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From the 10/8/2021 release of VAERS data:

Found 1,069 cases where Age is 65-or-more and Vaccine is 6VAX-F or ADEN or ADEN_4_7 or ANTH or BCG or CEE or CHOL or DF or DPIPV or DPP or DT or DTAP or DTAPH or DTAPHEPBIP or DTAPIPV or DTAPIPVHIB or DTIPV or DTOX or DTP or DTPHEP or DTPHIB or DTPIHI or DTPIPV or DTPPHIB or DTPPVHBHPB or EBZR or FLU(H1N1) or FLU3 or FLU4 or FLUA3 or FLUA4 or FLUC3 or FLUC4 or FLUN(H1N1) or FLUN3 or FLUN4 or FLUR3 or FLUR4 or FLUX or FLUX(H1N1) or H5N1 or HBHEPB or HBPV or HEP or HEPA or HEPAB or HEPATYP or HIBV or HPV2 or HPV4 or HPV9 or HPVX or IPV or JEV or JEV1 or JEVX or LYME or MEA or MEN or MENB or MENHIB or MER or MM or MMR or MMRV or MNC or MNQ or MNQHIB or MU or MUR or OPV or PER or PLAGUE or PNC or PNC10 or PNC13 or PPV or RAB or RUB or RV or RV1 or RV5 or RVX or SMALL or SSEV or TBE or TD or TDAP or TDAPIPV or TTOX or TYP or UNK or VARCEL or VARZOS or YF and Patient Died and Vaccination Date from '1990-01-01' to '2020-11-30'

Table

   
AgeCountPercent
65-75 Years37434.99%
75+ Years69565.01%
TOTAL1,069100%



Case Details

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VAERS ID: 25581 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: Oregon  
Vaccinated:1990-01-25
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 585A4 / 2 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Encephalitis, Infection
SMQs:, Lack of efficacy/effect (narrow), 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: 1990-05-19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no known allergies, non responder to previous 3 dose /w MSD vaccine
Allergies:
Diagnostic Lab Data: 10Jan90 titer test = non responsive, Herpes varicella recovered from brain
CDC Split Type: EBU900170

Write-up: Pt given a series of 3 MSD Hep-B vaccines, & 2 Engerix-B vaccines due to being non responder. Pt developed encephalitis & died. Herpes varicella recovered form brain


VAERS ID: 26318 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-10-09
Onset:1990-10-11
   Days after vaccination:2
Submitted: 1990-10-17
   Days after onset:6
Entered: 1990-10-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 1 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-12
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC Split Type:

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


VAERS ID: 26655 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Female  
Location: Michigan  
Vaccinated:1990-10-18
Onset:1990-10-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Back pain
SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


VAERS ID: 26713 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-10-02
Onset:1990-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-09
   Days after onset: 7
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: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


VAERS ID: 26721 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Iowa  
Vaccinated:1990-10-24
Onset:1990-11-02
   Days after vaccination:9
Submitted: 1990-11-14
   Days after onset:12
Entered: 1990-11-26
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Demyelination (narrow), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC Split Type:

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


VAERS ID: 27141 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1990-10-22
Onset:1990-10-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-25
   Days after onset: 3
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: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


VAERS ID: 27159 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted: 1990-12-17
Entered: 1990-12-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / UNK - / -

Administered by: Private       Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC Split Type:

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


VAERS ID: 27275 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:1990-11-26
Onset:1990-11-26
   Days after vaccination:0
Submitted: 1990-12-26
   Days after onset:30
Entered: 1991-01-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / UNK LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


VAERS ID: 27529 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:1990-11-06
Onset:1990-11-07
   Days after vaccination:1
Submitted: 1991-01-18
   Days after onset:72
Entered: 1991-01-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Right ventricular failure
SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-10
   Days after onset: 33
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: CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


VAERS ID: 28753 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:1990-11-23
Onset:1990-11-24
   Days after vaccination:1
Submitted: 1990-11-30
   Days after onset:6
Entered: 1991-03-04
   Days after submission:94
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 RA / -

Administered by: Other       Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-29
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


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?


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: 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: 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: 29960 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-10-02
Onset:1990-10-09
   Days after vaccination:7
Submitted: 1991-01-14
   Days after onset:97
Entered: 1991-04-18
   Days after submission:93
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-09
   Days after onset: 0
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: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC Split Type: MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


VAERS ID: 34946 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-11-23
Onset:1990-11-26
   Days after vaccination:3
Submitted: 1991-09-19
   Days after onset:296
Entered: 1991-09-23
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Arteritis, Cerebral haemorrhage, Cough, Encephalopathy, Myalgia, Paraesthesia, Pyrexia, Red blood cell sedimentation rate increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-04
   Days after onset: 158
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 48 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pepcid, Synthroid
Current Illness:
Preexisting Conditions: CVA; Hyperthyroidism; Lithiasis, renal; Tuberculosis; Hypertens; Diplopia; Arthritis; Hypothyroidism; Esophageal stricture; Reflux esophagitis; Hiatal hernia; Rhinitis, allergic;
Allergies:
Diagnostic Lab Data: FEB91 ESR 89, 11, 78, 15; ANA 1:320 Homogenous; 28JAN91 Biopsy-Temporal arteritis; FEB91 X-ray-lt lower lobe infiltrate;7FEB91 CT Scan-areas of inc density; 15FEB91 MRI-Multiple parenchymal hemorrhages; 27FEB91 EEG-Mod severe encepahlopathy
CDC Split Type: WAES91090244

Write-up: Pt vaxed 23NOV90 & on 26NOV90 devel a cough which worsened during next wk; fever, myalgia, malaise, & weakness in lower extremities;Polymyalgia rheumatica & temporal arteritis were poss dx; 28JAN91 biopsy pos for arteritis; paresthesias;


VAERS ID: 36623 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-10-07
Onset:1991-10-20
   Days after vaccination:13
Submitted: 1991-11-07
   Days after onset:18
Entered: 1991-11-25
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Hyperglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC Split Type: SD91025

Write-up: 20OCT91 pt expired;


VAERS ID: 36624 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-10-08
Onset:1991-10-09
   Days after vaccination:1
Submitted: 1991-10-28
   Days after onset:19
Entered: 1991-11-25
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Diarrhoea, Nausea, Right ventricular failure, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-14
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ
Current Illness: NONE
Preexisting Conditions: arthritis, hypertension
Allergies:
Diagnostic Lab Data: total bilirubin results inconclusive;
CDC Split Type: SD91026

Write-up: Nausea, vomiting, diarrhea started 9OCT or 10OCT, diarrhea stopped but was still nauseated; MD ordered Phenergan supp 13OCT91; congestive heart failure was reason for death;


VAERS ID: 36644 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:1991-09-23
Onset:1991-09-25
   Days after vaccination:2
Submitted: 1991-10-01
   Days after onset:6
Entered: 1991-11-26
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 0127P / 3 LA / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Hypoxia, Malaise, Respiratory disorder, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-09-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Gastroenteritis
Preexisting Conditions: moderate to marked atherosclerosis, coronary artery
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91311

Write-up: Pt became ill 2 days following inject; admitted to hosp because of dehydration; died 28SEP91; death certificate-ventricular fibrillation, hypoxia, aspiration, gastric contents;


VAERS ID: 36736 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:1991-11-11
Onset:1991-11-12
   Days after vaccination:1
Submitted: 1991-11-25
   Days after onset:13
Entered: 1991-12-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 1 LA / -

Administered by: Unknown       Purchased by: Private
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC Split Type:

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


VAERS ID: 37846 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Arizona  
Vaccinated:1991-10-18
Onset:1991-11-14
   Days after vaccination:27
Submitted: 1991-12-03
   Days after onset:19
Entered: 1991-12-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Procardia, Ascriptin
Current Illness: NONE
Preexisting Conditions: previous hx brainstomy tia w/flaccid FEB91
Allergies:
Diagnostic Lab Data: MRI Scan-neg; LP-normal; NCV loss of F waves, slowing;
CDC Split Type:

Write-up: 3 wks post inject pt devel paralysis;


VAERS ID: 37877 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1991-10-25
Onset:1991-11-20
   Days after vaccination:26
Submitted: 1991-12-03
   Days after onset:13
Entered: 1991-12-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01071P / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Anorexia, Intestinal obstruction, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Aldactone, Edecrin, Premarin, Prednisone, Ativan
Current Illness: NONE
Preexisting Conditions: Alzheimer''s dementia, CHF, hypertension, chronic lymphedeme
Allergies:
Diagnostic Lab Data:
CDC Split Type: WV9158

Write-up: 20NOV91 began vomiting @ 130AM x 2 refused to eat through the day; no audible bowel sounds @ 715PM & c/o abd tenderness & admitted to Hosp 20NOV; bowel resection completed due to volvolus of bowel;


VAERS ID: 38150 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1991-12-04
Onset:1991-12-04
   Days after vaccination:0
Submitted: 1991-12-20
   Days after onset:16
Entered: 1991-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


VAERS ID: 38733 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1991-10-13
Onset:1991-10-14
   Days after vaccination:1
Submitted: 1991-12-05
   Days after onset:52
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-17
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


VAERS ID: 38734 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-10-13
Onset:1991-10-13
   Days after vaccination:0
Submitted: 1991-12-05
   Days after onset:53
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Chest pain, Dyspnoea, Haematemesis, Hyperhidrosis, Pallor, Right ventricular failure, Tremor
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-15
   Days after onset: 2
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: NONE
Current Illness: NONE
Preexisting Conditions: pt had diabetes, congestive heart failure & a peptic ulcer;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361005J

Write-up: w/in hrs of receiving flu vax pt began shaking & exp vomiting w/a small amount of blood noted; following morning pt exp chest pain, SOB, paleness & clamminess; pt was hospitalized & died 15OCT91; COD congestive heart failure;


VAERS ID: 38735 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-10-08
Onset:1991-10-13
   Days after vaccination:5
Submitted: 1991-12-05
   Days after onset:53
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-26
   Days after onset: 13
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


VAERS ID: 38816 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: Nevada  
Vaccinated:1991-11-26
Onset:1991-12-18
   Days after vaccination:22
Submitted: 1992-01-07
   Days after onset:20
Entered: 1992-01-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


VAERS ID: 39014 (history)  
Form: Version 1.0  
Age: 95.0  
Sex: Female  
Location: Illinois  
Vaccinated:1991-11-12
Onset:1991-12-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-15
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


VAERS ID: 39077 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-11-20
Onset:1991-11-20
   Days after vaccination:0
Submitted: 1992-01-20
   Days after onset:61
Entered: 1992-01-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Myocardial infarction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-20
   Days after onset: 0
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, Synthroid, Feldene
Current Illness: NONE
Preexisting Conditions: No known allergies; hypertension, hypothyroidism, arthritis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt was administered flu vax @ approx 1215 PM 20NOV91 VS-nl; pt had taken flu vax previously remained in the clinic for 15 to 20mins p/inject; pt passed out on the golf course @ approx 2PM to ER dx MI; no evidence of allergic rxn;


VAERS ID: 39281 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1991-11-13
Onset:1991-11-18
   Days after vaccination:5
Submitted: 1992-01-16
   Days after onset:59
Entered: 1992-01-31
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia
SMQs:, Agranulocytosis (broad), Gastrointestinal perforation (narrow), Oropharyngeal infections (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-26
   Days after onset: 8
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: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


VAERS ID: 39455 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:1991-12-14
Onset:1991-12-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


VAERS ID: 39586 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Nevada  
Vaccinated:1992-02-07
Onset:1992-02-08
   Days after vaccination:1
Submitted: 1992-02-12
   Days after onset:4
Entered: 1992-02-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiac failure, Coronary artery disease
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-02-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Allergies:
Diagnostic Lab Data: autopsy;
CDC Split Type:

Write-up: Acute coronary failure secondary to CAD;


VAERS ID: 39713 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:1991-12-14
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Encephalitis, Encephalopathy, Movement disorder, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Diabinese, Procardia XL, Tenormin, Capoten, Provachol, Aldactone, Lasix;
Current Illness:
Preexisting Conditions: Type II DM-incr chol, HTN, CHF;
Allergies:
Diagnostic Lab Data: EEG-?temporal lobe problem, MRI; lab eval none positive;
CDC Split Type:

Write-up: Pt devel encephalopathy thought to be encephalitis-unknown cause; (initially c/o numbness rt hand x 2 wks opposite arm from inject then deterioration of motor skills & mental status over 5 days;


VAERS ID: 39742 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-09
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


VAERS ID: 39743 (history)  
Form: Version 1.0  
Age: 104.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-27
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK GM / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


VAERS ID: 39744 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-10-28
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Cerebrovascular accident
SMQs:, 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


VAERS ID: 39745 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-29
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK - / IM

Administered by: Other       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-05
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


VAERS ID: 39746 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-11-06
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308912 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Hepatic cirrhosis
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Lasix PRN
Current Illness: mild CHF, end stage liver disease
Preexisting Conditions: NKA, hepatic encephalopathy, hx hyponatremia, mild CHF,dry gangrene;
Allergies:
Diagnostic Lab Data: End stage liver disease 21OCT91 Ammonia level=148 (ref range 11-35); BUN=25, serum creatinine=1.6;
CDC Split Type: HI9206

Write-up: adm dx mild CHF, dry gangrene; final dx cardiac resp arrest, ASCVD, cirrhosis; pt died 7NOV91;


VAERS ID: 40951 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-12-19
Onset:1991-12-27
   Days after vaccination:8
Submitted: 1992-03-24
   Days after onset:88
Entered: 1992-04-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21215 / UNK - / IM A

Administered by: Private       Purchased by: Public
Symptoms: Cardiac arrest, Coagulopathy, Dyspnoea, Lactic acidosis, Pharyngitis, Pneumonia, Respiratory disorder, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1992-01-05
   Days after onset: 9
Permanent Disability? No
Recovered? No
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: Chemotherapy w/Cytoxan, Vincristine, Procarbazine, Pred, & Bleomycin
Current Illness: Lymphoma
Preexisting Conditions: lymphoma, leukemia
Allergies:
Diagnostic Lab Data: CXR
CDC Split Type: PA9280

Write-up: 27DEC91 fever, fatigue, weak; 28DEC91 t102, ATB recvd; 31DEC91 fever, cough worse to hosp ER; cxr done; not admitted; 1JAN92 to hosp ER was admitted; heart stopped in ICU died 5JAN92;


VAERS ID: 41862 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Nebraska  
Vaccinated:1991-12-12
Onset:1991-12-22
   Days after vaccination:10
Submitted: 1992-04-30
   Days after onset:129
Entered: 1992-05-11
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / 7+ LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Anaemia, Asthenia, Malaise, Myelofibrosis, Oedema peripheral, Otitis media
SMQs:, Cardiac failure (broad), Angioedema (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Blood premalignant disorders (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NE9212

Write-up: 10 days p/flu vax felt poorly-tired; MD tests done found to be very anemic; dx rare acute myleofibrosis of the bone; gets blood transfusions every 2 wks; has also had ear infects & now swelling of the feet is very weak;


VAERS ID: 43970 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1990-10-11
Onset:1990-11-15
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 1992-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11208 / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: 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? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-16
   Days after onset: 121
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: many, including LP, EMG;
CDC Split Type:

Write-up: progressive LE weakness, GBS;


VAERS ID: 44074 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Female  
Location: California  
Vaccinated:1991-11-14
Onset:1991-11-21
   Days after vaccination:7
Submitted: 1992-02-19
   Days after onset:90
Entered: 1992-08-10
   Days after submission:172
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: CA9277

Write-up: pt had a massive heart attack;


VAERS ID: 46276 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Female  
Location: Texas  
Vaccinated:1992-10-07
Onset:1992-10-08
   Days after vaccination:1
Submitted: 1992-10-14
   Days after onset:6
Entered: 1992-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 338971 / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Aphasia, Encephalopathy, Grand mal convulsion, Paralysis
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nasalide, Megace, Theophyllin, Digoxin, K Ce, Lasix, Coumadin, Iron, ALbuterol inhaler, Atrovent;
Current Illness: breast cancer w/metasitasis, CHF
Preexisting Conditions: organic brain synd, recurrent deep vein thrombosis & pulmonar-embolism;
Allergies:
Diagnostic Lab Data: neg head CT x 2; neg LP; THeophylline level + digoxin levels non toxic;
CDC Split Type:

Write-up: seizures, grand mal w/in 12 hrs of vax; diffuse encephalopathy w/bilateral lower extremities & rt upper extremities paresis, aphasia;


VAERS ID: 46528 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Female  
Location: Michigan  
Vaccinated:1992-10-06
Onset:1992-10-07
   Days after vaccination:1
Submitted: 1992-10-13
   Days after onset:6
Entered: 1992-10-28
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Atrial fibrillation, Dermatitis bullous, Hallucination, Herpes zoster, Hypertension, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: 892289001E

Write-up: Pt recvd flu vax the next evening devel a rash & some blisters on breasts & back; dx w/herpes zoster; tx Zovirax & DPH; also exp inc BP & hallucinations; adm to hosp 12OCT92;


VAERS ID: 46787 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-10-08
   Days after onset:5
Entered: 1992-11-09
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public       Purchased by: Other
Symptoms: Cardiovascular disorder, Electrocardiogram abnormal, Malaise, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: h/o heart disease
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 924092016

Write-up: Death & myocardial infarction are reported in pt who recvd flu vax on 2OCT92; 3OCT92 was not feeling well & went to ER; had MI (full EKG changes); pt had a classical heart attack & died;


VAERS ID: 47149 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1992-10-13
Onset:1992-10-24
   Days after vaccination:11
Submitted: 1992-10-30
   Days after onset:6
Entered: 1992-11-12
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928223 / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Trazadone, Tedrol, Prosom, Buspar
Current Illness: chronic bronchitis-alzheimers
Preexisting Conditions: PCN, Novacaine-alzheimers
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


VAERS ID: 47189 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:1992-10-28
Onset:1992-11-03
   Days after vaccination:6
Submitted: 1992-11-09
   Days after onset:6
Entered: 1992-11-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928217 / 1 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Cough, Hypertension, Hypotension, Malaise, Muscle twitching, Respiratory disorder, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Prozac, Synthroid, Trental, Tylenol, ASA, Senokot, Mult vit, Dulcolax;
Current Illness: NONE
Preexisting Conditions: no allergies-CVA rt hemopoisis, mild depression, plural effusions''
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: laughing, talking & eating well 2NOV92; 3NOV92 wake & vomited BP 180/110, P 100; 550 became listless, BP 75/50, P diff to count; twitching


VAERS ID: 47268 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Missouri  
Vaccinated:1992-10-23
Onset:1992-10-25
   Days after vaccination:2
Submitted: 1992-10-29
   Days after onset:4
Entered: 1992-11-16
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928215 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of CAD & chronic debilitation;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had an acute myocardial infarction on 25OCT92; pt did not recover; long hx of cornary artery disease & chronic debilitation;


VAERS ID: 47308 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Illinois  
Vaccinated:1992-10-16
Onset:1992-10-17
   Days after vaccination:1
Submitted: 1992-11-13
   Days after onset:27
Entered: 1992-11-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928226 / UNK RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, K-tab, Hydralazme
Current Illness:
Preexisting Conditions: hypertension, moderate carotid artery stenosis, lt venous insufficiency;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up:


VAERS ID: 47309 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-11-02
Onset:1992-11-02
   Days after vaccination:0
Submitted: 1992-11-04
   Days after onset:2
Entered: 1992-11-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military       Purchased by: Military
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: could not breath went into full arrest;


VAERS ID: 47310 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1992-11-02
Onset:1992-11-03
   Days after vaccination:1
Submitted: 1992-11-04
   Days after onset:1
Entered: 1992-11-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2F311704 / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin, Clinoril med, for hypertension;
Current Illness: diabetes/hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found on floor @ home in full arrest;


VAERS ID: 47492 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-11-12
   Days after onset:40
Entered: 1992-11-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK LA / -

Administered by: Public       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-04
   Days after onset: 1
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: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: PA92327

Write-up: 3OCT92 seen in Er admitted to hosp;


VAERS ID: 47493 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-11-12
   Days after onset:40
Entered: 1992-11-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK LA / -

Administered by: Public       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: PA92328

Write-up: pt seen in ER where died 3OCT92;


VAERS ID: 47668 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1992-10-09
Onset:1992-10-21
   Days after vaccination:12
Submitted: 1992-10-26
   Days after onset:5
Entered: 1992-12-03
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS9256

Write-up: pt had massive coronary & died on 21OCT92;


VAERS ID: 47857 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-11-05
Onset:1992-11-05
   Days after vaccination:0
Submitted: 1992-12-07
   Days after onset:32
Entered: 1992-12-09
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 335914 / 1 - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0100V / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Cardiovascular disorder, Hyperhidrosis, Hypertrophy, Malaise, Myocardial infarction, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-05
   Days after onset: 0
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: COPD, end stage; hyperlimpidemia; hypertension
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES92111093

Write-up: pt recvd vax & approx 9 hrs following vax pt devel sweating & did not feel well; pts husband suggested ER but pt did not; pt died @ home;


VAERS ID: 48415 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:1992-10-08
Onset:1992-10-12
   Days after vaccination:4
Submitted: 1992-10-15
   Days after onset:3
Entered: 1992-12-23
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928243 / 3 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Cardiovascular disorder, Myocardial infarction, Nausea, Shock
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-12
   Days after onset: 0
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: hx of coronary problems
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA92210

Write-up: 930AM 12OCT92 MD office w/nausea, weak; hx of heart disease; BP 162/50-sent ot ER expired 1152 12OCT92 w/prob dx of myocardial infarction;


VAERS ID: 48672 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1992-10-29
Onset:1992-11-22
   Days after vaccination:24
Submitted: 1992-11-30
   Days after onset:8
Entered: 1993-01-04
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928217 / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Anxiety, Cardiac arrest, Condition aggravated, Dyspnoea, Hypertension, Hyperventilation, Myocardial infarction, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, Lanoxin, Calan SR, Humulin, Axid, Nitrobid, Elavil, Nifedipineoth
Current Illness: NONE
Preexisting Conditions: CAD, IDDM, Hypertension, chronic CHF, cardiomegaly;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WV9242

Write-up: dyspnea, anxiety, P56, R36, BP 200/90, 02 on transferred to hosp; causes of death-cardiac failure, CHF, Ischemic cardiomyopathy, COPD; also exp discomfort & tingling in arms; R36 shallow & labored;


VAERS ID: 49057 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:1992-10-21
Onset:1992-11-07
   Days after vaccination:17
Submitted: 1992-11-23
   Days after onset:16
Entered: 1993-01-14
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Haemorrhage, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC Split Type: 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


VAERS ID: 54005 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:1993-01-25
Onset:1993-05-20
   Days after vaccination:115
Submitted: 1993-06-10
   Days after onset:21
Entered: 1993-06-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 5 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt non responder @ 74 w/Engerix-B #4;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 6JAN93 titer neg; 7APr93 titer neg;
CDC Split Type: EBU930429

Write-up: Dialysis pt recvd 5 doses of Engerix-B & was found to be a nonresponder; 26APR93 pt self dicontinued the dialysis & died on 20MAy03;


VAERS ID: 56467 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:1993-09-30
Onset:1993-10-01
   Days after vaccination:1
Submitted: 1993-10-02
   Days after onset:1
Entered: 1993-10-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938137 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 340938 / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Sinemet; Parlodel, Xanax, Doxepin, Furosemide, ASA, Paxil
Current Illness: parkinsons, skin (contact derm);
Preexisting Conditions: sulfa/motrin advanced parkinsons disease;
Allergies:
Diagnostic Lab Data: last labs 20AUG93 Serum NA 127; serum CA+ 8.5; chlorids 88;
CDC Split Type:

Write-up: resp/cardiac arrest;


VAERS ID: 56603 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: California  
Vaccinated:1993-09-30
Onset:1993-09-30
   Days after vaccination:0
Submitted: 1993-10-01
   Days after onset:1
Entered: 1993-10-15
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

Administered by: Private       Purchased by: Other
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


VAERS ID: 56721 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:1993-10-09
Onset:1993-10-10
   Days after vaccination:1
Submitted: 1993-10-12
   Days after onset:2
Entered: 1993-10-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / UNK - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Deep vein thrombosis, Nausea, Pulmonary embolism, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


VAERS ID: 56832 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:1993-10-01
Onset:1993-10-11
   Days after vaccination:10
Submitted: 1993-10-20
   Days after onset:9
Entered: 1993-10-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-14
   Days after onset: 3
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: Dyazide-Micro K; Ventolin-Aero Bid uniphyl;
Current Illness: NONE
Preexisting Conditions: bronchial asthma, hypertensive cardio vascular disease;
Allergies:
Diagnostic Lab Data: LP-nl; EMG-nl; consistant w/GBS:
CDC Split Type:

Write-up: ascending paralysis, w/resp failure, consistant w/GBS;


VAERS ID: 56919 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1993-09-29
Onset:1993-09-30
   Days after vaccination:1
Submitted: 1993-10-27
   Days after onset:27
Entered: 1993-11-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


VAERS ID: 57008 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Arizona  
Vaccinated:1993-09-30
Onset:1993-10-01
   Days after vaccination:1
Submitted: 1993-10-18
   Days after onset:17
Entered: 1993-11-05
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / 4 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Hyperventilation, Hypocalcaemia, Leukocytosis, Pneumonia, Pyrexia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-08
   Days after onset: 7
Permanent Disability? No
Recovered? No
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: Prednisone; Methotrexate;
Current Illness:
Preexisting Conditions: pulmonary fibrosis, past hx TB, theumatoid arthritis;
Allergies:
Diagnostic Lab Data: family refused autopsy;
CDC Split Type: CO5040

Write-up: died p/being hospitalized for interstitial pneumonia; day p/vax felt SOB & started to cough; 5OCt admitted;


VAERS ID: 57323 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:1993-09-13
Onset:1993-09-14
   Days after vaccination:1
Submitted: 1993-10-29
   Days after onset:45
Entered: 1993-11-12
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 493814 / UNK - / A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Blood thromboplastin decreased, Confusional state, Dementia, Encephalitis, Leukopenia, Pyrexia, Red blood cell sedimentation rate increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: remains hospitalized on ventilator; outcome remains guarded;
Allergies:
Diagnostic Lab Data: WBC 2.3; nl 4-11; sed rate 36; Ptt 5; CSF WNL; Bl no grwoth; titer for EEE, california E, st louis E pending; Enterovirus & Herpes cultures being done on CSF;;
CDC Split Type:

Write-up: rapid progressive dementia ventilation for respiratory failure, t105; family states confusion started about 16 hrs p/vax; post flu vax encephalitis;


VAERS ID: 57470 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:1993-10-01
Onset:1993-10-17
   Days after vaccination:16
Submitted: 1993-11-10
   Days after onset:24
Entered: 1993-11-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Myelitis, Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 25 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC Split Type:

Write-up: poss transverse myelitis w/paralysis from chest down;


VAERS ID: 57611 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:1993-10-07
Onset:1993-10-08
   Days after vaccination:1
Submitted: 1993-11-10
   Days after onset:33
Entered: 1993-11-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Arrhythmia
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-08
   Days after onset: 0
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: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


VAERS ID: 57612 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:1993-10-23
Onset:1993-10-23
   Days after vaccination:0
Submitted: 1993-11-10
   Days after onset:18
Entered: 1993-11-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-23
   Days after onset: 0
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


VAERS ID: 58061 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: West Virginia  
Vaccinated:1993-10-07
Onset:1993-10-12
   Days after vaccination:5
Submitted: 1993-11-16
   Days after onset:35
Entered: 1993-12-09
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 3 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC Split Type: MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


VAERS ID: 58089 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-10-25
Onset:1993-11-06
   Days after vaccination:12
Submitted: 1993-11-12
   Days after onset:6
Entered: 1993-12-09
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


VAERS ID: 58095 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: South Carolina  
Vaccinated:1993-11-02
Onset:1993-11-03
   Days after vaccination:1
Submitted: 1993-11-24
   Days after onset:21
Entered: 1993-12-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-15
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


VAERS ID: 58132 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Virginia  
Vaccinated:1993-10-08
Onset:1993-10-28
   Days after vaccination:20
Submitted: 1993-11-16
   Days after onset:19
Entered: 1993-12-13
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, CSF test abnormal, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy
SMQs:, Rhabdomyolysis/myopathy (narrow), Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC Split Type: 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;


VAERS ID: 58319 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Female  
Location: Missouri  
Vaccinated:1993-10-22
Onset:1993-11-26
   Days after vaccination:35
Submitted: 1993-12-11
   Days after onset:15
Entered: 1993-12-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK RA / -

Administered by: Private       Purchased by: Other
Symptoms: Hepatic failure
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: acute hepatocellular failure;


VAERS ID: 58410 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:1993-12-14
Onset:1993-12-14
   Days after vaccination:0
Submitted: 1993-12-15
   Days after onset:1
Entered: 1993-12-27
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private       Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-14
   Days after onset: 0
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: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


VAERS ID: 58871 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:1993-09-28
Onset:1993-12-18
   Days after vaccination:81
Submitted: 1994-01-03
   Days after onset:16
Entered: 1994-01-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Pneumonia
SMQs:, Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC Split Type:

Write-up: respiratory failure, usual interstital pneumonia, death;


VAERS ID: 58884 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-10-14
Onset:1993-10-28
   Days after vaccination:14
Submitted: 1993-12-29
   Days after onset:62
Entered: 1994-01-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock
SMQs:, Acute renal failure (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-11-27
   Days after onset: 30
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:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


VAERS ID: 59156 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:1993-10-01
Onset:1993-10-01
   Days after vaccination:0
Submitted: 1994-01-04
   Days after onset:95
Entered: 1994-01-18
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis
SMQs:, Peripheral neuropathy (narrow), Conduction defects (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


VAERS ID: 60715 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Virginia  
Vaccinated:1993-10-08
Onset:1993-11-04
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 1994-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, CSF test abnormal, Guillain-Barre syndrome, Pain
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: HCTZ
Current Illness:
Preexisting Conditions: large cell lymphoma of abdo; dx SEP93 treated w/ 3 cycles of meds; ASCVD, MI
Allergies:
Diagnostic Lab Data: CSF protein inc @ 155;
CDC Split Type:

Write-up: Pt exp GBS secondary to flu vax given 8OCT93; since the vax pt had exp 2-3 wks of upper body discomfort & weakness;


VAERS ID: 61058 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:1992-10-12
Onset:1992-11-12
   Days after vaccination:31
Submitted: 1994-03-09
   Days after onset:482
Entered: 1994-03-28
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Nuchal rigidity, Peroneal nerve palsy, Pruritus, Speech disorder
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dementia (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC Split Type:

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


VAERS ID: 64533 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:1993-09-20
Onset:1993-09-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-11-05
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 47 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC Split Type: 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


VAERS ID: 61682 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-03-21
Onset:1993-03-21
   Days after vaccination:0
Submitted: 1994-04-05
   Days after onset:379
Entered: 1994-04-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 2J41015 / UNK RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Anorexia, Confusional state, Crying, Hypotonia, Muscle spasms, Muscle twitching, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-04-20
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: fx humerus
Preexisting Conditions: CHF (under control); Chrone''s disease (under control);
Allergies:
Diagnostic Lab Data: devel infect from chronic foley, treated; then exotic inf, systemic mycotic infect;
CDC Split Type:

Write-up: temp couple hrs p/vax; disoriented, abt wk, 10 days later not eating, became cranky, abt 2 wks later unusual high pitched crying, moaning, twitching, spasms; limp & unresponsive & staring;


VAERS ID: 63321 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: Montana  
Vaccinated:1991-06-17
Onset:1991-08-01
   Days after vaccination:45
Submitted: 1994-06-03
   Days after onset:1037
Entered: 1994-06-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arrhythmia, Cardiac arrest, Drug ineffective
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-09-22
   Days after onset: 783
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: diabetes; Hemodialysis;
Allergies:
Diagnostic Lab Data: AUG91 Anti-HBs 0.9 neg;
CDC Split Type: WAES94011244

Write-up: pt recvd vax 17JUN91 & lab testing in AUG92 showed HBs antibody 0.9. pt died;


VAERS ID: 63322 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Montana  
Vaccinated:1992-05-20
Onset:1992-08-01
   Days after vaccination:73
Submitted: 1994-06-03
   Days after onset:671
Entered: 1994-06-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Lack of efficacy/effect (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-06
   Days after onset: 492
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: hemodialysis; Diabetes;
Allergies:
Diagnostic Lab Data: AUG92 Anti-HBs 0.7 neg;
CDC Split Type: WAES94020586

Write-up: pt recvd 3 doses of Hep B vax 13NOV91, 14DEC91 & 20MAY92 & lab testing in AUG92 showed HBs antibody 0.7; pt discontinued hemodialysis in DEC93 & died of renal failure on 06DEC93;


VAERS ID: 65692 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Female  
Location: Montana  
Vaccinated:1992-05-03
Onset:0000-00-00
Submitted: 1994-07-26
Entered: 1994-08-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Vascular anomaly
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-07-02
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: JUL92 Anti-HBs 146.9 pos
CDC Split Type: WAES94050829

Write-up: Pt recvd vax & did not seroconvert; 11 of 16 dialysis pts were vaxed w/Hep B vax & were anti-HBs neg approx 3 months p/series; on f/u lab testing in JUL92 showed HBs antibody 146.9; pt devel ruptured abdo aneurysm & died on 2JUL93;


VAERS ID: 68050 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1994-10-04
Onset:1994-10-20
   Days after vaccination:16
Submitted: 1994-10-26
   Days after onset:6
Entered: 1994-11-07
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948100 / 4 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Arteriosclerosis, Cardiac arrest, Chest pain, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-26
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: valium;
Current Illness: none;
Preexisting Conditions: nka anxiety, nervousness;
Allergies:
Diagnostic Lab Data: cardiac work up;
CDC Split Type:

Write-up: pt recvd vax; 20oct94 seen in ER for chest pain; started 7AM after eating; walked 10 blocks to hosp; admit 22oct94 expired;


VAERS ID: 68153 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Unknown  
Location: New Hampshire  
Vaccinated:1994-10-10
Onset:1994-10-20
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1994-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51113 / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Asthenia, Cough, Pneumonia, Pyrexia, Thirst
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-05
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin, Furosemide, Capoten;
Current Illness:
Preexisting Conditions: IDDM, HTN, obesity
Allergies:
Diagnostic Lab Data: K 3.3;
CDC Split Type: NH94033

Write-up: 2 wks p/vax pt became weak, tired, anorexic, devel fever, cough, pneumonia; progressing to death;


VAERS ID: 68154 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:1994-10-14
Onset:1994-10-16
   Days after vaccination:2
Submitted: 1994-11-08
   Days after onset:23
Entered: 1994-11-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51113 / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Dehydration, Myasthenic syndrome, Pneumonia, Right ventricular failure
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Malignancy related conditions (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-04
   Days after onset: 19
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: s/p CVA many yrs ago
Preexisting Conditions: s/p CVA many yrs ago;
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH94034

Write-up: 2d p/vax pt became anorexic, thirsty, devel lt leg weakness; became dehydrated, was hospitalized & went into CHF- ? pneumonia;


VAERS ID: 68382 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: New York  
Vaccinated:1994-10-17
Onset:1994-10-19
   Days after vaccination:2
Submitted: 1994-10-25
   Days after onset:6
Entered: 1994-11-14
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Asthenia, Condition aggravated, Dyspnoea, Lung disorder, Malaise, Somnolence, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: many meds (unspecified); prednisone;
Current Illness: severe chest pain the day a/flu shot;
Preexisting Conditions: severe chronic osteoarthritis; respiratory problems; recurrent pulmonary infections; intermittent angina w/frequent exacerbations of CHF; Parkinsons disease; HCVD; chronic bronchitis w/recurrent asthma; ASHD w/angina;
Allergies:
Diagnostic Lab Data: not provided;
CDC Split Type: 32777

Write-up: pt recvd single dose of flu vax as a prophylaxis 17oct94; pt died 19oct94; cause of death unk; pt was recving many other meds;


VAERS ID: 68383 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: New York  
Vaccinated:1994-10-17
Onset:1994-10-17
   Days after vaccination:0
Submitted: 1994-10-25
   Days after onset:8
Entered: 1994-11-14
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Condition aggravated, Hypotension
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-20
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: many meds(unspecified); antidepressant;
Current Illness: edema; severe obtundation; hypotensive;
Preexisting Conditions: osteoarthritis, back & knees; arthritis large axial joints; bladder incontinent; hx of rt mastectomy 10-12 yrs ago for breast carcinoma; chronic bacteriuria; fibromyalgia; erratic appetite; depression; degenerative heart disease;
Allergies:
Diagnostic Lab Data: not provided;
CDC Split Type: 32778

Write-up: pt recvd single dose of vax on 17oct94 as a prophylaxis; pt died 20oct94; cause of death unk; pt was receiving many oth meds;


VAERS ID: 68384 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:1994-10-17
Onset:1994-10-21
   Days after vaccination:4
Submitted: 1994-10-24
   Days after onset:3
Entered: 1994-11-14
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiovascular disorder, Condition aggravated, Lung disorder
SMQs:, Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: many meds (unspecified);
Current Illness:
Preexisting Conditions: alcohol abuse -$g progressive neuropathy, uncertain etiology; hypertension; atrial fibrillation; macular degeneration; constipation; recurrent UTI''s; hx of left ovarian cyst; COPD; rt hip fracture, intertrochanteric, s/p internal fixation;
Allergies:
Diagnostic Lab Data: not provided;
CDC Split Type: 32779

Write-up: pt recvd single dose of flu vax as a prophylaxis 17oct94; pt died 21oct94; cause of death unk; pt was receiving many oth meds;


VAERS ID: 68505 (history)  
Form: Version 1.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-10-14
Onset:1994-10-14
   Days after vaccination:0
Submitted: 1994-11-09
   Days after onset:26
Entered: 1994-11-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00474P / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Cardiomegaly, Dyspnoea, Electrocardiogram ST segment elevation, Pneumonia, Pyrexia, Renal impairment, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-10-18
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Ampicillin, APAP #3; vit Fe, serax, Vit C
Current Illness: pedal edema $g 3 wks; r hip pain recurren
Preexisting Conditions: UTI; hx heart disease & heart failure
Allergies:
Diagnostic Lab Data: minimal urine output; good hematocrit 44; WBC count 5,000; platelet count 147,000; LDH 152; CPK 65; NA 143, K 3.7, Chloride 102, CO2 24, BUn 22, creatinine 2.6, glucose 117; PT & PTT WNL; 9AM VS BP 77/36, P162, R34, t101; lung-rhonchi;
CDC Split Type:

Write-up: pt recvd vax 14OCT93 by 15OCT pt was dyspneic, had a rt middle lobe pneumonia & then cardiogenic shock; BP by EMS 80/60; pt given med; 02 sat is 84% to 86%; pt c/o chest pain; EKG showed ST segment elevation inferiorly;cardiomegaly; t101


VAERS ID: 68571 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1994-11-04
Onset:1994-11-04
   Days after vaccination:0
Submitted: 1994-11-10
   Days after onset:6
Entered: 1994-11-18
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948032 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Coma, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: pt recvd vax; cardiac arrest w/ VF several hrs later; in hosp pt unconscious;


VAERS ID: 68944 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1994-11-16
Onset:1994-11-17
   Days after vaccination:1
Submitted: 1994-11-21
   Days after onset:4
Entered: 1994-11-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51010 / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Shock, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Coumadin; Maxzide
Current Illness: NONE
Preexisting Conditions: NKDA; DMII, CHF, hypertension, Hypertriglyceridonic
Allergies:
Diagnostic Lab Data: rhythm strip-Vf
CDC Split Type:

Write-up: pt collapsed in kitchen-ambulance arrived pt in vent fib-coded-died; flu vax given 16NOV & pt died 17NOV;


VAERS ID: 69159 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1994-10-31
Onset:1994-10-31
   Days after vaccination:0
Submitted: 1994-11-23
   Days after onset:23
Entered: 1994-12-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51129 / 2 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Hypernatraemia, Hyperventilation, Hypotension, Hypothermia, Infection, Pneumonia, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-09
   Days after onset: 9
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: pt exp flu-like s/s @ 77yrs w/flu #1~ ()~~~In patient
Other Medications: Lanoxin, Calan, nitropatch; Haldol; Zantac
Current Illness: NONE
Preexisting Conditions: hx of CVA, organic brain synd, UTI, hypertension, UGI bleed, CAD, allergies Tetrapline, PCN, Prunes, coffee, cream, jello
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax 31OCT94 1030AM & 1PM devel cold, clammy skin w/t97.2 ax; 2PM t103.3 R; 250PM T102.6R; Epi given-to ER dx febrile illness-poss viral synd, hypernatremia/chloremia, d/c ed on 1NOV; died 9NOV94;


VAERS ID: 69183 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Florida  
Vaccinated:1994-11-14
Onset:1994-11-14
   Days after vaccination:0
Submitted: 1994-11-15
   Days after onset:1
Entered: 1994-12-02
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00774P / 3 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: capoten, ativan, nitrodur patch, micro K; reg ASA; bumex; nitrostat;
Current Illness: none;
Preexisting Conditions: calan sr, severe cardiomyopathy;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt came to ofc for lab work;wife requested he have flu vax;given in am, approx 15 min after leaving,wife called from hosp er,stated after getting into car pt Lt arm began twitching & head fell over to side;


VAERS ID: 69952 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: Alabama  
Vaccinated:1994-12-15
Onset:1994-12-15
   Days after vaccination:0
Submitted: 1994-12-21
   Days after onset:6
Entered: 1994-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-12-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL9445

Write-up: pt recvd vax; found dead by his wife approx 2 hrs p/ vax;


VAERS ID: 72312 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-11-05
Onset:1994-11-15
   Days after vaccination:10
Submitted: 1994-11-30
   Days after onset:15
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: Alzheimer''s disease;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343010S

Write-up: pt recvd vax & devel upper-resp symptoms with congestion, elevated temp, & cough; pt went on to be treated w/ATB;


VAERS ID: 72313 (history)  
Form: Version 1.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-10-27
Onset:1994-11-13
   Days after vaccination:17
Submitted: 1994-11-30
   Days after onset:17
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Dyspnoea, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: Congestive heart failure, anemia, atrial fibrillation;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343011S

Write-up: pt recvd vax & devel upper resp symptoms w/congestion, cough, elevated temp, & shortness of breath; x-ray showed congestive heart failure; Rocephin IM was given;


VAERS ID: 72314 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-10-13
Onset:1994-11-18
   Days after vaccination:36
Submitted: 1994-11-30
   Days after onset:12
Entered: 1995-02-07
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948142 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Hypoxia, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: COPD, diabetes, hypertension, emphysema;
Allergies:
Diagnostic Lab Data: lot# 4948142 was reviewed & found to be satisfactory;
CDC Split Type: 894343012S

Write-up: pt recvd vax & devel upper-respiratory symptoms with cough & congestion; oxygen was continued;


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