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| VAERS ID: | 25023 (history) | Vaccinated: | 1989-10-23 | | Age: | | Onset: | 1989-12-07, Days after vaccination: 45 | | Gender: | Male | Submitted: | 0000-00-00 | | Location: | Pennsylvania | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: receiving gold therapy for rhematiod arthritis | | Current Illness: URI | | Preexisting Conditions: rhematoid arthritis | | Diagnostic Lab Data: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (FLUZONE) | CONNAUGHT LABORATORIES | | | | | |
| Administered by: Unknown Purchased by: Unknown | Symptoms: Guillain-Barre syndrome SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
| | Write-up: pt has URI prior to onset of Guillian-Barre symptoms. He has rheumatoid arthritis & was receiving gold therapy concurrently. He was given the flu vaccine on 23Oct89 |
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| VAERS ID: | 25025 (history) | Vaccinated: | 0000-00-00 | | Age: | | Onset: | 1990-01-10 | | Gender: | Unknown | Submitted: | 0000-00-00 | | Location: | Florida | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: treated with Hydroxazine | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (FLUZONE) | CONNAUGHT LABORATORIES | 9J01133 | | | | |
| Administered by: Unknown Purchased by: Unknown | Symptoms: Pruritus,
Rash SMQs:, Anaphylactic reaction (broad)
| | Write-up: rash, pruritus |
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| VAERS ID: | 25030 (history) | Vaccinated: | 1989-12-01 | | Age: | 66.0 | Onset: | 1989-12-03, Days after vaccination: 2 | | Gender: | Female | Submitted: | 0000-00-00 | | Location: | New York | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: Lisinopril 20mg, Verapamil 120mg, HCTZ 25mg, Thyrolar | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (FLUZONE) | CONNAUGHT LABORATORIES | 9F01202 | | | | |
| 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)
| | 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. |
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| VAERS ID: | 25065 (history) | Vaccinated: | 1989-10-24 | | Age: | 20.0 | Onset: | 1989-11-03, Days after vaccination: 10 | | Gender: | Female | Submitted: | 0000-00-00 | | Location: | New Jersey | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: | | Current Illness: | | Preexisting Conditions: Diabetic & Cystic fibrosis | | Diagnostic Lab Data: | | CDC 'Split Type': B073089143 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) | PFIZER/WYETH | | | | | |
| Administered by: Private Purchased by: Unknown | Symptoms: Injection site reaction,
Tenosynovitis SMQs:
| | Write-up: Pt experienced tendinitis of the biceps brachii of her arm 10 days /p receiving influenza virus vaccine. |
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| VAERS ID: | 25069 (history) | Vaccinated: | 1989-11-09 | | Age: | 34.0 | Onset: | 1989-11-15, Days after vaccination: 6 | | Gender: | Male | Submitted: | 0000-00-00 | | Location: | Michigan | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: | | Current Illness: | | Preexisting Conditions: allery to penicillins & shell-fish | | Diagnostic Lab Data: | | CDC 'Split Type': B073089154 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) | PFIZER/WYETH | | | IM | | |
| Administered by: Private Purchased by: Unknown | Symptoms: Rash,
Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow)
| | Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered |
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| VAERS ID: | 25070 (history) | Vaccinated: | 1989-11-21 | | Age: | | Onset: | 0000-00-00 | | Gender: | Male | Submitted: | 0000-00-00 | | Location: | Wisconsin | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': B073090001 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) | PFIZER/WYETH | | | | | |
| Administered by: Unknown Purchased by: Unknown | Symptoms: Guillain-Barre syndrome SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
| | Write-up: Pt developed weakness in his arms and legs, DX as Guillain-Barre Syndrome /p receiving Influenza Virus Vaccine |
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| VAERS ID: | 25071 (history) | Vaccinated: | 1989-10-27 | | Age: | | Onset: | 1989-10-27, Days after vaccination: 0 | | Gender: | Female | Submitted: | 0000-00-00 | | Location: | Minnesota | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': B073089142 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) | PFIZER/WYETH | 4898137 | | IM | | |
| Administered by: Private Purchased by: Unknown | Symptoms: Dizziness,
Headache,
Influenza,
Injection site oedema,
Injection site pain,
Injection site reaction,
Nausea SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)
| | Write-up: pt developed erythema, edema, warmth, itching, stinging & pain in approx. 4" X 6" area at site of injection /p receiving vaccine. Experienced flu-like symptoms. That include haedache, light-headedness, dizziness, nausea within 3 hrs /p vacc |
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| VAERS ID: | 25074 (history) | Vaccinated: | 1989-11-06 | | Age: | 73.4 | Onset: | 1989-11-07, Days after vaccination: 1 | | Gender: | Female | Submitted: | 0000-00-00 | | Location: | Washington | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': B073090004 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) | PFIZER/WYETH | | | | | | PPV: PNEUMO (NO BRAND NAME) | UNKNOWN MANUFACTURER | | | | | |
| Administered by: Private Purchased by: Unknown | Symptoms: Oedema,
Pain,
Pyrexia SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
| | Write-up: Pt experienced severe pain & edema in lt arm from shoulder to hand, & fever /p receiving Influenza Virus. Symptoms persisted for approx. 2 wks & pt recovered |
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| VAERS ID: | 25075 (history) | Vaccinated: | 1989-11-07 | | Age: | 43.5 | Onset: | 1989-11-07, Days after vaccination: 0 | | Gender: | Female | Submitted: | 1989-11-09, Days after onset: 2 | | Location: | New Jersey | Entered: | 1990-07-09, Days after submission: 241 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? Yes |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: UNK | | Current Illness: UNK | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': B073089147 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) | PFIZER/WYETH | 4898169 | | 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)
| | Write-up: Pt exp swelling & pain of her lt arm, neck, elbow, wrist & shoulder immediately p/receiving flu vax; also exp arthritis & lymphadenopathy which required hospitalization & 2 surgical operations; exp numbness, dec movement & pain; |
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| VAERS ID: | 25076 (history) | Vaccinated: | 0000-00-00 | | Age: | 65.0 | Onset: | 0000-00-00 | | Gender: | Male | Submitted: | 0000-00-00 | | Location: | Ohio | Entered: | 1990-07-09 | |
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Previous Vaccinations: | | Other Medications: | | Current Illness: | | Preexisting Conditions: | | Diagnostic Lab Data: | | CDC 'Split Type': B073089153 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) | PFIZER/WYETH | | | IM | | |
| Administered by: Private Purchased by: Unknown | Symptoms: Confusional state SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
| | Write-up: Pt became confused within a minute or two /p receiving Influenza Virus Vaccine. He became disoriented & could not remember the route to his home. Symptoms slowly abated within 3 days. |
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