|
| VAERS ID: | 212034 | Vaccination Date: | 2003-11-07 | | Age: | 47.0 | Onset Date: | 2003-11-09 Days later: 2 | | Gender: | Male | Submitted: | 2003-11-09 | | State: | Maryland | Entered: | 2003-11-09 | |
| 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: | | Preexisting Conditions: none | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500013P | 0 | IN | | | PPV | MERCK & CO. INC. | | 0 | IM | LA | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Fatigue, Rhinitis | | Write-up: Patient is a health 47 year old male physician. Annual attenuated virus flu vaccination received for the past five years without any sequelae. 36 hours post flu-mist innoculation, Patient developed persistent, extremely bothersome rhinitis and fatigue. No fever, myalgia, or other symptoms. |
|
|
| VAERS ID: | 212176 | Vaccination Date: | 2003-11-08 | | Age: | 44.0 | Onset Date: | 2003-11-10 Days later: 2 | | Gender: | Female | Submitted: | 2003-11-12 | | State: | Tennessee | Entered: | 2003-11-12 | |
| 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: FloNase | | Preexisting Conditions: Allergic to sulfa and thimersol | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | unknown | 0 | IN | | |
| Administered by: Unknown Purchased by: Private | | Symptoms: Fatigue, Rhinorrhoea | | Write-up: Runny nose, stuffy nose, sneezing, fatigue, scratchy throat |
|
|
| VAERS ID: | 212658 | Vaccination Date: | 2003-10-22 | | Age: | 5.0 | Onset Date: | 2003-10-24 Days later: 2 | | Gender: | Male | Submitted: | 2003-11-18 | | State: | D.C. | Entered: | 2003-11-18 | |
| 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: Flovent, Singulair | | Preexisting Conditions: Mild asthma | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Private Purchased by: Private | | Symptoms: Prostration, Rhinorrhoea | | Write-up: 2 days after vaccination, vaccinee had profuse rhinorrhea that lasted approximately 3 days. Vaccinee also had conjunctival injection. No fever was noted. 3 days after vaccination, father had prostration without fever or rhinorrhea which lasted 24 hours. 4 days after vaccination, mother had prostration without fever or rhinorrhea which lasted 24 hours. |
|
|
| VAERS ID: | 212684 | Vaccination Date: | 2003-10-02 | | Age: | 43.0 | Onset Date: | 2003-10-05 Days later: 3 | | Gender: | Male | Submitted: | 2003-10-29 | | State: | Massachusetts | Entered: | 2003-11-19 | |
| 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: Valtrex | | Preexisting Conditions: PCN allergy | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | IN | | |
| Administered by: Other Purchased by: Other | | Symptoms: Chills, Influenza like illness, Lethargy, Pyrexia | | Write-up: Flu like symptoms, fever, chills, lethargy. Still sick. |
|
|
| VAERS ID: | 213158 | Vaccination Date: | 2003-11-21 | | Age: | 46.0 | Onset Date: | 2003-11-21 Days later: 0 | | Gender: | Female | Submitted: | 2003-11-29 | | State: | California | Entered: | 2003-11-28 | |
| 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: BEXTRA 20MG | | Preexisting Conditions: HERNIATED DISC WITH EPIDURAL INJECTION ON 11/11/2003. | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | | | | |
| Administered by: Unknown Purchased by: Private | | Symptoms: Dizziness, Fatigue, Headache, Pharyngolaryngeal pain, Vertigo | | Write-up: FATIGUE, SORE THROAT, VERTIGO/DIZZINESS, HEADACHE. RESTED, DRANK FLUIDS, TOOK TYLENOL FOR 24 HOURS AFTER ONSET OF SYMPTOMS. SYMPTOMS STARTED WITH FATIGUE AND SORE THROAT AROUND 9PM ON 11/21 (DATE OF VACCINE) AND I WOKE UP ON 11/22 WITH VERTIGO/DIZZINESS/HEADACHE AND THOUGHT I WOULD FAINT IF I TRIED TO GET OUT OF BED. SYMPTOMS RESOLVED BY THE TIME I WOKE UP ON 11/23 |
|
|
| VAERS ID: | 213609 | Vaccination Date: | 2003-12-05 | | Age: | 20.0 | Onset Date: | 2003-12-05 Days later: 0 | | Gender: | Female | Submitted: | 2003-12-05 | | State: | Texas | Entered: | 2003-12-08 | |
| 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: NONE | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500020P | 0 | IN | | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Fatigue, Pain | | Write-up: Patient complained of body aches and fatigue about 5 hours after innoculation. No treatment indicated. |
|
|
| VAERS ID: | 213610 | Vaccination Date: | 2003-12-05 | | Age: | 32.0 | Onset Date: | 2003-12-05 Days later: 0 | | Gender: | Female | Submitted: | 2003-12-05 | | State: | Texas | Entered: | 2003-12-08 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: VSS; Pulse Ox 98% | | Previous Vaccinations: | | Other Medications: NONE | | Preexisting Conditions: Codeine Allergy | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | 500020P | 0 | IN | | |
| Administered by: Private Purchased by: Other | | Symptoms: Dyspnoea, Hypoaesthesia, Tracheal oedema | | Write-up: Complained of numbness to tongue, lips, face, complained of swelling to throat and difficulty breathing. FU: 30 minutes after vaccination she felt chest pain, her vital signs, monitored every 30 minutes, were okay. Oxymetry was normal. An ambulance was called, 0.3 cc epinephrine were administered but patients symptom continued to progress. Patient was sent to ER, from where she was released after 4-5 hours. |
|
|
| VAERS ID: | 213642 | Vaccination Date: | 2003-12-04 | | Age: | 24.0 | Onset Date: | 2003-12-07 Days later: 3 | | Gender: | Female | Submitted: | 2003-12-08 | | State: | Iowa | Entered: | 2003-12-08 | |
| 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: ortho-tricyclen | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | unknown | | IN | | |
| Administered by: Public Purchased by: Public | | Symptoms: Chills, Headache, Influenza like illness, Lethargy, Pyrexia | | Write-up: Flu-like symptoms (101-degree fever, headache, chills, lethargy) |
|
|
| VAERS ID: | 213811 | Vaccination Date: | 2003-11-11 | | Age: | 13.0 | Onset Date: | 2003-11-11 Days later: 0 | | Gender: | Male | Submitted: | 2003-12-01 | | State: | Massachusetts | Entered: | 2003-12-10 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: Fever | | Diagnostic Lab Data: Chest film 11/13/03 confirms penumonia. | | Previous Vaccinations: | | Other Medications: UNK | | Preexisting Conditions: UNK | | CDC 'Split Type': HQWYE263825NOV03 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | FLUN | MEDIMMUNE, INC./WYETH LABORATORIES, INC | | 0 | IN | | |
| Administered by: Private Purchased by: Other | | Symptoms: Pneumonia, Pyrexia | | Write-up: This case was considered medically important (OMIC). Information regarding FluMist nasal solution was received from a pediatrician regarding a 13 year old male who developed pneumonia. Relevant medical history was not provided. Indication for FluMist was immunization. Product was administered on an unspecified date. Dose regimen was not provided. Concomitant medications were not reported. The pediatrician reported that the child had a fever on the same day as the FluMist administration. One hour post-immunization, his fever was 104 degrees F. Two days post-immunization, he was diagnosed with pneumonia. No additional information was available at the time of this report. Follow UP: The reporter considered this event medically important. Follow-up information received from the physician on 16-Dec-2003 provided patient identifiers, immunization date, onset date, test results and outcome. Information regarding Flumist (2003-2004 Formula) (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a pediatrician regarding a 13 year old male who develooped penumonia. At 13 years of age, the child received the first dose on 11-Nov-20003. The pediatrician reported that the child developed a fever 4 hours post -immunization. The fever ranged from 102 deg. F. to 104 deg F and persisted for 2 days. On 13-Nov-2003, the child was seen by the pediatrician and diagnosed with pneumonia. The child recovered. The pediatrician noted that she did not consider this event related to vaccine administratiion. |
|
|
| VAERS ID: | 213889 | Vaccination Date: | 2003-12-10 | | Age: | 18.0 | Onset Date: | 2003-12-10 Days later: 0 | | Gender: | Female | Submitted: | 2003-12-11 | | State: | Texas | Entered: | 2003-12-12 | |
| 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 | 500020P | 0 | IN | | |
| Administered by: Private Purchased by: Other | | Symptoms: Abdominal pain, Dizziness, Feeling hot, Hyperhidrosis, Nausea | | Write-up: Ten minutes after administration pt c/o nausea, feeling hot and faint. Assisted to bed to lie down. BP 100/60, P 60. Diaphoretic. Thirty minutes after administration of vaccine c/o abdominal cramping and had BM. BP 110/70, P 68. Fifty minutes after administration of FluMist feeling normal. |
|
|
