|
VAERS ID: |
26490 (history) |
Form: |
Version 1.0 |
Age: |
36.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1990-10-23 |
Onset: | 1990-10-23 |
Days after vaccination: | 0 |
Submitted: |
1990-10-24 |
Days after onset: | 1 |
Entered: |
1990-11-05 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
RA / IM |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
- / 1 |
LA / SC |
Administered by: Private Purchased by: Private Symptoms: Injection site reaction,
Pharyngitis SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Pepcid; Lo-ovral Current Illness: Preexisting Conditions: Hx similar response to flu vaccine last yr, no problem this yr when flue vaccine given in divided doses. Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with Pneumococcal/Influenza developed local erythema& induration at inject site, sensation of tightness in throat; occurred 4 hrs after pt took Benadryl 50mg; tighness relieved; took 2nd dose in AM, size of erythema decreased. |
|
VAERS ID: |
26491 (history) |
Form: |
Version 1.0 |
Age: |
70.0 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: | 1990-10-22 |
Onset: | 1990-10-22 |
Days after vaccination: | 0 |
Submitted: |
1990-10-25 |
Days after onset: | 3 |
Entered: |
1990-11-05 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Oedema,
Rash SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Lanoxin Thyroid Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with Flu shot developed redness, swelling,rash. Injection was given 22OCT90. Pt did not report rx until it was gone on 25OCT90. |
|
VAERS ID: |
26497 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1990-10-25 |
Onset: | 1990-10-25 |
Days after vaccination: | 0 |
Submitted: |
1990-10-29 |
Days after onset: | 4 |
Entered: |
1990-11-05 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01670P / 1 |
RA / IM |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
226928 / 1 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Nausea,
Pyrexia,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with Influenza/PNU-IMUNE approx 1 hr following administration of vaccine pt developed nausea, vomiting, fever lasting approx 12 hrs. |
|
VAERS ID: |
26504 (history) |
Form: |
Version 1.0 |
Age: |
66.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1990-09-26 |
Onset: | 1990-10-14 |
Days after vaccination: | 18 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01770P / UNK |
LA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Cough,
Ear pain,
Headache,
Pharyngitis,
Sinusitis SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Physical Exam only CDC Split Type:
Write-up: Pt vaccinated with FLUOGEN developed sore throat, headache, earache, sinus drainage thru 22OCT90. Cough, congestion chest appt w/ Dr. Given antibiotic & expectorant by MD dx URI. "Symptoms not due to influenza injection." |
|
VAERS ID: |
26596 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-10-01 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
289967 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion,
Encephalitis,
Stupor SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 900180401
Write-up: Pt vaccinated with Influenza Vaccine 3-4 days after, pt had a seizure like episode at home, was found unresponsive and hospitalized. Admitted to ICU for 5 days. Treatment included oxygen and IV fluids. Discharged, admitted to Nursing Home. |
|
VAERS ID: |
26597 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
289967 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion,
Stupor,
Thinking abnormal SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 900180402
Write-up: Pt vaccinated with Influenza Virus 3-4 days after vaccination, 80 yo woman found unresponsive, hospitalized. Pt had a seizure at home & another during hosp. Treatment included IV fluids. In ICU for 24 hrs dx altered level of consciousness. |
|
VAERS ID: |
26600 (history) |
Form: |
Version 1.0 |
Age: |
42.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1990-10-09 |
Onset: | 1990-10-09 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Diazepam; Biscodyl, Demerol Current Illness: Preexisting Conditions: Spastic & dystomiquadraplegia, Cerebral palsy Allergies: Diagnostic Lab Data: CBC CDC Split Type:
Write-up: Pt vaccinated with Influenza Vaccine developed hives over entire body, low grade fever. |
|
VAERS ID: |
26605 (history) |
Form: |
Version 1.0 |
Age: |
75.0 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: | 1990-10-30 |
Onset: | 1990-10-30 |
Days after vaccination: | 0 |
Submitted: |
1990-11-01 |
Days after onset: | 2 |
Entered: |
1990-11-09 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
OF11200 / UNK |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Chills,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Diabetes Allergies: Diagnostic Lab Data: WBC 9000; BS 370; UA - negative CDC Split Type:
Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done. |
|
VAERS ID: |
26614 (history) |
Form: |
Version 1.0 |
Age: |
44.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 1990-11-01 |
Onset: | 1990-11-01 |
Days after vaccination: | 0 |
Submitted: |
1990-11-03 |
Days after onset: | 2 |
Entered: |
1990-11-13 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908509 / UNK |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Injection site mass,
Injection site reaction SMQs:, Extravasation events (injections, infusions and implants) (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Ogen Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with Influenza Vaccine became itchy in area lt arm; hard in area; sl swollen, red & warm started evening 1NOV90 has continued stated less red & swollen today 3NOV90. |
|
VAERS ID: |
26615 (history) |
Form: |
Version 1.0 |
Age: |
49.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1990-10-25 |
Onset: | 1990-11-01 |
Days after vaccination: | 7 |
Submitted: |
1990-11-05 |
Days after onset: | 4 |
Entered: |
1990-11-13 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908192 / UNK |
LA / IM |
Administered by: Other Purchased by: Private Symptoms: Herpes zoster,
Pruritus,
Pyrexia,
Rash SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Ascriptin, Sectal Current Illness: Preexisting Conditions: Previous allergic rx to B/P med Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack. |
|