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| VAERS ID: | 214230 | Vaccinated: | 2003-12-11 | | Age: | 5.0 | Onset: | 2003-12-11, Days after vaccination: 0 | | Gender: | Male | Submitted: | 2003-12-15, Days after onset: 4 | | Location: | Nebraska | Entered: | 2003-12-22, Days after submission: 7 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: NONE | | Previous Vaccinations: | | Other Medications: NONE | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500034P | 0 | IN | | |
| Administered by: Public Purchased by: Other | | Symptoms: Pyrexia | | Write-up: Child ran a fever of 104.6 during the night after receiving the flu mist at noon on Thursday December 11. Alternating Tylenol and Advil. Temperature at 100.6 at time of this report. Mother reported prior illness 1 week before with a temp of 104.8. She also reported he had ran a temp of 100.7 the day before the vaccine was given. |
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| VAERS ID: | 214258 | Vaccinated: | 2003-12-12 | | Age: | 42.0 | Onset: | 2003-12-16, Days after vaccination: 4 | | Gender: | Female | Submitted: | 2003-12-20, Days after onset: 4 | | Location: | Massachusetts | Entered: | 2003-12-20, Days after submission: 0 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 9/4/03 | | IN | | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Chills, Fatigue, Rhinorrhoea | | Write-up: *runny nose/nasal congestion *no fever but mild case of the chills *tiredness, weakness, fatigue The live intranasal virus was administered on 12/12/03 at 8:30 a.m., and I was symptom-free until app. 8:30 a.m. of 12/16/03 when I lay down for a nap and slept for three hours. I needed to rest in bed for all of Tuesday and Wednesday. By Thursday, I could summon the energy to walk for two miles on my treadmill. By Friday, I felt well enough to go for a long walk and then see The Lord of the Rings with my family that night. in bed |
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| VAERS ID: | 214264 | Vaccinated: | 2003-10-16 | | Age: | 11.0 | Onset: | 2003-10-16, Days after vaccination: 0 | | Gender: | Male | Submitted: | 2003-10-18, Days after onset: 2 | | Location: | Massachusetts | Entered: | 2003-12-23, Days after submission: 66 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: Contact dermatitis due to plants | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500032P | 0 | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Erythema, Heart rate increased, Laryngeal oedema, Oedema, Pruritus, Rash macular, Throat tightness, Urticaria | | Write-up: Flumist given at 6:46pm appr. 20 mins after receiving vaccine pt had complaints of blotchy redness on back of neck and complaints of throat swelling. Assessed by Dr and 2 tsp of Benadryl given. No difficulty breathing. Assessed every 5 minutes until 7:35. No symptoms at this time. Follow up on 10/13/04 states: "information obtained from the reporter indicated that <20 minutes after FluMist pt had hive-like rash in neck (4-5 reddish spots 2cms in diameter), itching in neck, plus sensation of throat swelling which lasted for approximately 45 minutes. Pulse was 96/min, O2 saturation 99%. Given Benadryl 2 tsp's (presentation 12.5mgs/5ml) 5 min after symptoms onset. The only history of allergy was dermatitis after poison ivy." |
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| VAERS ID: | 214265 | Vaccinated: | 2003-12-09 | | Age: | 10.0 | Onset: | 2003-12-10, Days after vaccination: 1 | | Gender: | Male | Submitted: | 2003-12-16, Days after onset: 6 | | Location: | Ohio | Entered: | 2003-12-23, Days after submission: 7 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: NONE | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: Allergy to PCN | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500001P | 0 | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Abdominal pain, Diarrhoea, Dysgeusia, Vomiting | | Write-up: Abdominal cramping, vomiting, and later diarrhea for approx 1 week. After receiving the flu-mist. Pt states he felt it run down the back of his throat and he swallowed some. Follow up: "Seen on 12/15/03, abd soft/ increased bowel sounds. Had complained he could taste the Flumist for a week in his throat." |
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| VAERS ID: | 214339 | Vaccinated: | 2003-12-11 | | Age: | 43.0 | Onset: | 2003-12-13, Days after vaccination: 2 | | Gender: | Male | Submitted: | 2003-12-16, Days after onset: 3 | | Location: | Virginia | Entered: | 2003-12-24, Days after submission: 8 | |
| Life Threatening Illness? Yes |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? Yes, 3 days | | Extended hospital stay? No |
| Current Illness: Attention Deficit Disorder | | Diagnostic Lab Data: Cardiac cath-100% occular right main | | Previous Vaccinations: | | Other Medications: Depakote; Dextrostat; | | Preexisting Conditions: History of Hypercholesterimia-off lipitor 5 months. | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500016N | 0 | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Myocardial infarction | | Write-up: MI-required stent |
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| VAERS ID: | 214416 | Vaccinated: | 2003-12-12 | | Age: | 9.0 | Onset: | 2003-12-12, Days after vaccination: 0 | | Gender: | Male | Submitted: | 2003-12-18, Days after onset: 6 | | Location: | Missouri | Entered: | 2003-12-23, Days after submission: 5 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': MO2003108 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500003P | 0 | IN | | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Cough | | Write-up: Mother called to report child developed "cruddy sounding cough" for 2-3 days after administration. Child told mother he wanted to cough right after administration but couldn't cough and throat felt "funny". |
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| VAERS ID: | 214417 | Vaccinated: | 2003-12-19 | | Age: | 6.0 | Onset: | 2003-12-20, Days after vaccination: 1 | | Gender: | Male | Submitted: | 2003-12-23, Days after onset: 3 | | Location: | Florida | Entered: | 2003-12-23, Days after submission: 0 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: None done | | Previous Vaccinations: | | Other Medications: N/A | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 50047P | 0 | IN | | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Chest discomfort, Cough, Ear pain, Epistaxis, Pyrexia, Rhinitis | | Write-up: Healthy and asymptomatic prior to vaccination. Vaccinated with Flu-Mist On 12/19/03. On 12/20/03 developed couph, & chest "tightness' On 12/21/03 Cough worsened (croupy) and Fever to 103F reported. Temp. reported to have reached 105.5 on 12/22/03 ( report by mother). Seen by Dr. and put on Antibiotic 12/22/03. Temp. coming down today and child somewhat better today per mother. Medical records state rhinitis, epistaxis and ear pain. msv |
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| VAERS ID: | 214474 | Vaccinated: | 2003-12-11 | | Age: | 9.0 | Onset: | 2003-12-12, Days after vaccination: 1 | | Gender: | Male | Submitted: | 2003-12-19, Days after onset: 7 | | Location: | Maryland | Entered: | 2003-12-30, Days after submission: 11 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: UNK | | Previous Vaccinations: | | Other Medications: NONE | | Preexisting Conditions: UNK | | CDC 'Split Type': HQWYE687817DEC03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Retinal haemorrhage, Visual disturbance | | Write-up: This case was considered medically important (OMIC). Information regarding FluMist was received from the father of a 9 year old male who experienced retinal bleeding. AT 9 years of age, the child received a dose on 12/11/03. Upon awakening on 12/12/03, the child noticed "black spots" in the vision of his left eye. He was seen by an eye doctor who reported "bleeding in the retina but no detachment." The father indicated that his son's vision is improving but the spots persisted as of 12/12/03. The child's physician reported that he spoke with the mother of the patient and confirmed this event is accurate.No additional info was available at the time of this report. Follow-up information received from the physician provided confirmation of the event. |
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| VAERS ID: | 214475 | Vaccinated: | 2003-12-09 | | Age: | 41.0 | Onset: | 2003-12-14, Days after vaccination: 5 | | Gender: | Female | Submitted: | 2003-12-19, Days after onset: 5 | | Location: | Indiana | Entered: | 2003-12-30, Days after submission: 11 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? Yes, days | | Extended hospital stay? No |
| Current Illness: NONE | | Diagnostic Lab Data: ECG: abnormal; Fibrin D dimer: increased | | Previous Vaccinations: | | Other Medications: Unspecified contraceptive | | Preexisting Conditions: UNK | | CDC 'Split Type': HQWYE686917DEC03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Other Purchased by: Other | | Symptoms: Chest pain, Dyspnoea, Electrocardiogram abnormal, Fibrin increased, Oedema, Pleurisy | | Write-up: Information regarding Flumist (2003-2004 Formula) (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a healthcare professional regarding a 41 year old female pt who experienced pleurisy, inflammation, shortness of breath and chest pain. At 41 years of age, the pt received a dose on 12/09/2003. The pt who worked in the reporting physician's office, developed chest pain (chest pain) in the evening of 12/14/2003. The next day, she was still complaining of chest pain and shortness of breath (dyspnoea). An EKG was performed and it was abnormal. The pt was given nitroglycerin every five minutes for three doses. That same day, she was admitted to the hospital. Her chest pain continued through the night. She was diagnosed with pleurisy (pleurisy) and inflammation (inflammation). On 12/16/2003, she was discharged from the hospital. Test Results: Electrocardiogram (results: abnormal) was done on 15-Dec-2003. Additionally, fibrin D dimer (results: increased) was done on an unspecified date. No additional information was available at the date of this report. Follow-up information received from the patient's physician provided event outcome and county where vaccine was administered. She recovered. |
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| VAERS ID: | 214532 | Vaccinated: | 2003-12-08 | | Age: | 5.0 | Onset: | 2003-12-08, Days after vaccination: 0 | | Gender: | Male | Submitted: | 2003-12-19, Days after onset: 11 | | Location: | South Carolina | Entered: | 2003-12-31, Days after submission: 12 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500017P | 0 | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Erythema, Rash, Rhinorrhoea | | Write-up: Pt reacted to FluMist after it was given to him on 12/08/03. His mom said he started with runny nose and red rash all over his body. Pt came back into the office and treated with Zyrtec and Oraped. |
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