National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

Using all 649092 cases in the database

Case Details (Sorted by Vaccination Date)

This is page 1346 out of 6491

Result pages: prev   1247 1248 1249 1250 1251 1252 1253 1254 1255 1256 1257 1258 1259 1260 1261 1262 1263 1264 1265 1266 1267 1268 1269 1270 1271 1272 1273 1274 1275 1276 1277 1278 1279 1280 1281 1282 1283 1284 1285 1286 1287 1288 1289 1290 1291 1292 1293 1294 1295 1296 1297 1298 1299 1300 1301 1302 1303 1304 1305 1306 1307 1308 1309 1310 1311 1312 1313 1314 1315 1316 1317 1318 1319 1320 1321 1322 1323 1324 1325 1326 1327 1328 1329 1330 1331 1332 1333 1334 1335 1336 1337 1338 1339 1340 1341 1342 1343 1344 1345 1346 1347 1348 1349 1350 1351 1352 1353 1354 1355 1356 1357 1358 1359 1360 1361 1362 1363 1364 1365 1366 1367 1368 1369 1370 1371 1372 1373 1374 1375 1376 1377 1378 1379 1380 1381 1382 1383 1384 1385 1386 1387 1388 1389 1390 1391 1392 1393 1394 1395 1396 1397 1398 1399 1400 1401 1402 1403 1404 1405 1406 1407 1408 1409 1410 1411 1412 1413 1414 1415 1416 1417 1418 1419 1420 1421 1422 1423 1424 1425 1426 1427 1428 1429 1430 1431 1432 1433 1434 1435 1436 1437 1438 1439 1440 1441 1442 1443 1444 1445   next


VAERS ID: 73548 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Massachusetts  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-04-24
   Days after onset:0
Entered: 1995-04-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP289 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LA / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715L / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Gaze palsy, Hypotonia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? No
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vomited 5x w/in 15-20mins post vax, became limp, eyes rolled back;


VAERS ID: 73579 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Minnesota  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-04-25
   Days after onset:1
Entered: 1995-04-28
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61099 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61099 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0717A / 2 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Oedema peripheral, Pyrexia, Skin nodule, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn 22FEB95 @ 2mos w/ACT HIB/DTP #1 dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: red, hard swollen leg x 2 hr, crying x 2 hr; fussy throughout noc; fever 100 till about 7PM; better mood p/that;


VAERS ID: 73884 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Oregon  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-04-26
   Days after onset:2
Entered: 1995-05-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA424A6 / 1 LA / IM
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. J1155 / 3 RA / -

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Back pain, Insomnia, Lymphadenopathy, Myalgia, Pharyngitis, Pyrexia, Renal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: UA WNL
CDC Split Type:

Write-up: 1630 on 24APR95 pt c/o sore throat, swollen glands, feeling achy all over, esp in lower back, kidney area; c/o feeling feverish; sx gradually inc from 1630 & c/o restless noc; feeling tired;


VAERS ID: 73888 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Hawaii  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-04-24
   Days after onset:0
Entered: 1995-05-05
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372932 / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731A / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380940 / 3 MO / PO

Administered by: Military       Purchased by: Military
Symptoms: Injection site hypersensitivity, Pruritus, Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt broke out w/itchy, red rash @ site of vax which spread/larger in size w/elevate macules some confluent w/pale center in same extremity (lt thigh & lt buttocks); this happened 2 hr p/vax; few hives in opposite leg also;


VAERS ID: 73924 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: Unknown  
Vaccinated:1995-04-24
Onset:1995-04-25
   Days after vaccination:1
Submitted: 1995-04-28
   Days after onset:3
Entered: 1995-05-08
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1592A4 / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp red inj site, edema, hot to touch, hard w/1st Hep B vax~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 24APR95 & 24 hr later lt arm @ inj site became very red, edema, hot to touch, hard;


VAERS ID: 73930 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: New Jersey  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-04-24
   Days after onset:0
Entered: 1995-05-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51119 / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 4H51119 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 718F3 / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: neonatal jaundice-no tx req''d
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NJ9521

Write-up: inconsolable crying from time of vax until present; t101 R @ present despite APAP;


VAERS ID: 73939 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Utah  
Vaccinated:1995-04-24
Onset:1995-04-26
   Days after vaccination:2
Submitted: 1995-05-02
   Days after onset:6
Entered: 1995-05-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4A61095 / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61095 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: URI (rhinorrhea, cough);
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EEG/CT scan brain/CBC/SMA
CDC Split Type:

Write-up: onset sz (minor, but persistent not assoc w/fever-started on Phenobarb for control


VAERS ID: 73983 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: New Mexico  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-04-25
   Days after onset:1
Entered: 1995-05-11
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J51162 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4J51162 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0716F / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Hypoventilation, Injection site hypersensitivity, Oedema peripheral, Pallor, Pyrexia, Salivary hypersecretion, Somnolence, Tremor
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: pt recvd hepB by MSD lot# 1067A 1MAR95;
Current Illness: mild umbilical hernia blocked tear ducts
Preexisting Conditions: hip click 5wk premie
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NM95009

Write-up: t101 w/APAP-crying, pale, clammy, drooling, swollen leg, site red, chin quivering; saw MD that afternoon; shallow breathing; 25APR95 doing better but still sleepy;


VAERS ID: 74036 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Male  
Location: Maine  
Vaccinated:1995-04-24
Onset:1995-04-25
   Days after vaccination:1
Submitted: 1995-05-08
   Days after onset:13
Entered: 1995-05-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 384975 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 388924 / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Agitation, Injection site hypersensitivity, Injection site mass, Injection site oedema, Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: 0-? ear infect
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: ME95017

Write-up: mom reported pt had a sl fever <100 w/swelling about the size of a quarter in the rt thigh; also stated inc fussiness & crying the area was pink-warm to touch & very firm;


VAERS ID: 74111 (history)  
Form: Version 1.0  
Age: 0.7  
Gender: Female  
Location: Texas  
Vaccinated:1995-04-24
Onset:1995-04-28
   Days after vaccination:4
Submitted: 1995-05-06
   Days after onset:8
Entered: 1995-05-15
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4A61045 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0450A / 3 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61045 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 3 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin, ATB
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: maculopapular erythematous eruption over the entire body;


VAERS ID: 74138 (history)  
Form: Version 1.0  
Age: 1.1  
Gender: Male  
Location: Montana  
Vaccinated:1995-04-24
Onset:1995-05-02
   Days after vaccination:8
Submitted: 1995-05-05
   Days after onset:3
Entered: 1995-05-17
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M307LF / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0728A / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: neg
CDC Split Type: MT95007

Write-up: onset 3MAY95 t102.4-103, very fussy for 3 days, a few red raised papules;


VAERS ID: 74309 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Colorado  
Vaccinated:1995-04-24
Onset:1995-04-26
   Days after vaccination:2
Submitted: 1995-04-26
   Days after onset:0
Entered: 1995-05-30
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4A61075 / 5 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 6719C / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site mass, Injection site oedema, Oedema peripheral, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: T 99.7 ear; pulse 106
CDC Split Type: CO95024

Write-up: pt recv vax;mom noted upper arm/shoulder swollen,size of baseball, beet red & hard;to er; T 99.7ear;11x10cm of erythema & swelling,lt arm & deltoid;dx as cellulitis;tx w/ cephalexin;


VAERS ID: 74318 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Georgia  
Vaccinated:1995-04-24
Onset:1995-04-25
   Days after vaccination:1
Submitted: 1995-05-01
   Days after onset:6
Entered: 1995-05-30
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3K51086 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0082A / 2 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0706C / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA95070

Write-up: pt recv vax; has large red area to lt thigh about size of orange; area sl swollen; no hard place to area;


VAERS ID: 74352 (history)  
Form: Version 1.0  
Age: 8.0  
Gender: Male  
Location: Maryland  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1995-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1405A / 1 LA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Convulsion, Eye disorder, Hypertonia, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: hx of 1 prior sz as a small infant;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; w/in 1 min, body stiffened in a sz like manner,lasting approx 25 sec;made sl snoring sound; eyes rolled out to side w/ no LOC;prior to inject pt was instructed to blow rapidly to dec pain of inject;hyperventilation;


VAERS ID: 74447 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Female  
Location: California  
Vaccinated:1995-04-24
Onset:1995-05-15
   Days after vaccination:21
Submitted: 1995-05-18
   Days after onset:3
Entered: 1995-05-31
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp excessive vaginal bleeding, miscarriage @ 32 y/o w/Engerix-B dose 2;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 15MAY95 HBSA nonresponder
CDC Split Type: 950044561

Write-up: pt recv 3rd dose of vax 24APR95 & was found to be a nonresponder;


VAERS ID: 74469 (history)  
Form: Version 1.0  
Age: 37.0  
Gender: Female  
Location: Florida  
Vaccinated:1995-04-24
Onset:1995-04-29
   Days after vaccination:5
Submitted: 1995-05-03
   Days after onset:4
Entered: 1995-06-02
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 120396 / 2 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, CSF test abnormal, Headache, Meningitis, Neck pain, Oedema peripheral, Osteoarthritis, Red blood cell sedimentation rate increased
SMQs:, Cardiac failure (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: synthroid, effexs
Current Illness: none
Preexisting Conditions: migraine
Allergies:
Diagnostic Lab Data: CT scan of head- neg; Sed rate 68; CSF, WBC 21, Lymph 21;
CDC Split Type: FL95035

Write-up: pt recv vax;HA,cough,low back pain swelling/pain of "big toes";c/o chills;fever,myalgia,pain neck;ankles swollen/painful;sneeze;MD felt serum sickness vs mycoplasmal infect w/meningitis,arthritis,?Lyme disease;in er,dx of meningitis;


VAERS ID: 74491 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: Louisiana  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-05-15
   Days after onset:21
Entered: 1995-06-05
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51057 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4M51117 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380946 / 3 MO / PO

Administered by: Public       Purchased by: Other
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? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: LA950505

Write-up: pt recv vax; inc T 104.7;apap & tepid bath given; fever came down then started rising again;to er; MD feels inc T probably due to vax;


VAERS ID: 74602 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: New York  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-06-04
   Days after onset:41
Entered: 1995-06-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 384977 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 717B5 / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: CBC:UA
CDC Split Type:

Write-up: pt recv vax; fever, prolonged irritability, started 3 hr p/ vax & lasted over 6 hr;


VAERS ID: 74620 (history)  
Form: Version 1.0  
Age: 23.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-04-28
   Days after onset:4
Entered: 1995-06-08
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 358913 / UNK RA / -

Administered by: Public       Purchased by: Public
Symptoms: Hyperaesthesia, Injection site mass, Injection site oedema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: PPD by connaught, #238111
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9542

Write-up: pt recv vax; soreness at inject site, swelling which became hard; transient itching at different sites;skin more sensitive to stimuli; seen in hlth dept; tx w/ tetracycline, ibuprofen;


VAERS ID: 74631 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: North Carolina  
Vaccinated:1995-04-24
Onset:1995-05-08
   Days after vaccination:14
Submitted: 1995-06-06
   Days after onset:29
Entered: 1995-06-08
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 5 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 6616A / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715E / 4 - / -

Administered by: Public       Purchased by: Other
Symptoms: Arthralgia, Arthritis, Leukocytosis, Pain, Pyrexia, Red blood cell sedimentation rate increased, Rheumatoid arthritis, Uveitis
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ocular infections (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: PPD, apap;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ESR = 122; WBC = 21,000
CDC Split Type: NC95053

Write-up: pt recv vax; joint pain & noc fevers following adm of vax;pain started 2 wk p/ vax; uveitis;JRA;


VAERS ID: 74642 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Maryland  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-06-05
   Days after onset:42
Entered: 1995-06-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426149 / 3 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Hypotonia, Pallor, Stupor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax;devel sudden limp, unresponsive;was described as pale white & not breathing for less than 1 min;brief CPR by babysitter; no cyanosis;


VAERS ID: 74802 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: New York  
Vaccinated:1995-04-24
Onset:1995-04-29
   Days after vaccination:5
Submitted: 1995-05-25
   Days after onset:26
Entered: 1995-06-13
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH - / 1 - / IM L

Administered by: Public       Purchased by: Public
Symptoms: CSF test abnormal, Drug ineffective, Infection, Meningitis, Pyrexia, Sepsis
SMQs:, Agranulocytosis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: H. influenzae type b isolated from CSF & BC; hearing test results nl;
CDC Split Type: 895146010L

Write-up: pt recv vax 29APR pt became febrile & was hospitalized; H. influenzae type b isolated from CSF & blood cultures; dx HIB meningitis; tx w/cefotaxime; pt is stable @ time of this report; 25MAY is anticipating discharge fr hosp; pt recovered;


VAERS ID: 75603 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Massachusetts  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-06-27
   Days after onset:64
Entered: 1995-07-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP287 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520NA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 356929 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Crying, Screaming
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recv vax; high pitched cry for 36 hr; no tx; no change w/ apap;


VAERS ID: 76445 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Kansas  
Vaccinated:1995-04-24
Onset:1995-04-25
   Days after vaccination:1
Submitted: 1995-06-05
   Days after onset:41
Entered: 1995-08-07
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G51000 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265LJ / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714A / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: KS95025

Write-up: mom reports pt started w/a rash around neck & behind ear; pt has a welt;


VAERS ID: 86719 (history)  
Form: Version 1.0  
Age:   
Gender: Male  
Location: Illinois  
Vaccinated:1995-04-24
Onset:1995-04-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1996-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
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? No
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: no relevant data;
CDC Split Type: WAES95050312

Write-up: pt recv vax 24APR95 & 25APR95 devel fever of 104;fever lasted for 4 days;no further details were provided;


VAERS ID: 86727 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-04-24
Onset:1995-05-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1996-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Cough, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95050597

Write-up: pt recv vax; exp fever, rhinitis and cough; recovered 14-15 days later;


VAERS ID: 89144 (history)  
Form: Version 1.0  
Age: 65.0  
Gender: Male  
Location: Maryland  
Vaccinated:1995-04-24
Onset:1995-04-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1996-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Injection site pain, Oedema, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NO relevant data;
CDC Split Type: WAES96032358

Write-up: pt recv vax 24APR95 & pt exp pain @ inj sit & pain down the arm;25MAR95 pt arm became swollen, red, hot & painful;pt recovered;


VAERS ID: 90058 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: California  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1996-05-15
   Days after onset:387
Entered: 1996-09-19
   Days after submission:127
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4A61091 / 2 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1317A2 / UNK LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61091 / 2 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1051A / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 390923 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Crying, Diarrhoea, Pyrexia, Screaming, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: test were done in MD office;
CDC Split Type:

Write-up: w/in hr of receiving vax had vomit, diarrhea & temp of 101-103;crying & screaming all day;


VAERS ID: 92954 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Female  
Location: Florida  
Vaccinated:1995-04-24
Onset:1995-04-26
   Days after vaccination:2
Submitted: 1996-01-30
   Days after onset:279
Entered: 1996-10-30
   Days after submission:274
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1377A1 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Arthropathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hormones, Estrace;pt recv dose 2 of Engerix vax 22MAY95 by SKB;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950091041

Write-up: pt recv vax & 2 days p/vax exp soreness & stiffness of shoulder joint & breast tenderness;no rxn w/2nd dose 22MAY95;


VAERS ID: 74953 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Foreign  
Vaccinated:1995-04-24
Onset:1995-04-24
   Days after vaccination:0
Submitted: 1995-06-13
   Days after onset:50
Entered: 1995-06-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPIPV: DTP + IPV (NO BRAND NAME) / SANOFI PASTEUR - / 2 - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Cyanosis, Dyspnoea, Pallor, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5956

Write-up: pt recv vax; 4 hr later turned blue, had grunting respiration & seemed to breathe p/ been shaken,episode lasted 4 mins;p/ this seemed to be in a trance,was pale;given O2;recovered & hosp overnoc for observation;


VAERS ID: 100477 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Female  
Location: Foreign  
Vaccinated:1995-04-24
Onset:1995-04-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1997-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Coma, Coordination abnormal, Delirium, Encephalitis, Hypotonia, Infection, Nystagmus, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 970172821

Write-up: pt recv vax 24APR95-day after 3rd inj devel violent headaches, vomiting, viral rhonboencephalitis; viral encephalitis was the final diagnosis; pt lapsed into a coma for 15 days; remains in vegatative state; permanent brain damage


VAERS ID: 202525 (history)  
Form: Version 1.0  
Age: 1.08  
Gender: Female  
Location: Foreign  
Vaccinated:1995-04-24
Onset:0000-00-00
Submitted: 2003-04-29
Entered: 2003-05-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0420A / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autism
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES99031654

Write-up: Information has been received from a legal firm regarding a case in litigation concerning a female child who on 4/24/95, at the age of 13 months, was vaccinated with a dose of MMR II (610757/0420A; HW56340). Subsequently, it is alleged that the pt developed autism. Upon internal review, autism was considered to be an other important medical event (OMIC). No further info is available. Follow up on 08/25/2003: "Follow up information was received on 08/11/2003 that reported the patient became very hot and developed a temperature immediately after receiving the vaccination. The temperature remained throughout that evening and night. Her mother gave her acetaminophen as advised by the physician. Her mother noticed that she slept for longer and in a deeper manner that night. Her mother recalled this, as the patient was the only one of her children to have any reaction to the vaccination. The patient''s sleeping pattern changed from the time of receiving the vaccination. She now started waking in the middle of the night for no apparent reason. It would take hours to get the patient back to sleep. She would be extremely disruptive when she woke. Her vocal behavior also changed within days of receiving the vaccination. She started to talk less and her verbal skills regressed. Her eating and drinking habits also changed within four weeks of receiving the vaccination. She now became extremely fussy in what she would eat to the extent that she practically stopped eating altogether. her mother became very concerned about her weight. Her fluid intake also changed dramatically. She started to drink a vast amount of fluids, especially juice. She would drink bottle after bottle and this continued for quite a length of time. Within four weeks of the vaccination, the patient''s temperature control also altered. She started to become extremely hot and sweated quite a lot. Many aspects of the patient''s behavior appeared to change within four to six weeks of receiving the vaccination. Her mother considered that she had become a lot harder to handle and please. The patient''s demeanor also appeared to change, she constantly appeared miserable. Her mother considered that she might have been suffering from depression. The patient had previously been a very healthy child. After receiving the vaccination, she became extremely susceptible to infection. Her susceptibility to injection continued until she was around 18 months of age. Within 4-6 weeks, the patient''s reaction to physical touch appeared to change. She had previously loved attention, affection and cuddles. She could barely stand being touched. She would to stiff every time her mother held her. This also made it difficult to give the patient any form of medication. Within the same time fram,e the manner in which the patient interacted with other children changed. She now ignoared other children and paid little attention to her brother and sisters. Her play changed, she ceased plaing with her dollies in the manner that she had previously. She wrapped them up and carried them under her arm. Within a couple of months of receiving the vaccination, the patient had become completely silent. She made no noise whatsoever for a number of months. From eighteen months onwards, the patient developed ritualistic behaviors. One example of this was that her pillow would have to be in a certain position and in turn, her head would have to be in a certain position on the pillow. She also started to have a lot of tempertantrums where she could become extremely violent. She began to wander around the house in her own wrold, oblivious to others. Her mother expressed her concerns to the health visitor at her 18 month check. The health visitor suggested that the patient could be deaf. this was a suggestion that the patient''s mother and father considered might be a possiblity for quite some time. The patient was referred for a hearing assessment in 09/1996. Although the patient suffered from fluctuating glue ear, which might have contributed to her language delay, her hearing was eventually found to be normal. She was referred to a speech and language therapist in April 1997. Her patterns of speech and language difficulties were noted to be in the areas of interaction withothers, sharing information verbally in social communication, and creative imaginary play. She used strings of "jargon" sounds, some gesture and occasional one to three word phrases to communicate. She was using "jargon" and pointing to make requests and comment on items of interest but was not greeting people verbally or using language to convey information for joint activities with others. A pediatrician assessed her in May 1997. He diagnosed her as showing sufficient features to merit placing her ''on the autistic continuum''. He noted that her speech and language was the area where she suffered from major delay. Her expressive language was limited to jargon and echolalia and she communicated her needs by pulling and pointing. her comprehension was at the two word stage.


VAERS ID: 73616 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Arizona  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-26
   Days after onset:1
Entered: 1995-05-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4948225 / UNK - / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 4J51171 / UNK - / IM

Administered by: Military       Purchased by: Military
Symptoms: Anxiety, Chest pain, Dizziness, Malaise, Myalgia, Paraesthesia, Tachycardia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp flu-like sx p/multiple vax in basic training;~ ()~~~In patient
Other Medications: BCP, TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt recv vax 25APR95 @ 1400hr; sx w/in 1-2 hr of lightheadedness, N/V & rt arm tingling (site of inj); that PM pt had feeling of pushing on lungs, anxiety, gen malaise, body aches; cont anxiousness & body aches on 26APR95 w/tachycardia


VAERS ID: 73621 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-04-26
   Days after onset:0
Entered: 1995-05-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Sinusitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild URI sx
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt devel fever of 103-105 according to mom; temp taken by ear; temp devel < 24hrs post vax; pt seen in ofc next day w/no temp & dx sinusitis rx APAP & Motrin during temp


VAERS ID: 73863 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Connecticut  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-04-28
   Days after onset:2
Entered: 1995-05-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426121 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 386942 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Grand mal convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CAT Scan/CSF nl
CDC Split Type: CT9509

Write-up: status epilepticus, afeb, w/in 24 hr p/vax;


VAERS ID: 73873 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: D.C.  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-05-02
   Days after onset:7
Entered: 1995-05-04
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51037 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51037 / 4 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0550A / 1 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recv vax 25APR95 in rt arm; that noc felt warm; 26APR to clinic w/ 11x7 cm area of redness & swelling in rt deltoid down to elbow, w/mild swelling of lower arm & hand; no fever; rx warm wet compresses, DPH, APAP;


VAERS ID: 73925 (history)  
Form: Version 1.0  
Age: 1.6  
Gender: Male  
Location: Massachusetts  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-25
   Days after onset:0
Entered: 1995-05-08
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP289 / 4 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718A / 3 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Crying, Screaming
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: neonatal jaundice, papular urticaria, OM
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: onset of inconsolable crying, screaming for 4 hr 1/2 hr p/shot given;


VAERS ID: 73937 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: California  
Vaccinated:1995-04-25
Onset:0000-00-00
Submitted: 1995-05-01
Entered: 1995-05-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426118 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1649A2 / UNK RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 394924 / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-04-26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS (coroner''s report) 24 hr p/vax;


VAERS ID: 73940 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Mississippi  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-05-05
   Days after onset:10
Entered: 1995-05-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Convulsion, Delirium, Encephalopathy, Mental retardation severity unspecified, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT severe dz: loss grey/white different
CDC Split Type:

Write-up: pt recv vax afternoon was somnolent-fever on APAP-tonic/clonic sz; severe encephalopathy


VAERS ID: 73969 (history)  
Form: Version 1.0  
Age: 0.9  
Gender: Female  
Location: Ohio  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-25
   Days after onset:0
Entered: 1995-05-10
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G51027 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4G51027 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714C / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site pain, Screaming, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: skull fracture (approx age 5mos)
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OH95052

Write-up: mom stated approx 4 hr p/vax given pt had white film around lips, "starred" or cried inconsolably for 5 to 6 hr; also soreness @ the site of inj;


VAERS ID: 73974 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Alabama  
Vaccinated:1995-04-25
Onset:1995-04-29
   Days after vaccination:4
Submitted: 1995-05-04
   Days after onset:5
Entered: 1995-05-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Dysphagia, Hypokinesia, Laryngospasm, Lymphadenopathy, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sibling exp fever @5mos & 15mos w/MMR doses 1 & 2;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MMR given 25APR95 pt felt warm & was given APAP 29APR95 pt unable to lift head, unable to swallow neck & glands swollen; t102-103; MD stated to give more APAP; 4MAY95 pt still has rash; gland, throat still swollen; t100 today;


VAERS ID: 74006 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Missouri  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-05-01
   Days after onset:6
Entered: 1995-05-12
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51011 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0858A / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51011 / 1 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Crying, Injection site hypersensitivity, Injection site oedema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO95030

Write-up: t101.5; rt leg swelled real, real red very sensitive non-stop screaming-crying;


VAERS ID: 74019 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: California  
Vaccinated:1995-04-25
Onset:1995-05-04
   Days after vaccination:9
Submitted: 1995-05-05
   Days after onset:1
Entered: 1995-05-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1128A / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sz 10 days p/the MMR;


VAERS ID: 74032 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Arkansas  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-26
   Days after onset:1
Entered: 1995-05-15
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 388929 / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Infection, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR9532

Write-up: mom called 2PM to say pt had a t103 last evening-given APAP-temp down to 102 ax; pt vomited; slept all noc; took temp this AM & it was 103; MD dx viral infect


VAERS ID: 74033 (history)  
Form: Version 1.0  
Age: 9.0  
Gender: Male  
Location: Florida  
Vaccinated:1995-04-25
Onset:1995-04-30
   Days after vaccination:5
Submitted: 1995-05-02
   Days after onset:2
Entered: 1995-05-15
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0730A / 2 - / -

Administered by: Public       Purchased by: Unknown
Symptoms: Cough, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Ritalin
Current Illness: NONE
Preexisting Conditions: Ritalin for ADD/immune globulin
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: FL95029

Write-up: t103.7 mom sponged pt to dec temp; 1MAY95 t103 taken to PMD; rx Cefzol, Motrin & APAP; coughing, runny nose;


VAERS ID: 74100 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Texas  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-25
   Days after onset:0
Entered: 1995-05-15
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4A61103 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1646B2 / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61103 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Crying, Cyanosis, Lymphadenopathy, Pallor, Rhinitis, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX95078

Write-up: mom stated pt awoke w/high pitch scream & color was bad advised to take pt to ER;pt had drainage @ back of throat; glands were swollen, color flushed, pale, blue corner of mouth & temple


VAERS ID: 74106 (history)  
Form: Version 1.0  
Age: 0.1  
Gender: Female  
Location: Virginia  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-26
   Days after onset:1
Entered: 1995-05-15
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61143 / 1 - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61143 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Crying, Screaming
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VA95027

Write-up: shrill cry started 5PM & was loud & cont; seen by MD about 730PM-8PM; crying stopped approx 830PM; pt fell asleep; no fever; mom had used APAP;


VAERS ID: 74119 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Arizona  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-04-27
   Days after onset:1
Entered: 1995-05-16
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G51000 / 3 LA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4G51029 / 3 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0730A / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 388919 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: AZ9511

Write-up: pt recv vax & pt''s mom reported pt''s lt arm is swollen to twice the size of the rt arm; mom took pt to ER


VAERS ID: 74136 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: California  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-30
   Days after onset:5
Entered: 1995-05-17
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386989 / 6 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 394924 / UNK MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Cough, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: sl cough only
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recv vax 25APR95, that noc got fever; next day got rash on face which then spread to body; fever lasted 3 days; no emesis, diarrhea; little cough 25APR95 only; on PE appeared to be roseola;


VAERS ID: 74160 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Male  
Location: California  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1995-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4M51065 / 3 GM / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LD / 3 GM / -

Administered by: Private       Purchased by: Unknown
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives w/pruritus, no fever 12 hr or next day p/vax given rashes mostly on thighs & legs;


VAERS ID: 74204 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Alabama  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-25
   Days after onset:0
Entered: 1995-05-22
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4K54125 / 5 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0615A / 2 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0719K / 5 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Cyanosis, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamins w/iron; PPD lot# 238911
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL9514

Write-up: approx 1030AM wheezing-dyspnea-sl cyanosis upon returning to clinic-MD gave DPH;


VAERS ID: 74265 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Texas  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-05-22
   Days after onset:26
Entered: 1995-05-25
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1250A / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Headache, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
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: no relevant data
CDC Split Type: WAES95050274

Write-up: pt recv vax;the following day, exp HA, was shaky & possibly had a sz;was hosp for tx;


VAERS ID: 74307 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Colorado  
Vaccinated:1995-04-25
Onset:1995-05-01
   Days after vaccination:6
Submitted: 1995-05-02
   Days after onset:1
Entered: 1995-05-30
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5L51034 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J1142 / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Rash, Skin nodule
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: CO95022

Write-up: pt recv vax; 5 days p/ DT adm, was indurated & erythematous;erythema was 5 1/2 by 3 3/4 cm; induration 2x2;


VAERS ID: 74610 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-04-27
   Days after onset:1
Entered: 1995-06-08
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1224A / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0729A / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714M / 4 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI95037

Write-up: pt recv vax; lt arm below inject site & "almost" down to elbow about 6" is red & hot to touch; some blister near where where the bandaid was applied;


VAERS ID: 74623 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-04-27
   Days after onset:1
Entered: 1995-06-08
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4H51035 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0727A / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0716B / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Lymphadenopathy, Pain, 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? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA95145

Write-up: pt recv vax; pain rt axilla early am; mild fever of 99.7;seen by FMD who informed mom,rxn related to Dtap;also has enlarged axillary lymph nodes;tx w/ apap;pt to return in 2 wk if nodes enlarge;pt to check w/ MD once a wk;


VAERS ID: 74625 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-27
   Days after onset:2
Entered: 1995-06-08
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4S51138 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4S51138 / UNK LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0716D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Febrile convulsion, Opisthotonus, Screaming, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA95147

Write-up: pt recv vax; devel v in pm of vax; afebrile sz; hosp x 2 days; sz characterized by arching of back;also cried for a period of 12 hr;


VAERS ID: 74646 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-06-06
   Days after onset:42
Entered: 1995-06-08
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID (NO BRAND NAME) / PFIZER/WYETH 4938218 / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: prenatal vits;
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; low grade fever 99.6; induration & erythema at inject site; apap reduced fever;compresses relieved erythema & induration; all resolved in approx 72 hr;


VAERS ID: 74749 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Tennessee  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-04-27
   Days after onset:1
Entered: 1995-06-12
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4K51154 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0776A / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Injection site oedema, Pain, Vasodilatation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: TN95038

Write-up: pt recv vax;rt deltoid area very swollen; arm red & feels warm to touch;Dad said pt had been crying w/ pain;to clinic; apap, dph & erythromycin given;


VAERS ID: 74767 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: Georgia  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-05-01
   Days after onset:5
Entered: 1995-06-12
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0052A / 3 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hypersensitivity
SMQs:, Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: na~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA95072

Write-up: pt recv vax; to hosp apparently due to systematic allergic rxn to vax;


VAERS ID: 74903 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:1995-04-25
Onset:1995-05-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 1995-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51006 / 3 - / A
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51006 / 3 - / A
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0710M / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK9522

Write-up: 6 days p/vax pt devel rash around inj site; initially had a few red bumps then spread rapidly until an 8.6cm area was affected & red bump colased; warm to touch & itchy; faded much by next morning;


VAERS ID: 75267 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Maryland  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-06-16
   Days after onset:52
Entered: 1995-06-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Convulsion, Electroencephalogram abnormal, Grand mal convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: pt exp high fever, swelling @ 2mo w/DTP #1 dose~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG, CAT Scan-both neg
CDC Split Type:

Write-up: sz w/in 60sec of administration of vax EPI given x 2 hr @ hosp; 2 grand mal sz since 25APR95 currently taking Tegretol & cont to have focal sz, no prev sz hx prior to vax;


VAERS ID: 75311 (history)  
Form: Version 1.0  
Age: 1.6  
Gender: Male  
Location: Arizona  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4A61075 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M315LE / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0720A / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AZ9514

Write-up: pt exp hives started Wednesday-all over;


VAERS ID: 75332 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: California  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-05-25
   Days after onset:30
Entered: 1995-06-23
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426115 / UNK LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611A2 / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0717K / UNK MO / PO

Administered by: Military       Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash to body


VAERS ID: 75393 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Michigan  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-05-05
   Days after onset:9
Entered: 1995-06-26
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4C61142 / 5 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0831A / 2 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718K / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI95054

Write-up: onset of gen hives on 26APR95; tx in ER 28APR95 w/prescription for DPH; completely subsided by 1MAY95;


VAERS ID: 75448 (history)  
Form: Version 1.0  
Age: 33.0  
Gender: Female  
Location: Louisiana  
Vaccinated:1995-04-25
Onset:1995-04-28
   Days after vaccination:3
Submitted: 1995-05-25
   Days after onset:27
Entered: 1995-06-27
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1129A / 1 - / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61118 / 1 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Laryngospasm, Lymphadenopathy, Skin nodule, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergies to pecans, grass, molds, pollens, strawberries, sub
Allergies:
Diagnostic Lab Data: Strep test, mono test, WBC, throat culture-all neg;
CDC Split Type: LA950602

Write-up: swollen glands-extreme-posterior neck, behind ears, under jaw-down neck on rt & lt sides & clavicle; throat swelled-impairing breathing w/nodules (red)-started approx 1 wk p/vax;


VAERS ID: 75512 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: Georgia  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-04-28
   Days after onset:2
Entered: 1995-06-30
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4C61142 / 4 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130KE / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0551A / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Rash, Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: GA95082

Write-up: pt recv vax;noted red spots on lower legs;red blotches over body;had no fever; took pt to PMD who observed wheals & flakes over trunk & extremities;no resp problems;tx w/ dph;hives gradually disappeared per mom;


VAERS ID: 75514 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Georgia  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-05-03
   Days after onset:8
Entered: 1995-06-30
   Days after submission:58
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 369909 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0706C / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anaemia, Crying, Dehydration, Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: GA95084

Write-up: pt recv vax; loud piercing cry, d & v; dehydration, anemia; to hosp;


VAERS ID: 75639 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Illinois  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1995-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4M51065 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1383W / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 713K5 / 1 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Somnolence, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax;extreme lethargy, sleepiness & staring at noc when pt awakened fr sleep, occurred noc of vax & next day;probably related to sleep pattern rather than vax;


VAERS ID: 76014 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Ohio  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-07-11
   Days after onset:77
Entered: 1995-07-19
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51056 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0709B / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: cried all the way home, during the noc, excessive crying-somewhat inconsolable p/last DTP;


VAERS ID: 76197 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Iowa  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-07-20
   Days after onset:86
Entered: 1995-07-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 384975 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0634W / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0710F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Crying, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Bentyl PRN colic
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: IA95028

Write-up: prolonged crying (screaming) began 2-3 hr p/inj; cont for 4 1/2 hr; temp was 97.4R @ time of inj & elevated to 101R x 24hrs; mom called MD & was advised on APAP dosage;


VAERS ID: 76328 (history)  
Form: Version 1.0  
Age: 51.0  
Gender: Female  
Location: Texas  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-04-26
   Days after onset:1
Entered: 1995-08-01
   Days after submission:97
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX ID) / PASTEUR MERIEUX INST. J1155 / 2 LA / -

Administered by: Other       Purchased by: Other
Symptoms: Hypersensitivity, Injection site hypersensitivity, Injection site mass, Injection site oedema, Injection site pain, Lymphadenopathy, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rash w/tetanus onset age & dose unk~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP 130/60
CDC Split Type: TX95119

Write-up: local rxn rash; pain swelling, inc warmth, induration or lump w/o abscess; adenopathy, allerg event hives;


VAERS ID: 76410 (history)  
Form: Version 1.0  
Age: 52.0  
Gender: Female  
Location: Virginia  
Vaccinated:1995-04-25
Onset:1995-04-28
   Days after vaccination:3
Submitted: 1995-07-27
   Days after onset:90
Entered: 1995-08-03
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. - / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: estratest
Current Illness: none
Preexisting Conditions: cats, cherries, iodine, bees
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recv vax;approx 3-5 days later became red,swollen,warm covering large area around inject site & lasted about 1 wk;


VAERS ID: 76420 (history)  
Form: Version 1.0  
Age: 52.0  
Gender: Male  
Location: Virginia  
Vaccinated:1995-04-25
Onset:1995-04-28
   Days after vaccination:3
Submitted: 1995-07-27
   Days after onset:90
Entered: 1995-08-03
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. - / 1 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / 1 LA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recv vax; approx 3-5 days later, pt''s arm became very red, swollen & warm covering large area around site;lasted 1 wk;


VAERS ID: 82400 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Female  
Location: Unknown  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-05-23
   Days after onset:27
Entered: 1995-11-14
   Days after submission:175
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1472A1 / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Erythema nodosum, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950046041

Write-up: pt recvd vax & 24hrs p/vax pt exp swelling in foot & was found to have erythema nodosum;sx cont


VAERS ID: 82457 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Unknown  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-05-31
   Days after onset:36
Entered: 1995-11-14
   Days after submission:167
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1653B2 / 1 - / IM L

Administered by: Other       Purchased by: Other
Symptoms: Chills, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950048001

Write-up: pt recvd vax & 3hrs post vax pt exp severe chills & nausea;these sx lasted 1 1/2 days;


VAERS ID: 82468 (history)  
Form: Version 1.0  
Age: 38.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-04-25
Onset:1995-04-30
   Days after vaccination:5
Submitted: 1995-06-14
   Days after onset:45
Entered: 1995-11-14
   Days after submission:153
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1591A4 / 3 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Diarrhoea, Dizziness, Headache, Hypertonia, Insomnia, Nuchal rigidity, Oedema peripheral, Paraesthesia
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950051701

Write-up: pt recvd vax & 5 days p/vax exp stiffness in rt inj arm, shoulder, & neck some numbness & sl edema on same arm;also h/a, dizziness, diarrhea & not sleeping well;pt examined by neurologist who found some paresthesia


VAERS ID: 80038 (history)  
Form: Version 1.0  
Age: 63.0  
Gender: Female  
Location: California  
Vaccinated:1995-04-25
Onset:1995-10-26
   Days after vaccination:184
Submitted: 1995-11-11
   Days after onset:16
Entered: 1995-12-13
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 5F61114 / 2 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1076B / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Premarin;Dyaxide;ASA or Aleve
Current Illness: NONE
Preexisting Conditions: erythromycin allergies, osteoarthritis
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt exp redness & edema (2inch by 3inch rectangular) @ edges occuring 2inch below site of vax;intense, sharp demarcated area;


VAERS ID: 81155 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Illinois  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1996-01-18
   Days after onset:268
Entered: 1996-01-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51099 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1651B2 / 2 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51099 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pt was a premature infant & on apnea monitor
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: IL960008

Write-up: pt recvd vax 25APR95 & had an apnea episode following shot;pt was seen by MD who decided that was a rxn to DTP/HIB;pt has been on apnea monitor for prematurity anyway;MD will give DT


VAERS ID: 83449 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Female  
Location: Massachusetts  
Vaccinated:1995-04-25
Onset:1995-04-26
   Days after vaccination:1
Submitted: 1995-04-28
   Days after onset:2
Entered: 1996-02-01
   Days after submission:279
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP289 / 4 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 715L3 / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Cellulitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax; rt cellulitis p/ vax; adm to hosp for 2 days;


VAERS ID: 85109 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Male  
Location: Florida  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 1995-05-02
   Days after onset:7
Entered: 1996-03-14
   Days after submission:317
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / SC
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Public       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Immunoglogulin given 25APR95
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895131002S

Write-up: 2hr p/vax pt devel a fever of 104 as well as redness & soreness around the inj site;rxn subsided w/in 24hrs;


VAERS ID: 83713 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: Colorado  
Vaccinated:1995-04-25
Onset:1995-05-05
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1744W / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis
SMQs:, Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC Split Type: CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


VAERS ID: 86720 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: North Carolina  
Vaccinated:1995-04-25
Onset:1995-04-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1996-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1057A / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Erythema multiforme, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95050424

Write-up: pt recv vax 25APR95 & 29APR95 pt devel rash consistent w/erythema multiforme;rash peaked on 30APR95 & was essentially resolved on 3MAY95;


VAERS ID: 88785 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: California  
Vaccinated:1995-04-25
Onset:1996-06-11
   Days after vaccination:413
Submitted: 0000-00-00
Entered: 1996-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: Reflux esophageal;
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES96061346

Write-up: pt recv vax; therapy included metoclopramide;on 11jun96 pt devel chicken pox w/ greater than 200 lesions;


VAERS ID: 198801 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Connecticut  
Vaccinated:1995-04-25
Onset:2003-04-27
   Days after vaccination:2924
Submitted: 2003-02-25
   Days after onset:60
Entered: 2003-03-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Chromosome abnormality, Convulsion, Drug toxicity, Immune system disorder, Neuropathy
SMQs:, Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My son had a seizure less than 48 hours after his 4 month DPT vaccine. He was hospitalized and continues to have seizures to this day. The medical record states Kleinelter''s syndrome and neurodegenerative disorder. My son still has seizures on a daily basis. He is developmentally delayed. His immune system is damaged. He has heavy metal toxicity due to these vaccines CDPT- from the thimersol. He does not live a normal childhood and hasn''t since the age of 4 months and lost his identical twin due to these vaccines.


VAERS ID: 184055 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Foreign  
Vaccinated:1995-04-25
Onset:1995-04-25
   Days after vaccination:0
Submitted: 2002-04-26
   Days after onset:2558
Entered: 2002-05-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chromosome abnormality, Nervous system disorder
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0204USA01936

Write-up: Information has been received from a pediatrician concerning a 1 year old female who on 4/25/95 was vaccinated with a 1st dose of MMRII. In 1995, the pt experienced a hereditary disorder of the nervous system which was "recently" dx''d as "hereditary motor-sensory neuropathy type 1 A". The child''s parents had a certificate made by an expert stating that the onset of the child''s disorder is due to the vaccination. According to the expert''s certificate, the cause should be a non-apparent meningitis due to the mumps virus of the vaccine. The outcome of the child''s experience was reported as a permanent disability. Hereditary motoric-sensitive neuropathy was considered to be disabling. No further information is available. No new info on a 15-day follow up reported received 3/10/2003.


VAERS ID: 73950 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: West Virginia  
Vaccinated:1995-04-26
Onset:1995-04-27
   Days after vaccination:1
Submitted: 1995-04-28
   Days after onset:1
Entered: 1995-05-09
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M315LE / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0970A / UNK LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: rt thigh swollen @ site 2"x3" underlying muscle swollen; no rashes; vax mark on lt thigh-no inflamed;


VAERS ID: 73984 (history)  
Form: Version 1.0  
Age: 36.0  
Gender: Female  
Location: Virginia  
Vaccinated:1995-04-26
Onset:1995-04-26
   Days after vaccination:0
Submitted: 1995-04-28
   Days after onset:2
Entered: 1995-05-11
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0201B / UNK RA / -
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61156 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: dilantin
Current Illness: denies
Preexisting Conditions: hx sz
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA95023

Write-up: lt deltoid red, hot to touch area $g50mm w/swelling/painful-no known hx of prev TD-c/o discomfort immed p/vax; instructed to apply ice x next 24hrs then warm soaks;


VAERS ID: 74034 (history)  
Form: Version 1.0  
Age: 37.0  
Gender: Female  
Location: Florida  
Vaccinated:1995-04-26
Onset:1995-04-27
   Days after vaccination:1
Submitted: 1995-05-04
   Days after onset:7
Entered: 1995-05-15
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1319A6 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Dizziness, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic PCN & Sulfa based drugs
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: FL95030

Write-up: dizziness, nausea, sl t99.5 oral; no treatment received;


VAERS ID: 74186 (history)  
Form: Version 1.0  
Age: 0.9  
Gender: Female  
Location: Illinois  
Vaccinated:1995-04-26
Onset:1995-04-27
   Days after vaccination:1
Submitted: 1995-05-05
   Days after onset:8
Entered: 1995-05-19
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51101 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1066A / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51101 / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 384940 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Injection site hypersensitivity, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: pyloric stenosis-was in hosp for 2 months w/blood trans;
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL950053

Write-up: On 27th started having vomiting & diarrhea, than that went away & then started running t100-101, then broke out in rash 4MAY95; took to ER on 3rd & 4th of MAY; rash was around hips, legs, ankles & around top of diaper; area around inj red;


VAERS ID: 74275 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: Missouri  
Vaccinated:1995-04-26
Onset:1995-04-27
   Days after vaccination:1
Submitted: 1995-05-01
   Days after onset:4
Entered: 1995-05-25
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51112 / 4 LA / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0835A / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 072AW / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: none
CDC Split Type: MO95034

Write-up: pt recv vax; woke up in am w/ digging into hands due to itching & reddened rash;


VAERS ID: 74280 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Female  
Location: Virginia  
Vaccinated:1995-04-26
Onset:1995-04-26
   Days after vaccination:0
Submitted: 1995-05-04
   Days after onset:8
Entered: 1995-05-25
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0201B / 1 RA / -
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61156 / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Abscess, Oedema peripheral, Pain, Pruritus, Pyrexia, Skin discolouration, Skin nodule, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: VA95030

Write-up: pt recv vax;early eve was itching;devel fever of 40C;apap given;arm became swollen & hard & painful;applied warm water w/ salt;induration of 50 mm & purplish red swelling in the ctr;area felt warm to touch;to MD;


VAERS ID: 74336 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Male  
Location: Ohio  
Vaccinated:1995-04-26
Onset:1995-04-27
   Days after vaccination:1
Submitted: 1995-05-01
   Days after onset:4
Entered: 1995-05-30
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1292A / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Pain, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: seen by dermatologist;
CDC Split Type: OH95060

Write-up: pt recv vax; rash started on lt arm day p/ vax; progressed on both arms p/ 3rd day; raised, itchy; pt c/o burning; dx as dermatitis by dermatologist;


VAERS ID: 74337 (history)  
Form: Version 1.0  
Age: 44.0  
Gender: Female  
Location: Ohio  
Vaccinated:1995-04-26
Onset:1995-04-28
   Days after vaccination:2
Submitted: 1995-05-15
   Days after onset:17
Entered: 1995-05-30
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1360A / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: OH95061

Write-up: pt recv vax; pt threw up, n & d on Friday; sick till Sat; very tired; no further emesis; better on Sun;


VAERS ID: 74658 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Mississippi  
Vaccinated:1995-04-26
Onset:1995-04-26
   Days after vaccination:0
Submitted: 1995-05-25
   Days after onset:29
Entered: 1995-06-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426121 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0700A / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 396923 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Pyrexia, Respiratory disorder
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EEG, CXR & lab work
CDC Split Type: MS95024

Write-up: pt recv vax 26APR95 & shortly p/arriving home pt had 2 sz & then started having problems breathing; pt was taken to hosp & given advil & APAP & was hospitalized x 4 days; pt had t103.7 on arrival to hosp; pt is now doing well states aunt;


VAERS ID: 74750 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Tennessee  
Vaccinated:1995-04-26
Onset:1995-04-26
   Days after vaccination:0
Submitted: 1995-04-28
   Days after onset:2
Entered: 1995-06-12
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426118 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1163A / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715F / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Face oedema, Pyrexia, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: med for asthma
Current Illness: none
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: none
CDC Split Type: TN95039

Write-up: pt recv vax;ear infect; several hr p/ vax, devel inc T 103; blotchy rash on face , eyes swollen; did not want to take bottle;to see MD; MD said rxn to vax or poss roseola; dph given & rash has cleared;


VAERS ID: 75318 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Female  
Location: California  
Vaccinated:1995-04-26
Onset:1995-04-26
   Days after vaccination:0
Submitted: 1995-04-27
   Days after onset:1
Entered: 1995-06-23
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G61080 / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Amblyopia, Asthenia, Headache, Injection site oedema, Neck pain, Pain, Vasodilatation, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Optic nerve disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: herbal pills
Current Illness: loose yellow stool x couple days
Preexisting Conditions: allergic to PCN-hx of chronic fatigue synd
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA95058

Write-up: 26APR95 pt recv vax had shooting pains up arm @ time of vax; shooting up neck to head @ noc; last noc warm, tired vomited x 1 p/AM; site of inj sl puffy; blurred vision this AM rt eye temporary


VAERS ID: 75558 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: Alaska  
Vaccinated:1995-04-26
Onset:1995-04-26
   Days after vaccination:0
Submitted: 1995-05-01
   Days after onset:5
Entered: 1995-07-03
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4M51063 / 4 - / IM L

Administered by: Other       Purchased by: Unknown
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? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: APAP-allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AK95020

Write-up: (R) t103.4R 4hrs p/DTP inj; reduced w/Motrin suspension over 48hr period;


VAERS ID: 76141 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Alabama  
Vaccinated:1995-04-26
Onset:1995-06-01
   Days after vaccination:36
Submitted: 1995-06-28
   Days after onset:27
Entered: 1995-07-25
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1544A4 / 1 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Foetal disorder, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Foetal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: oral contraceptives
Current Illness:
Preexisting Conditions: dizziness, pregnant
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950043711

Write-up: pt recv vax & exp dizziness & nausea for a few hr immed following vax; pt was treated & discharged from ER; sx resolved; LMP 6APR95; ultrasound determined that pt is approx 3months pregnant & fetus is deformed & has no heartbeat;


VAERS ID: 83208 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: California  
Vaccinated:1995-04-26
Onset:1995-04-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1996-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 390954 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718A / UNK MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: no allergies;no birth defects, viral defections sepsis
Allergies:
Diagnostic Lab Data: CBC neg; urine culture neg; blood culture neg;
CDC Split Type: CA960024

Write-up: 24-48hrs p/vax pt devel generalized rash & hives (urticaria) all over the body & wheezing noted upon admission to hosp;t101.2;rx atarax, hydrocortisone


VAERS ID: 86728 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-04-26
Onset:1995-05-03
   Days after vaccination:7
Submitted: 1995-05-03
   Days after onset:0
Entered: 1996-06-05
   Days after submission:399
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Anuria, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: no relevant data
CDC Split Type: WAES95050598

Write-up: pt recv vax; devel fever, was very fussy and did not urinate for 24 hrs;


Result pages: prev   1247 1248 1249 1250 1251 1252 1253 1254 1255 1256 1257 1258 1259 1260 1261 1262 1263 1264 1265 1266 1267 1268 1269 1270 1271 1272 1273 1274 1275 1276 1277 1278 1279 1280 1281 1282 1283 1284 1285 1286 1287 1288 1289 1290 1291 1292 1293 1294 1295 1296 1297 1298 1299 1300 1301 1302 1303 1304 1305 1306 1307 1308 1309 1310 1311 1312 1313 1314 1315 1316 1317 1318 1319 1320 1321 1322 1323 1324 1325 1326 1327 1328 1329 1330 1331 1332 1333 1334 1335 1336 1337 1338 1339 1340 1341 1342 1343 1344 1345 1346 1347 1348 1349 1350 1351 1352 1353 1354 1355 1356 1357 1358 1359 1360 1361 1362 1363 1364 1365 1366 1367 1368 1369 1370 1371 1372 1373 1374 1375 1376 1377 1378 1379 1380 1381 1382 1383 1384 1385 1386 1387 1388 1389 1390 1391 1392 1393 1394 1395 1396 1397 1398 1399 1400 1401 1402 1403 1404 1405 1406 1407 1408 1409 1410 1411 1412 1413 1414 1415 1416 1417 1418 1419 1420 1421 1422 1423 1424 1425 1426 1427 1428 1429 1430 1431 1432 1433 1434 1435 1436 1437 1438 1439 1440 1441 1442 1443 1444 1445   next

New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=1346&PERPAGE=100&ESORT=VAX-DATE


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166