|
VAERS ID: |
25030 (history) |
Form: |
Version 1.0 |
Age: |
66.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1989-12-01 |
Onset: | 1989-12-03 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
9F01202 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Encephalitis,
Guillain-Barre syndrome,
Myalgia SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Lisinopril 20mg, Verapamil 120mg, HCTZ 25mg, Thyrolar Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Mylagias occurred within 3 days of immun. Seen on 4 additional occasions for continued pain & increasing eye/temporal pain. Considered poss. meningoencephalitis due to vaccine. Admit to hosp for Guillain-Barre Synd. on 15Feb90. |
|
VAERS ID: |
25075 (history) |
Form: |
Version 1.0 |
Age: |
43.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1989-11-07 |
Onset: | 1989-11-07 |
Days after vaccination: | 0 |
Submitted: |
1989-11-09 |
Days after onset: | 2 |
Entered: |
1990-07-09 |
Days after submission: | 241 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4898169 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Arthralgia,
Arthritis,
Back pain,
Hypokinesia,
Injection site hypersensitivity,
Lymphadenopathy,
Neck pain,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: B073089147
Write-up: Pt experienced a local reaction within 24 hrs at the site of injection, described as a bullseye, after receiving influenza virus vaccine. Also observed was supraclavicular swelling including lymph nodes. |
|
VAERS ID: |
25584 (history) |
Form: |
Version 1.0 |
Age: |
31.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1990-01-26 |
Onset: | 1990-02-20 |
Days after vaccination: | 25 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4898139 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Asthenia,
Bradycardia,
Dizziness,
Guillain-Barre syndrome,
Hyperhidrosis,
Influenza,
Neuropathy,
Tachycardia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Darachlor 4 tabs; Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: nerve conduction studies consistant w/Guillian- Barre synd. CDC Split Type: 894076003A
Write-up: Pt developed Gullain-Barre Synd. characterized as ascending myopathy, myalgia & automic neuropathy, with bradycardia & flushing. Pt was hospitalized. |
|
VAERS ID: |
25675 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1989-10-12 |
Onset: | 1989-10-13 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4898171 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Asthenia,
Confusional state SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Pt has previously received Influenza vaccine every yr /w out rxn.~ ()~~~In patient Other Medications: Prednisone, K-Lor, Lasix, Feledene, Bronkosol, NSS Nebulizer, Alupent Inhaler, Zaroxolyn Current Illness: Preexisting Conditions: Pt has hx of connective tissue disorder Allergies: Diagnostic Lab Data: CDC Split Type: 890211001B
Write-up: Pt received Influenza vaccine when awoke on the day after was in a semi-conscious state, grossly confused & weak; unable to recognize his wife or his doctor. This reaction has been previously reported to USP. |
|
VAERS ID: |
26302 (history) |
Form: |
Version 1.0 |
Age: |
62.0 |
Sex: |
Female |
Location: |
Oklahoma |
Vaccinated: | 1990-08-21 |
Onset: | 1990-09-01 |
Days after vaccination: | 11 |
Submitted: |
0000-00-00 |
Entered: |
1990-10-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Public Purchased by: Unknown Symptoms: Guillain-Barre syndrome SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Bentyl, Zantac, Tylenol, Maalox, Centrium Vitamins Current Illness: Preexisting Conditions: Plasmapheresis Allergies: Diagnostic Lab Data: CSF Protein 104 CDC Split Type:
Write-up: Pt vaccinated with Influenza Vaccine development of Guillain Barre Synd had influenza vaccine on 21AUG90. |
|
VAERS ID: |
26332 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Female |
Location: |
Delaware |
Vaccinated: | 1990-10-08 |
Onset: | 1990-10-08 |
Days after vaccination: | 0 |
Submitted: |
1990-10-10 |
Days after onset: | 2 |
Entered: |
1990-10-24 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908181 / UNK |
- / IM A |
Administered by: Private Purchased by: Private Symptoms: Hyperhidrosis,
Hypoglycaemia,
Speech disorder,
Vertigo SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (narrow), Hypoglycaemia (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: No previous hx of hypoglycemia or hyperglycemia Allergies: Diagnostic Lab Data: Blood Glucose 22 mg/d1 CDC Split Type: 890284001B
Write-up: Pt vaccinated w/Influenza Virus Vaccine experienced vertigo, slurred speech, & excessive sweating. Hospitalized & found to be severely hypoglycemic. |
|
VAERS ID: |
26667 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1990-10-18 |
Onset: | 1990-10-20 |
Days after vaccination: | 2 |
Submitted: |
1990-10-30 |
Days after onset: | 10 |
Entered: |
1990-11-16 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908196 / 4 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Abdominal pain,
Asthenia,
Diarrhoea,
Gastroenteritis,
Hypovolaemia,
Nausea,
Pyrexia SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 890303005B
Write-up: Pt vax w/ flu dev diarrhea & abd cramps two days after vax. Hosp X 4 days; dx = gastroenteritis w/ resultant hypovolemia. Pt also dev fever. Sxs resolved. |
|
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: |
26716 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1990-10-24 |
Onset: | 1990-11-05 |
Days after vaccination: | 12 |
Submitted: |
1990-11-15 |
Days after onset: | 10 |
Entered: |
1990-11-26 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908201 / UNK |
- / IM A |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Dysphagia,
Guillain-Barre syndrome,
Neck pain,
Pain,
Paraesthesia,
Paralysis SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Elevated CSF protein CDC Split Type:
Write-up: Pt vaccinated with Influenza c/o severe neck & throat pain spreaded down resulting in generalized weakness & arm numbness. Admitted to hosp w/proximal weakness & difficulty swollowing & paralysis. Probable GBS. |
|
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)
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. |
|