|
VAERS ID: |
29150 (history) |
Form: |
Version 1.0 |
Age: |
87.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 1990-10-24 |
Onset: | 1990-10-26 |
Days after vaccination: | 2 |
Submitted: |
1990-11-20 |
Days after onset: | 25 |
Entered: |
1991-03-15 |
Days after submission: | 115 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11200 / 2 |
LA / - |
Administered by: Public Purchased by: Public Symptoms: Cardiac failure,
Myocardial infarction SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-26
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: MN90002
Write-up: Admitted to hosp on 26OCT90 died on 26OCT90; MI w/cardiac arrest. |
|
VAERS ID: |
29271 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1990-11-08 |
Onset: | 1990-12-26 |
Days after vaccination: | 48 |
Submitted: |
0000-00-00 |
Entered: |
1991-03-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11221 / 1 |
LA / IM |
Administered by: Other Purchased by: Unknown Symptoms: Cough,
Cyanosis,
Dyspnoea,
Hypoxia,
Leukocytosis,
Pyrexia,
Respiratory disorder SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 14 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: 11DEC90- WBC 16,700 w/no diff + PHS; ABG(RA)-7.48/PO2 36/PCO2 32; LFTS- NL CDC Split Type:
Write-up: Pt developed progressive cough, DOE & low grade fever about 24 hrs p/vax x 2wks; Admitted to Hosp from 11DEC to about 20DEC w/bilateral pulmonary infiltrates hypoxemia & mild leukocytosis; No bacteriologic diagnosis was made; |
|
VAERS ID: |
29350 (history) |
Form: |
Version 1.0 |
Age: |
66.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1990-11-07 |
Onset: | 1990-11-10 |
Days after vaccination: | 3 |
Submitted: |
1991-03-22 |
Days after onset: | 132 |
Entered: |
1991-03-25 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
025808 / 4 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Encephalitis SMQs:, Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-11-29
Days after onset: 19
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 49 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Dyazide Current Illness: NONE Preexisting Conditions: Hypertension, mild Allergies: Diagnostic Lab Data: MRI & convalescent serum consistent CDC Split Type:
Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot"; |
|
VAERS ID: |
29510 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-12-15 |
Onset: | 1990-12-16 |
Days after vaccination: | 1 |
Submitted: |
1991-03-26 |
Days after onset: | 100 |
Entered: |
1991-04-03 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / 1 |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Anorexia,
Asthenia,
Atelectasis,
Chills,
Cough,
Headache,
Myalgia,
Paraesthesia,
Pharyngitis,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, ? days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: ASA Current Illness: NONE Preexisting Conditions: No egg allergy Allergies: Diagnostic Lab Data: CBC, Sed RAT, Cold agglutinins, chemistry profile, CT scan of head & abdomin, Legionella titer - all WNL; CXR mild basilar; atelectasis during acute phase; CDC Split Type: 914090005
Write-up: Polymyalgia rheumatica reported in MD receiving FLUOGEN 1st shot 15DEC90; sx of URI, fevers to 101, chills w/rigors, myalgia, headache, fatigue, anorexia, non productive cough & dysesthesias of scalp; Atelectasis on CXR; |
|
VAERS ID: |
29811 (history) |
Form: |
Version 1.0 |
Age: |
73.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-10-19 |
Onset: | 1990-10-20 |
Days after vaccination: | 1 |
Submitted: |
1991-03-08 |
Days after onset: | 139 |
Entered: |
1991-04-08 |
Days after submission: | 30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908200 / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Influenza,
Myasthenic syndrome,
Neoplasm malignant,
Neuropathy,
Neuropathy peripheral,
Pain,
Pyrexia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), 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: UKN Current Illness: Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases; Allergies: Diagnostic Lab Data: CDC Split Type: 891078001B
Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy; |
|
VAERS ID: |
29946 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Male |
Location: |
New Mexico |
Vaccinated: | 1990-10-01 |
Onset: | 1990-10-01 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-04-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Brain stem syndrome,
Neuropathy SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Pt had flu shot 1 yr ago w/out problems Allergies: Diagnostic Lab Data: MRI & CT head scan - WNL; Sp Tap- no available CDC Split Type: 904090006
Write-up: Brain stem disordr, cranial nerve palsies are rept''d in a pt rec''d Fluogen; Approx 1OCT90 rec''d vax 1 wk later developed cranial nerve palsies w/the concern of a poss demyelinating condition of the brain stem; |
|
VAERS ID: |
29955 (history) |
Form: |
Version 1.0 |
Age: |
39.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-10-31 |
Onset: | 1990-11-15 |
Days after vaccination: | 15 |
Submitted: |
1990-11-29 |
Days after onset: | 14 |
Entered: |
1991-04-18 |
Days after submission: | 139 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908204 / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Arthralgia,
Asthenia,
Chest pain,
Cough,
Hyperhidrosis,
Hypertension,
Influenza,
Paraesthesia,
Pharyngitis,
Pyrexia SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Cardizem 30 mg tid, Presantine 50 mg tid Current Illness: none Preexisting Conditions: angio-plasty Allergies: Diagnostic Lab Data: Neurological evaluation CDC Split Type: CA9139
Write-up: Recvd injection 31Oct90- 15Nov90 numbness in lt arm-hand-went to ER-Adm for observation over night. DX virus-infection-still very tired. Had neurological evaluation. |
|
VAERS ID: |
30242 (history) |
Form: |
Version 1.0 |
Age: |
47.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1990-10-26 |
Onset: | 1990-11-06 |
Days after vaccination: | 11 |
Submitted: |
1991-04-05 |
Days after onset: | 150 |
Entered: |
1991-04-29 |
Days after submission: | 23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908181 / 1 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Abscess,
Central nervous system neoplasm,
Cerebral infarction,
Cerebrovascular accident,
Multiple sclerosis,
Neuropathy,
Speech disorder,
Thinking abnormal SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Demyelination (narrow), Non-haematological tumours of unspecified malignancy (narrow), Immune-mediated/autoimmune disorders (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? Yes, 46 days
Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient Other Medications: none Current Illness: none Preexisting Conditions: Allergies: Diagnostic Lab Data: MRI-lesion on lt side of brain, biopsy-inconclusive results r/o a glimona & multiple sclerosis. CDC Split Type: 891099001B
Write-up: Pt experienced severe vomiting & cold sx approx 1 wk /p receiving vax on 9NOV90; Developed severe speaking difficulties 4mo later & was hospitalized; MRI revealed a lesion on the lt side of brain; dx w/demyelinating encephalopathy; |
|
VAERS ID: |
30243 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 1990-10-25 |
Onset: | 1990-11-01 |
Days after vaccination: | 7 |
Submitted: |
1991-04-05 |
Days after onset: | 155 |
Entered: |
1991-04-29 |
Days after submission: | 23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908181 / 1 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Vomiting SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: none specified Current Illness: none Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 891099002B
Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids |
|
VAERS ID: |
30720 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1990-10-01 |
Onset: | 1991-02-15 |
Days after vaccination: | 137 |
Submitted: |
1991-05-16 |
Days after onset: | 89 |
Entered: |
1991-05-20 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Headache,
Hypoxia,
Infection,
Lung disorder,
Myalgia,
Pyrexia,
Respiratory disorder SMQs:, Rhabdomyolysis/myopathy (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 11 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg CDC Split Type: 914090047
Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later; |
|