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| VAERS ID: | 331739 | Vaccinated: | 2008-10-21 | | Age: | 21.0 | Onset: | 2008-10-26, Days after vaccination: 5 | | Gender: | Male | Submitted: | 2008-11-10, Days after onset: 15 | | Location: | Unknown | Entered: | 2008-11-10, 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: ESR-wnl UA-wnl CBC-wnl | | Previous Vaccinations: rash~Influenza (Seasonal) (FluLaval)~1~21.00~In Patient | | Other Medications: None | | Preexisting Conditions: None | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | GLAXOSMITHKLINE BIOLOGICALS | aflla177aa | 0 | IM | UN | |
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| VAERS ID: | 331766 | Vaccinated: | 2008-10-28 | | Age: | 57.0 | Onset: | 2008-10-28, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2008-11-05, Days after onset: 8 | | Location: | New Hampshire | Entered: | 2008-11-10, Days after submission: 5 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: Unknown, but denied fever | | Diagnostic Lab Data: EKG; BW - results unknown | | Previous Vaccinations: | | Other Medications: Unknown | | Preexisting Conditions: Allergy to sulfa + hx multiple other allergies (unknown which ones) | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | 02751AA | | IM | LA | |
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| VAERS ID: | 331769 | Vaccinated: | 2008-10-29 | | Age: | 4.0 | Onset: | 2008-10-31, Days after vaccination: 2 | | Gender: | Female | Submitted: | 2008-11-06, Days after onset: 6 | | Location: | Kentucky | Entered: | 2008-11-10, Days after submission: 4 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: None | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | DTAP | SANOFI PASTEUR | U2356CA | 4 | IM | RL | | FLU | SANOFI PASTEUR | U2811AA | 1 | IM | LL | | IPV | SANOFI PASTEUR | A1060 | 4 | SC | RL | | MMR | MERCK & CO. INC. | 08914 | 1 | IM | LA | |
| Administered by: Private Purchased by: Public | | Symptoms: Hyperaemia, Injection site erythema, Injection site induration, Injection site pruritus, Injection site rash, Injection site warmth | | Write-up: Pt received 5th dose DTaP (TRIPEDIA from Sanofi) on (R) thigh on 10/29/08. Woke up on 10/31 (<48 hrs) with red, itchy, hot enlarging rash at the vaccine site, had 5x inches indurated, hyperemia all around the vaccination site. RTC BENADRYL, KEFLEX given cold/warm compress. |
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| VAERS ID: | 331772 | Vaccinated: | 2008-10-06 | | Age: | 77.0 | Onset: | 2008-10-07, Days after vaccination: 1 | | Gender: | Female | Submitted: | 2008-11-09, Days after onset: 33 | | Location: | Illinois | Entered: | 2008-11-10, Days after submission: 1 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: None | | Diagnostic Lab Data: None | | Previous Vaccinations: | | Other Medications: Atenolol, Dyazide | | Preexisting Conditions: Hypertension | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2785HA | 0 | UN | LA | |
| Administered by: Other Purchased by: Private | | Symptoms: Injected limb mobility decreased, Injection site pain | | Write-up: Severe soreness in left shoulder (injection site) resulting in inability to use arm (per patient). Suggested treatment over the counter with Ibuprofen, and a doctor visit, if no relief. |
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| VAERS ID: | 331776 | Vaccinated: | 2008-10-31 | | Age: | 65.0 | Onset: | 2008-10-31, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2008-11-07, Days after onset: 7 | | Location: | Florida | Entered: | 2008-11-10, Days after submission: 3 | |
| 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: B/P Medication (name unknown) | | Preexisting Conditions: HTN | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2771AA | 0 | IM | LA | |
| Administered by: Public Purchased by: Private | | Symptoms: Swollen tongue, Throat tightness | | Write-up: Client received Influenza Virus vaccine at 12:00 pm 10/31/2008. Client returned to clinic-12:20pm 10/31/08 with c/o throat tightness and enlarged tongue upon exam, noted enlarged tongue. Pharynx open. Lungs CTA bilaterally no wheezing. Epipen 1:1000 .3mg given in L anterolateral thigh at 12:23 p.m.... Paramedics arrived at 12:25 p.m client reported felt better after Epipen. Client sent to ER via ambulance for further evaluation at 12:30 pm 10/31/2008. |
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| VAERS ID: | 331779 | Vaccinated: | 2008-11-04 | | Age: | 55.0 | Onset: | 2008-11-04, Days after vaccination: 0 | | Gender: | Female | Submitted: | 0000-00-00 | | Location: | Arizona | Entered: | 2008-11-10 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: None | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: CLARITIN, PROZAC | | Preexisting Conditions: Intolerance to milk. | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2809AA | 0 | IM | LA | | PPV | MERCK & CO. INC. | 0990U | 0 | IM | RA | |
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| VAERS ID: | 331780 | Vaccinated: | 2008-10-20 | | Age: | 9.0 | Onset: | 2008-10-31, Days after vaccination: 11 | | Gender: | Male | Submitted: | 2008-10-31, Days after onset: 0 | | Location: | New York | Entered: | 2008-11-10, Days after submission: 10 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: Asthma Exacerbation | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: Claritin, Albuterol | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2790BA | | UN | LA | |
| Administered by: Private Purchased by: Unknown | | Symptoms: Urticaria | | Write-up: Hives occurring the next morning, treatment Benadryl 06hr pm. Was seen 11/3/08 hives were resolved by the next day. |
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| VAERS ID: | 331789 | Vaccinated: | 2008-10-20 | | Age: | 46.0 | Onset: | 2008-10-21, Days after vaccination: 1 | | Gender: | Female | Submitted: | 2008-11-06, Days after onset: 16 | | Location: | Utah | Entered: | 2008-11-10, Days after submission: 4 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: Not reported. | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: History of Eustachian tube problems (not specified). | | CDC 'Split Type': 200803358 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | | | UN | UN | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Deafness unilateral, Sudden hearing loss | | Write-up: Initial report received from a health professional on 27 October 2008. A 46-year-old female patient had received a dose of FLUZONE SV 2008-2009 (lot number unknown; route and site of administration not reported) on 20 October 2008 and within 24 hours, she complained of sudden hearing loss in her right ear. The patient was seen by a physician on 22 October 2008. No additional details were provided. Documents held by sender: None |
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| VAERS ID: | 331790 | Vaccinated: | 2008-10-26 | | Age: | 66.0 | Onset: | 2008-10-26, Days after vaccination: 0 | | Gender: | Male | Submitted: | 2008-11-06, Days after onset: 11 | | Location: | Nevada | Entered: | 2008-11-10, Days after submission: 4 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: Not reported. | | Previous Vaccinations: | | Other Medications: PRILOSEC; UROXATRAL; glucosamine; vitamin B; AVODART | | Preexisting Conditions: Patient's past medical history included enlarged prostate, acid reflux, CIPRO allergies and NEOSPORIN antibiotic cream allergy. | | CDC 'Split Type': 200803361 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2742A | 9 | IM | LA | |
| Administered by: Other Purchased by: Other | | Symptoms: Chest discomfort, Cough, Dyspnoea, Eye discharge, Eye pain, Heart rate increased, Ocular hyperaemia, Speech disorder, Vaccine positive rechallenge, Vision blurred, Wheezing | | Write-up: Initial information was received on 28 October 2008 from a consumer. A 66 year old male patient with a history of enlarged prostate, acid reflux, allergies to CIPRO and NEOSPORIN antibiotic cream received an intramuscular left deltoid injection of FLUZONE (lot number U2742AA) on 26 October 2008 at 1:25 PM. The patient reported that he received FLUZONE on a yearly basis since 1999. He had similar symptoms in the past although the symptoms were not as severe. On 26 October 2008 at 5:30 PM the patient developed difficulty breathing, wheezing, coughing, couldn't talk and upper chest discomfort. At 6:30 PM the patient's eyes became gritty, white pus coming out of the eyes, eyes were blood shot and vision was blurred. At 7:30 PM his pulse was elevated. At 8:15 the patient was still wheezing but improved after he took BENADRYL. On 27 October 2008 his eyes were hurting and on 28 October 2008 his eyes were red. It was noted that the patient was seen by the paramedics but refused to go to the hospital. The patient was not recovered at the time of the report. List of Documents held by Sender: None. |
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| VAERS ID: | 331791 | Vaccinated: | 0000-00-00 | | Age: | 79.0 | Onset: | 0000-00-00 | | Gender: | Female | Submitted: | 2008-11-06 | | Location: | Virginia | Entered: | 2008-11-10, Days after submission: 4 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: Not reported. | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: Not reported. | | CDC 'Split Type': 200803365 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | UNKNOWN MANUFACTURER | | | UN | UN | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Aspiration pleural cavity, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Dyspnoea, Ex-tobacco user, Pericarditis, Pleural effusion, Vaccination complication | | Write-up: Initial report received from another manufacturer on 29 October 2008 who received the report from a health care professional. A female patient (age not reported) developed reactive pericarditis after receiving an unspecified influenza vaccine. The date of the vaccine administration and the date of onset of symptoms were not specified. No additional details were reported. Documents held by sender: None 11/21/08 Reviewed Pulmo records received from CDC. FINAL DX: COPD Records reveal patient had been hospitalized 12/2002 w/pleural effusion secondary to flu shot & was seen in office 8/9/2003. Had thoracentesis in hospital that was non-diagnostic. Cardiac w/u neg. Had continued SOB. Ex-smoker who quit 12/2002. CXR c/w COPD. Tx w/inhalers. |
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