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| VAERS ID: | 216067 | Vaccinated: | 2003-11-12 | | Age: | 26.0 | Onset: | 2003-11-12, Days after vaccination: 0 | | Gender: | Male | Submitted: | 2003-12-15, Days after onset: 33 | | Location: | Missouri | Entered: | 2004-02-05, Days after submission: 52 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: UNK | | Diagnostic Lab Data: UNK | | Previous Vaccinations: | | Other Medications: UNK | | Preexisting Conditions: UNK | | CDC 'Split Type': HQWYE3131 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Other Purchased by: Other | | Symptoms: Vision blurred | | Write-up: Information regarding Flumist (2003-2004 Formula) (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a 26-year-old male who experienced blurred vision after receiving a dose on 12-Nov-2003. Medical history: Relevant medical history was not provided. Product details: Indication for Flumist (2003-2004 Formula) was immunization. Product was administered on 12-Nov-2003. Dose regimen was 1 dose 1 time per day (nasal). Concomitant therapy: Concomitant medications were not reported. Event details: The patient experienced blurred vision (vision blurred) after receiving a dose on 12-Nov-2003. No additional information was available at the time of this report. |
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| VAERS ID: | 216068 | Vaccinated: | 2003-10-11 | | Age: | 70.0 | Onset: | 2003-10-11, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2003-11-13, Days after onset: 33 | | Location: | New Jersey | Entered: | 2004-02-05, Days after submission: 84 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: UNK | | Diagnostic Lab Data: UNK | | Previous Vaccinations: | | Other Medications: Evista | | Preexisting Conditions: UNK | | CDC 'Split Type': HQWYE3430 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | 0 | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Headache, Medication error, Nasal congestion | | Write-up: A 70-year-old female reported that she inadvertently received a dose of Flumist (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen) on 11-Oct-2003, and since then has had a "stuffy nose and a headache". Medical History: relevant medical history was not provided. Product details: Indication for Flumist (2003-2004 Formula) was immunization. Product was administered on 11-Oct-2003. Dose regimen was 1 dose (intranasal). Concomitant therapy: Concomitant therapy included Evista (raloxifene hydrochloride). Event details: On 11-Oct-2003, subsequent to Flumist administration, she developed stuffy nose (nasal congestion) and headache (headache). As of 15-Oct-2003, the events had not resolved. No additional information was available at the time of this report. |
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| VAERS ID: | 216070 | Vaccinated: | 2003-10-16 | | Age: | 39.0 | Onset: | 2003-10-16, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2003-11-10, Days after onset: 25 | | Location: | New Jersey | Entered: | 2004-02-05, Days after submission: 87 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: UNK | | Diagnostic Lab Data: UNK | | Previous Vaccinations: Influenza (unknown mfr);Left arm sore and black and blue and swollen for 2 weeks;;38;In Patient | | Other Medications: Synthroid | | Preexisting Conditions: Hypothyroidism; Post nasal drip | | CDC 'Split Type': HQWYE376721OCT03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Private Purchased by: Other | | Symptoms: Dysgeusia | | Write-up: A 39 year old female reported that she received a dose of Flumist nasal solution on 10/16/03 and experienced a strange taste in her mouth after vaccine administration. The patient's concurrent illnesses included hypothyroidism and post-nasal drip. Indication for Flumist was immunization. Product was administered on 10/16/03. Dose regimen was 0.5mL (IN). Concomitant therapy included Synthroid. Subsequently to Flumist administration, the patient reported that the Flumist tasted strange, and she continued to taste it for 30 minutes, up to the time of calling in this report. No additional information was available at the time of this report. |
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| VAERS ID: | 216072 | Vaccinated: | 2003-10-16 | | Age: | 46.0 | Onset: | 2003-10-16, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2003-11-12, Days after onset: 27 | | Location: | Virginia | Entered: | 2004-02-05, Days after submission: 85 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: UNK | | Diagnostic Lab Data: UNK | | Previous Vaccinations: | | Other Medications: Celebrex, Excedrin, Percocet, synthroid | | Preexisting Conditions: Arthritis, back pain, hypothyroidism, migraine, hysterectomy, sinusitis. | | CDC 'Split Type': HQWYE429722OCT03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 5000BP | 0 | IN | | |
| Administered by: Other Purchased by: Other | | Symptoms: Dizziness, Dry throat, Migraine, Pain, Sneezing, Vision blurred | | Write-up: Information regarding Flumist was received from a healthcare professional regarding a 46 year old female pt who experienced lightheadedness, migraine headaches, blurred vision, body ache, sneezing and scratchy throat. At 46 years of age, the pt received a dose on 10/16/03. The pt's concurrent illness include migraine headaches, chronic back pain, hypothyroidism, and arthritis with a past history of sinusitis (frequent) and hysterectomy. The pt became lightheaded, and started having migraine headaches and blurred vision on 10/16/03. She then developed body aches, sneezing and a scratchy throat on 10/17/03. She recovered. |
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| VAERS ID: | 216076 | Vaccinated: | 2003-10-18 | | Age: | 13.0 | Onset: | 2003-10-19, Days after vaccination: 1 | | Gender: | Female | Submitted: | 2003-12-15, Days after onset: 57 | | Location: | Texas | Entered: | 2004-02-05, Days after submission: 52 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: UNK | | Previous Vaccinations: Influenza (FluMist);;;9;In Sibling | | Other Medications: NONE | | Preexisting Conditions: UNK | | CDC 'Split Type': HQWYE467123OCT03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Abdominal pain, Nasal congestion, Pharyngolaryngeal pain, Pyrexia | | Write-up: Follow up information received from the physician included additional events, medical history, patient date of birth, vaccines received within four weeks, and illnesses at the time of vaccination. Information regarding Flumist nasal solution was received from a healthcare professional regarding a 13 year old female patient who experienced a stuffy nose, a runny nose, abdominal pain, fever, and a sore throat. The patient also received product that was stored at a temperature that was higher than allowable and was not frozen. At 13 years of age, the patient received a dose on 10/18/03. The patient had no relevant medical history. Indication for Flumist was immunization. Product was administered on 10/18/03. Dose regimen was 1 dose 1 time per day (IN). Patient was not taking any concomitant therapy. The patient experienced a stuffy nose, a runny nose and abdominal pain on 10/19/03. She was treated with Triaminic. The patient also developed a temperature of 100.2 degrees F. The physician indicated that the patient received product that was stored by the pharmacy at a temperature that was higher than allowable and was not frozen. |
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| VAERS ID: | 216077 | Vaccinated: | 2003-10-22 | | Age: | 60.0 | Onset: | 2003-10-22, Days after vaccination: 0 | | Gender: | Male | Submitted: | 2003-11-10, Days after onset: 19 | | Location: | Michigan | Entered: | 2004-02-05, Days after submission: 87 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: UNK | | Diagnostic Lab Data: UNK | | Previous Vaccinations: | | Other Medications: Acetylsalicylic Acid; Lipitor; Nitro; Tenormin; Vasotec | | Preexisting Conditions: Alcohol poisoning; Alcoholism; Cardiac failure congestive; Chronic obstructive airways disease | | CDC 'Split Type': HQWYE468523OCT03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500014P | | IN | | |
| Administered by: Public Purchased by: Public | | Symptoms: Dysarthria, Visual disturbance | | Write-up: Information regarding Flumist nasal solution was received from a healthcare professional regarding a 60 year old male who experienced slurred speech and saw spots before his eyes. At 60 years of age, the patient received a dose of 10/22/2003. The patient's concurrent illnesses include cardiac failure congestive, chronic obstructive airways disease, alcoholism, and alcohol intoxication. Indication for Flumist was immunization. Product was administered on 10/22/03. Dose regimen was 0.5mL 1 time per day (IN). Concomitant therapy included Lipitor, Vasotec, Acetylsalicylic Acid, Tenormin and sublingual NTG. The patient developed slurred speech and saw spots before his eyes on 10/22/03. No additional information was available at the date of this report. |
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| VAERS ID: | 216078 | Vaccinated: | 2003-11-27 | | Age: | 44.0 | Onset: | 2003-11-29, Days after vaccination: 2 | | Gender: | Female | Submitted: | 2003-12-15, Days after onset: 16 | | Location: | New Jersey | Entered: | 2004-02-05, Days after submission: 52 | |
| 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: UNK | | CDC 'Split Type': HQWYE479909DEC03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Bronchitis, Chills, Cough, Influenza like illness, Laryngitis, Musculoskeletal stiffness, Nausea, Pyrexia | | Write-up: Information regarding Flumist was received from a physician regarding his 44 year old wife who developed flu-like symptoms, nausea, stiffness, chills, low grade fever, laryngitis and cough following vaccine administration on 11/27/03. On 11/29/03, she developed flu-like symptoms characterized by nausea, stiffness (musculoskeletal stiffness), chills and low grade fever. On 12/3/03, she developed laryngitis. As of 12/4/03, the laryngitis, cough, and "mild bronchitis symptoms" persisted. No additional info was available at the time of this report. |
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| VAERS ID: | 216079 | Vaccinated: | 2003-10-18 | | Age: | 9.0 | Onset: | 2003-10-19, Days after vaccination: 1 | | Gender: | Male | Submitted: | 2003-11-18, Days after onset: 30 | | Location: | Texas | Entered: | 2004-02-05, Days after submission: 79 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: UNK | | Previous Vaccinations: | | Other Medications: NONE | | Preexisting Conditions: UNK | | CDC 'Split Type': HQWYE480324OCT03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Medication error, Rhinorrhoea | | Write-up: Follow-up info received provided the pt's date of birth, vaccinations receive within four weeks, medical history, and illness at the time of vaccination. Information regarding Flumist was received from a healthcare professional regarding a 9 year old male pt who experienced stuffy nose, runny nose. The pt received product that was stored at a temp that was higher than allowable and was not frozen. At 9 years of age, the pt received a dose on 10/18/03. The pt experienced stuffy nose and runny nose on 10/19/03. The pt's symptoms were treated with Triaminic. On 10/20/03, the pt had no complaints. The reporter indicated that the pt received product that was stored by the pharmacy at a temp that was higher than allowable and was not frozen. |
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| VAERS ID: | 216080 | Vaccinated: | 2003-10-21 | | Age: | | Onset: | 2003-10-21, Days after vaccination: 0 | | Gender: | Female | Submitted: | 2003-11-10, Days after onset: 20 | | Location: | Unknown | Entered: | 2004-02-05, Days after submission: 87 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: UNK | | Diagnostic Lab Data: UNK | | Previous Vaccinations: | | Other Medications: UNK | | Preexisting Conditions: UNK | | CDC 'Split Type': HQWYE483024OCT03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500014P | | IN | | |
| Administered by: Other Purchased by: Other | | Symptoms: Postnasal drip | | Write-up: Information has been received from a health care professional concerning a female pt who experienced postnasal sensation after receiving Flumist on 10/21/03. The pt experienced postnasal sensation on 10/21/03. No additional info was available at the time of this report. |
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| VAERS ID: | 216081 | Vaccinated: | 2003-12-02 | | Age: | 49.0 | Onset: | 2003-12-03, Days after vaccination: 1 | | Gender: | Female | Submitted: | 2003-12-16, Days after onset: 13 | | Location: | California | Entered: | 2004-02-05, Days after submission: 51 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: UNK | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': HQWYE495709DEC03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Pharyngolaryngeal pain, Pyrexia | | Write-up: Information regarding Flumist was received from consumer regarding a 49 year old female pt who experienced sore throat with phlegm and fever < 100 deg. At 49 years of age, the pt received a dose on 12/2/03. The pt experienced sore throat with phlegm and fever < 100 deg on 12/3/03. The pt was treated with Tylenol but as of 12/3/03 the symptoms persisted. No additional info was available at the time of this report. |
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