrating feeling and weakness. Some tingling and twitching continued as I went to sleep tonight. Today 10/18/04 I still feel an odd sensation over my body and some muscle twitching. Other symptoms included deep leg pain & knee pain or stiffness that began Saturday afternoon - helped w/ Ibuprofen. Buzzing, tingling throughout body. Kept me awake several nights. Then it became sporadic buzzing, tingling, pinching and worst of all constant fasciculation and parethesia. Continued symptoms to present. Symptoms occur 24 hrs a day! Some days better, some worse than others. DR has recommend that I do not get an influenza vaccine next year.


VAERS ID: 227911 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: Illinois  
Vaccinated:2004-09-30
Onset:2004-10-08
   Days after vaccination:8
Submitted: 2004-10-13
   Days after onset:5
Entered: 2004-10-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1418AA / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaemia, Anxiety, Asthenia, Cough, Difficulty in walking, Dyspnoea, Fatigue, Haemolytic anaemia, Influenza like illness, Laboratory test abnormal, Liver function test abnormal, Myalgia, Pharyngitis, Pyrexia, Rhinitis, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Haemolytic disorders (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nexium 20mg PO qd; Docetaxel 170mg infusion; Gemcitabine 1500mg infusion.
Current Illness:
Preexisting Conditions: Discharge Summary received on 11/17/2004 states pt had a history of malignant neoplasm. Medical Record received on 11/17/2004 states pt had a history of esophageal reflux, intraabdominal masses, lung metastases, and leiomyosarcoma.
Allergies:
Diagnostic Lab Data: Bil 2.3; Alk pho 233; SGOT 69; HDL 376; Hgb 4.4; Plt 511; Retic 5.7; Haptoglobin 223; +VE cold agglutinin, staphylococcus PCR pending. Medical Record received on 11/17/2004 states reticulocytosis and liver studies abnormal.
CDC Split Type:

Write-up: Patient had uterine leiomyoscarcoma 1999 with pulmonary metastasis. Patient received her second cycle of her cheo-taxotere and gemzar in 9/28/04 and had a flu vaccine 9/30. 10/8 developed flu-like symptoms which include cough, fatigue, and myalgia, and questionable fever. 10/9 increased weakness that she was unable to walk around the home. 10/10 reported improvement and also reported taking Aleve, Advil, Tylenol, and Robitussin. 10/11 continued to have difficulties in walking without help but her cold symptoms resolved. Patient also noted minor transient blurred vision which resolved within 30 minutes and also anxiety. 10/12 admitted to ICU through ED on wheelchair when her Hgb was found to be 4.4. Discharge Summary received on 11/17/2004 states pt experienced anemia. Medical Record received on 11/17/2004 states pt experienced dyspnea and hemolytic anemia.


VAERS ID: 228678 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Female  
Location: Montana  
Vaccinated:2004-10-04
Onset:2004-10-04
   Days after vaccination:0
Submitted: 2004-10-18
   Days after onset:14
Entered: 2004-11-02
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1379AA / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pruritus, Rash maculo-papular, Tongue oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone; Allegra
Current Illness:
Preexisting Conditions: Only reported allergies: Bactrim - hives 4 years ago; Codeine 35 years ago; Irritable; No medical problems. No current medications.
Allergies:
Diagnostic Lab Data: No labs. Future vaccination has been contraindicated by treating MD.
CDC Split Type:

Write-up: Individual given influenza vaccine (as is in high risk group) on 10/4/04 in left deltoid without difficulty. Later that day, developed diffuse maculopapular rash on stomach, sides, back armpits, and down arms and mild itching. 2 days later swelling to tongue. Doctor prescribed tapering doses of Prednisone for 6 days; still requiring Allegra. Symptoms are decreased in severity but still persist as of this date 10/18/04. Follow up 02/4/05: symptoms resolved entirely after several days, no complaints since then.


VAERS ID: 228886 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Texas  
Vaccinated:2004-10-27
Onset:2004-10-27
   Days after vaccination:0
Submitted: 2004-11-08
   Days after onset:12
Entered: 2004-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI458AA / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Aphasia, Bradycardia, Convulsion, Delirium, Encephalitis, Hypoxia, Infection, Intracranial pressure increased, Meningitis, Mental retardation severity unspecified, Nervous system disorder, Nystagmus, Oedema, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (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: NONE
Current Illness: NONE
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: MRI of the brain on 11/2/04 consistent with meningitis and encephalitis with progressing edema
CDC Split Type:

Write-up: Patient developed fever several hours after receiving vaccine. He was seen by his PCP on 10/29 and given antibiotics for a suspected sinus infection. Later that same day he developed seizures and was admitted to the hospital. A lumbar puncture was consistent with meningio encephalitis. He was intubated and placed on a ventilator on 10/31. Increased intracranial pressure required the placement of a ICP catheter on 11/2. On 11/8 he was extubated and was responsive to painful stimuli. Discharge Summary received on 2/14/2005 states ADEM, aphasic, malnourished, meningitis, fever, bradycardia and nystagmus. As per annal follow up report: as of 12/06/2005 patient is permanently brain damaged, permanently mentally retarded and has seizures constantly.


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