|
VAERS ID: |
25487 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-02-16 |
Onset: | 1990-03-17 |
Days after vaccination: | 29 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
40967/2130R / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Pyrexia,
Rash maculo-papular 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? Yes
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: none CDC Split Type: WAES90040109
Write-up: 19 mon. male vaccinated /w MMRII vaccine. 17Mar90, developed a maculopapular rash of both arms, legs & cheek /w high fever. Rash became purpuric 2Apr90. Rash remitted spontaneously total duration 15-17 days. No further info. provided |
|
VAERS ID: |
25525 (history) |
Form: |
Version 1.0 |
Age: |
35.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-04-11 |
Onset: | 1990-04-18 |
Days after vaccination: | 7 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
1987R / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Chest pain,
Dehydration,
Pyrexia,
Rash SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Echocardiogram was normal. CDC Split Type: WAES90050402
Write-up: Pt. vaccinated w/Measles virus vaccine, live on 11-APR-90. 18-APR-90 or 19-APR-90 developed fever. 20-APR-90 developed rash pt was hospitalized on 24-APR-90 w/dx of measles w/dehydration & chest pain. Rule out pericarditis. |
|
VAERS ID: |
25532 (history) |
Form: |
Version 1.0 |
Age: |
28.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1990-05-04 |
Onset: | 1990-05-04 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MER: MEASLES + RUBELLA (MR-VAX II) / MERCK & CO. INC. |
461701053R / 2 |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: Arthralgia,
Cough,
Malaise,
Otitis media,
Overdose,
Pneumonia,
Rash maculo-papular,
Tendon disorder SMQs:, Anaphylactic reaction (broad), Drug abuse and dependence (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: chest x-ray- neg. CDC Split Type: WAES90060287
Write-up: Pt was inadvertently revaccinated /w MMR vaccine twice within a 5 month period. 6May90 developed malaise, otitis media, viral pneumonia & tendinitis lt wrist. Also measle like symtoms/w rash & cough.Symtoms X 4 wks. Hosp.on 7Jun90. see WORM |
|
VAERS ID: |
25554 (history) |
Form: |
Version 1.0 |
Age: |
10.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-06-07 |
Onset: | 1990-06-20 |
Days after vaccination: | 13 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
48381/0691S / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: unknown Current Illness: no relevant history Preexisting Conditions: Allergies: Diagnostic Lab Data: no relevant data CDC Split Type: WAES90060998
Write-up: R.Ph reported 10 y.o. was given vaccine & 13 days later had a seizure. |
|
VAERS ID: |
25556 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1989-10-20 |
Onset: | 1989-10-25 |
Days after vaccination: | 5 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
42622/1644R / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Sepsis SMQs:, Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1989-10-25
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: no relevant history Preexisting Conditions: Allergies: Diagnostic Lab Data: autopsy-strep sepsis, The physician & autopsy pathologist felt that the pt''s dealth was not related to vaccination. CDC Split Type: WAES89100782
Write-up: MD reported pt initially vac. w/ MMR live at 15 mo''s was vac. w/ booster MMR on 10-20-89 along w/ DTP. Pt died 10-25-89. Autopsy = overwhelming strep. sepsis. MD and autopsy pathologist felt pt death not related to vaccination. |
|
VAERS ID: |
25561 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-06-26 |
Onset: | 1990-07-06 |
Days after vaccination: | 10 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
12275 / UNK |
- / IM |
Administered by: Private Purchased by: Private Symptoms: CSF test abnormal,
Convulsion,
Leukocytosis,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: LUMBAR PUNCTURE - NEUTROPHILS IN CSF. CULTURE NEGATIVE. WBC 11,400 (69 POLYS, 9 BANDS) CSF 26 RBC''S 6 WBC''S (3 POLYS & 3 LYMPHS) CDC Split Type:
Write-up: HAD VAC ON 6-26-90. ON 7-6-90, TEMP 105.5, HAD SZ X 10 MINUTES. ADMITTED TO HOSP. LP ABNORM (NEUTROPHILS IN CSF) CULTURE NEGATIVE. CHILD FINE |
|
VAERS ID: |
25568 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-05-26 |
Onset: | 1990-05-28 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
1014S / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Grand mal convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: no relevent history Allergies: Diagnostic Lab Data: MRI 19Jun90- normal, EEG 19Jun-90 minimal abnormality CDC Split Type: WAES90070154
Write-up: Pt vacc. /w Measles virus 26May90. A day & 1/2 /p vacc. pt had grand mal sizure. Pt in ER. 19Jul90 MRI scan and EEG demonstrated minimal abnormality. Additional info. requested. |
|
VAERS ID: |
25611 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1990-06-29 |
Onset: | 1990-06-30 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
409672130R / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Atrioventricular block,
Chest pain,
Pericarditis SMQs:, Systemic lupus erythematosus (broad), Conduction defects (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: medical history of pericarditis Allergies: Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis CDC Split Type: WAES90070002
Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized |
|
VAERS ID: |
25620 (history) |
Form: |
Version 1.0 |
Age: |
23.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-05-04 |
Onset: | 1990-05-07 |
Days after vaccination: | 3 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: Anorexia,
Asthenia,
Back pain,
Chills,
Cough,
Drug ineffective,
Headache,
Hyperglycaemia,
Malaise,
Nausea,
Photophobia,
Pyrexia,
Rash maculo-papular,
Urinary tract infection,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: insulin & buffered aspirin Current Illness: Preexisting Conditions: allergy codeine, diabetes mellitus Allergies: Diagnostic Lab Data: Serum glucose May89- 150''s prior 70-80''s, Serum glucose 17May89- 249, urine culture 7May89-Entercoccuus, staphylococcus, Lumbar puncture 15May89- normal CDC Split Type: ARR52.371
Write-up: 3 days /p vaccine pt felt queazy, weak /w nausea, & vomited. 6 days post vaccine experianced lt buttock and LB pain, photophobia, headache, fever & chills. 15May90 hospitalized /w bilat. buttock pain,fever,rash,abdo & backpain. Recovered |
|
VAERS ID: |
25629 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 1990-05-09 |
Onset: | 1990-05-11 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Asthenia,
Conjunctivitis,
Cough,
Dehydration,
Diarrhoea,
Drug ineffective,
Headache,
Pain,
Pharyngitis,
Photophobia,
Pruritus,
Pyrexia,
Rash maculo-papular,
Vomiting SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES90051228
Write-up: Pt vaccinated w/MMRII, 2 days following vaccination she experienced generalized achiness, fever, fatigue, rash & intermittent vomiting w/loose bowel movements. See WORM for more details. |
|