|
VAERS ID: |
28077 (history) |
Form: |
Version 1.0 |
Age: |
72.0 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1990-10-16 |
Onset: | 1990-10-31 |
Days after vaccination: | 15 |
Submitted: |
1991-02-07 |
Days after onset: | 99 |
Entered: |
1991-02-12 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0J11164 / UNK |
- / - |
Administered by: Military Purchased by: Other Symptoms: Asthenia,
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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Diabanase Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: CO3771
Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy. |
|
VAERS ID: |
28566 (history) |
Form: |
Version 1.0 |
Age: |
67.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11217 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Influenza SMQs:, Infective pneumonia (broad), Opportunistic infections (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: not available Allergies: Diagnostic Lab Data: not available; CDC Split Type: CO3693
Write-up: Flu-like sx; Was hospitalized; |
|
VAERS ID: |
28340 (history) |
Form: |
Version 1.0 |
Age: |
58.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 1990-11-09 |
Onset: | 1990-11-20 |
Days after vaccination: | 11 |
Submitted: |
1991-02-14 |
Days after onset: | 86 |
Entered: |
1991-02-18 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
PD02680P / UNK |
LA / IM |
Administered by: Other Purchased by: Public Symptoms: Asthenia,
Back pain,
Guillain-Barre syndrome,
Paralysis SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), 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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: Information from hosp. has not yet been received. CDC Split Type:
Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91 |
|
VAERS ID: |
28359 (history) |
Form: |
Version 1.0 |
Age: |
47.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1990-10-31 |
Onset: | 1990-12-10 |
Days after vaccination: | 40 |
Submitted: |
1991-02-15 |
Days after onset: | 67 |
Entered: |
1991-02-18 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908205 / 2 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Facial palsy,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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, 20 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Prednisone, Lopressor, Lasix, Vasotec Current Illness: Preexisting Conditions: Lupus, hypertension Allergies: Diagnostic Lab Data: EMG-polyneuropathy, EEG-normal CDC Split Type:
Write-up: Numbness, tingling, face hands, feet. Paralysis, face. Weakness, upper & lower extremities |
|
VAERS ID: |
28380 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 1990-10-01 |
Onset: | 1990-10-10 |
Days after vaccination: | 9 |
Submitted: |
1991-02-06 |
Days after onset: | 119 |
Entered: |
1991-02-18 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908209 / 1 |
- / IM A |
Administered by: Private Purchased by: Private Symptoms: Influenza,
Pharyngitis,
Pyrexia,
Sepsis SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: none Current Illness: Preexisting Conditions: pt has hx of cerebrovascular accident Allergies: Diagnostic Lab Data: CDC Split Type: 890291003B
Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept |
|
VAERS ID: |
28416 (history) |
Form: |
Version 1.0 |
Age: |
76.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1991-01-02 |
Onset: | 1991-01-28 |
Days after vaccination: | 26 |
Submitted: |
1991-01-28 |
Days after onset: | 0 |
Entered: |
1991-02-25 |
Days after submission: | 28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908209 / 3 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Asthenia,
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, 7 days
Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient Other Medications: Cardezem Current Illness: none Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema Allergies: Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure CDC Split Type: GA9115
Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease |
|
VAERS ID: |
28474 (history) |
Form: |
Version 1.0 |
Age: |
84.0 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: | 1991-01-25 |
Onset: | 1991-01-31 |
Days after vaccination: | 6 |
Submitted: |
1991-02-01 |
Days after onset: | 1 |
Entered: |
1991-02-25 |
Days after submission: | 24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
289967 / 3 |
LA / - |
Administered by: Public Purchased by: Public Symptoms: Angina pectoris,
Leukocytosis,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Other ischaemic heart disease (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient Other Medications: Heart meds are routinely taken Current Illness: none Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago Allergies: Diagnostic Lab Data: variety-slight elevation of WBC only thing found CDC Split Type: WA91509
Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution |
|
VAERS ID: |
28476 (history) |
Form: |
Version 1.0 |
Age: |
28.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 1990-09-27 |
Onset: | 1990-09-28 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908193 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Headache,
Influenza,
Paraesthesia,
Paralysis SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Infective pneumonia (broad), Opportunistic infections (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Developed headache & flu-like sx for approx 2 days followed by slight numbness of hands & feet. Developed weakness that progressed to paralysis. |
|
VAERS ID: |
28835 (history) |
Form: |
Version 1.0 |
Age: |
70.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 1990-10-02 |
Onset: | 1990-10-24 |
Days after vaccination: | 22 |
Submitted: |
1990-11-07 |
Days after onset: | 14 |
Entered: |
1991-03-06 |
Days after submission: | 119 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
02580P / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Arthralgia,
Arthritis,
Chills,
Coma,
Dehydration,
Injection site reaction,
Palpitations,
Pyrexia,
Rash,
Syncope,
Vomiting SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (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? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: B/P 145/89 CDC Split Type: MD91006
Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug |
|
VAERS ID: |
29143 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 1990-11-25 |
Onset: | 1990-12-01 |
Days after vaccination: | 6 |
Submitted: |
1991-03-07 |
Days after onset: | 96 |
Entered: |
1991-03-14 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Cyanosis,
Dysphonia,
Myasthenic syndrome,
Neoplasm malignant,
Vocal cord paralysis SMQs:, Anaphylactic reaction (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Non-haematological malignant tumours (narrow), Immune-mediated/autoimmune disorders (narrow)
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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: considering myasthenia gravis as the etiology.CT SCAn &MRI of upper chest&neck initially-neg.F/U CT SCAN of upper chest:tumor involving SVC&both recurrent laryngeal nerves@thoracic inlet. CDC Split Type: 914090008
Write-up: Bilat paramedian vocal cord paralysis reported in pt receiving Fluogen. Had flu vax in Nov90 & became hoarse late Dec90. Seen mid Jan & found to have bilat paramedian vocal cord paralysis. As of 18Feb91, pt better. Dx=myasthenia gravis? |
|