|
VAERS ID: |
26826 (history) |
Form: |
Version 1.0 |
Age: |
25.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-10-19 |
Onset: | 1990-10-20 |
Days after vaccination: | 1 |
Submitted: |
1990-10-23 |
Days after onset: | 3 |
Entered: |
1990-11-27 |
Days after submission: | 35 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11217 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Nuchal rigidity SMQs:
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: allerigc to ibuprofen, sulfa drugs Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with Fluzone developed painful stiff neck x5 days; No fever or other symptoms; No muscle ache or sensory nerve changes noticed. |
|
VAERS ID: |
26837 (history) |
Form: |
Version 1.0 |
Age: |
79.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1990-10-25 |
Onset: | 1990-11-01 |
Days after vaccination: | 7 |
Submitted: |
1990-11-15 |
Days after onset: | 14 |
Entered: |
1990-11-28 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Gastrointestinal haemorrhage,
Pain,
Pleural effusion,
Rash,
Splenomegaly,
Vasculitis,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)
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, 10 days
Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula~ ()~~~In patient Other Medications: Synthroid, Aldactazide Current Illness: none Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 890311001B
Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting. |
|
VAERS ID: |
26838 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Arizona |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1990-11-15 |
Entered: |
1990-11-28 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Respiratory disorder SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)
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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Chest x-ray: Pleural effusion CDC Split Type: 890311002B
Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening. |
|
VAERS ID: |
26839 (history) |
Form: |
Version 1.0 |
Age: |
55.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: | 0000-00-00 |
Onset: | 1990-11-12 |
Submitted: |
1990-11-16 |
Days after onset: | 4 |
Entered: |
1990-11-28 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Face oedema,
Oedema SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Nasalide, Zejtril Current Illness: HTN Preexisting Conditions: Duricef, Novacain, Feldene, Reglan Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated developed swelling-lips, face lt arm & lt hand. Seen in ER 13NOV90. Vsikeril injection in ER Hydroxyzine pam 50mg TID x 7 days. Seen in MD office 15NOV90 for f/u |
|
VAERS ID: |
26843 (history) |
Form: |
Version 1.0 |
Age: |
82.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1990-10-08 |
Onset: | 1990-10-10 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908205 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Abscess,
Oedema,
Pyrexia SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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: Calan SR Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Blood culture - negative; abscess culture - negative CDC Split Type:
Write-up: Pt vaccinated with Influenza developed swelling in lt arm w/low grade temp. Treated as allergic reaction w/short course Prednisone. Developed sterile abscess & fevers. Required hospitalization & surgery drainage . |
|
VAERS ID: |
26844 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 1990-09-01 |
Onset: | 1990-09-01 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Stevens-Johnson syndrome SMQs:, Severe cutaneous adverse reactions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 904090004
Write-up: Pt vaccinated with FLUOGEN developed Stevens-Johnson Synd. No other details known. |
|
VAERS ID: |
26861 (history) |
Form: |
Version 1.0 |
Age: |
37.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-11-06 |
Onset: | 1990-11-06 |
Days after vaccination: | 0 |
Submitted: |
1990-11-16 |
Days after onset: | 10 |
Entered: |
1990-11-30 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
02580P / UNK |
LA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Headache,
Pruritus,
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? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Demulen; Ceclor, Caleen. Current Illness: Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria |
|
VAERS ID: |
26862 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: | 1990-11-08 |
Onset: | 1990-11-08 |
Days after vaccination: | 0 |
Submitted: |
1990-11-26 |
Days after onset: | 18 |
Entered: |
1990-11-30 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11223 / 5 |
LA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Malaise,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Doxepin HCL, Hytrin, Dipyradimole Current Illness: Preexisting Conditions: Hypertension Allergies: Diagnostic Lab Data: CDC Split Type: MA900001
Write-up: Pt vac w/ flu vac developed weakness and mild numbness in torso lasting seven days. Denies difficulty breathing has not had prior reactions to Flu vaccine. 14Feb91: Neurologist comment," insufficient evidence to relate sx to flu shot". |
|
VAERS ID: |
26863 (history) |
Form: |
Version 1.0 |
Age: |
72.0 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: | 1990-10-31 |
Onset: | 1990-11-07 |
Days after vaccination: | 7 |
Submitted: |
1990-11-26 |
Days after onset: | 19 |
Entered: |
1990-11-30 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11224 / 3 |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Chest pain,
Gastroenteritis SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Noninfectious diarrhoea (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: Allergies: Diagnostic Lab Data: EKG - WNL CDC Split Type: MA900002
Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same |
|
VAERS ID: |
26864 (history) |
Form: |
Version 1.0 |
Age: |
58.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1990-11-01 |
Onset: | 1990-11-10 |
Days after vaccination: | 9 |
Submitted: |
1990-11-15 |
Days after onset: | 5 |
Entered: |
1990-11-30 |
Days after submission: | 15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11224 / 1 |
RA / SC |
Administered by: Public Purchased by: Public Symptoms: Chills,
Gastroenteritis,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious diarrhoea (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: Allergies: Diagnostic Lab Data: CDC Split Type: MA900003
Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date. |
|