|
VAERS ID: |
31380 (history) |
Form: |
Version 1.0 |
Age: |
61.0 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: | 1990-09-28 |
Onset: | 1990-10-10 |
Days after vaccination: | 12 |
Submitted: |
1991-06-12 |
Days after onset: | 245 |
Entered: |
1991-06-17 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / 1 |
LA / - |
Administered by: Private Purchased by: Private Symptoms: CSF test abnormal,
Guillain-Barre syndrome,
Myasthenic syndrome SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Cardizem Current Illness: HTN, ASHD Preexisting Conditions: none Allergies: Diagnostic Lab Data: spinal tap showing elevated protein CDC Split Type:
Write-up: Pt recvd vax 28SEP90. Pt developed progressive muscle weakness. Hospitalized 11OCT90 w/acute Guillian-Barre Synd. The pt required plasmapheresis & respirator support. |
|
VAERS ID: |
31633 (history) |
Form: |
Version 1.0 |
Age: |
79.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1990-11-12 |
Onset: | 1990-11-18 |
Days after vaccination: | 6 |
Submitted: |
1991-06-12 |
Days after onset: | 205 |
Entered: |
1991-06-21 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Pneumonia SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 5 days
Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no~ ()~~~In Sibling Other Medications: Current Illness: none Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung Allergies: Diagnostic Lab Data: chest xray CDC Split Type:
Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax. |
|
VAERS ID: |
31993 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1989-11-27 |
Onset: | 1989-12-10 |
Days after vaccination: | 13 |
Submitted: |
1991-06-19 |
Days after onset: | 555 |
Entered: |
1991-07-01 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01209P / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Anaemia,
Atelectasis,
Atrial fibrillation,
Pericarditis,
Thrombocytopenia SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (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, 24 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: NONE CDC Split Type: 914089002
Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec |
|
VAERS ID: |
43894 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1988-11-25 |
Onset: | 1988-12-10 |
Days after vaccination: | 15 |
Submitted: |
1991-01-04 |
Days after onset: | 755 |
Entered: |
1991-09-03 |
Days after submission: | 241 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Back pain,
CSF test abnormal,
Electrocardiogram abnormal,
Guillain-Barre syndrome,
Hypertension,
Hyporeflexia,
Paraesthesia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Cardiomyopathy (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
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: ~ ()~~~In patient Other Medications: Orudis Capsules Current Illness: NONE Preexisting Conditions: pt has known allergy to PCN; inc cholesterol in the past; pos for diabetes mellitus in mom & dad; father also had emphysema; Allergies: Diagnostic Lab Data: Spinal fluid analysis-inc spinal fluid protein, nl glucose & w/o leukocytes; Cholesterol 319; Triglycerides 276; EMG & Nerve conduction velocities showed mltifocal conduction abn; CDC Split Type: B073089012
Write-up: Pt recvd flu vax & was admitted to hosp w/extremity weakness & numbness; approx 4-5 days prior to admission, pt had dorsal & epigastric pain assoc w/tingling in hands & feet;poss GBS; also areflexia; BP 190/100; |
|
VAERS ID: |
35111 (history) |
Form: |
Version 1.0 |
Age: |
15.0 |
Sex: |
Female |
Location: |
Indiana |
Vaccinated: | 1988-10-31 |
Onset: | 1988-11-01 |
Days after vaccination: | 1 |
Submitted: |
1990-11-12 |
Days after onset: | 741 |
Entered: |
1991-09-30 |
Days after submission: | 321 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Other Symptoms: Gait disturbance,
Guillain-Barre syndrome,
Headache,
Hyporeflexia,
Influenza,
Myalgia,
Myasthenic syndrome,
Paraesthesia SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)
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, 55 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: UNK Current Illness: UNK Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response; CDC Split Type: 890318005B
Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS; |
|
VAERS ID: |
33096 (history) |
Form: |
Version 1.0 |
Age: |
68.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1990-10-18 |
Onset: | 1990-11-12 |
Days after vaccination: | 25 |
Submitted: |
1991-02-21 |
Days after onset: | 101 |
Entered: |
1991-10-15 |
Days after submission: | 235 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908209 / 2 |
- / IM A |
Administered by: Other Purchased by: Private Symptoms: Asthenia,
Guillain-Barre syndrome,
Hyporeflexia,
Paraesthesia 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7; Allergies: Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies; CDC Split Type: 890354002B
Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS; |
|
VAERS ID: |
35524 (history) |
Form: |
Version 1.0 |
Age: |
49.0 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: | 1990-09-27 |
Onset: | 1990-10-07 |
Days after vaccination: | 10 |
Submitted: |
1990-10-15 |
Days after onset: | 8 |
Entered: |
1991-10-16 |
Days after submission: | 366 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908201 / 1 |
RA / IM |
Administered by: Other Purchased by: Private Symptoms: Asthenia,
Guillain-Barre syndrome,
Paraesthesia 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, 10 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: 890312002B
Write-up: following vax pt devel GBS; sx included weakness & tingling in the legs; Hospitalization was required due to progressive weakness; pt improved p/an initial course of 5-6 plasmapheresis tx; 1 wk later, pt was retreated w/5-6 plasmapheresis; |
|
VAERS ID: |
35525 (history) |
Form: |
Version 1.0 |
Age: |
74.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1990-12-04 |
Onset: | 1990-12-19 |
Days after vaccination: | 15 |
Submitted: |
1991-06-11 |
Days after onset: | 173 |
Entered: |
1991-10-16 |
Days after submission: | 127 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908195 / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Guillain-Barre syndrome,
Paralysis SMQs:, Peripheral neuropathy (narrow), 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? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: UNK Current Illness: unk Preexisting Conditions: unk Allergies: Diagnostic Lab Data: UNK CDC Split Type: 891198011B
Write-up: Pt devel GBS w/paralysis approx 3 wks p/receiving influenza vax; pt believes the vax caused this problem; |
|
VAERS ID: |
35526 (history) |
Form: |
Version 1.0 |
Age: |
55.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1990-11-09 |
Onset: | 1990-11-24 |
Days after vaccination: | 15 |
Submitted: |
1991-06-07 |
Days after onset: | 194 |
Entered: |
1991-10-16 |
Days after submission: | 131 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908194 / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Guillain-Barre syndrome,
Hypertension,
Paraesthesia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90; Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted; CDC Split Type: 890354001B
Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds; |
|
VAERS ID: |
35646 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1991-09-24 |
Onset: | 1991-09-24 |
Days after vaccination: | 0 |
Submitted: |
1991-10-01 |
Days after onset: | 7 |
Entered: |
1991-10-21 |
Days after submission: | 20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
312978 / UNK |
- / IM A |
Administered by: Private Purchased by: Private Symptoms: Myasthenic syndrome,
Myelitis,
Neuropathy SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (narrow)
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? Yes, 30 days
Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient Other Medications: UNK Current Illness: UNK Preexisting Conditions: several medical problems-not specified Allergies: Diagnostic Lab Data: Cervical Myelogram-WBC 175; MRI-swelling C4-C6; CDC Split Type: 910183701
Write-up: 62 y/o pt immunized 24SEP91 & w/in 12 hrs post vax, pt exp weakness in the lt arm & leg; Hospitalized on 26SEP; dx w/transverse myelitis; tx w/high dose IV steroids; pt stable, still hospitalized as of 8OCT91; |
|