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VAERS ID: 38876 (history)  
Age: 1.2  
Gender: Male  
Location: Minnesota  
Vaccinated:1991-09-24
Onset:1991-09-25
   Days after vaccination:1
Submitted: 1991-12-03
   Days after onset:69
Entered: 1992-01-17
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 304924 / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 0 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Cough, Crying, Dyspnoea, Laryngitis, Pneumonia, Pyrexia, Stridor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 26SEP91 RBC 4.83, white count 9,100, hemoglobin 12.3, hematocrit 37, MCHC 33.2, MCH 25, MCV 77, 58 segs, 1 eo, 8 monos, 33 lymphs; throat cult-nl; cold agglutin titer less than 1:4; x-ray;
CDC Split Type: MN91052

Write-up: Pts mom came into office stating that the evening p/pt recvd vax was hospitalized w/pneumonia & croup; mom stated MD indicated that this could be a poss reaction to DTP vax; rxn reported on 16OCT; pt irritable, crying, stridor, vomit, fever


VAERS ID: 38877 (history)  
Age: 65.0  
Gender: Male  
Location: Minnesota  
Vaccinated:1991-10-28
Onset:1991-10-30
   Days after vaccination:2
Submitted: 1991-11-04
   Days after onset:5
Entered: 1992-01-17
   Days after submission:74
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918121 / 0 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hypokinesia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MN91053

Write-up: Client c/o pain in lt arm, limited mobility, lasting 3 wks length was seen by MD;


VAERS ID: 38878 (history)  
Age: 1.3  
Gender: Female  
Location: Minnesota  
Vaccinated:1991-12-05
Onset:1991-12-12
   Days after vaccination:7
Submitted: 1991-12-17
   Days after onset:5
Entered: 1992-01-17
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 3 RA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 306959 / 2 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Infection, 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MN91054

Write-up: Awoke w/fever of 104 treated by parents w/APAP; fever continued until 17DEC & was treated w/APAP; seen by MD 730AM 17DEC dx as virus no evidence of OM; no treatment prescribed; afebrile for past 32 hrs; remains fussy;


VAERS ID: 38879 (history)  
Age: 32.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1991-12-12
Onset:1991-12-17
   Days after vaccination:5
Submitted: 1991-12-23
   Days after onset:6
Entered: 1992-01-17
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1J21144 / 0 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Diarrhoea, Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (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), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: 11NOV91 MMR given MSD; Lot #0859t;SC;lt arm and OPV Lederle;298956;po
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MN92001

Write-up: t99.6 on 17DEC nausea, diarrhea, h/a, irritable the diarrhea & irritability has persisted still present 23DEC;


VAERS ID: 38880 (history)  
Age: 0.4  
Gender: Male  
Location: North Carolina  
Vaccinated:1991-08-02
Onset:1991-08-02
   Days after vaccination:0
Submitted: 1992-01-08
   Days after onset:159
Entered: 1992-01-17
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HB / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614L / 1 - / PO

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NC92001

Write-up: Fever 102 R Friday night until Sunday noon gradually came down & no fever p/Sunday night; did not eat or drink for 48 hrs p/shot; high pitched screaming from Friday about 6PM until Sunday night for long period of time; Seen by MD;


VAERS ID: 38881 (history)  
Age: 2.0  
Gender: Male  
Location: Nebraska  
Vaccinated:1992-01-07
Onset:1992-01-08
   Days after vaccination:1
Submitted: 1992-01-10
   Days after onset:2
Entered: 1992-01-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 0 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Lymphadenopathy, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NE921

Write-up: Pt ran fever of 103.2 R the day p/receiving MMR vax; APAP given & improved pts sx; pt was not eating & lethargic; parents did not contact MD; On 10JAN92 parent reports pt has swollen glands but is not running a fever;


VAERS ID: 38882 (history)  
Age: 1.5  
Gender: Female  
Location: Oklahoma  
Vaccinated:1992-01-07
Onset:1992-01-07
   Days after vaccination:0
Submitted: 1992-01-09
   Days after onset:2
Entered: 1992-01-17
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308924 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308954 / 2 - / PO

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OK921

Write-up: Continuous crying for @ least 5 hrs following vax administration; no fever; no neurologic abnormalities noted;


VAERS ID: 38883 (history)  
Age: 0.6  
Gender: Female  
Location: South Carolina  
Vaccinated:1992-01-09
Onset:1992-01-09
   Days after vaccination:0
Submitted: 1992-01-09
   Days after onset:0
Entered: 1992-01-17
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 2 RL / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: SC92008

Write-up: Pt devel local reaction, reddened area around inject site w/in 1 min following inject; applied cool compress & requested pt wait x 20 min; area around inject site was sl pink when pt left clinic; Advised mom to contact MD if needed;


VAERS ID: 38885 (history)  
Age: 61.0  
Gender: Male  
Location: New York  
Vaccinated:1991-11-27
Onset:1991-12-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1992-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

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

Write-up: Guillain-Barre Synd (GBS);


VAERS ID: 38886 (history)  
Age: 42.0  
Gender: Female  
Location: Virginia  
Vaccinated:1992-01-09
Onset:1992-01-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1530T / - - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthma, Malaise
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, Cronolyn, Aerobid, Ventolin
Current Illness:
Preexisting Conditions: asthmatic bronchitis, allergist will pursue scratch test to r/o pneumovax or vehicle; hx sl reaction to eggs;
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1400 felt strange, 1410 notable wheezing audibly w/prolonged expiratory component able to converse & respond; 1425-1430 Methylprednisolone; 1435 Diphenhydramine, Albuterol; to hosp;


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