|
| VAERS ID: |
26159 (history) |
| Form: |
Version 1.0 |
| Age: |
52.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 1990-09-20 |
| Onset: | 1990-09-20 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-10-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Private Purchased by: Unknown
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-09-20
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Methyprednisolone, Verapamil, Proventil, Albuterol, Anhydrous Theophylline
Current Illness: Severe Bronchial Asthma
Preexisting Conditions: Pt was hospitalized 2-3 yrs ago for hypertensive Crisis & Severe Bronchial Asthma.
Allergies:
Diagnostic Lab Data: HGT=5''6"; WGT=99lbs; Morning of 20SEP90 BP=142/86;P=72/min®.
CDC Split Type: 904090001
Write-up: Pt vaccinated with FLUOGEN who has severe bronchial asthma seen in MD ofc well VS stable & chest clear, death & respiratory arrest. |
|
| VAERS ID: |
26318 (history) |
| Form: |
Version 1.0 |
| Age: |
92.0 |
| Sex: |
Female |
| Location: |
Alabama |
| Vaccinated: | 1990-10-09 |
| Onset: | 1990-10-11 |
| Days after vaccination: | 2 |
| Submitted: |
1990-10-17 |
| Days after onset: | 6 |
| Entered: |
1990-10-22 |
| Days after submission: | 5 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11216 / 1 |
- / IM A |
Administered by: Private Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-12
Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC Split Type:
Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90. |
|
| VAERS ID: |
26655 (history) |
| Form: |
Version 1.0 |
| Age: |
65.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 1990-10-18 |
| Onset: | 1990-10-25 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-11-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F112117 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Asthenia,
Back pain
SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain. |
|
| VAERS ID: |
26713 (history) |
| Form: |
Version 1.0 |
| Age: |
77.0 |
| Sex: |
Male |
| Location: |
Maryland |
| Vaccinated: | 1990-10-02 |
| Onset: | 1990-10-02 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-11-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
02580P / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Apnoea,
Cardiac arrest,
Pneumonia,
Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-09
Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 904090003
Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90. |
|
| VAERS ID: |
27141 (history) |
| Form: |
Version 1.0 |
| Age: |
84.0 |
| Sex: |
Male |
| Location: |
Oklahoma |
| Vaccinated: | 1990-10-22 |
| Onset: | 1990-10-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
287974 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Nausea,
Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-10-25
Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died |
|
| VAERS ID: |
27159 (history) |
| Form: |
Version 1.0 |
| Age: |
69.0 |
| Sex: |
Female |
| Location: |
North Carolina |
| Vaccinated: | 1990-11-26 |
| Onset: | 0000-00-00 |
| Submitted: |
1990-12-17 |
| Entered: |
1990-12-26 |
| Days after submission: | 9 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
OF11208 / UNK |
- / - |
Administered by: Private Purchased by: Public
Symptoms: Bronchitis,
Cough,
Influenza
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-12-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC Split Type:
Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later. |
|
| VAERS ID: |
27275 (history) |
| Form: |
Version 1.0 |
| Age: |
82.0 |
| Sex: |
Male |
| Location: |
Minnesota |
| Vaccinated: | 1990-11-26 |
| Onset: | 1990-11-26 |
| Days after vaccination: | 0 |
| Submitted: |
1990-12-26 |
| Days after onset: | 30 |
| Entered: |
1991-01-02 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01870P / UNK |
LA / IM |
Administered by: Other Purchased by: Other
Symptoms: Apnoea,
Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-11-26
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired. |
|
| VAERS ID: |
27529 (history) |
| Form: |
Version 1.0 |
| Age: |
78.0 |
| Sex: |
Female |
| Location: |
New Hampshire |
| Vaccinated: | 1990-11-06 |
| Onset: | 1990-11-07 |
| Days after vaccination: | 1 |
| Submitted: |
1991-01-18 |
| Days after onset: | 72 |
| Entered: |
1991-01-24 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11226 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Right ventricular failure
SMQs:, Cardiac failure (narrow), Pulmonary hypertension (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-12-10
Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3759
Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms. |
|
| VAERS ID: |
28753 (history) |
| Form: |
Version 1.0 |
| Age: |
80.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 1990-11-23 |
| Onset: | 1990-11-24 |
| Days after vaccination: | 1 |
| Submitted: |
1990-11-30 |
| Days after onset: | 6 |
| Entered: |
1991-03-04 |
| Days after submission: | 94 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11203 / 1 |
RA / - |
Administered by: Other Purchased by: Public
Symptoms: Cough,
Depression,
Dizziness,
Dyspnoea,
Hyperhidrosis,
Pallor,
Pharyngitis,
Pyrexia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1990-11-29
Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA9130
Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB. |
|
| VAERS ID: |
29143 (history) |
| Form: |
Version 1.0 |
| Age: |
65.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 1990-11-25 |
| Onset: | 1990-12-01 |
| Days after vaccination: | 6 |
| Submitted: |
1991-03-07 |
| Days after onset: | 96 |
| Entered: |
1991-03-14 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / IM |
Administered by: Private Purchased by: Private
Symptoms: Cyanosis,
Dysphonia,
Myasthenic syndrome,
Neoplasm malignant,
Vocal cord paralysis
SMQs:, Anaphylactic reaction (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Non-haematological malignant tumours (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: considering myasthenia gravis as the etiology.CT SCAn &MRI of upper chest&neck initially-neg.F/U CT SCAN of upper chest:tumor involving SVC&both recurrent laryngeal nerves@thoracic inlet.
CDC Split Type: 914090008
Write-up: Bilat paramedian vocal cord paralysis reported in pt receiving Fluogen. Had flu vax in Nov90 & became hoarse late Dec90. Seen mid Jan & found to have bilat paramedian vocal cord paralysis. As of 18Feb91, pt better. Dx=myasthenia gravis? |
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