|
VAERS ID: |
36485 (history) |
Form: |
Version 1.0 |
Age: |
64.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1991-10-24 |
Onset: | 1991-10-28 |
Days after vaccination: | 4 |
Submitted: |
1991-11-05 |
Days after onset: | 8 |
Entered: |
1991-11-19 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918169 / 2 |
- / - |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
302959 / 1 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Anorexia,
Cough,
Pneumonia,
Pyrexia,
Salivary hypersecretion SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No 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: Current Illness: Bronchitis chronic, heart problem Preexisting Conditions: Severe bronchitis, CHF Allergies: Diagnostic Lab Data: CDC Split Type: CA91132
Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia; |
|
VAERS ID: |
36486 (history) |
Form: |
Version 1.0 |
Age: |
78.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1991-10-10 |
Onset: | 1991-10-11 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1991-11-19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918170 / UNK |
- / - |
Administered by: Public Purchased by: Unknown Symptoms: Dizziness,
Hypokinesia,
Infection,
Lung disorder,
Myalgia,
Vomiting SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament 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: NONE~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991 Allergies: Diagnostic Lab Data: CXR-showed Bilateral infiltrates; CDC Split Type: CA91133
Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia; |
|
VAERS ID: |
36558 (history) |
Form: |
Version 1.0 |
Age: |
63.0 |
Sex: |
Female |
Location: |
West Virginia |
Vaccinated: | 1991-10-29 |
Onset: | 1991-10-29 |
Days after vaccination: | 0 |
Submitted: |
1991-11-14 |
Days after onset: | 16 |
Entered: |
1991-11-21 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01401P / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Amblyopia,
Asthenia,
Hypotension,
Palpitations SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Dehydration (broad), Hypokalaemia (broad)
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, 3 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Zantac & Pepzid tabs Current Illness: alcoholic liver cirrhosis Preexisting Conditions: peptic ulcer disease Allergies: Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal CDC Split Type: WV9149
Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization; |
|
VAERS ID: |
36577 (history) |
Form: |
Version 1.0 |
Age: |
87.0 |
Sex: |
Female |
Location: |
Alabama |
Vaccinated: | 1991-10-15 |
Onset: | 1991-10-28 |
Days after vaccination: | 13 |
Submitted: |
1991-11-14 |
Days after onset: | 17 |
Entered: |
1991-11-22 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918132 / UNK |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Condition aggravated SMQs:
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, 8 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: chronic medical condition but stable Preexisting Conditions: COPD Allergies: Diagnostic Lab Data: CDC Split Type: AL91033
Write-up: Pt is known to have COPD; had excerbation needing hospitalization from 28OCT91 to 5NOV91; |
|
VAERS ID: |
36579 (history) |
Form: |
Version 1.0 |
Age: |
51.0 |
Sex: |
Male |
Location: |
Alabama |
Vaccinated: | 1991-11-01 |
Onset: | 1991-11-08 |
Days after vaccination: | 7 |
Submitted: |
1991-11-14 |
Days after onset: | 6 |
Entered: |
1991-11-22 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918132 / UNK |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Respiratory disorder SMQs:, Acute central respiratory depression (broad), Respiratory failure (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, 3 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: stable @ time of vax Preexisting Conditions: hx of asthma Allergies: Diagnostic Lab Data: CDC Split Type: AL91035
Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91; |
|
VAERS ID: |
36589 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1991-11-06 |
Onset: | 1991-11-15 |
Days after vaccination: | 9 |
Submitted: |
1991-11-18 |
Days after onset: | 3 |
Entered: |
1991-11-22 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918129 / 1 |
LL / IM |
Administered by: Public Purchased by: Private Symptoms: Convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), 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? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium Current Illness: NONE Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG Allergies: Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153; CDC Split Type:
Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants; |
|
VAERS ID: |
36611 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 1991-10-31 |
Onset: | 1991-11-09 |
Days after vaccination: | 9 |
Submitted: |
1991-11-15 |
Days after onset: | 6 |
Entered: |
1991-11-25 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918146 / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Dysphagia,
Guillain-Barre syndrome,
Hypokinesia,
Myalgia,
Myasthenic syndrome,
Paraesthesia,
Vomiting SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), 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, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Advil, Cardizem Current Illness: NONE Preexisting Conditions: arthritis; hyperderssion sinc 3; hypothyroidism, allergic to PCN Allergies: Diagnostic Lab Data: CBC-normal; p-3.6; otherwise chem normal; Electormogram; CSF; GM slain-neg; smear fangus-neg; glucose; protein, APT; electrolytes, SGPT, total CPK, sigmoid; LP revealed mild inc in portein in spinal fluid & GBS dx; CXR-normal CDC Split Type: MO9190
Write-up: 9NOV91 numbness & tingling lower extremities; 10NOV91 could no longer stand; arms have movement but weak;grasp weak, vomiting, muscular pain, some difficulty swallowing; |
|
VAERS ID: |
36612 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Female |
Location: |
Mississippi |
Vaccinated: | 1991-11-06 |
Onset: | 1991-11-06 |
Days after vaccination: | 0 |
Submitted: |
1991-11-07 |
Days after onset: | 1 |
Entered: |
1991-11-25 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918153 / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Chills,
Myalgia,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: pt stated was healthy @ time; Preexisting Conditions: had rt breast & lymph nodes removed p/each breast was dx; Allergies: Diagnostic Lab Data: NONE CDC Split Type: MS9151
Write-up: Pt states approx 2 hrs p/vax was given, pt began having a fever of 101 to103 & a chill & aching severly; pt was taken to Hosp ER & admitted; This was pts 1st flu immun; |
|
VAERS ID: |
36629 (history) |
Form: |
Version 1.0 |
Age: |
71.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 1991-09-27 |
Onset: | 1991-09-28 |
Days after vaccination: | 1 |
Submitted: |
1991-10-01 |
Days after onset: | 3 |
Entered: |
1991-11-25 |
Days after submission: | 55 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918202 / UNK |
- / IM A |
Administered by: Public Purchased by: Public Symptoms: Asthenia,
Cerebrovascular accident,
Hypertension,
Myasthenic syndrome,
Pneumonia,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 8 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: MS Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke; |
|
VAERS ID: |
36651 (history) |
Form: |
Version 1.0 |
Age: |
69.0 |
Sex: |
Female |
Location: |
Utah |
Vaccinated: | 1991-10-16 |
Onset: | 1991-10-16 |
Days after vaccination: | 0 |
Submitted: |
1991-11-01 |
Days after onset: | 16 |
Entered: |
1991-11-26 |
Days after submission: | 25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21216 / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Asthma,
Hypertension,
Pyrexia,
Tachycardia SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: ~ ()~~~In patient Other Medications: Micronase Current Illness: NONE Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes Allergies: Diagnostic Lab Data: EKG-normal-lt on moniter until AM; CDC Split Type: UT9126
Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM; |
|