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| VAERS ID: | 331854 | Vaccinated: | 2008-11-06 | | Age: | 40.0 | Onset: | 2008-11-06, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2008-11-10, Days after onset: 4 | | Location: | Vermont | Entered: | 2008-11-10, Days after submission: 0 | |
| 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 | | FLU | NOVARTIS VACCINES AND DIAGNOSTICS | 87877 | 0 | IM | LA | |
| Administered by: Other Purchased by: Other | | Symptoms: Injection site pain | | Write-up: Pain in arm where the injection was given. Tx=Ibuprofen - one time 400mg. Hurt for 3 days. |
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| VAERS ID: | 331855 | Vaccinated: | 2008-10-30 | | Age: | 86.0 | Onset: | 2008-10-30, Days after vaccination: 0 | | Gender: | Female | Submitted: | 0000-00-00 | | Location: | Indiana | Entered: | 2008-11-10 | |
| 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: PLAVIX; ASA; LOTRAL CAPTOPRIL; TOPROL XL; SIMVASTATIN; | | Preexisting Conditions: None | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2745AA | | IM | LA | |
| Administered by: Private Purchased by: Private | | Symptoms: Anxiety, Feeling abnormal, Flushing, Heart rate increased, Respiratory rate increased, Vomiting | | Write-up: 3 pm 10/30/08 Sister phoned stating Pt does not feel good at all. States pt's face is very flushed, P-100, R-44 and feeling very anxious. Pt vomited. Denied SOB, wheezing, hives, paleness or dizziness. Pt advised per Dr to use TYLENOL and rest. May also take BENADRYL. |
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| VAERS ID: | 331856 | Vaccinated: | 2008-10-23 | | Age: | 8.0 | Onset: | 2008-10-26, Days after vaccination: 3 | | Gender: | | Submitted: | 0000-00-00 | | Location: | Massachusetts | Entered: | 2008-11-10 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: No | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: None | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2831AA | 1 | IM | RA | | PPV | MERCK & CO. INC. | 1679U | 0 | SC | RA | |
| Administered by: Private Purchased by: Private | | Symptoms: Injection site erythema, Injection site pain, Injection site swelling | | Write-up: 10-23-08 Pt received Fluvax and PPV23 in RA -10-27-2008 seen for c/o 24 degree redness, swelling, tenderness @ injection site- recommend ice, diphenhydramine prn with effect. Given PPV23 because only received 2 doses PCV7- History asthma- |
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| VAERS ID: | 331859 | Vaccinated: | 2008-10-29 | | Age: | 50.0 | Onset: | 2008-10-30, Days after vaccination: 1 | | Gender: | Female | Submitted: | 2008-11-03, Days after onset: 4 | | Location: | Georga | Entered: | 2008-11-10, 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': GA09094 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2807AA | 0 | IM | RA | |
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| VAERS ID: | 331866 | Vaccinated: | 2008-10-16 | | Age: | 60.0 | Onset: | 2008-10-17, Days after vaccination: 1 | | Gender: | Male | Submitted: | 2008-11-05, Days after onset: 19 | | Location: | D.C. | Entered: | 2008-11-10, Days after submission: 5 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: Cellulitis @ injection site | | Diagnostic Lab Data: WBC on 10/18/2008 - 12.0, 86.4 segs ; WBC on 10/19/2008, 10.9, 79.0 segs; WBC 10/20/2008, 7.4, 72 segs | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: HTN; Seizure DIS; PUD - all -> Erythromycin and Chromotin | | CDC 'Split Type': 2008001 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2752AA | | UN | RA | | PPV | MERCK & CO. INC. | 08030 | 0 | UN | RA | |
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| VAERS ID: | 331873 | Vaccinated: | 2008-11-07 | | Age: | 19.0 | Onset: | 2008-11-09, Days after vaccination: 2 | | Gender: | Male | Submitted: | 2008-11-10, Days after onset: 1 | | Location: | Mississippi | Entered: | 2008-11-10, Days after submission: 0 | |
| 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: none | | Preexisting Conditions: none | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | UNKNOWN MANUFACTURER | | | | | |
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| VAERS ID: | 331874 | Vaccinated: | 2008-10-10 | | Age: | 65.0 | Onset: | 2008-10-14, Days after vaccination: 4 | | Gender: | Female | Submitted: | 2008-11-10, Days after onset: 27 | | Location: | Florida | Entered: | 2008-11-10, Days after submission: 0 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: Had symptoms of respiratory illness 1-2 weeks prior to vaccination. | | Diagnostic Lab Data: None | | Previous Vaccinations: | | Other Medications: Lisinopril and Prevastat | | Preexisting Conditions: Hypertension Hyperlipdemia | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2789AA | 1 | IM | LA | | PPV | MERCK & CO. INC. | 0224X | 0 | IM | RA | |
| Administered by: Public Purchased by: Public | | Symptoms: Condition aggravated, Cough, Pyrexia, Respiratory disorder, Rhinorrhoea | | Write-up: Patient reports exacerbation of cough, increased mucus and respiratory symptoms with fever 4-5 days after influenza vaccine. Still has symptoms. Has not seen MD. Taking OTC cough syrup and Tylenol. |
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| VAERS ID: | 331875 | Vaccinated: | 2008-11-06 | | Age: | 46.0 | Onset: | 2008-11-06, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2008-11-10, Days after onset: 4 | | Location: | Minnesota | Entered: | 2008-11-10, 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: none | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | UNKNOWN MANUFACTURER | | 1 | | | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Cough, Dyspnoea, Eye irritation, Eye pruritus, Headache, No reaction on previous exposure to drug, Ocular hyperaemia, Pain, Palpitations, Pyrexia, Respiratory tract congestion | | Write-up: This healthy 46-year-old received a flu shot around 10:30 a.m. this morning. Around noon she developed a dry, hacky cough, mild headache and body aches. She took some cold medicine thereafter developing a feeling of palpitations and mild shortness of breath. Now at 5:30 p.m. those two symptoms have resolved, but she feels very achy, has very red, irritated, itchy eyes, a fever and congestion. She does note in retrospect that she did have some body aches this morning upon waking. No known exposures. No previous reaction to flu shots. No history of egg allergy or other comorbidities. |
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| VAERS ID: | 331876 | Vaccinated: | 2008-10-10 | | Age: | 65.0 | Onset: | 2008-10-12, Days after vaccination: 2 | | Gender: | Male | Submitted: | 2008-11-10, Days after onset: 29 | | Location: | Florida | Entered: | 2008-11-10, Days after submission: 0 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: Recent Surgery | | Diagnostic Lab Data: Had Melanoma removed from left posterior Shoulder 10/03/08. | | Previous Vaccinations: | | Other Medications: None | | Preexisting Conditions: Hx colon CA, Melanoma | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2789AA | 1 | IM | RA | | PPV | MERCK & CO. INC. | 0224X | 0 | IM | LA | |
| Administered by: Military Purchased by: Public | | Symptoms: Condition aggravated, Cough, Influenza, Injection site pain, Pyrexia, Rhinorrhoea, Tenderness | | Write-up: Client reports pain in left shoulder near injection site beginning 2 days after immunization. Pain and tenderness increased through 3rd and th day. Still has pain with certain movements and tendernees. Denies swelling,redness or induration. States feels like when he had a torn muscle. Took Tylenol. Also reprots exacerbation of "flu" symptoms, increase, cough, Mucus, slight fever 4-5 days after immunizations recieved. |
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| VAERS ID: | 331879 | Vaccinated: | 2008-10-20 | | Age: | 77.0 | Onset: | 2008-10-20, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2008-11-10, Days after onset: 21 | | Location: | South Carolina | Entered: | 2008-11-10, Days after submission: 0 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? Yes, 4 days | | Extended hospital stay? No |
| Current Illness: None | | Diagnostic Lab Data: Unknown LABS: WBC 13.5, neutros 90.1%, lymphs 1%. Urine c/s (+) Klebsiella pneumonia. | | Previous Vaccinations: | | Other Medications: Unknown | | Preexisting Conditions: Allergies: sulfa PMH: GERD, hiatal hernia, pancreatitis, gasteoenteritis, arthritis, CHF. | | CDC 'Split Type': SC0815 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU | SANOFI PASTEUR | U2765AA | 1 | IM | LA | | PPV | MERCK & CO. INC. | 1679U | | IM | LA | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Asthenia, Breast pain, Cellulitis, Culture urine positive, Dehydration, Fall, Gastroenteritis, Immediate post-injection reaction, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Klebsiella infection, Lymphocyte percentage decreased, Musculoskeletal pain, Nausea, Neutrophil percentage increased, Urinary tract infection, Vomiting, White blood cell count increased | | Write-up: Received flu and pneumonia vaccine on 10/20/08. C/O pain in injection site (LA) immediately. Continued to be painful with radiation under arm to L breast area. Vomiting on 10/21/08--reported to ER on 10/21/08. Swelling, redness @ site. Patient requested both given in L arm. Patient has signed release of record form to get hospital records for further medical information regarding this incident. 11/18/08 Reviewed hospital medical records of 10/21-10/24/2008. FINAL DX: cellulitis left shoulder; right shoulder pain secondary to fall at home; & acute gastroenteritis w/dehydration Records reveal patient experienced nausea, vomiting & weakness x 2 days. Injection site edema, erythema, warmth & pain which extended into left anterior chest wall. |
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