|
VAERS ID: |
41099 (history) |
Form: |
Version 1.0 |
Age: |
1.6 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1992-02-20 |
Onset: | 1992-02-21 |
Days after vaccination: | 1 |
Submitted: |
1992-03-19 |
Days after onset: | 27 |
Entered: |
1992-04-06 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
318908 / 4 |
LA / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M160HH / 2 |
RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1531T / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0642M / 4 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Cellulitis 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? 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: CDC Split Type: GA9242
Write-up: Began Friday 21FEB92 went to ER admitted-d/c sat evening 22FEB92 dx Cellulitis |
|
VAERS ID: |
41118 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1992-01-17 |
Onset: | 1992-01-20 |
Days after vaccination: | 3 |
Submitted: |
1992-02-13 |
Days after onset: | 24 |
Entered: |
1992-04-06 |
Days after submission: | 52 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M180HH / 4 |
RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1531T / 1 |
LA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0637D / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Bronchitis,
Convulsion,
Iron deficiency anaemia,
Leukocytosis,
Otitis media,
Pneumonia,
Pyrexia,
Respiratory alkalosis SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (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, 4 days
Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: White count 27,600 w/ 63 segs, 12 bands, 22 lymphs, & 3 monos; Hemoglobin 10.1, hematocrit 30.4; UA-neg; SMA-21-neg x/for AST-40; LDH-315, Alk phos-188, CO2-15.3, & glucose-120; CXR-poss bronchitis; CDC Split Type: GA9261
Write-up: Admitted to hosp 20JAN92 w/t105.6; pt exp eye rolling back, shaking all over; cough, coryza, congestion; also vomiting, rhonchi, bronchitis, OM, FE def anemia, pneumonia; |
|
VAERS ID: |
41133 (history) |
Form: |
Version 1.0 |
Age: |
1.6 |
Sex: |
Male |
Location: |
Missouri |
Vaccinated: | 1991-11-08 |
Onset: | 1991-12-02 |
Days after vaccination: | 24 |
Submitted: |
1992-03-26 |
Days after onset: | 115 |
Entered: |
1992-04-07 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
306928 / 3 |
LA / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1140T / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0645C / 2 |
MO / PO |
Administered by: Public Purchased by: Private Symptoms: Lymphadenopathy SMQs:, 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: NONE~ ()~~~In patient Other Medications: NONE Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: MO92016
Write-up: Pt recvd vax 8NOV91 & 2DEC91 lump node devel in left neck; lymph node inflamed pt recvd ATB; 4DEC91 surgery; |
|
VAERS ID: |
41139 (history) |
Form: |
Version 1.0 |
Age: |
1.6 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1992-02-05 |
Onset: | 1992-02-17 |
Days after vaccination: | 12 |
Submitted: |
1992-04-02 |
Days after onset: | 45 |
Entered: |
1992-04-07 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M565FP / 4 |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1351T / 1 |
- / SC |
Administered by: Private Purchased by: Unknown 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? No
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: NONE Allergies: Diagnostic Lab Data: EEG-neg; CDC Split Type:
Write-up: Sz on 17FEB92 11 days p/MMR/HIB; |
|
VAERS ID: |
41213 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 1991-12-06 |
Onset: | 1991-12-21 |
Days after vaccination: | 15 |
Submitted: |
1992-04-03 |
Days after onset: | 104 |
Entered: |
1992-04-13 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 1 |
LA / SC |
Administered by: Private Purchased by: Private Symptoms: Ecchymosis,
Thrombocytopenia,
Thrombocytopenic purpura SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: 21DEC PH-11.8; plt f/u 30DEC91 361; CDC Split Type:
Write-up: Mom noted new bruises both knees on 21DEC91 took to pts orthopedic hosp for eval; Plt ct 11.8 adm for IVIG; dx ITP; discharge 23DEC91 PH 104; |
|
VAERS ID: |
41283 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: | 1992-03-24 |
Onset: | 1992-04-02 |
Days after vaccination: | 9 |
Submitted: |
1992-04-13 |
Days after onset: | 10 |
Entered: |
1992-04-20 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M160HH / 4 |
LA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1156T / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
308954 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Convulsion,
Cyanosis,
Pneumonia SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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, 1 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CXR-minimal perihilar pneum; Hgb-12.7; CBC=WBC 10,100; Hct-37; CDC Split Type: OK9217
Write-up: Had convuls type seizure @ home per moms hx; pt became cyanotic & was placed in towel & taken to ER; |
|
VAERS ID: |
41318 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1992-01-27 |
Onset: | 1992-02-06 |
Days after vaccination: | 10 |
Submitted: |
1992-02-11 |
Days after onset: | 5 |
Entered: |
1992-04-20 |
Days after submission: | 68 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1140T / 1 |
RL / SC |
Administered by: Public Purchased by: Public Symptoms: Arthropathy,
Conjunctivitis,
Convulsion,
Hypokinesia,
Photophobia,
Pyrexia,
Urticaria SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Arthritis (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, 2 days
Extended hospital stay? No
Previous Vaccinations: pt exp rxn 26NOV90 @ 2mos w/DTP #1; sibling exp rxn @ 4mos w/DTP #2;~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: rxn to DTP 26NOV90; Allergies: Diagnostic Lab Data: spinal tap-nl; CDC Split Type: WI92012
Write-up: 6FEB92 pt devel fever 101 ax; eyes red & light sensitive; also blotchy rash all over; pt taken to MD; had sz which mom states lasted 5min; pt hospitalized x 2 days; also devel joint stiffness w/some difficulty walking; |
|
VAERS ID: |
41319 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1991-02-13 |
Onset: | 1991-02-26 |
Days after vaccination: | 13 |
Submitted: |
1992-01-28 |
Days after onset: | 336 |
Entered: |
1992-04-20 |
Days after submission: | 82 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0J11070 / 1 |
LA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1712S / 1 |
RA / SC |
Administered by: Public Purchased by: Public Symptoms: Apnoea,
Cardiac arrest,
Convulsion,
Encephalitis,
Hypothermia,
Infection,
Meningitis,
Stupor SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Accidents and injuries (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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? Yes, 14 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Many test done; spinal tap-no growth on cultures p/6months; CDC Split Type: WI92013
Write-up: Pt very sick; 17JAN92 dx meningitis/encephalitis; pt recvd vax on 13FEB91; On 20, 23 & 24FEB92 had a sl fever w/no other sx; On 26FEB91 @ 430PM mom noted pt looked dazed, pt did not respond; began sz & stopped breathing, CPR, cardiac arrest |
|
VAERS ID: |
41343 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: | 1992-03-30 |
Onset: | 1992-03-31 |
Days after vaccination: | 1 |
Submitted: |
1992-04-09 |
Days after onset: | 8 |
Entered: |
1992-04-20 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
1F31022 / 2 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M130HJ / 2 |
RL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
G0123 / 2 |
RL / IM |
Administered by: Private Purchased by: Private Symptoms: Convulsion,
Gaze palsy,
Pyrexia,
Stupor SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), 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, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Amoxicilling Current Illness: URI/mee Preexisting Conditions: irritable lethargic infant r/o sepsis; hosp 13NOV-16NOV all neg; Allergies: Diagnostic Lab Data: EEG-neg; CDC Split Type:
Write-up: Rolled back eyes & tonic-clonic movements (seizure) followed by sleep, low grade fever; |
|
VAERS ID: |
41360 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Male |
Location: |
Alaska |
Vaccinated: | 1992-02-25 |
Onset: | 1992-03-08 |
Days after vaccination: | 12 |
Submitted: |
1992-03-24 |
Days after onset: | 16 |
Entered: |
1992-04-22 |
Days after submission: | 28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
293949 / 4 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M140HS / 3 |
RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1899S / 1 |
RL / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
302935 / 3 |
MO / PO |
Administered by: Public Purchased by: Private Symptoms: Bronchiolitis,
Cough,
Dehydration,
Infection,
Pyrexia,
Rash SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (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? 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: NONE Allergies: Diagnostic Lab Data: bronchiolitis; CDC Split Type: AK92009
Write-up: Pt devel a high fever 105 w/body rash, dehydration & a prod cough; pt was hospitalized x 24 hrs & tx w/mist tent, IV fluids, PCN; d/c on PCN VK dx bronchiolitis; |
|