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VAERS ID: 25001 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Wisconsin  
Vaccinated:1990-06-04
Onset:1990-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9Q01042 / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loud intense cry with screaming for 1 1/2 hrs. Seen next day, child normal.


VAERS ID: 25002 (history)  
Form: Version 1.0  
Age: 82.0  
Gender: Male  
Location: Foreign  
Vaccinated:1989-11-20
Onset:1989-11-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. M0870 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Thioridazine, Triazolam,
Current Illness:
Preexisting Conditions: Senile dementia, Diabetes mellitus, seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES90040535

Write-up: 23 hrs post vaccination, developed seizures followed by rigor. Vaccine was given as a prophylaxis.


VAERS ID: 25003 (history)  
Form: Version 1.0  
Age: 0.8  
Gender: Male  
Location: Texas  
Vaccinated:1990-01-29
Onset:1990-02-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259962 / 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 241950 / 4 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.


VAERS ID: 25004 (history)  
Form: Version 1.0  
Age: 0.9  
Gender: Male  
Location: New York  
Vaccinated:1989-11-13
Onset:1989-11-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 232961 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chills, Dermatitis contact, Oedema genital, Pelvic pain
SMQs:, Angioedema (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 890269201

Write-up: Pt developed chills for approx. 1 hr, felt achy all over, genital area turned red with some swelling, no pain 24 hrs later, now has pain in genital area. Genitals pain, swelling, redness for 8 days. Fever, dematitis contact, rigors


VAERS ID: 25005 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: Oklahoma  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 247955 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthritis, Injection site oedema, Injection site reaction
SMQs:, Systemic lupus erythematosus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 890277901

Write-up: 7 patients within 2 weeks have reported joint pain & tenderness which radiated up to the shoulder, redness & slight swelling @ injection site, no treatment prescribed, 1 patient is due to visit a neurologist for shoulder. Vaccines routine


VAERS ID: 25006 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Ohio  
Vaccinated:1989-11-17
Onset:1989-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 247953 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: no hx of local or systemic rxns
Allergies:
Diagnostic Lab Data:
CDC Split Type: 890278001

Write-up: 16 yr old female feeling faint & then had seizure within a few min. /p Td/MMR immunization. MD is uncertain if seizure was due to hyperventilation episode. No treatment initiated. Pt asymptomatic. Vaccine given routine


VAERS ID: 25007 (history)  
Form: Version 1.0  
Age: 39.0  
Gender: Unknown  
Location: Oregon  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 229968 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site inflammation, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (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: 900005902

Write-up: 2 or 3 patients who received immunization & developed swollen red arm.


VAERS ID: 25008 (history)  
Form: Version 1.0  
Age: 75.0  
Gender: Female  
Location: Unknown  
Vaccinated:1989-07-05
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 199602 / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site inflammation, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (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: 8901590.01

Write-up: Pt developed an inject site rxn. Aea was erthematous, hard & warm to touch several days /p immunization, treated w/ Benadryl.


VAERS ID: 25009 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Florida  
Vaccinated:1990-04-05
Onset:1990-04-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0333P / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Deafness
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: recurrent otitis media, measles
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES90030661

Write-up: 15mon. male w/ hx of recurrent ear infections & measles in Feb. 89''. 5Apr89 was given MMR. Within 24 hrs /p vaccine, parents noted hearing deficit, confirmed by physician exam.


VAERS ID: 25010 (history)  
Form: Version 1.0  
Age: 1.7  
Gender: Male  
Location: Foreign  
Vaccinated:1989-10-29
Onset:1989-12-01
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. A2223P / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Bronchitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Promethanzine HCL given 21Dec89-21Dec89
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Dianostic test - Autopsy, Date Dec89 , comment - Streptococcal tracheobronchitis
CDC Split Type: WAES90060362

Write-up: 17 mon. male, received 29Oct89 MMR vaccine 1 dose. 21Dec89 received therapy w/ Promethazine HCL, HS. 22Dec89 infant found dead. Post mortem revealed acute Streptococcal tracheobronchitis.


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