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Case Details (Sorted by Vaccination Date)

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VAERS ID: 71786 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Ohio  
Vaccinated:1995-02-14
Onset:1995-02-15
   Days after vaccination:1
Submitted: 1995-02-20
   Days after onset:5
Entered: 1995-02-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4C51005 / 2 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4C51005 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 386939 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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:
CDC Split Type: OH95018

Write-up: seizures, febrile;


VAERS ID: 71827 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: Ohio  
Vaccinated:1995-02-14
Onset:1995-02-14
   Days after vaccination:0
Submitted: 1995-02-23
   Days after onset:9
Entered: 1995-02-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J51164 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1152A / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4J51164 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 384953 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cyanosis, Hypotonia, Pallor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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? Yes, ? 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 taken to hosp via ambulance p/apparent apneic episode; pt recvd vax on day of episode; pt got up from nap & became limp & turned blue while mom was changing diaper; pt pale but alert w/cyanosis; neuro exam intact;


VAERS ID: 71919 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Illinois  
Vaccinated:1995-02-14
Onset:1995-02-14
   Days after vaccination:0
Submitted: 1995-02-14
   Days after onset:0
Entered: 1995-03-06
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51057 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1066A / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4M51118 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 384939 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Chills, Hypersensitivity, Hyperventilation, Hypotonia, Pallor, Pyrexia, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL950011

Write-up: pt recvd vax 945AM 14FEB95 & @1130AM mom called stated pt was shivering & shaking, t101 R; brought pt back to clinic; pt limp & pale; HR 180; R48; called MD & ambulance; sent to hosp adm; t105; dx allerg react to pertussis vax;


VAERS ID: 71961 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: New Hampshire  
Vaccinated:1995-02-14
Onset:1995-02-14
   Days after vaccination:0
Submitted: 1995-03-01
   Days after onset:15
Entered: 1995-03-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 4M51065 / 3 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0793A / 3 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Anorexia, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp fever @ 4mos w/DTP #2;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH95004

Write-up: fever 102 x 2 days, irritable, lethargic, inc intake (refuses foods x 2d);


VAERS ID: 72053 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Oklahoma  
Vaccinated:1995-02-14
Onset:1995-02-14
   Days after vaccination:0
Submitted: 1995-02-16
   Days after onset:2
Entered: 1995-03-13
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0656A / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51056 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 384941 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Gaze palsy, Hypotension, Hypotonia, Salivary hypersecretion, Somnolence, Stupor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: BP 70/40, pulse 109
CDC Split Type: OK959

Write-up: w/in 15 mins p/vax car driving home, grandmother described pt as foaming @ the mouth, eyes rolling back in head, apparently non-responsive; upon return to clinic aprox 1130AM; pt partially responsive to voice, crying a times, limp & drowsy;


VAERS ID: 72384 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Georgia  
Vaccinated:1995-02-14
Onset:0000-00-00
Submitted: 1995-02-27
Entered: 1995-03-27
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0052A / 3 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0551A / 1 - / SC A

Administered by: Public       Purchased by: Unknown
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: denies
Preexisting Conditions: denies
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA95022

Write-up: pt recvd vax;exp rash & ran T 103 p/ vax;advised mom to call MD;MD felt unusual rxn but not related to vax;mom to take pt for a throat culture & ear check;


VAERS ID: 72792 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Texas  
Vaccinated:1995-02-14
Onset:1995-02-23
   Days after vaccination:9
Submitted: 1995-02-27
   Days after onset:4
Entered: 1995-04-03
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0732A / 2 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Headache, Malaise, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), 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? No
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:
CDC Split Type: TX9541

Write-up: 23FEB95 p/school felt bad, t103.5 c/o h/a; 24FEB95 home from school t99; APAP form inc temp w/relief of h/a & inc temp; 26FEB95 rash on trunk & arms (t99.2 on 27FEB95); DPH for itching;


VAERS ID: 72796 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Wyoming  
Vaccinated:1995-02-14
Onset:0000-00-00
Submitted: 1995-03-28
Entered: 1995-04-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51146 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1287A / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61146 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0711C / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-02-22
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WY952

Write-up: pt came to office 14FEB95 for immunization; pt died 22FEB95 dx sid;


VAERS ID: 74544 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Male  
Location: Maryland  
Vaccinated:1995-02-14
Onset:1995-02-14
   Days after vaccination:0
Submitted: 1995-03-22
   Days after onset:36
Entered: 1995-06-06
   Days after submission:75
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1514W / 1 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Hyperhidrosis, Hypersensitivity, Nausea, Nervousness, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: advised to start on beta blocker to dec BP
Allergies:
Diagnostic Lab Data: ultrasound of abd; pt had blood drawn;
CDC Split Type: MD95016

Write-up: pt devel numbness lt arm followed by sweating was restless during the noc-vomited about 12-15times; taken to ER by mom 930 on 24FEB95; allergic to vax;


VAERS ID: 75299 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Female  
Location: Ohio  
Vaccinated:1995-02-14
Onset:1995-02-14
   Days after vaccination:0
Submitted: 1995-06-16
   Days after onset:121
Entered: 1995-06-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RUB: RUBELLA (MERUVAX II) / MERCK & CO. INC. 0680A / UNK LA / SC

Administered by: Public       Purchased by: Other
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (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: motrin, colace, MOM
Current Illness: post delivery - non immune
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; acute asthma attack 30 mins p/ vax; tx w/ proventil inhaler then cont tx w/ serevent inhaler


VAERS ID: 82136 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Colorado  
Vaccinated:1995-02-14
Onset:1995-02-14
   Days after vaccination:0
Submitted: 1995-02-20
   Days after onset:6
Entered: 1995-11-14
   Days after submission:267
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1415A4 / 1 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (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:
CDC Split Type: 950014001

Write-up: pt recvd vax & w/in 5 hrs post vax pt exp nausea,vomiting,& diarrhea;these sx subsided w/o treatment;


VAERS ID: 186008 (history)  
Form: Version 1.0  
Age:   
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-02-14
Onset:1995-11-01
   Days after vaccination:260
Submitted: 2002-05-31
   Days after onset:2402
Entered: 2002-06-04
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0717A / 3 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Autism, Drug toxicity, Nervous system disorder
SMQs:, Anticholinergic syndrome (broad), Drug abuse and dependence (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? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ2441324MAY2002

Write-up: An attorney reported that a male child received series of Orimune, DTP and Tripedia, Engerix-B, ActHIB, and MMR vaccines from shortly after birth through 18 months of age. It is alleged that, as a result of the cumalative exposure of thimerosal in the vaccines he received until 18 months of age, the child suffered mercury poisoning and neurological injuries that are permanent in nature. He was reportedly healthy at birth, with normal APGAE scores. At 18 months of age, the child reportedly began to regress and now suffers from "disintegrative autism or autism spectrum disorder." Immunization record included by the reporter also indicated that the child continued to receive DTP, Orimune and MMR vaccines past 18 months of age.


VAERS ID: 71758 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: North Carolina  
Vaccinated:1995-02-15
Onset:1995-02-15
   Days after vaccination:0
Submitted: 1995-02-16
   Days after onset:1
Entered: 1995-02-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4M51065 / 4 - / IM L

Administered by: Private       Purchased by: Public
Symptoms: Hypokinesia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 3 hrs p/vax to mid anterior thigh pt exp pain & dec motion; rx Ibuprofen


VAERS ID: 71790 (history)  
Form: Version 1.0  
Age: 0.9  
Gender: Female  
Location: West Virginia  
Vaccinated:1995-02-15
Onset:1995-02-16
   Days after vaccination:1
Submitted: 1995-02-17
   Days after onset:1
Entered: 1995-02-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G65120 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460LA / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 708K4 / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: fetal alcohol synd
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recvd vax; T 104; Motrin for fever; v;


VAERS ID: 71808 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: Texas  
Vaccinated:1995-02-15
Onset:1995-02-15
   Days after vaccination:0
Submitted: 1995-02-17
   Days after onset:2
Entered: 1995-02-27
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3G51130 / 4 - / IM L

Administered by: Public       Purchased by: Public
Symptoms: Condition aggravated, Hyperhidrosis, Pyrexia, Respiratory disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), 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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Phenobarbital
Current Illness: NONE
Preexisting Conditions: sz disorder-peripheral pulmonic stenosis; dad has CP
Allergies:
Diagnostic Lab Data: Phenobarbital level down 17FEB95 pending
CDC Split Type: TX9533

Write-up: vague parental description-pt w/known sz DO on PB, level is pending; pt vax w/DT 15FEB95 1130AM- 2PM to ER w/heavy breathing, sweating & shaking different from when had sz; ER MD gave APAP for 100.4 R temp & sent home w/no labs:


VAERS ID: 71815 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:1995-02-15
Onset:1995-02-16
   Days after vaccination:1
Submitted: 1995-02-20
   Days after onset:4
Entered: 1995-02-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 381900 / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0698H / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 713B6 / 5 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: PPD by Connaught lot# 239011
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 24 hrs p/vax pt devel 7x10 cm area erythema w/minimal tenderness rt anterior thigh; tx cool compresses & APAP


VAERS ID: 71910 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1995-02-15
Onset:1995-02-16
   Days after vaccination:1
Submitted: 1995-02-23
   Days after onset:7
Entered: 1995-03-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP289 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0400A / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 378943 / 5 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
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: allergic to Trimethoprim-Sulfamethoxoxide
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 8-10 cm area of local redness & induration devel aprox 24 hrs p/inject @ inject site; pruritus non-tender; resolved spontaneously later;


VAERS ID: 72020 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Alabama  
Vaccinated:1995-02-15
Onset:1995-02-15
   Days after vaccination:0
Submitted: 1995-02-27
   Days after onset:12
Entered: 1995-03-13
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J51151 / 2 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4J51151 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 710D2 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Crying, Pain, 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: CBC-Blood CXR-WNL
CDC Split Type: AL9506

Write-up: high pitch crying for 3-4 days; t104 for same period of time cried as if in pain when picked up to be held; treated w/Rocephin ATB shot & pt Advil on 20FEB; CBC & blood CXS-WNL; f/u in 2 days w/improvement


VAERS ID: 72128 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Ohio  
Vaccinated:1995-02-15
Onset:1995-02-16
   Days after vaccination:1
Submitted: 1995-02-27
   Days after onset:11
Entered: 1995-03-20
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4K51154 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265LJ / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714C / 2 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Anorexia, Insomnia, 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, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: sl cold w/ sniffles
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: spinal tap neg; blood work ?
CDC Split Type: OH95021

Write-up: pt recvd vax;exp high fever of 104.3 day p/ vax;did not eat;fussiness,did not sleep much;to er 17feb95;hosp x 3 days;tx w/ atb''s,O2 per cannula; spinal tap neg;


VAERS ID: 72364 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:1995-02-15
Onset:1995-02-16
   Days after vaccination:1
Submitted: 1995-02-17
   Days after onset:1
Entered: 1995-03-27
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 2 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0712E / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Oedema peripheral, Urticaria, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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: ~ ()~~~In patient
Other Medications: APAP; PPD by Connaught lot# 238311
Current Illness: NONE
Preexisting Conditions: poss allergy to Ceclor
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA95035

Write-up: approx 72 hrs p/vax pt lt arm swollen from elbow to p/shoullder sl redness, heat w/palpation; mom states pt had hives on back & stomach last nite called MD who ordered DPH;


VAERS ID: 72389 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Male  
Location: Hawaii  
Vaccinated:1995-02-15
Onset:1995-02-15
   Days after vaccination:0
Submitted: 1995-02-21
   Days after onset:6
Entered: 1995-03-27
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1736W / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Infection, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), 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? 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: apap
Current Illness: sl fever previous noc & was teething;
Preexisting Conditions: tx for eczema & dry skin during 1st yr;
Allergies:
Diagnostic Lab Data: spinal tap:neg;blood cultures done;
CDC Split Type: HI9503

Write-up: pt recvd vax;fussy & unusual T;to er & T 105;ice bath given;fever came down w/ acetaminophen;spinal tap neg;red spots,rash noted on 17feb;resolved by 19feb;dx:viral infect found in blood cultures & possible Roseola;


VAERS ID: 72664 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Male  
Location: Michigan  
Vaccinated:1995-02-15
Onset:1995-02-26
   Days after vaccination:11
Submitted: 1995-03-08
   Days after onset:10
Entered: 1995-03-31
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 377911 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0855A / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Febrile convulsion, Rash
SMQs:, Anaphylactic reaction (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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:
Current Illness: resolving bronchitis
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CXR neg
CDC Split Type:

Write-up: pt recvd vax; 26feb febrile sz, fine red rash;


VAERS ID: 72780 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Texas  
Vaccinated:1995-02-15
Onset:1995-02-15
   Days after vaccination:0
Submitted: 1995-02-22
   Days after onset:7
Entered: 1995-04-03
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380998 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0714H / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Pyrexia
SMQs:, 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: genetian violet;
Current Illness: thrush
Preexisting Conditions: allergic to nystatin
Allergies:
Diagnostic Lab Data: none
CDC Split Type: TX95025

Write-up: pt recvd vax;sl maculo papular eruption around tetramune inject as well as on trunk,face,arms,neck;gradually disappearing; some fever; no convuls;


VAERS ID: 72821 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Female  
Location: Michigan  
Vaccinated:1995-02-15
Onset:1995-02-27
   Days after vaccination:12
Submitted: 1995-03-27
   Days after onset:28
Entered: 1995-04-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 6831A / 1 LL / -

Administered by: Private       Purchased by: Private
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: rubeola ABS IGM 1:16/ Rubella neg;
CDC Split Type:

Write-up: pt recvd vax; approx 2 wks post MMR,pt presented w/ measles exanthema;


VAERS ID: 73396 (history)  
Form: Version 1.0  
Age: 0.9  
Gender: Male  
Location: California  
Vaccinated:1995-02-15
Onset:1995-02-15
   Days after vaccination:0
Submitted: 1995-02-15
   Days after onset:0
Entered: 1995-04-24
   Days after submission:67
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51007 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0657A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51007 / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Chills, Gaze palsy, Hypotonia, Personality disorder, Pyrexia, Screaming, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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)

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: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CA95046

Write-up: 10AM 15FEB95 recvd vax & eyes rolled & pt went limp x 15sec then regained airway & crying; 2nd shot given no problem; 2PM same day mom concerned pt has not stopped crying, nothing consoles pt, claws @ parents, shaky like, chills, t101.5;v


VAERS ID: 74084 (history)  
Form: Version 1.0  
Age: 1.1  
Gender: Male  
Location: Texas  
Vaccinated:1995-02-15
Onset:1995-02-15
   Days after vaccination:0
Submitted: 1995-04-10
   Days after onset:53
Entered: 1995-05-15
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380968 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0732A / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, Hypersensitivity, Pyrexia, Vasodilatation
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: NONE~ ()~~~In patient
Other Medications: OTC cough medicine
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX95060

Write-up: couple of hr p/shot t104 gave APAP as instructed fever did not go down;face red, eyes swollen x 3 days-took to ER was told rxn to shot;1mo later ate eggs for breakfast-couple hr then t104 face red, eye swollen;MD said allergy to eggs


VAERS ID: 74212 (history)  
Form: Version 1.0  
Age: 68.0  
Gender: Male  
Location: Washington  
Vaccinated:1995-02-15
Onset:1995-02-28
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 1995-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4F61058 / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Arthritis, Infection
SMQs:, Systemic lupus erythematosus (broad), Arthritis (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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden onset over 1-2 days of progressive joint pains-none in shoulders; rx w/NSAID


VAERS ID: 77756 (history)  
Form: Version 1.0  
Age: 57.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1995-02-15
Onset:1995-02-23
   Days after vaccination:8
Submitted: 1995-05-08
   Days after onset:73
Entered: 1995-06-01
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J61014 / UNK LA / IM

Administered by: Public       Purchased by: Other
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Enalapril, Premarin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5850

Write-up: redness & swelling @ site; treated w/Dicloxacillin


VAERS ID: 74511 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Michigan  
Vaccinated:1995-02-15
Onset:1995-02-24
   Days after vaccination:9
Submitted: 1995-05-31
   Days after onset:95
Entered: 1995-06-05
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 377911 / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1051A / 1 LA / SC

Administered by: Other       Purchased by: Unknown
Symptoms: Convulsion, Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: recovered fr rose
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CT scan of head, EEG, blood test;
CDC Split Type:

Write-up: pt recv vax;had a sz 1-2 mins;to hosp er where pt had another brief sz w/ a rectal T 101;


VAERS ID: 81449 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Male  
Location: North Carolina  
Vaccinated:1995-02-15
Onset:1995-02-16
   Days after vaccination:1
Submitted: 1995-02-24
   Days after onset:8
Entered: 1995-09-06
   Days after submission:193
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 380957 / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Chills, Influenza, Injection site hypersensitivity, Pyrexia, Rhinitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: NA~ ()~~~In patient
Other Medications: unk
Current Illness: flu-like illness in geographical area
Preexisting Conditions: hx of asthma & recurrent pneumonias
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 950031601

Write-up: 1 of 3 adult pts vaxed from the same pnu-immune lot# who devel an adverse event;pt immunized 15FEB95;16FEB devel high fever,feeling weak,head congestion,chills & large local redness around inj site;also flu-like sx x 1wk;recovered


VAERS ID: 81999 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: New Hampshire  
Vaccinated:1995-02-15
Onset:1995-02-17
   Days after vaccination:2
Submitted: 1995-08-31
   Days after onset:194
Entered: 1995-10-13
   Days after submission:43
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX ID) / PASTEUR MERIEUX INST. K0040 / 2 - / A

Administered by: Other       Purchased by: Other
Symptoms: Injection site hypersensitivity, Pain, Phlebitis
SMQs:, Thrombophlebitis (broad), 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5826

Write-up: phlebitis in axilla to around chest;initially very painful;pain dec as of 2MAR95;local rxn size of quarter;25APR95 f/u both doses given in lt deltoid & both w/4cm surrounding erythema;


VAERS ID: 79538 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Texas  
Vaccinated:1995-02-15
Onset:1995-02-15
   Days after vaccination:0
Submitted: 1995-08-23
   Days after onset:188
Entered: 1995-11-20
   Days after submission:89
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 380998 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0570A / 3 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0703C / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Oedema, Pyrexia, Rash, Screaming
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: had rxn to prev vax~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: TX95182

Write-up: t103, crying for hrs & hrs, inconsolable;rash to rt leg w/swelling;Advil given by mouth;cold compress to leg;sent home w/instructions


VAERS ID: 84383 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Kansas  
Vaccinated:1995-02-15
Onset:1995-02-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1996-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 - / IM

Administered by: Other       Purchased by: Other
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? 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: WAES95030055

Write-up: pt recv vax 15FEB95 & 24hrs later exp a rash all over body & face;pt refused to see a MD;no further details were provided;


VAERS ID: 133825 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:1995-02-15
Onset:1995-03-01
   Days after vaccination:14
Submitted: 2000-02-08
   Days after onset:1805
Entered: 2000-02-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1056A2 / 3 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Apathy, Asthenia, Asthma, Convulsion, Coordination abnormal, Cough, Cyanosis, Dysarthria, Gait disturbance, Guillain-Barre syndrome, Hypertonia, Hypotonia, Hypoxia, Influenza, Meningism, Neuritis, Nuchal rigidity, Pharyngitis, Pyrexia, Speech disorder, Stupor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Asthma/bronchospasm (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gardenale
Current Illness:
Preexisting Conditions: Seizures w/ hypertonus, speech & gait temporary imparement, asthma, dust allergy
Allergies:
Diagnostic Lab Data: EEG, CT scan-no severe alteration. Electromiography confirmed polioradiculoneuritis.
CDC Split Type: 20000019901

Write-up: Fever, pharyngodynia, dx as flu. Vomiting, dysarthria, then seizure w/ hypertonus, gaze fixation & contact rupture. At ER motorial incoordination, head rigidity. Meningeal irritation, mild apathism, cough, hypotonia of limbs. Addit (cont)


VAERS ID: 199439 (history)  
Form: Version 1.0  
Age: 44.0  
Gender: Male  
Location: Foreign  
Vaccinated:1995-02-15
Onset:1997-02-11
   Days after vaccination:727
Submitted: 2003-03-12
   Days after onset:2220
Entered: 2003-03-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Fibrosis tendinous, Myofascitis, Polymyositis
SMQs:, Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: A muscular biopsy showed macrophagic myofascitis. Follow p: 11FEB1997: a muscular biopsy of the left deltoid: irregular size of myoctis, wit excessive nuclear centralization. Many several disseminated necrotic fibers with for several of them endomysial inflammatory infiltrates. Presences of regenerative basophilic fibers. No sign of vasculitis. Many eosinophilic calls associated to macrophages in the inflammatory infiltrates. Conclusion: eosinophilic polymyositis.
CDC Split Type: B0294259A

Write-up: The regulatory authority reported the occurrence of macrophagic myofascitis in a male subject vaccinated with an unspecified hep B vaccine for prophylaxis. The subject received an IM injection of hep B vaccine. After an unspecified time, a muscular biopsy showed macrophagic myofascitis (not medically confirmed). The event was considered as disabling. The outcome of the event was unknown. The regulatory authority didn''t assess the causality for the vaccine. Follow up: on 19OCT1994 and 18NOV1994, the subject received two injections of DTaP and poliomyelitis vaccine (DTP vaccine). ON 15FEB1995, the subject received the second injection of Engerix B. In 1996, the subject developed the first sxs (no more precision). Within an unspecified delay, he developed myalgia and fatigue which improved under corticotherapy. On 11FEB1997, a muscular biopsy of the left deltoid showed lesions of eosinophilic polymyositis. At an unspecified date, a muscular biopsy showed lesions of macrophagic myofascitis (not provided). At the time of reporting, the outcome of the events was unknown. According to the AFSSAPS, the events were disabling. A causal relationship was not performed.


VAERS ID: 202471 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Male  
Location: Foreign  
Vaccinated:1995-02-15
Onset:0000-00-00
Submitted: 2003-04-30
Entered: 2003-05-02
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Fibrosis tendinous, Goitre, Insomnia, Myalgia, Myofascitis, Thyroid disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Tendinopathies and ligament 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject concurrent medical condition included myalgia with increased creatine phosphokinase for several years(no more precision), depressive state with suicidal attempt and psychological disorder, oesophageal ulcer and colic polyposis.
Allergies:
Diagnostic Lab Data: Creatine phosphokinase, 985 U/L, 600 U/L, 1200 U/L Feb2002. February 1997: left deltoid muscular biopsy: myogenic modification with irregular size myocytes and excess of nuclear centralization. Numerous necrotic fibers. Some of them surrounded with endomysium inflammatory infiltrates. Presence of numerous eosinophils in these infiltrates. Evidence of macrophagic activation. February 2002: neurologic exam normal. Right deltoid muscular biopsy: macrophagic myofascitis and aspect of inflammatory myopathy.
CDC Split Type: B0297715A

Write-up: This case was reported by the regulatory authority and described the occurrence of a macrophagic myofascitis in a 45 year old male who received Engerix B for hep B prophylaxis. Medical history included blood transfusion. The subject concurrent medical condition included myalgia with increased creatine phosphokinase for several years(no more precision), depressive state with suicidal attempt and psychological disorder, oesophageal ulcer and colic polyposis. On 12/2/94 and 2/15/95, the subject received an injection of Engerix B at a dose of 20ug. In February 1997, a left deltoid biopsy showed myogenic modification with irregular size myocytes and excess of nuclear centralization, numerous necrotic fibers, some of them surrounded with endomysium inflammatory infiltrates, presence of numerous eosinophils in these infiltrates and evidence of macrophagic activation. An eosinophilic pneumopathy was suggested. In February 2002, the subject experienced general status alteration with insomnia and recurrence of myalgia. Neurological exam was normal. Creatine phosphokinase level was at 985 U/L. He was hospitalized and underwent a second muscular biopsy (right deltoid) which evidence macrophagic myofascitis associated with an aspect of inflammatory myopathy. At an unspecified date, the subject received symptomatic treatment. Due to important myalgia in upper and lower limbs, a treatment with corticoids (not well tolerated) and then with Skenan was administered. It was also reported thyroid disease with decreased thyroid stimulating hormone level, diffuse goitre and nodule and fluctuating creatine phosphokinase level between 600 and 1200 U/L. Myalgia were considered as disabling for day life activity. At the time of reporting, the subject had not yet recovered and was on sick leave. The regulatory authority causality relationship of the event with Engerix B was unlikely. A 15-day follow up report received 8/26/2003 adds: In November 2002, 4 limbs myalgia were persistent leading to decreased walking perimeter. In January 2003, persistent myalgia lead to insomnia. Myalgia were considered as disabling for day life activity. At the time of reporting, the pt had not yet recovered and was on sick leave. The causality relationship of the event with Engerix D was unlikely.


VAERS ID: 71785 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Tennessee  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-02-16
   Days after onset:0
Entered: 1995-02-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4A61082 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1541W / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61082 / UNK RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Anaemia, Apnoea, Shock, Stupor
SMQs:, Anaphylactic reaction (narrow), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (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, 2 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: SMA=18 nl; CBC (anemia);
CDC Split Type:

Write-up: pt recvd vax; hyporesponsive, shock rxn; brief apnea about 4-5 hrs p/vax; adm to hosp & will use monitor for a wk; anemia;


VAERS ID: 71811 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Illinois  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1995-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51169 / 2 - / IM L
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0796A / 2 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 70821 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Cyanosis, Hypothermia, Hypotonia, Pallor, Pyrexia, Somnolence, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: mom sent to check on baby-found had vomited in crib-skin felt cold-states color was blue-seemed limp-t100.5 in ER; lethargy; pt was pale; while pt @ home par felt temp was low 96; pt observed for hr appeared weaker than usual;


VAERS ID: 71852 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-02-17
   Days after onset:1
Entered: 1995-03-01
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J51164 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0944W / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 374934 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Crying, Injection site pain
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), Depression (excl suicide and self injury) (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: apap, vitamins;
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9546

Write-up: pt recvd vax; unconsolable crying w/ screaming from 10 am to 6:30pm off and on;difficult to feed;apap given w/out effect;both shot sites extremely tender;no fever;mom called Ped & he feels pt had rxn;


VAERS ID: 71879 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Wisconsin  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-02-20
   Days after onset:4
Entered: 1995-03-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51030 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51030 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0716H / UNK MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WI95007

Write-up: t103.6R, unconsolable crying for 24 hrs p/shot; APAP given-tepid bath, warm compress on leg;


VAERS ID: 71892 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: Washington  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-02-22
   Days after onset:6
Entered: 1995-03-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51169 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285LB / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0338A / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380938 / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated
SMQs:

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: APAP
Current Illness: pt had rash, ax fever of 101
Preexisting Conditions: exposure to cocaine in utero
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt recvd vax & had a temp of 101 ax; APAP given; 430PM same day mom brought pt back in w/t104.3 on APAP; fever dropped the next day-gone by Tuesday;


VAERS ID: 71944 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Georgia  
Vaccinated:1995-02-16
Onset:1995-02-17
   Days after vaccination:1
Submitted: 1995-03-03
   Days after onset:14
Entered: 1995-03-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 4C61075 / 5 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0282A / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, CSF test abnormal, Gait disturbance, Guillain-Barre syndrome, Infection, Influenza, Neuropathy, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
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: PPD by connaught;
Current Illness: none
Preexisting Conditions: na
Allergies:
Diagnostic Lab Data: CSF protein=78
CDC Split Type:

Write-up: pt recvd vax; V 2x at school & 1x at home w/ abdo pain;seen by MD,felt influenza;seen in Med ctr w/ influenza (but difficulty walking);pt adm w/ classical Guillain Barre synd;CSF protein=78;


VAERS ID: 71954 (history)  
Form: Version 1.0  
Age: 1.6  
Gender: Male  
Location: Ohio  
Vaccinated:1995-02-16
Onset:0000-00-00
Submitted: 1995-02-24
Entered: 1995-03-07
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 370904 / 5 - / L
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1615B2 / 2 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 208108 / 5 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Cough, Pyrexia, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), 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: TB;
Current Illness: na
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC & blood culture;
CDC Split Type:

Write-up: pt recvd vax;woke up crying; very bad cough; inc T; lethargic;to er;


VAERS ID: 71967 (history)  
Form: Version 1.0  
Age: 1.6  
Gender: Female  
Location: South Carolina  
Vaccinated:1995-02-16
Onset:1995-02-17
   Days after vaccination:1
Submitted: 1995-02-23
   Days after onset:6
Entered: 1995-03-07
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51011 / 4 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61046 / 4 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0692L12 / 4 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Gait disturbance, Injection site hypersensitivity, Injection site mass, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: mom notice pt limping Friday evening 17FEB95, then notice area to inject site, red, hot, swollen, hard & very tender to touch; mom & pt in clinic 20FEB95 told to use APAP or Advil for pain was also given Amox x 10 days;


VAERS ID: 71971 (history)  
Form: Version 1.0  
Age: 54.0  
Gender: Male  
Location: North Dakota  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-02-27
   Days after onset:11
Entered: 1995-03-07
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1436A4 / 1 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Face oedema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Coumadin, Lopressor
Current Illness: NONE
Preexisting Conditions: had angioplasty surgery fall 94
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: lt arm swelled w/same facial/peripheral edema; noted edema @ approx 6PM et cont til evening subsided next day; no chest pain/SOB;


VAERS ID: 71994 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Mississippi  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-02-27
   Days after onset:11
Entered: 1995-03-09
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51169 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0700A / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0871A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 382934 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anorexia, Crying, Oral candidiasis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unsure-mom said they did a finger stick;
CDC Split Type: MS95006

Write-up: about 2 hrs p/vax pt started screaming & crying & running elevated temp-gave APAP q 4 hrs & it wouldn''t bring it down-took pt to ER p/10PM w/temp $g104-had fever x couldn''t eat & was sick; thrush was dx 21FEB95;


VAERS ID: 71995 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: Mississippi  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-02-21
   Days after onset:5
Entered: 1995-03-09
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386987 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0700A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 382936 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Intracranial pressure increased, Otitis media, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS95007

Write-up: pt recvd vax 16FEB95 & pt started having a t103, having periods of trembling in upper & lower extremities; 17FEB95 had an edematous fontanel upon awaking was taken to MD; 18FEB95 dx OM & tx w/Augmentin


VAERS ID: 72028 (history)  
Form: Version 1.0  
Age: 71.0  
Gender: Female  
Location: Illinois  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-02-27
   Days after onset:11
Entered: 1995-03-13
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 368918 / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Conjunctivitis, Rash, Rash maculo-papular, Vasodilatation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Conjunctival disorders (narrow), Ocular infections (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:
Preexisting Conditions: sesame allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: IL950016

Write-up: Td shot-eyes & face red w/rash raised & chest; 6 days later arm had rash; no fever-feeling fine on 27DEC95;


VAERS ID: 72363 (history)  
Form: Version 1.0  
Age: 8.0  
Gender: Male  
Location: New York  
Vaccinated:1995-02-16
Onset:1995-02-17
   Days after vaccination:1
Submitted: 1995-03-08
   Days after onset:19
Entered: 1995-03-27
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4F60145 / UNK LA / IM

Administered by: Public       Purchased by: Public
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: NONE
Current Illness: NONE
Preexisting Conditions: hx of allergic dermatitis-during hot weather
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: BAQ012

Write-up: pt presented 5 days p/vax c/o itching & rash which devel 24 hrs p/vax-erythematous/urticaria rash-arms chest-pt recvd DPH PO-rash faded;


VAERS ID: 72639 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Indiana  
Vaccinated:1995-02-16
Onset:1995-02-24
   Days after vaccination:8
Submitted: 1995-03-07
   Days after onset:11
Entered: 1995-03-31
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0734A / 1 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Cough, Lymphadenopathy, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
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: test for infection & O2 level;
CDC Split Type: IN95004

Write-up: pt recvd vx 16FEB94; on 24FEB devel high fever (T 104.5), severe cough,swollen glands & 1 sz; to ER on 24FEB; MD prescribed amoxicillin & advil;mom did not mention vax to MD; on 26FEB pt developed a rash lasting 2 days; 08MAR94 pt is fine;


VAERS ID: 72739 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: California  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-03-02
   Days after onset:14
Entered: 1995-03-31
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51013 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 386940 / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Anorexia, Condition aggravated, 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:
Current Illness: could not drink much
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was crying cont 6 hrs p/shots; couldn''t drink formula for 1 1/2 days not including noc hrs; had to change brands of formula could handle other formula 1 1/2 days later;


VAERS ID: 72782 (history)  
Form: Version 1.0  
Age: 1.1  
Gender: Female  
Location: Texas  
Vaccinated:1995-02-16
Onset:1995-02-17
   Days after vaccination:1
Submitted: 1995-02-21
   Days after onset:4
Entered: 1995-04-03
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 374964 / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0774A / 1 RL / -

Administered by: Public       Purchased by: Public
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ATB
Current Illness: 4FEB95 fever & Ear inf
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX95027

Write-up: rash-much like measles rash; no fever; ENT clear;


VAERS ID: 73206 (history)  
Form: Version 1.0  
Age: 61.0  
Gender: Female  
Location: Florida  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-04-10
   Days after onset:52
Entered: 1995-04-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / -

Administered by: Private       Purchased by: Other
Symptoms: Hypokinesia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (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: PCN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax sx getting worse in inactive state, i.e. sleeping resting-arm becomes disfunctional; have to lift it w/other arm; very painful; during day it eases up, but have to take anti-inflam''s; pain in always present; given in rt arm,


VAERS ID: 73276 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Male  
Location: New York  
Vaccinated:1995-02-16
Onset:1995-02-18
   Days after vaccination:2
Submitted: 1995-02-27
   Days after onset:9
Entered: 1995-04-17
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1602W / 2 LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61118 / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, 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: na
CDC Split Type: NYS95009

Write-up: pt recvd vax; broke out in hives; lips became swollen;


VAERS ID: 73462 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Indiana  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-04-17
   Days after onset:59
Entered: 1995-04-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 386988 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 386988 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0706E / 2 MO / PO

Administered by: Private       Purchased by: Private
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:
Current Illness: URI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cried for solid 3 hrs p/vax given; mom did not let anyone know until time for 4mo shots 17APR95;


VAERS ID: 73557 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Colorado  
Vaccinated:1995-02-16
Onset:1995-02-17
   Days after vaccination:1
Submitted: 1995-02-20
   Days after onset:3
Entered: 1995-04-28
   Days after submission:66
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51104 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0705A / 2 RA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51104 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715A / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Dehydration, Infection, Sepsis
SMQs:, Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Dehydration (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: Prader Wili synd
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO95009

Write-up: Reporter states unclear whether this constitutes reporting but pt was seen w/in 24hr of vax for presumptive bacteremia & mild dehydration;


VAERS ID: 74061 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-04-13
   Days after onset:55
Entered: 1995-05-15
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J51138 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1513A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4J51138 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0703H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anorexia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA95135

Write-up: 7PM day of vax pt was fussy, did not eat normally & would fall asleep & then wake up crying; this lasted 3 days;


VAERS ID: 77757 (history)  
Form: Version 1.0  
Age: 73.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1995-02-16
Onset:1995-02-18
   Days after vaccination:2
Submitted: 1995-05-08
   Days after onset:78
Entered: 1995-06-01
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J61014 / UNK LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Headache, Injection site hypersensitivity, Injection site mass, Injection site oedema, Pyrexia, Rash maculo-papular
SMQs:, 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: bursitis rt shoulder
Preexisting Conditions: inflammatory arthritis, dupeytrus contracture
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5851

Write-up: swelling & erythema @ inj site, fever 101, h/a on 18FEB95; given DPH;21FEB95 large area macular erythema; area of inj erythematous, indurate; afeb; treated w/Keflex


VAERS ID: 78175 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: Oregon  
Vaccinated:1995-02-16
Onset:1995-02-17
   Days after vaccination:1
Submitted: 1995-02-27
   Days after onset:10
Entered: 1995-10-17
   Days after submission:231
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0281A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M430KJ / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1341W / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Coordination abnormal, Hypokinesia, Injection site pain, Pain, Rash maculo-papular, Vasodilatation
SMQs:, Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (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: APAP-oral
Current Illness: NONE
Preexisting Conditions: seasonal allergies mold, dust & pollen
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR9506

Write-up: evening of vax 2AM pt would not sit up in bed d/t pain in legs & apparent fever, felt warm to touch-states mom;the following day pt had noticeable sore legs guarded them;fine red rash on face & chest, abd & neck & balance off x 3 episodes


VAERS ID: 82246 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: Florida  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-06-20
   Days after onset:123
Entered: 1995-11-14
   Days after submission:147
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1646B2 / 3 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Gaze palsy, Hypertonia, Somnolence, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (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: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950015541

Write-up: pt recvd vax & 2mins later stiffened up,eyes rolled back,collapsed to the floor;pt observed by MD in office until was stable & then allowed home;pt felt sleepy afterwards;MD reports pt exp vasovagal episode


VAERS ID: 81880 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Wisconsin  
Vaccinated:1995-02-16
Onset:1995-02-16
   Days after vaccination:0
Submitted: 1995-05-18
   Days after onset:90
Entered: 1996-02-05
   Days after submission:263
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51073 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1163A / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51073 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0712A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cyanosis, Hyperhidrosis, Malaise, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: WI95013

Write-up: pt recvd vax about 1PM about 7PM pt listless, quiet, pale, lips were purple in color;skin clammy; sleep between 1/2 to 1hr when awoke color was good & seemed fine;given APAP;18MAY95 DPT not given


VAERS ID: 85244 (history)  
Form: Version 1.0  
Age: 42.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1995-02-16
Onset:1995-02-20
   Days after vaccination:4
Submitted: 1995-02-23
   Days after onset:3
Entered: 1996-04-01
   Days after submission:403
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4948083 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895059011A

Write-up: pt recv vax;5 days later,devel redness&irritation at inject site;pt had extensive redness&itching at inject site;


VAERS ID: 252576 (history)  
Form: Version 1.0  
Age: 35.0  
Gender: Female  
Location: Unknown  
Vaccinated:1995-02-16
Onset:0000-00-00
Submitted: 2006-03-07
Entered: 2006-03-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 611796 0445A / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Headache, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0503USA05089

Write-up: 44 year old female, with no pertinent medical history, who on 02/16/1995 was vaccinated with a first 10 mcg, intramuscular dose in the outer arm of hepatitis B virus vaccine. It was noted that the vaccination series was completed elsewhere. The reporter stated that not right away, but within the last couple of years, in approximately 2003 the patient experienced headaches, dizzy spells and some numbness. It was reported that the diagnosis was unknown. It was noted that the patient is still being treated. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 76676 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Foreign  
Vaccinated:1995-02-16
Onset:0000-00-00
Submitted: 1995-08-18
Entered: 1995-08-21
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Arthralgia, Asthenia, Hepatic function abnormal, Hepatocellular damage, Immune system disorder, Pyrexia, Urine analysis abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 20MAR ASAT 1392, ALAT 1704, ALKPH norm; 27MAR ASAT 1080; ALAT 1540 nl; 05APR ASAT 860; ALAT 1249 NA; 27APR ASAT nl; ALAT nl; ALkph NA; all the virologies were nl; immunologic test were nl but for anti LKM1 which was pos 1/1000
CDC Split Type: 950073041

Write-up: pt recv vax & 14 days p/2nd dose pt exp asthenia, vomiting, fever, abd pain, dark urine;pt treated w/corticoids, because an autoimmune hepatitis was suspected


VAERS ID: 97000 (history)  
Form: Version 1.0  
Age: 50.0  
Gender: Female  
Location: Foreign  
Vaccinated:1995-02-16
Onset:1995-07-01
   Days after vaccination:135
Submitted: 1997-04-11
   Days after onset:650
Entered: 1997-04-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Amblyopia, Gait disturbance, Hypokinesia, Paralysis, Retinal haemorrhage, Retinal oedema, Retinal vein thrombosis
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), 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? No
Previous Vaccinations: pt exp blurring of the vision w/dose 1 hep B vax;~ ()~~~In patient
Other Medications: Oestroporgesterone hormone replacement therapy for monopose;
Current Illness:
Preexisting Conditions: Menopause;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 970074581

Write-up: pt recv vax 16FEB95 & JUL95 ocular sx recurred, assoc w/paresis of the rt upper & lower limbs which caused problems w/walking for 2 days & then resolved spontaneously;pt consulted an ophthalmologist who noted presence of retinal hemorrhages


VAERS ID: 129817 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Foreign  
Vaccinated:1995-02-16
Onset:0000-00-00
Submitted: 1999-10-22
Entered: 1999-10-26
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 4 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Alopecia, Antinuclear antibody, Arthralgia, Asthenia, Cachexia, Laboratory test abnormal, Myalgia, Oedema peripheral, Red blood cell sedimentation rate increased, Stomatitis, Systemic lupus erythematosus
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Angioedema (broad), Systemic lupus erythematosus (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt recv DT & polio 8/4/98, ROR vax (MMR) 3/19/98
Current Illness:
Preexisting Conditions: cure of lt inguinal hernia
Allergies:
Diagnostic Lab Data: 6/16/99 creatinine-75;erythrocyte sed rat=37;ANA positive;antinuclear factors 1/320;
CDC Split Type: 1999027660

Write-up: p/vax pt hosp for butterfly lupus, peripheral polyarthralgia, general status deterioration & stomatitis;6/16/99 antinuclear factors positive (1/320);anti-native DNa antibodies positive;disseminated lupus erythematosus dx;tx corticoid drugs;


VAERS ID: 198909 (history)  
Form: Version 1.0  
Age: 1.08  
Gender: Female  
Location: Foreign  
Vaccinated:1995-02-16
Onset:0000-00-00
Submitted: 2003-03-03
Entered: 2003-03-06
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1442W / 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: Hearing test: normal; Visual acuity test: normal; Abdominal x-ray: Constipation with rectal loading and feces extending to the R colon; Hearing test: normal; Physical examination: Impression of some feces on L hand side of abdomen, nontender; Body Weight measurements: Birth weight: 8lb, 5oz; Body Height measurements: 91st centile (100cm); Body Weight measurements: 91st centile (17.5kg);
CDC Split Type: WAES99031963

Write-up: Information has been received from a foreign legal firm regarding a case in litigation concerning a female child who on 2/16/95 at 13 months old was vaccinated with MMR II (610066/1442W; 859330U). It has been alleged that subsequent to the vaccination, the pt developed autistic tendencies. Upon internal review, autistic tendencies was considered an other important medical event (OMIC). No further info is available. Follow up on 07/03/2003: "Follow up information received on 06/16/2003. It was reported that the patient was born the second of three children, all girls. After a normal but prolonged pregnancy, she was delivered at 42 weeks and weighted 8 pounds 5 ounces. She was reported to have been a healthy baby who ate and slept well. She sat at 5 months, crawled at 7 months and walked at 11-12 months. By her first birthday and until the age of 13 months, early speech developement was good. Her mother recalled 12-20 single words that were clearly spoken. At the age of 13 months, the patient received a MMRII immunization and her mother recalled a deterioration of behavior, socialization, and speech following this. At 25 months old, the patient was referred by her Health Visitor to speech therapy and the Senior Clinical Medical Officer after a delayed 18 month check. On 03/18/1996 the patient saw the Senior Clinical Medical Officer due to parental concerns about her lack of speech and communication. Her father was concerned that she was autistic. At the time of the assessment, the patient was 27 months old and her mother ws finding the patient''s behavior very difficult. She also reported that the patient had been hard to handle since the age of 1 year. It was also noted that the patient had slight eczema. The patient was evaluated using the Griffiths Scale of Developement Assessment and showed the following age-related skill levels: Locomotor-child of 22 months; Personal/Social-child of up to 18 months but were very dysfunctional; Hearing/Speech-18 month level and disordered; Eye/Hand Coordination-child of 19 months; and Performance-child of 21 months. In conclusion, the physician felt the patient had delayed and disordered communication development. Although autism was discussed with the mother, the physician did not want to say she was autistic at that point, but did understand and appreciate those characteristics of the patient''s relationships with other people that lead those who looked after her to consider she could be autistic. The physician felt the patient needed several more months of monitored progress before a firm diagnosis could be made. On 12/19/1997, the patient saw a Clinical Medical Officer who noted she was a healthy, lively child with good skin, hair, eyes and teeth. She objected to being examined further. On the 91st centile, both height (100cm) and weight (17.5kg) were appropriate because the patient kept her jacket and shoes on. It was noted the patient had attended a unit for children with severe communication problems for 1 term in 1997. It was also reported that the patient had been suffering from constipation and soiling for 1 year and had embarked on a series of investigations including a dietary consult. The physician concluded that the patient needed follow up with further investigation and treatments. On 01/27/1999, the patient saw a Pediatric Gastroenterologist as the mother wanted to exclude the fact that the MMRII vaccination might have had an affect on the patien''ts bowel symptoms. It was noted that she had intermittent problems with her bowels in that she had sticky and pasty stool which is often offensive and becomes more of a problem when she is stressed. She was also experiencing soiling and had never been toilet trained since she was a baby. She was going to the toilet up to 5 times a day and had gone more frequently in the past. There was no difficulty in flushing her stool, described as normal and brown in color, and there was no associated blood or mucous. No undigested food had been noted in her stool. She has had no vomiting or abdominal pain but was reported to be an extremely fussy eater. There was no weight loss or any mouth ulcers. Her mother reported that it was shortly after her MMRII vaccination that she began to display some behavioral problems as well as frequency of stool. On examination, the patient was well and growing nicely. She displayed isolated speech delay but tended to communicate very well by other means. She was noted to be a very social girl, and the physician felt that if a diagnosis of autism was at all proven, it would be at the mildest end of the spectrum. She had an impression of some feces on the left hand side of her abdomen but there was no tenderness felt. Her perianal region looked normal and Pelvic/Rectal exam was not performed. Abdominal x-ray revealed constipation with rectal loading and feces extending to the right side of the colon. The following investigations were performed/suggested (results not reported): colonoscopy; full blood count; Erythrocyte sedimentation rate (ESR); liver function; immunoglobulin subsets; T-Cell subsets, and radioallergosorbent (RAST) tests of cow''s milk and wheat. The physician stated that the patient on liquid paraffin during the day and ppicosulfate sodium (PICOLAX) at the weekeneds. In summary, the patient was diagnosed with extremely mild autism and consitpation/encopresis (primary). Immunization History: diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid, Haemophilus B conjugate vaccine (ACTHIB), meningococcal C vaccine, and poliovirus vaccine on 03/03/1999; diptheria toxoid (+) pertussis vaccine (+) tetanus toxoid, Haemophilus B conjugate vaccine (ACTHIB) and poliovirus vaccine on 03/31/1994 and 04/28/1994. It was reported that the patient experienced and recovered from pyrexia post immunization (therapy and date not reported). It was also reported that the patient experienced diarrhea and vomiting post immunization on 05/09/1994 and 05/12/1994. Follow up information received on 06/16/2003 contained the adverse experience of slight eczema (onset unknown). Upon internal review, autistic tendencies, constipation and encopresis (primary) were considered other important medical events (OMIC). No further information is available. A copy of the patien''ts complete medical record is available upon request."


VAERS ID: 205844 (history)  
Form: Version 1.0  
Age: 1.08  
Gender: Female  
Location: Foreign  
Vaccinated:1995-02-16
Onset:0000-00-00
Submitted: 2003-06-30
Entered: 2003-07-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1442W / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abnormal behaviour, Aggression, Antisocial behaviour, Autism, Constipation, Gastrointestinal disorder, Pyrexia, Speech disorder, Tonsillitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Body temp: fever.
CDC Split Type: WAES0306USA02080

Write-up: Information has been received from a foreign legal firm regarding a case in litigation concerning a female child, who on 2/16/95, at 13 months old, was vaccinated with MMR (second generation) (lot #610066/1442W; Batch #859330U). It was alleged that following the vaccination, the patient developed autism and chronic constipation. On 2/23/95 she was not eating and had a raised temperature. Tonsillitis was diagnosed and she was treated with a course of antibiotics. For the rest of the day following the vaccination, the patient started to bang her head deliberately against the floor and wall. At the same time she became withdrawn and isolated. She would not respond and stopped making eye contact and if attempts were made to occupy her or stop the head banging she would become aggressive. Between 4-6 weeks (about March 1995 ) she lost all interest in her toys. She started to bite and chew her own forearm, became a faddy eater, stopped speaking, and would wake during the night. On 2/27/96 the health visitor for speech and language therapy referrred her. On 3/29/96 she was seen by a doctor and a probable diagnosis of delayed and disordered communication development and autism was made. In September 1996 her speech slowly started to improve at nursery and her head banging stopped but she remained an aggressive child. Her nappies needed changing more frequently, 12-14 times daily and it became apparent the patient was having problems passing a stool. By the age of 3 years she was not potty trained. She was seen on 1/29/99 and was diagnosed with chronic constipation and was prescribed laxatives. A doctor confirmed a diagnosis of autism on 7/27/99. Upon review, the patient''s autism and constipation were considered to be important medical events (OMIC). No further information is available.


VAERS ID: 71816 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Connecticut  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-22
   Days after onset:5
Entered: 1995-02-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372935 / 2 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0048A / 2 LL / -

Administered by: Public       Purchased by: Public
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC nl;
CDC Split Type: CT9504

Write-up: pt recvd vax on 17FEB95 & devel fever of 107 on 19FEB95 seen in ER no findings on exam x/fever; nl exam;


VAERS ID: 71787 (history)  
Form: Version 1.0  
Age: 42.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-02-17
Onset:1995-02-18
   Days after vaccination:1
Submitted: 1995-02-21
   Days after onset:3
Entered: 1995-02-24
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 378903 / UNK LA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Oedema, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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:
Current Illness: early infect rt thumb;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax; redness & swelling started 18feb95 & has progressively worsened;


VAERS ID: 71789 (history)  
Form: Version 1.0  
Age: 1.1  
Gender: Male  
Location: North Carolina  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-20
   Days after onset:3
Entered: 1995-02-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 372935 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0873A / 2 - / SC L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0709L / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Crying, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: premature
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recvd vax; screaming & irritability $g 12 hrs; T 101.9;


VAERS ID: 71806 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Maine  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-17
   Days after onset:0
Entered: 1995-02-27
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1159W / 1 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: physician reported this pt to be well
Preexisting Conditions: ?2 days p/vax URI
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: ME95008

Write-up: approx 4 hrs p/vax pt exp an acute sz activity & was transported via ambulance to hosp ER; upon admission pt had a fever 103.8 (ear); no further sz activity;


VAERS ID: 71838 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Oregon  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-20
   Days after onset:3
Entered: 1995-02-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M430KJ / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0709B / 2 MO / PO

Administered by: Private       Purchased by: Public
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: conjunctivitis, peri-orbital, cellulitis
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: brief sz 5 hrs p/vax administration


VAERS ID: 71842 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Illinois  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-23
   Days after onset:6
Entered: 1995-02-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386988 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1645B2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 711H3 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Pallor, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: had apnea @ 1mo of age
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: very pale & grunty for 3-4 hrs-started @ 3hrs p/vax; also shaking of hands & quivering of lips for 3-4 hrs;


VAERS ID: 71882 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Indiana  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-20
   Days after onset:3
Entered: 1995-03-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4H51035 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0711M / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Myalgia, Oedema peripheral, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: PPD by connaught lot# 235911
Current Illness: NONE
Preexisting Conditions: food allergies
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: IN95008

Write-up: arm red, swollen, c/o soreness in area;


VAERS ID: 71887 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: North Dakota  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-23
   Days after onset:6
Entered: 1995-03-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 384975 / 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Crying, Dyspnoea, Infection, Insomnia, Muscle twitching, Pharyngitis, Pyrexia, Stupor
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (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: NONE
Current Illness: dx w/throat infect w/in 24 hrs of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: tests done in hosp lab
CDC Split Type: ND95003

Write-up: pt recvd vax & mom reported pt was very fussy all noc, had a high pitched whining cry & woke @ least every 2 hrs; pt given APAP q 4 hrs & that pt felt feverish; pt exp jerky motions, eyes looked funny, glazed over, frothy mouth; t101;


VAERS ID: 71908 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Oregon  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-18
   Days after onset:1
Entered: 1995-03-03
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386989 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1616B2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0713H / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Hypotonia, Pallor, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: while being held pt had episode of going limp & unresponsive & turning white/pale; lasted several mins thens resolved;


VAERS ID: 71917 (history)  
Form: Version 1.0  
Age: 0.7  
Gender: Female  
Location: Florida  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-22
   Days after onset:5
Entered: 1995-03-06
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1066A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0703C / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Hyperventilation, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Rondec for cold
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: FL95010

Write-up: 20FEB95 mom called & stated pt started vomiting 20 mins p/vax on 17FEB95; devel hives & inc resp on 17FEB95 mom instructed to take pt to ER 21FEB95 called & father stated MD @ ER told mom pt had react to vax; pt changed to another formula


VAERS ID: 71963 (history)  
Form: Version 1.0  
Age: 30.0  
Gender: Female  
Location: North Carolina  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-21
   Days after onset:4
Entered: 1995-03-07
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4948136 / UNK RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Hypertonia, Injection site hypersensitivity, Injection site mass, Malaise, Nuchal rigidity, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt described malaise, stiffness in neck & shoulder w/pain approx 3 hrs; p/inject erythema & induration approx fifty cent size @ site of inj; aporx 24 hrs post inj; tx w/analgesics & ice pack locally;


VAERS ID: 72105 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Ohio  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-03-13
   Days after onset:24
Entered: 1995-03-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51098 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0699A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 386943 / 2 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Agitation, Anorexia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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:
Current Illness:
Preexisting Conditions: diabetes insipidus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax;had been crying & fussy for approx 2 1/2 hrs;mom gave apap;pt cont to cry & could not be comforted;was not taking fluids;RN advised mom to contact MD;saw MD 11mar95; no residual effects reported;


VAERS ID: 72633 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-03-01
   Days after onset:12
Entered: 1995-03-31
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1545A / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site reaction, Leukocytosis, 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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: dec complement level;
Allergies:
Diagnostic Lab Data: blood ct''s neg, WBC 30k toxic;
CDC Split Type:

Write-up: pt recvd vax; devel fever 105 on 18feb; referred to er; T 105; WBC 30k toxic; severe local rxn, blood cts neg; h/o dec complement;


VAERS ID: 72641 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-02-17
Onset:1995-02-22
   Days after vaccination:5
Submitted: 1995-03-13
   Days after onset:19
Entered: 1995-03-31
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 370904 / 4 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Infection, Pyrexia, Rash, Sepsis, Skin discolouration, Somnolence, Stupor
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (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), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-02-22
   Days after onset: 0
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: rt inguinal hernia
Allergies:
Diagnostic Lab Data: cultures shows septicemia due to streptococcus-final report pending
CDC Split Type:

Write-up: pt recvd vax;devel fever on 18feb95;tx w/ fluids & apap;devel rash & d;22feb95 somewhat improved but lethargic;same day was mottled & unresponsive; to er & expired;


VAERS ID: 72758 (history)  
Form: Version 1.0  
Age: 69.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-02-17
Onset:1995-02-19
   Days after vaccination:2
Submitted: 1995-03-27
   Days after onset:36
Entered: 1995-03-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site mass, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (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: scalp laceration
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: red area on lt shoulder w/nodule @ site of inj


VAERS ID: 72759 (history)  
Form: Version 1.0  
Age: 54.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-02-17
Onset:1995-02-24
   Days after vaccination:7
Submitted: 1995-03-27
   Days after onset:31
Entered: 1995-03-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4J1014 / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Injection site pain
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: Procardia
Current Illness: finger laceration
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain, redness, swelling up to neck site of TD inj; hard nodule underneath redness;


VAERS ID: 73182 (history)  
Form: Version 1.0  
Age: 1.6  
Gender: Female  
Location: Washington  
Vaccinated:1995-02-17
Onset:1995-02-24
   Days after vaccination:7
Submitted: 1995-02-28
   Days after onset:4
Entered: 1995-04-13
   Days after submission:43
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386988 / 4 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1062A / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0388A / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0709A / 3 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Anorexia, Coordination abnormal, Cough, Diarrhoea, Lymphadenopathy, Pyrexia, Rash, Rhinitis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none - had fever wk before vax;
Preexisting Conditions: eczema
Allergies:
Diagnostic Lab Data: throat culture neg for strep;
CDC Split Type: WA951086

Write-up: pt recvd vax;high fever up to 105; had cough, began rash on 26feb;to MD;swollen glands,sore throat,poor appetite;runny nose,loose stools, poor balance


VAERS ID: 73305 (history)  
Form: Version 1.0  
Age: 0.8  
Gender: Female  
Location: Illinois  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-04-11
   Days after onset:52
Entered: 1995-04-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386988 / 2 LL / IM

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: NONE
Current Illness: obstructed lt PE tube
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: screaming for 2 days p/DTP;


VAERS ID: 73420 (history)  
Form: Version 1.0  
Age: 8.0  
Gender: Female  
Location: Tennessee  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-17
   Days after onset:0
Entered: 1995-04-24
   Days after submission:65
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0924A / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0712F / 2 MO / PO
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Bradycardia, Cardiovascular disorder, Headache, Hypertonia, Hyperventilation, Hypotension, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (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: denies
Current Illness: denies
Preexisting Conditions: denies
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN95024

Write-up: 1035AM immed p/vax pt appeared faint became pale; became ridged w/elbows, wrists, hands & fingers flexed to chest; never cynotic; 911 was called; BP 90;/40, P28 & R36; remained unconscious approx 30-45seconds; c/o h/a, nausea & dizziness;


VAERS ID: 73560 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Colorado  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-03-10
   Days after onset:21
Entered: 1995-04-28
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51104 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51104 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Bronchitis, Cough, Diarrhoea, Dyspnoea, Laryngitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: pt was born @ 34wks
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: CO95012

Write-up: pt recv vax 17FEB95 1130AM & 930PM pt had t104; pt taken to ER; pt was also having some diarrhea; pt was treated for bronchitis/croup & given ATB


VAERS ID: 73599 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Kansas  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-03-17
   Days after onset:28
Entered: 1995-05-01
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4C51004 / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 380949 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anorexia, 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp t100 & crying @ 2mos w/DTP/HIB combo #1 dose;~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: KS95013

Write-up: crying, fever 104, dec appetite from 11PM 17FEB95 through evening of 19FEB95;


VAERS ID: 73908 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: Michigan  
Vaccinated:1995-02-17
Onset:1995-02-24
   Days after vaccination:7
Submitted: 1995-03-10
   Days after onset:14
Entered: 1995-05-08
   Days after submission:58
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1224A / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 5 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1290A / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 386935 / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MI95023

Write-up: 24FEB high fever 103 treated w/APAP; 25FEB t105.2; 26FEB t105.6 had sz 3PM last about 1 1/2 min; taken to ER; mom stated that MD felt that episode not vaccine related; pt doing well presently;


VAERS ID: 74120 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Unknown  
Location: Louisiana  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-04-11
   Days after onset:52
Entered: 1995-05-17
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51057 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 4M51117 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708J / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Crying
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (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:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: LA950301

Write-up: 155PM 17FEB95 mom calls in w/ c/o crying on & off since approx 930AM; high pitched cry; sleep-awakens w/cry; urged to call MD or to go to ER; mom reports pt is fine; saw MD pt cried until 230-245PM that same day; cried when leg touched;


VAERS ID: 74223 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: South Carolina  
Vaccinated:1995-02-17
Onset:1995-02-21
   Days after vaccination:4
Submitted: 1995-05-17
   Days after onset:84
Entered: 1995-05-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1627W / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash all over body, face arm stomach, back, on set 3 days ago t100.1;


VAERS ID: 74513 (history)  
Form: Version 1.0  
Age: 36.0  
Gender: Female  
Location: New York  
Vaccinated:1995-02-17
Onset:1995-02-24
   Days after vaccination:7
Submitted: 1995-05-26
   Days after onset:90
Entered: 1995-06-05
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1738W / 1 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Chest pain, Injection site pain, Insomnia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG done - nl per pt;
CDC Split Type:

Write-up: pt recv vax; pins & needle & numbness; burning sensation in lt upper arm which spread into lt chest; could not fall asleep at noc;


VAERS ID: 74813 (history)  
Form: Version 1.0  
Age: 55.0  
Gender: Female  
Location: California  
Vaccinated:1995-02-17
Onset:0000-00-00
Submitted: 1995-06-05
Entered: 1995-06-13
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / -

Administered by: Private       Purchased by: Other
Symptoms: Hypokinesia, Insomnia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (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: Estrogen transderma patch
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 5JUN95;
CDC Split Type:

Write-up: waking throughout the noc if rolling over on arm; loss of nl use of arm w/o pain; sharp, shock like pain when moved certain ways; cannot reach up; caved in look under arm pit; difficult time putting on coat or clothes;


VAERS ID: 75779 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-06-09
   Days after onset:111
Entered: 1995-07-10
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51052 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0653A / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51052 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0712C / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Screaming
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA95159

Write-up: pt recv vax; very irritable for 8 hr; later same day, inconsolable crying for 5 hr; apap given q/ 4 hr;


VAERS ID: 75793 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Washington  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-02-21
   Days after onset:4
Entered: 1995-07-10
   Days after submission:138
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51013 / 2 LA / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1529W / 2 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0712M / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal pain, Infection, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament 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: ~ ()~~~In patient
Other Medications: none
Current Illness: viral illness
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA951112

Write-up: pt recv vax;ate hamburger & layed down & said did not feel good & had said stomach & body ached;to MD; T 101; apap & kept at ofc x 2 hr; fell asleep at 2; dx as viral;


VAERS ID: 76144 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1995-02-17
Onset:1995-02-17
   Days after vaccination:0
Submitted: 1995-07-20
   Days after onset:152
Entered: 1995-07-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1374A1 / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: WI95012

Write-up: felt very sleepy, muscle fatigue, slept most of next 24hr, fever 104 for about 24 hr; client came to clinic to receive dose #3 on 20JUl95 & it was not given due to these reported rxn in FEB95


VAERS ID: 85102 (history)  
Form: Version 1.0  
Age: 52.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1995-02-17
Onset:1995-02-18
   Days after vaccination:1
Submitted: 1995-02-24
   Days after onset:6
Entered: 1996-03-14
   Days after submission:384
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4948176 / 1 LA / SC

Administered by: Private       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: ~ ()~~~In patient
Other Medications:
Current Illness: chronic diverticulitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895067001S

Write-up: pt recv vax;devel large area of redness & tenderness at inject site;48 hrs later exp period of severe malaise;pt claims that immed following the inject,her diverticulitis improved but it has since gotten worse;


VAERS ID: 89510 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1995-02-17
Onset:1995-02-22
   Days after vaccination:5
Submitted: 1996-06-20
   Days after onset:483
Entered: 1996-08-23
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61156 / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Rash, Vasodilatation
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: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6454

Write-up: 15 x 10 cm area of erythema & warmth over deltoid, lt;onset occurred on the fifth day following inj;


VAERS ID: 278486 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Foreign  
Vaccinated:1995-02-17
Onset:1998-06-14
   Days after vaccination:1213
Submitted: 2007-05-14
   Days after onset:3256
Entered: 2007-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 1631A9 / 3 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Brain stem auditory evoked response normal, CSF test abnormal, Demyelination, Multiple sclerosis, Nuclear magnetic resonance imaging abnormal, Optic neuritis retrobulbar, Visual evoked potentials abnormal
SMQs:, Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Ocular infections (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, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Familial history of neurologic disease with multiple sclerosis for the grand mother.
Allergies:
Diagnostic Lab Data: In unspecified date : - Auditory evoked potential : Normal - Cerebrospinal fluid electrophoresis : oligoclonal banding - Somesthesic evoked potentials : Normal - Visual evoked potentials : Abnormal. In August 1998 : - MRI : Demyelinating area
CDC Split Type: B0220517A

Write-up: Case, reference number 1999005958-1, is a regulatory report from the foreign agency (CF9900017), referring to a female aged 16 years. The patient''s family history included multiple sclerosis (grand mother). On 21 December 1994, 25 January and 17 February 1995, the patient was vaccinated with Engerix B for hepatitis B prophylaxis. She then developed asthenia (no delay precision). On 14 June 1998, the patient developed left retrobulbar neuritis for which she was hospitalized on the same day. The patient was treated for retrobulbar neuritis with Solumedrol (methylpredisolone) for 3 days, followed by Cortancyl for 10 days. At an unspecified date, cerebrospinal fluid electrophoresis revealed oligoclonal banding. Visual evoked potentials were abnormal but auditory and sensitive evoked potentials were normal. In August 1998, MRI revealed demyelinating areas. Diagnosis of multiple sclerosis was then set. In February 1999, the patient still complained about asthenia. The most recent information received on 16 March 2000 reports the outcome of the patient as not yet recovered. Causality assessment was coded as dubious by foreign agency. Follow-up information was received on 03 May 2007 and revealed no significant information.


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