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Case Details (Sorted by Age)

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VAERS ID:59482 (history)  Vaccinated:1993-06-15
Age:16.0  Onset:1993-06-16, Days after vaccination: 1
Gender:Female  Submitted:1993-10-21, Days after onset: 127
Location:New Jersey  Entered:1993-11-03, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 930000641
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0  
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Cough
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Pt recvd vax & the next day exp persistent cough & asthma-like sx;

VAERS ID:59520 (history)  Vaccinated:1993-07-13
Age:16.0  Onset:1993-07-13, Days after vaccination: 0
Gender:Female  Submitted:1993-07-21, Days after onset: 8
Location:Virginia  Entered:1993-11-03, Days after submission: 105
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': 930002011
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1096A40IMA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recvd vax & 3 hrs p/dose had rash & itching on arms legs & face; pt was seen by a MD;

VAERS ID:60183 (history)  Vaccinated:1992-11-24
Age:16.0  Onset:1992-11-24, Days after vaccination: 0
Gender:Female  Submitted:1993-02-03, Days after onset: 71
Location:Ohio  Entered:1993-11-03, Days after submission: 273
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': EBU930179
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1066A2  RA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt recvd vax & exp pain, burning & stinging upon inject;

VAERS ID:60480 (history)  Vaccinated:1993-04-19
Age:16.0  Onset:1993-04-20, Days after vaccination: 1
Gender:Female  Submitted:1993-05-24, Days after onset: 34
Location:California  Entered:1993-11-03, Days after submission: 163
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': EBU930845
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1055A40IMLA
Administered by: Private     Purchased by: Private
Symptoms: Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt recvd vax & exp nausea, vomiting & sl temp elevation (99.1); was een by MD sx have subsided;

VAERS ID:60489 (history)  Vaccinated:1993-05-07
Age:16.0  Onset:1993-05-21, Days after vaccination: 14
Gender:Male  Submitted:1993-05-27, Days after onset: 6
Location:California  Entered:1993-11-03, Days after submission: 160
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': EBU930858
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1079A2 IMA
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Pt recvd vax & 21MAY93 exp Bell''s palsy pt was seen by MD; sx have not subsided;

VAERS ID:57647 (history)  Vaccinated:1993-08-20
Age:16.7  Onset:0000-00-00
Gender:Female  Submitted:1993-11-08
Location:Nevada  Entered:1993-11-23, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: pos pregnancy test;
CDC 'Split Type': NV93035
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0062W1SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES3409274PO 
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: pt stated that was not sexually active or pregnant @ the time of immun & that pt had a normal period that month; pt was actually 2 wks pregnant;

VAERS ID:57682 (history)  Vaccinated:1993-08-09
Age:16.7  Onset:1993-08-10, Days after vaccination: 1
Gender:Male  Submitted:1993-08-12, Days after onset: 2
Location:Idaho  Entered:1993-11-26, Days after submission: 106
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': ID93068
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES3569075IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chills, Delirium, Headache, Infection, Nausea, Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 9AUG93 vax administered 330PM; 10AUG93 930AM nausea/vomiting; 10AM temp inc & h/a then n/v x 4 hrs; 7PM chills & sleepy-delerious; poss viral illness;

VAERS ID:58070 (history)  Vaccinated:1993-08-24
Age:16.5  Onset:1993-08-24, Days after vaccination: 0
Gender:Male  Submitted:1993-10-19, Days after onset: 56
Location:Pennsylvania  Entered:1993-12-09, Days after submission: 51
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': PA93149
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1099A40 LA
Administered by: Public     Purchased by: Public
Symptoms: Insomnia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: tingling, numbness of whole lt side of body, unable to sleep lasted 2 days;

VAERS ID:58213 (history)  Vaccinated:1993-10-29
Age:16.1  Onset:1993-10-29, Days after vaccination: 0
Gender:Male  Submitted:1993-11-01, Days after onset: 3
Location:California  Entered:1993-12-13, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)PFIZER/WYETH49381580IMLA
Administered by: Public     Purchased by: Private
Symptoms: Headache, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: began to pass out immediately upon receiving flu shot, out for only 5-10 seconds; VS BP 98/68; P68; resp reg skin w/d; woke up alert/oriented p/15 mins sitting down taking fruit juice, BP 90/64, P64; feeling much better p/30 mins sl h/a;

VAERS ID:58317 (history)  Vaccinated:1993-10-14
Age:16.0  Onset:1993-10-14, Days after vaccination: 0
Gender:Male  Submitted:1993-10-14, Days after onset: 0
Location:Texas  Entered:1993-12-20, Days after submission: 67
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt''s sibling exp sz @ high school w/Td booster #unk #;
Other Medications: NONE
Current Illness: negative
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': TX93230
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES3489102IMLA
Administered by: Public     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)
Write-up: immed p/vax pt fell backwards across exam table & had mild sx lasted less than 1 min; pt regained consciousnesss; VS taken all WNL; MD did neuro exam-was neg; less than 10 mins p/sz had 2 more similar to 1st;

VAERS ID:58865 (history)  Vaccinated:1993-11-16
Age:16.1  Onset:1993-11-16, Days after vaccination: 0
Gender:Female  Submitted:1993-11-19, Days after onset: 3
Location:Arizona  Entered:1994-01-07, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn @ 2mos w/DTP all doses;
Other Medications:
Current Illness: NONE
Preexisting Conditions: numerous allergies;
Diagnostic Lab Data:
CDC 'Split Type': AZ9342
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES3499060IMLA
Administered by: Other     Purchased by: Public
Symptoms: Face oedema, Injection site hypersensitivity, Injection site oedema, Injection site pain, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: when mom picked pt up p/school, face was swollen hands swollen, inject site was red, swollen & tender to touch; t101 x 3 days;

VAERS ID:59131 (history)  Vaccinated:1993-03-03
Age:16.0  Onset:1993-03-21, Days after vaccination: 18
Gender:Male  Submitted:1993-03-23, Days after onset: 2
Location:California  Entered:1994-01-18, Days after submission: 301
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': CA94005
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0966V  RA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0670M PO 
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4938033  LA
Administered by: Public     Purchased by: Public
Symptoms: Pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash started on neck & face 21MAR93; mom says getting worse & is now painful; no fever or URI;

VAERS ID:59300 (history)  Vaccinated:1993-07-21
Age:16.3  Onset:1993-07-21, Days after vaccination: 0
Gender:Female  Submitted:1993-08-04, Days after onset: 14
Location:Kansas  Entered:1994-01-27, Days after submission: 176
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NOnE
Diagnostic Lab Data:
CDC 'Split Type': KS93053
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES3269856IMLA
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiovascular disorder, Hyperhidrosis, Muscle twitching, Pallor, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: twitching of arms & hands noted by sister while waiting for mom to pay for inject; walked from treatment room to pt-color pale, skin cool & moist, unresponsive to verbal stimuli, pulse thin, no resp until placed on floor then began crying;

VAERS ID:59408 (history)  Vaccinated:1994-01-21
Age:16.8  Onset:1994-01-21, Days after vaccination: 0
Gender:Female  Submitted:1994-01-24, Days after onset: 3
Location:Massachusetts  Entered:1994-01-31, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PCN
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1246A41IMRA
Administered by: Private     Purchased by: Public
Symptoms: Pruritus, Rash, Skin nodule
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 1 cm nodule, erythema, pruritus;

VAERS ID:60696 (history)  Vaccinated:1994-01-25
Age:16.3  Onset:1994-01-25, Days after vaccination: 0
Gender:Female  Submitted:1994-01-28, Days after onset: 3
Location:Minnesota  Entered:1994-02-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': MN94002
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0341W1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt devel local immed @ site of inject lt deltoid w/swelling, erythema, & welts; 5 mins p/inject hives/welts spread to abdo & back w/extensive itching/irritation a systemic react; applied ice to local area; site of inject;

VAERS ID:59810 (history)  Vaccinated:1993-10-14
Age:16.7  Onset:1993-10-23, Days after vaccination: 9
Gender:Female  Submitted:1994-02-09, Days after onset: 109
Location:Kentucky  Entered:1994-02-14, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Menstrual disturbance
Current Illness:
Preexisting Conditions: No relevant history
Diagnostic Lab Data: pregnancy test 28OCT93 pos;
CDC 'Split Type': WAES93110070
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1143W1IM 
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: Pt recvd vax & 28OCT93 a pregnancy test was pos; pt elected to terminate pregnancy during the wk of 23OCT93;

VAERS ID:59977 (history)  Vaccinated:1994-02-14
Age:16.7  Onset:1994-02-14, Days after vaccination: 0
Gender:Male  Submitted:1994-02-14, Days after onset: 0
Location:Missouri  Entered:1994-02-22, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MO94010
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES3D510790 LA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: fainted & mild sz <30 secs; no loss of bowel/bladder control; seen by MD & released;

VAERS ID:62673 (history)  Vaccinated:1992-06-01
Age:16.8  Onset:1992-06-01, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Florida  Entered:1994-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: allergy, phenergan
Diagnostic Lab Data: no relevant data
CDC 'Split Type': WAES93020818
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Asthenia, Malaise, Myalgia, Pyrexia, Rash, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt rcvd vax; w/in 24 hrs of 2nd dose; pt devel erythema & rash on face; pt exp malaise; achy joints; muscles aches; generalized weakness; flushing & t 101;

VAERS ID:62885 (history)  Vaccinated:1993-03-24
Age:16.4  Onset:1993-03-24, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Louisiana  Entered:1994-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES93031383
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Ear pain, Headache, Lymphadenopathy, Nausea, Pharyngitis
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recvd vax 24MAR93 & on the same day devel h/a, sore throat, lt sided earache, swollen glands & nausea; No further details were provided;

VAERS ID:63631 (history)  Vaccinated:1992-10-12
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Ohio  Entered:1994-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES93051052
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: pt recvd vax & exp unspecified reaction; No further details were provided;

VAERS ID:64062 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Delaware  Entered:1994-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: no relevant data;
CDC 'Split Type': WAES93071106
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Cough, Rhinitis
SMQs:, Anaphylactic reaction (broad)
Write-up: pt recvd vax; w/in 24 hrs after vax, pt devel runny nose & a cough; cough was severe & lasted for 8-10 days; tx dilaudid;

VAERS ID:64082 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:North Carolina  Entered:1994-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: no relevant data;
CDC 'Split Type': WAES93080126
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Face oedema, Laryngospasm, Serum sickness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Hypersensitivity (narrow)
Write-up: pt recvd vax; pt exp''d a serum sickness rx including swelling of nose & throat;

VAERS ID:64111 (history)  Vaccinated:1993-08-12
Age:16.0  Onset:1993-08-13, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Delaware  Entered:1994-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: no relevant data;
CDC 'Split Type': WAES93080755
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Anorexia, Asthenia, Infection, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recvd vax; pt devel weakness, fever & t 101; ppt had no appetite, & pain in stomach; lab tests revealed pos EBV titer of 640; pt tx w/ anacin;

VAERS ID:64364 (history)  Vaccinated:1993-11-18
Age:16.5  Onset:1993-11-20, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:1994-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES93120043
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1043W IM 
Administered by: Other     Purchased by: Other
Symptoms: Infection, Laboratory test abnormal, Lymphocytosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: pt recvd vax on 18NOV93 & 20NOV93 devel a fever of 102; No further details were provided;

VAERS ID:60699 (history)  Vaccinated:1994-02-23
Age:16.8  Onset:1994-02-24, Days after vaccination: 1
Gender:Female  Submitted:1994-03-04, Days after onset: 8
Location:Minnesota  Entered:1994-03-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC 'Split Type': MN94005
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1138V1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Lymphadenopathy, Myalgia, Neck pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: neckache, fever h/a, body aches, enlarged lymph glands x 4 days;

VAERS ID:60735 (history)  Vaccinated:1994-03-01
Age:16.4  Onset:1994-03-03, Days after vaccination: 2
Gender:Female  Submitted:1994-03-04, Days after onset: 1
Location:Louisiana  Entered:1994-03-17, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': LA940306
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES356906  LA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site oedema, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 2 days following vax pt states awoke AM 3MAR94 w/swelling of baseball @ inject site; called MD & APAP & DPH given; 4MAR94 swellling dec-pain gone;

VAERS ID:61533 (history)  Vaccinated:1994-03-22
Age:16.4  Onset:1994-03-22, Days after vaccination: 0
Gender:Male  Submitted:1994-03-25, Days after onset: 3
Location:Virginia  Entered:1994-04-04, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD; Dicloxacillin, Bacitracin oint;
Current Illness:
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC 'Split Type': VA94018
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES3489100 RA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: local erythema upper rt lateral arm @ site of Td given 22MAR93; area of erythema irregular approx 5x6cm; no induration, no tenderness; cool compresses to affected area; 10-15mins 3-4 x day;

VAERS ID:62031 (history)  Vaccinated:1994-01-31
Age:16.1  Onset:1994-01-31, Days after vaccination: 0
Gender:Female  Submitted:1994-02-02, Days after onset: 2
Location:Georgia  Entered:1994-04-22, Days after submission: 78
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': GA94020
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0970V1SCL
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES3D510790IMA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Myalgia, Nausea, Oedema peripheral, Pain, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: soreness immed p/inject mostly next Am; nausea next Am this Am pain worst in arm & into back; pt''s arms red, arms & hand are swollen & painful;

VAERS ID:62493 (history)  Vaccinated:1994-03-23
Age:16.3  Onset:1994-03-23, Days after vaccination: 0
Gender:Female  Submitted:1994-03-29, Days after onset: 6
Location:Montana  Entered:1994-05-09, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin, Humulin N, Humulin R;
Current Illness: NONE
Preexisting Conditions: diabetes diagnosed & 5 1/2 yrs ago;
Diagnostic Lab Data: pt self tested both urine ketones & blood sugars; ketones neg @ 1PM & 4PM; bld sugar 190 @ 1PM, 140 @ 420PM;
CDC 'Split Type': MT94010
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES9853265IMLA
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain, Chills, Condition aggravated, Pallor, Pyrexia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recvd vax & became ill about 2 1/2 hrs p/vax; c/o initially stomach cramps, fever, chills & then vomiting; felt faint, was pale;

VAERS ID:63084 (history)  Vaccinated:1994-04-20
Age:16.8  Onset:1994-04-20, Days after vaccination: 0
Gender:Male  Submitted:1994-04-22, Days after onset: 2
Location:Minnesota  Entered:1994-05-24, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: rapid strept test;
CDC 'Split Type': MN94027
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1734W1SC 
Administered by: Public     Purchased by: Public
Symptoms: Pharyngitis, Pruritus, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow)
Write-up: 20APR rash, itchy, sore throat-DPH; 21APR t101, welts came up DPH given; 22APR rash gone, fever 98, sore throat; rash;

VAERS ID:65489 (history)  Vaccinated:1992-09-03
Age:16.4  Onset:1993-06-02, Days after vaccination: 272
Gender:Female  Submitted:0000-00-00
Location:Oregon  Entered:1994-06-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Septra, Prenatal vits
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES92100656
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: Public     Purchased by: Other
Symptoms: Abnormal labour, Urinary tract infection
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: pt recvd vax 3SEP92 & was subsequently found to be pregnant; during pregnancy devel a UTI & was treated w/Septra; pt also devel preterm labor; 2JUN93 @ 40 wks gestational age pt delivered an 8lb 4 oz female;

VAERS ID:65565 (history)  Vaccinated:1993-02-01
Age:16.0  Onset:1993-02-01, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Pennsylvania  Entered:1994-06-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES93061387
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: pt recvd vax in FEB93 & w/in 5 days of the vax pt began to have sz-like activity intermittently w/2 to 3 szs per day; pt was hospitalized; @ the time of this report pt having 1 sz per week & was collapsing;

VAERS ID:65641 (history)  Vaccinated:1993-10-07
Age:16.0  Onset:1993-10-07, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Missouri  Entered:1994-06-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES93100395
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1100W   
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1123W1  
Administered by: Other     Purchased by: Other
Symptoms: Amblyopia, Anxiety, Pallor, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recvd vax 7OCT93 & 10 mins p/vax had a vasovagal episode characterized by turning pale, anxiety, tachycardia & passing out for 5 to 10 seconds; pt also exp blurred vision;

VAERS ID:63932 (history)  Vaccinated:1994-06-21
Age:16.3  Onset:1994-06-21, Days after vaccination: 0
Gender:Female  Submitted:1994-06-21, Days after onset: 0
Location:Texas  Entered:1994-06-30, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: TB skin test by Connaught lot# 2354M;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1333W  LA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: student came for vax appeared to be feeling well; about 5 mins p/vax mom returned to clinic stated was having breathing problems & stomach hurt & felt a bit nauseated; pt was sent to ER;

VAERS ID:64476 (history)  Vaccinated:1993-11-12
Age:16.8  Onset:1993-11-19, Days after vaccination: 7
Gender:Female  Submitted:1994-06-29, Days after onset: 221
Location:California  Entered:1994-07-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD by Connaught lt arm ID; APAP
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0195W1SCRA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES356904 IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: swelling itching & redness @ site wherre Td was administered sx began 2nd day p/vax given; pt seen 7 days p/vax red, warm, indurated, non-tender patch found @ exam site;

VAERS ID:64481 (history)  Vaccinated:1994-06-24
Age:16.8  Onset:1994-06-27, Days after vaccination: 3
Gender:Female  Submitted:1994-07-01, Days after onset: 4
Location:California  Entered:1994-07-05, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES360911 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 3 days p/vax the site became a hard ball, then red & itching to 6.5 x 7.5 of erythema w/2x3 cm center of darker red color;

VAERS ID:64621 (history)  Vaccinated:1994-01-27
Age:16.4  Onset:1994-01-29, Days after vaccination: 2
Gender:Female  Submitted:1994-01-31, Days after onset: 2
Location:Washington  Entered:1994-07-12, Days after submission: 161
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hismanal; Xantac
Current Illness:
Preexisting Conditions: coin urticaria;
Diagnostic Lab Data:
CDC 'Split Type': WA941049
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1554V0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: difficult breathing-4 hrs; dizziness immed-4 hrs; nausea immed; muscle aches-5hrs-19hrs; h/a 4 hrs- 26 hrs;

VAERS ID:64686 (history)  Vaccinated:1994-05-23
Age:16.9  Onset:1994-05-25, Days after vaccination: 2
Gender:Female  Submitted:1994-06-02, Days after onset: 8
Location:Colorado  Entered:1994-07-13, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Naprosan
Current Illness: NONE
Preexisting Conditions: wheat, soy, corn, milk, mold-3 yrs
Diagnostic Lab Data: NONE
CDC 'Split Type': CO94044
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIES4B510650SCLA
Administered by: Public     Purchased by: Private
Symptoms: Oedema peripheral, Pharyngitis, Pruritus, Pyrexia, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 2 days following vax pt devel t101 & hives covering body, swelling of hands & feet, as swelling dec itching of hands & feet began; seen by MD; 2JUN94 URI developing;

VAERS ID:65818 (history)  Vaccinated:1994-07-11
Age:16.6  Onset:1994-07-12, Days after vaccination: 1
Gender:Female  Submitted:1994-07-25, Days after onset: 13
Location:Ohio  Entered:1994-08-08, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Neut 0.30L & 0.40 L; Lymph 1.00L & .60L; Neut 19L & 33L; lymphocyte 54H, 35; RH ATYP 6H 3;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0892W1SCA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Basophilia, Headache, Hypochromic anaemia, Leukopenia, Myalgia, Pyrexia, Red blood cell abnormality
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: fever for 5 days, frontal h/a; had ache in finger only when fever; no swelling; pt was also tired;

VAERS ID:65883 (history)  Vaccinated:1994-08-03
Age:16.2  Onset:1994-08-03, Days after vaccination: 0
Gender:Female  Submitted:1994-08-04, Days after onset: 1
Location:Kentucky  Entered:1994-08-12, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt grandmother w/cardiac arrest sev hrs p/vax;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT head neg, WBC 2 0k w/ 25 bands;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES3569035 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0554A1SC 
Administered by: Private     Purchased by: Unknown
Symptoms: Dyspnoea, Hypotension, Leukocytosis, Speech disorder, Stupor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: sudden LOC 10 mins p/immun, hypotension w/progressive to slurred speech, SOB, dec responsiveness x 6 hrs;

VAERS ID:65885 (history)  Vaccinated:1994-07-20
Age:16.1  Onset:0000-00-00
Gender:Female  Submitted:1994-08-02
Location:Missouri  Entered:1994-08-12, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEA: MEASLES (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Public
Symptoms: Conjunctivitis, Lacrimal disorder
SMQs:, Severe cutaneous adverse reactions (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular infections (broad), Hypersensitivity (broad)
Write-up: eyes were watery, irritated, red; pt taken to ER & given eye drops;

VAERS ID:66623 (history)  Vaccinated:1993-06-04
Age:16.0  Onset:1993-06-04, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Oklahoma  Entered:1994-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Ventolin inhaler; Beclovent inhaler
Current Illness:
Preexisting Conditions: hx of asthma;
Diagnostic Lab Data: NA
CDC 'Split Type': 930126501
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES340938 IM 
Administered by: Private     Purchased by: Private
Symptoms: Condition aggravated, Hypersensitivity, Visual disturbance
SMQs:, Angioedema (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: approx 5 seconds p/vax pt was unable to see & immed had an asthmatic/allergic react; pt was treated in office w/Epi, Ventolin, 02; pt recovered w/in 20 mins;

VAERS ID:67039 (history)  Vaccinated:1994-08-19
Age:16.9  Onset:1994-08-19, Days after vaccination: 0
Gender:Male  Submitted:1994-08-19, Days after onset: 0
Location:Texas  Entered:1994-10-03, Days after submission: 45
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD by Connaught lot# 235411
Current Illness: none;
Preexisting Conditions: none;
Diagnostic Lab Data:
CDC 'Split Type': TX94206
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0773A1SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0702C1PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4B610521IMRA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt appeared to tolerate vax; pt was found uncouscious

VAERS ID:67047 (history)  Vaccinated:1994-09-06
Age:16.3  Onset:1994-09-06, Days after vaccination: 0
Gender:Female  Submitted:1994-09-06, Days after onset: 0
Location:Texas  Entered:1994-10-03, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none;
Other Medications: mantoux;
Current Illness: none;
Preexisting Conditions: none;
Diagnostic Lab Data:
CDC 'Split Type': TX94216
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4F61059 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recvd vax & fainted after vax; BP 100/60 observed x 15-20 min w/o further problems;

VAERS ID:67193 (history)  Vaccinated:1994-08-15
Age:16.2  Onset:1994-08-15, Days after vaccination: 0
Gender:Female  Submitted:1994-10-07, Days after onset: 53
Location:Missouri  Entered:1994-10-11, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: migraine, tonsillectomy, adenoidectomy, premature infant, phyaryngitis, dehydration;
Diagnostic Lab Data: glucose 179, serum cholesterol 223, C4 complement 20, C3 complement 130, eosinophils 1.0%, ESR 22, IgE 3, complement levels 139;
CDC 'Split Type': WAES94100015
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1IM 
Administered by: Private     Purchased by: Other
Symptoms: Angioneurotic oedema, Arthralgia, Face oedema, Laboratory test abnormal, Pyrexia, Rash, Red blood cell sedimentation rate increased, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt recvd vax & exp rash, hives, welts & angioedema; pt subsequently hosp due to angiodema; meds given; 30sep94 welts & rash persisted;

VAERS ID:67368 (history)  Vaccinated:1994-09-27
Age:16.4  Onset:1994-10-03, Days after vaccination: 6
Gender:Female  Submitted:1994-10-13, Days after onset: 10
Location:Ohio  Entered:1994-10-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Diagnostic Lab Data: none;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0773A1 LA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Malaise, Nausea, Rash maculo-papular
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax & devel n; h; malaise; & broke out fine papular rash on neck & abdo;

VAERS ID:67380 (history)  Vaccinated:1994-10-11
Age:16.8  Onset:0000-00-00
Gender:Female  Submitted:1994-10-13
Location:California  Entered:1994-10-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none;
Preexisting Conditions: none;
Diagnostic Lab Data: rxn to td;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recvd vax & had swollen upper arm & redness;

VAERS ID:67452 (history)  Vaccinated:1994-10-04
Age:16.0  Onset:1994-10-04, Days after vaccination: 0
Gender:Male  Submitted:1994-10-05, Days after onset: 1
Location:Georgia  Entered:1994-10-21, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none;
Preexisting Conditions: none;
Diagnostic Lab Data: none;
CDC 'Split Type': GA94150
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0551A1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope, Vasodilatation
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recvd vax & fainted; red area on back of head;aroused easily /w ammonia

VAERS ID:67472 (history)  Vaccinated:1994-10-05
Age:16.6  Onset:1994-10-06, Days after vaccination: 1
Gender:Male  Submitted:1994-10-07, Days after onset: 1
Location:Missouri  Entered:1994-10-21, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt had fever at age 5;
Other Medications:
Current Illness: none;
Preexisting Conditions: none;
Diagnostic Lab Data:
CDC 'Split Type': MO94075
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES3G511533 RA
Administered by: Public     Purchased by: Public
Symptoms: Lymphadenopathy, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: mom stated pt''s arm was swollen; red hot w/ enlarged lymph nodes in neck;mom did not take to PMD;reported to school hlth ofc.

VAERS ID:68726 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Unknown  Submitted:1994-08-23
Location:Pennsylvania  Entered:1994-10-26, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': CO5174
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Lymphadenopathy
SMQs:
Write-up: lymph edema of the arm; No other details provided; 17DEC94 No response to f/u request;

VAERS ID:68854 (history)  Vaccinated:1992-12-16
Age:16.1  Onset:1992-12-16, Days after vaccination: 0
Gender:Male  Submitted:1994-01-27, Days after onset: 407
Location:New York  Entered:1994-10-26, Days after submission: 271
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': CO4622
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIES 0SCA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site inflammation, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: localized rash; tender to touch 6mm x 6 mm; area around inject site red & inflammed; given DPH; on Tegretal; NKA;

VAERS ID:67668 (history)  Vaccinated:1994-09-26
Age:16.5  Onset:1994-10-20, Days after vaccination: 24
Gender:Male  Submitted:1994-10-24, Days after onset: 4
Location:Indiana  Entered:1994-10-27, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Diagnostic Lab Data: Blood sugar 1173;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0773A1 LA
Administered by: Private     Purchased by: Private
Symptoms: Diabetes mellitus, Hyperglycaemia, Vomiting, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recvd vax, seen for weight loss; was vomiting; had type I diabetes;

VAERS ID:67864 (history)  Vaccinated:1994-09-19
Age:16.7  Onset:1994-09-19, Days after vaccination: 0
Gender:Female  Submitted:1994-10-28, Days after onset: 39
Location:Pennsylvania  Entered:1994-10-31, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt fever/red blotches w/MMR dose 1
Other Medications: NONE
Current Illness:
Preexisting Conditions: hx of allergic bronchitis bornchospasm
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0660A SC 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4B61036 IM 
Administered by: Private     Purchased by: Private
Symptoms: Anaphylactoid reaction, Arrhythmia, Chest pain, Deafness transitory, Dyspnoea, Hypersensitivity, Rash maculo-papular, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hearing impairment (narrow), Hypersensitivity (narrow)
Write-up: rash,shakiness,difficulty in breathing;c/o rash-macular papular,itchy x 5 hrs,chest tightness,swelling of nasal cavity,throat & ears;vomiting x 1;MMR given 1600-rxn 0400;heart irreg rhythm;lungs-CTA bilat;some epigast tenderness /w palpitat

VAERS ID:69786 (history)  Vaccinated:1994-11-19
Age:16.5  Onset:1994-11-19, Days after vaccination: 0
Gender:Female  Submitted:1994-07-25, Days after onset: 117
Location:Virginia  Entered:1994-10-31, Days after submission: 98
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: in pt, hives at 15 yrs w/ 2 dose of imovax;
Other Medications: provental, vanceril
Current Illness: none
Preexisting Conditions: asthma, hx of seasonal allergies
Diagnostic Lab Data:
CDC 'Split Type': CO5156
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST. 2  
Administered by: Military     Purchased by: Military
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax;hhives 18-24 hrs p/ 2nd in post exposure series;27jan94 tx w/ DPH;resolved in 25 mins;tx w/ DPH & prednisone prior to 4 & 5; no further rxns;

VAERS ID:70088 (history)  Vaccinated:1993-09-07
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:1993-09-28
Location:New Jersey  Entered:1994-10-31, Days after submission: 398
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: augmentin,entex LA;
Current Illness:
Preexisting Conditions: sinusitis;
Diagnostic Lab Data:
CDC 'Split Type': 930025241
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMA
Administered by: Other     Purchased by: Other
Symptoms: Hepatic function abnormal, Hepatomegaly
SMQs:, Liver related investigations, signs and symptoms (narrow), Cardiomyopathy (broad)
Write-up: pt recvd vax;sometime p/ 1st dose had elev liver func test & hematomegaly;seen by MD

VAERS ID:70925 (history)  Vaccinated:1994-08-02
Age:16.0  Onset:1994-08-03, Days after vaccination: 1
Gender:Female  Submitted:1994-08-17, Days after onset: 14
Location:New Jersey  Entered:1994-10-31, Days after submission: 75
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: swam w/jelly fish
Diagnostic Lab Data: Strep neg;
CDC 'Split Type': 940072061
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1392A20IMA
Administered by: Private     Purchased by: Private
Symptoms: Pharyngitis, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax & the next day exp rash on side, back, chest, arms, & leg; addtl pt exp a sore throat; these sx were treated on 3UG94 w/ Amoxil & 5AUG94 w/Atarax; 6AUG94 rash is more pronounced;

VAERS ID:69058 (history)  Vaccinated:1994-11-15
Age:16.7  Onset:1994-11-16, Days after vaccination: 1
Gender:Female  Submitted:1994-11-18, Days after onset: 2
Location:Virginia  Entered:1994-11-29, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk;
Other Medications:
Current Illness: none;
Preexisting Conditions: allergy shots;
Diagnostic Lab Data: none;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES4F51132 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypertonia, Injection site hypersensitivity, Injection site mass, Myalgia, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), 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), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt recvd vax on 15nov94; pt had fallen 2 days prior & hurt Lt shoulder & neck; vax given lt deltoid;on 17nov94 spasm & tenderness of lt trapezius & neck muscle; quarter sized area of erythema surrounding inject site, minimal induration;

VAERS ID:69358 (history)  Vaccinated:1994-11-08
Age:16.0  Onset:1994-11-08, Days after vaccination: 0
Gender:Male  Submitted:1994-11-08, Days after onset: 0
Location:Wyoming  Entered:1994-12-06, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none;
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Diagnostic Lab Data: na;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES4F510720IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Dyspnoea, Headache, Hyperhidrosis, Hypertension, Hyperventilation, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: pt recvd vax 11:30; at 12:55, to mom & c/o diaphoresis, tremors;h/a & n;1:02 mom came to rn;pt was diaphoretic,cold,clammy, tremerous hands,feet & head; n;dizziness;BP 182/90;AP 110 w/ c/o dyspnea;meds given;sxs resolved;

VAERS ID:69702 (history)  Vaccinated:1994-12-05
Age:16.6  Onset:1994-12-06, Days after vaccination: 1
Gender:Female  Submitted:1994-12-12, Days after onset: 6
Location:Florida  Entered:1994-12-19, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: OC
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1199A60 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recvd vax 5DEC94 & on 6DEC94 pt presented w/fine red flat lesions on lt extremity pos pruritus; rash gone on 12DEC94;

VAERS ID:71419 (history)  Vaccinated:1994-11-28
Age:16.3  Onset:1995-01-21, Days after vaccination: 54
Gender:Female  Submitted:1995-02-08, Days after onset: 18
Location:New Hampshire  Entered:1995-02-13, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recvd Imovax 31OCT94 & 28OCT94 lot# J1208; & Immagam by Connaught lot# K00505 28OCT94; Zovirax PRN
Current Illness: diarrhea & vomiting x 24hrs 1 wk prior
Preexisting Conditions: NKA
Diagnostic Lab Data: Bl count nl; spinal fluid no WBC, total protein 169 (nl 64);
CDC 'Split Type': NH95003
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.J12084IMA
Administered by: Private     Purchased by: Private
Symptoms: CSF test abnormal, Gait disturbance, Guillain-Barre syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: 21JAN numbness in legs; dad thought it was related to cross country skiing; 24JAN numbness in arms & legs; called MD, went to ER;

VAERS ID:71807 (history)  Vaccinated:1990-06-04
Age:16.9  Onset:1990-06-05, Days after vaccination: 1
Gender:Female  Submitted:1995-02-18, Days after onset: 1719
Location:California  Entered:1995-02-27, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: RH factor 62 4/92; Esonophils 8;
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.089051IMLA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Laboratory test abnormal, Osteoarthritis, Rheumatoid arthritis
SMQs:, Guillain-Barre syndrome (broad), Arthritis (narrow)
Write-up: had swollen & painful finger joints day p/vax 4JUN90; has had intermittent joint pain & fatigue since then; has been dx w/rheumatoid arthritis;

VAERS ID:72032 (history)  Vaccinated:1995-01-11
Age:16.9  Onset:1995-01-13, Days after vaccination: 2
Gender:Female  Submitted:1995-02-10, Days after onset: 28
Location:Michigan  Entered:1995-03-13, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': MI95016
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MICHIGAN DEPT PUB HLTHTD6131B IMRA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 2 days following Td vax pt devel rash & was taken to MD & put on the Medrol DOse pack along w/DPH; pt was given a Medrol Dose Pack on 31JAN95;

VAERS ID:74580 (history)  Vaccinated:1994-11-07
Age:16.7  Onset:1994-11-07, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Florida  Entered:1995-03-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES94120288
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Dizziness, Dyspepsia, Influenza, Myalgia, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific dysfunction (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: pt recv vax;1-2 days later, devel fever, malaise & cold like synd which MD noted were not serious;

VAERS ID:72610 (history)  Vaccinated:1995-02-24
Age:16.0  Onset:1995-03-01, Days after vaccination: 5
Gender:Female  Submitted:1995-03-07, Days after onset: 6
Location:Georgia  Entered:1995-03-31, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type': GA95030
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0082A1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Diarrhoea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recvd vax;v & d & abdo pain started 1mar95 & cont;advised to take to er;pt seen in hosp;given IV glucose & meds;PC to PT 15mar,still has d,pt is 6 wks post partum,now has a rash;

VAERS ID:72747 (history)  Vaccinated:1995-03-08
Age:16.3  Onset:1995-03-09, Days after vaccination: 1
Gender:Male  Submitted:1995-03-13, Days after onset: 4
Location:Rhode Island  Entered:1995-03-31, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp t103, h/a, nausea @ 6 w/TD #1;
Other Medications: APAP & DPH
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4H611191IMLA
Administered by: Private     Purchased by: Public
Symptoms: Headache, Injection site reaction, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: local react & fever to 103.8 20 hrs p/shot & mild h/a; little nausea; no vomiting; signs & sz subsided w/in next 48 hrs;

VAERS ID:73036 (history)  Vaccinated:1995-03-06
Age:16.3  Onset:1995-03-06, Days after vaccination: 0
Gender:Female  Submitted:1995-03-24, Days after onset: 18
Location:New York  Entered:1995-04-10, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': BA95B010
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0924A1 RA
Administered by: Private     Purchased by: Private
Symptoms: Face oedema, Lacrimal disorder, Oedema peripheral, Pruritus, Rhinitis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow)
Write-up: sneezing, swelling of hands, feet, face, itching, watery eyes;

VAERS ID:73116 (history)  Vaccinated:1995-03-29
Age:16.8  Onset:1995-03-29, Days after vaccination: 0
Gender:Male  Submitted:1995-03-30, Days after onset: 1
Location:Minnesota  Entered:1995-04-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Epi
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': MN95005
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0972A1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Apnoea, Bradycardia, Convulsion, Cyanosis, Gaze palsy, Hypertonia, Opisthotonus, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (narrow), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: pt recvd vax 5 mins later facial color pale, head down to knees for 2 breaths then sat up & lost consciousness;back & legs, neck all stiffened, eyes rolled back;pt assisted to floor had snoarous resp x 1min then stiffened arching back; sz;

VAERS ID:73266 (history)  Vaccinated:0000-00-00
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:1995-04-11
Location:Minnesota  Entered:1995-04-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: in pt, finger pain at 16 yrs of age w/ 1&2 doses of engerix B;
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 950027661
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 2IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Condition aggravated, Cyanosis, Insomnia, Laboratory test abnormal, Oedema peripheral, Pain, Rash, Vasculitis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: pt recvd vax;p/ each of the 1st & 2nd dose,exp self limited bilateral pain of last 3 fingers;p/ 3rd inject,pain reappeared on same territory,inc w/ heat & dec w/cold;dx of vasculitis;hosp;analgesic,tegretol,corticoids,propanolol given;

VAERS ID:74501 (history)  Vaccinated:1994-11-04
Age:16.3  Onset:1994-11-15, Days after vaccination: 11
Gender:Male  Submitted:1995-05-09, Days after onset: 174
Location:New Jersey  Entered:1995-06-05, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: sore throat
Preexisting Conditions: allergies by mom''s report:cats, dogs, cold urticaria;
Diagnostic Lab Data:
CDC 'Split Type': ND9523
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH49380505IM 
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Infection, Myalgia, Pain, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax; gene muscle aches approx 2 1/2 wk p/ immun; pain resolved 2 wk p/ onset;however pt exp inc fatigue (sleeping 18 hr per day);oth tests neg x/ for parvovirus titer (mom''s hx);dx as chronic fatigue synd;dx not related to vax;

VAERS ID:75191 (history)  Vaccinated:1995-03-27
Age:16.2  Onset:1995-03-28, Days after vaccination: 1
Gender:Female  Submitted:1995-04-07, Days after onset: 9
Location:New Hampshire  Entered:1995-06-19, Days after submission: 73
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data: NONE
CDC 'Split Type': NH95014
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1502820IM 
Administered by: Private     Purchased by: Public
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: hives all over body seen on 7APR95 still has hives; itching-given DPH

VAERS ID:80486 (history)  Vaccinated:1995-05-11
Age:16.0  Onset:1995-05-15, Days after vaccination: 4
Gender:Female  Submitted:1995-05-23, Days after onset: 8
Location:Pennsylvania  Entered:1995-06-23, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: mitral valve prolapse
Diagnostic Lab Data:
CDC 'Split Type': 950044281
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0IMA
Administered by: Other     Purchased by: Other
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recvd vax & 4 days later pt exp nausea which subsided w/in 24hrs;

VAERS ID:75813 (history)  Vaccinated:1995-07-05
Age:16.1  Onset:1995-07-06, Days after vaccination: 1
Gender:Male  Submitted:1995-07-06, Days after onset: 0
Location:Tennessee  Entered:1995-07-10, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT of head, LP-results pending
CDC 'Split Type': TN95059
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4H61118 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Headache, Nuchal rigidity, Photophobia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: pt presented to ofc c/o severe h/a, & fever; PE reveals nuchal rigidity & photophobia; pt admitted to hosp for eval

VAERS ID:75883 (history)  Vaccinated:1995-06-28
Age:16.4  Onset:1995-07-05, Days after vaccination: 7
Gender:Female  Submitted:1995-07-10, Days after onset: 5
Location:New York  Entered:1995-07-14, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Retin A cream; Cleocin lotion
Current Illness: facial acne
Preexisting Conditions: minor oral labial HSV
Diagnostic Lab Data: NA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0491B0 LA
Administered by: Private     Purchased by: Private
Symptoms: Condition aggravated, Haemorrhage, Herpes simplex, Mouth ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: severe episode of recurrent HSV (ovalabial) 7 days p/vax; although pt has had minor orolabial HSV in past, this episode was markedly worse; entire lower lip was heavily involved w/heavy crusting, fissuring & bleeding w/extensive lesions

VAERS ID:76138 (history)  Vaccinated:1995-07-11
Age:16.1  Onset:1995-07-12, Days after vaccination: 1
Gender:Female  Submitted:1995-07-17, Days after onset: 5
Location:Wisconsin  Entered:1995-07-25, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: in pt, hives at 13 yrs w/ 1 flu vax; fever,local tenderness at 9 yrs w/ 5 dtp;
Other Medications:
Current Illness: none
Preexisting Conditions: asplenia (surgical)
Diagnostic Lab Data: blood culture CBC...
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES3789741IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Condition aggravated, Injection site pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax; severe local erythema & tenderness at site of vax starting hr p/ adm; moderate fever (prompting hosp due to asplenia & hematologists protocol for fever management);

VAERS ID:76413 (history)  Vaccinated:1995-07-28
Age:16.4  Onset:1995-07-28, Days after vaccination: 0
Gender:Male  Submitted:1995-07-29, Days after onset: 1
Location:Minnesota  Entered:1995-08-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1441A41IM 
Administered by: Public     Purchased by: Private
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax; urticarial rash 12 hr p/ vax w/ edema of hands;

VAERS ID:76827 (history)  Vaccinated:1995-07-10
Age:16.0  Onset:1995-07-10, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:California  Entered:1995-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mom reports pt had similar rxn to TD & Hep B vax
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': CA95090
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4G610805IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Malaise, Myalgia, Pyrexia, Similar reaction on previous exposure to drug
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: onset w/in few hr of fever to 102, chills, whole body aching, listlessness;APAP given;pt took liquids & slept;24 hr later temp still 101 but pt awake, hungry, & feeling better;Thimerosol? advised consult w/PMD;Thimerosol & adverse rxn

VAERS ID:77156 (history)  Vaccinated:1995-07-27
Age:16.5  Onset:1995-08-03, Days after vaccination: 7
Gender:Female  Submitted:1995-08-21, Days after onset: 18
Location:Washington  Entered:1995-09-01, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none
Other Medications: PPD skin test on 21AUG
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type': WA951151
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406A0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax;devel hives,was itching almost 1 wk later;on 21aug95 recv PPD test & devel hives on arms & legs;to PMD & was put on meds;

VAERS ID:77365 (history)  Vaccinated:1995-08-02
Age:16.9  Onset:1995-08-02, Days after vaccination: 0
Gender:Male  Submitted:1995-08-02, Days after onset: 0
Location:Texas  Entered:1995-09-13, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC 'Split Type': TX95152
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1241A  RA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0720C PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4F61059  LA
Administered by: Public     Purchased by: Unknown
Symptoms: Pallor, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: sitting in chair, became pale, started shaking lasted approx 15sec; pt states fainted; no apparent injury or hx of sz disorder

VAERS ID:77467 (history)  Vaccinated:1995-08-22
Age:16.8  Onset:0000-00-00
Gender:Female  Submitted:1995-08-30
Location:Florida  Entered:1995-09-18, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: PPD by Connaught lot# 238011
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: +preg test @ hosp 28AUG95
CDC 'Split Type': FL95058
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0974A1SCLL
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5C71114 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: 22AUG95 pt stated LMP end of JUL95 denies pregnant, informed not to get pregnant x 3mo d/t birth defects fr MMR; 28AUG95 returned w/PPD-pregnant test pos

VAERS ID:77555 (history)  Vaccinated:1995-08-25
Age:16.0  Onset:1995-08-25, Days after vaccination: 0
Gender:Male  Submitted:1995-08-28, Days after onset: 3
Location:Florida  Entered:1995-09-18, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: na
Other Medications: atb, apap
Current Illness: shark bite, elbow fracture
Preexisting Conditions: none
Diagnostic Lab Data: cultures (site not specified) neg; RBC nl; WBC nl;
CDC 'Split Type': 895243006L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4958174 IM 
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Coma, Headache, Injection site hypersensitivity, Myasthenic syndrome, Oedema, Paraesthesia, Tremor
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: mom said pt sustained shark bite & fx elbow;to er;recv vax,ATB,apap;w/in 2 min "solid streaks of white radiating down arm;swelling;to hosp;dx cellulitis;paresthesia,tremor,HA & coma;local rxn at inject site;myasthenia;pt to see neurologist

VAERS ID:77949 (history)  Vaccinated:1995-08-02
Age:16.2  Onset:1995-08-02, Days after vaccination: 0
Gender:Male  Submitted:1995-08-10, Days after onset: 8
Location:Michigan  Entered:1995-10-10, Days after submission: 61
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp sz @ 14 w/MMR dose 2;sibling exp rxn w/various types vax
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': MI95105
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0523B0 LA
Administered by: Public     Purchased by: Public
Symptoms: Apnoea, Convulsion, Dizziness, Gaze palsy, Hypertonia, Hypotension, Pallor, Similar reaction on previous exposure to drug, Syncope
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), Convulsions (narrow), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: pt had a tonic-clonic sz 10mins p/vax;adm w/episode of apnea @ 15seconds, pt was able to inform NP that was ready to pass out, postictally pt was alert; BP 90/60 p/sz;extremities shook;pale, eye rolled back, apnea, dizziness;

VAERS ID:81770 (history)  Vaccinated:1994-02-08
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:1995-08-31
Location:Florida  Entered:1995-10-13, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': CO5504
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX ID)PASTEUR MERIEUX INST. 2 A
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: titer less than 1:5; test performed @ lab on blood sample drawn 25JUL94;

VAERS ID:81320 (history)  Vaccinated:1994-08-17
Age:16.7  Onset:1994-08-22, Days after vaccination: 5
Gender:Male  Submitted:1995-08-31, Days after onset: 374
Location:West Virginia  Entered:1995-10-17, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: dog bite
Preexisting Conditions: no allergy hx;no known conditions
Diagnostic Lab Data:
CDC 'Split Type': CO5600
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST. 4IMA
Administered by: Public     Purchased by: Other
Symptoms: Amblyopia, Headache, Rash
SMQs:, Anaphylactic reaction (broad), Optic nerve disorders (broad), Hypersensitivity (narrow)
Write-up: bad h/a, eyes blurred, rash;treated w/Pred;was hospitalized on 9SEP94 for cephalgia;r/o rabies;seen in office on 12SEP94;well as of 11OCT94;while jogging, unprovoked bit by stray dogs

VAERS ID:81980 (history)  Vaccinated:1994-11-11
Age:16.8  Onset:1994-11-11, Days after vaccination: 0
Gender:Female  Submitted:1995-08-31, Days after onset: 292
Location:New York  Entered:1995-10-17, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: PCN; IMOGAM RIG by Merieux lot# K0050J given 11NOV94;
Current Illness: cat scratches & bites
Preexisting Conditions: pcn
Diagnostic Lab Data:
CDC 'Split Type': CO5694
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.J08130IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: fever 100 & generalized flushing face & body w/in 6-8hrs of inj;also recvd PCN for cat bites & scratches;14DEC94 series completed w/no addl events;fever & flushing disappeared p/4 days & did not return

VAERS ID:78191 (history)  Vaccinated:1995-09-26
Age:16.9  Onset:1995-09-27, Days after vaccination: 1
Gender:Male  Submitted:1995-09-28, Days after onset: 1
Location:Mississippi  Entered:1995-10-18, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: NONE
Preexisting Conditions: when younger age 4-11 took allergy shots;asthma when younger
Diagnostic Lab Data:
CDC 'Split Type': MS95043
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1385A1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5A710245IMLA
Administered by: Public     Purchased by: Other
Symptoms: Headache, Injection site oedema, Pain, Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt states has raised area on lt collar bone;sore around collarbone-area 20cm in size;noticed it yesterday afternoon;also swelling noted @ site of inj of Td;states haad bad h/a yesterday;not as bad today

VAERS ID:79119 (history)  Vaccinated:1995-08-08
Age:16.1  Onset:1995-08-26, Days after vaccination: 18
Gender:Female  Submitted:0000-00-00
Location:Georgia  Entered:1995-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxil, vancenase
Current Illness: sinusitis
Preexisting Conditions: allergy sulfa
Diagnostic Lab Data: no relevant data
CDC 'Split Type': WAES95081924
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0406B   
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Skin disorder
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax; devel red bumps over legs, backs, arms;seen at md ofc w/ continuation of rash which was then vesicular;tx w/ dph;afebrile & was not ill except for head lice which was tx w/ permethrin

VAERS ID:79197 (history)  Vaccinated:1995-08-25
Age:16.0  Onset:1995-08-29, Days after vaccination: 4
Gender:Male  Submitted:0000-00-00
Location:Connecticut  Entered:1995-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES95081901
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0409B   
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax 25AUG95 & 27AUG95 pt exp a generalized rash w/20-30 lesions;29AUG95 pt devel severe varicella characterized by normal appearing lesions & large (1-1.5inch) fluid filled bullae on trunk & extremities;11SEP95 pt recovered;

VAERS ID:79203 (history)  Vaccinated:1995-06-06
Age:16.1  Onset:1995-07-17, Days after vaccination: 41
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:1995-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: asthma
Diagnostic Lab Data: no relevant data
CDC 'Split Type': WAES95080346
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0378B0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax;17jul95 devel varicella like rash which spontaneously resolved w/ in 10 days; reporter felt like exp related to vax;

VAERS ID:78497 (history)  Vaccinated:1995-10-18
Age:16.9  Onset:1995-10-18, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:North Carolina  Entered:1995-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: diabetes
Preexisting Conditions: diabetes
Diagnostic Lab Data:
CDC 'Split Type': NC95116
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1652A90IMLA
Administered by: Other     Purchased by: Public
Symptoms: Laryngospasm, Rash
SMQs:, Anaphylactic reaction (narrow), Dystonia (broad), Hypersensitivity (narrow)
Write-up: started w/erythema of upper chest & lt arm 15mins p/inj;approx 30mins later c/o tightness of throat;contacted family MD, DPH given;

VAERS ID:78715 (history)  Vaccinated:1995-10-18
Age:16.6  Onset:1995-10-18, Days after vaccination: 0
Gender:Male  Submitted:1995-10-31, Days after onset: 13
Location:Oklahoma  Entered:1995-11-07, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine, APAP suppositories
Current Illness: status post spelenectomy
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 895312002L
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES3929420IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Anaphylactoid reaction, Cyanosis, Dizziness, Hyperglycaemia, Hypotension, Nausea, Respiratory disorder
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & devel anaphylactic rxn which was treated w/DPH, 02 & breathing tx;rxn resolved w/in 24hr;

VAERS ID:78878 (history)  Vaccinated:1995-10-25
Age:16.3  Onset:1995-10-26, Days after vaccination: 1
Gender:Male  Submitted:1995-11-06, Days after onset: 11
Location:Wisconsin  Entered:1995-11-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: chest wall pains/non cardiac
Diagnostic Lab Data: NA no labs ordered
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES390902 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Chills, Nausea, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)
Write-up: chills dreaming of surrounded by fires, restless, nausea rolling over, vomitting on an empty stomach 3AM; threw up breakfast 7AM; sleepy x 12hrs;

VAERS ID:78969 (history)  Vaccinated:1995-08-14
Age:16.5  Onset:1995-08-16, Days after vaccination: 2
Gender:Female  Submitted:1995-08-29, Days after onset: 13
Location:Oregon  Entered:1995-11-14, Days after submission: 77
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mantoux test by Connaught lot# 238311
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC 'Split Type': OR9528
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.340W1 RA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES4A610089 LA
Administered by: Unknown     Purchased by: Public
Symptoms: Injection site mass, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: 16AUG95 c/o pain lt shoulder, Motrin;28AUG95 c/o pain lt deltoid, strength intact, t99.4, not warm to touch site, 9cm of induration, given Motrin; seen by MD f/u31AUG95; 29AUG95 reports a little better today

VAERS ID:81580 (history)  Vaccinated:1994-09-19
Age:16.0  Onset:1994-09-20, Days after vaccination: 1
Gender:Female  Submitted:1994-11-10, Days after onset: 51
Location:Illinois  Entered:1995-11-14, Days after submission: 369
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': 940087161
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1398B20IMA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax & next day exp a hot,itchy,raised,swollen,eyrthematous inj site;addl had an induration of 1/2 cm @ inj site;elocon cream was applied locally;

VAERS ID:82288 (history)  Vaccinated:1995-04-06
Age:16.0  Onset:1995-04-06, Days after vaccination: 0
Gender:Female  Submitted:1995-04-06, Days after onset: 0
Location:North Dakota  Entered:1995-11-14, Days after submission: 222
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 950033531
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1610A21IMLA
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER 0 RA
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Injection site mass, Oedema peripheral, Pain, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recvd vax; w/in 12 hrs post-vaccination, exp a swollen lt arm, & a lump at the inject site (lt arm);exp redness radiating down her lt arm & into back;lt arm pain & back pain;vax given on lt arm;

VAERS ID:82503 (history)  Vaccinated:1995-06-27
Age:16.0  Onset:1995-06-27, Days after vaccination: 0
Gender:Female  Submitted:1995-08-09, Days after onset: 43
Location:Unknown  Entered:1995-11-14, Days after submission: 97
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC 'Split Type': 950061871
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1378A10IMA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Malaise, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recvd vax & 2hrs post vax exp severe vomiting & abd cramping which have resolved;addl 2hrs post vax exp malaise & nausea;sx resolved w/in 7 days;no further problems;

VAERS ID:82505 (history)  Vaccinated:1995-06-27
Age:16.0  Onset:1995-06-27, Days after vaccination: 0
Gender:Female  Submitted:1995-07-10, Days after onset: 13
Location:Unknown  Entered:1995-11-14, Days after submission: 127
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': 950061891
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1378A10IMA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)
Write-up: pt recvd vax & immed post vax exp redness & heat @ inj site;sx resolved;

VAERS ID:82543 (history)  Vaccinated:1995-07-05
Age:16.9  Onset:1995-07-12, Days after vaccination: 7
Gender:Female  Submitted:1995-09-15, Days after onset: 65
Location:Alabama  Entered:1995-11-14, Days after submission: 60
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 12JUL95 SGOT 0 elevated; SGPT 0 elevated; GGT 0 elevated
CDC 'Split Type': 950066111
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1436A42IMA
Administered by: Other     Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Hepatic function abnormal, Hepatitis, Infection
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow)
Write-up: pt recvd vax & 7 days p/vax exp elevated liver function tests: AST,ALT,& GGT were elevated;sx persist;

VAERS ID:79657 (history)  Vaccinated:1995-09-27
Age:16.8  Onset:1995-09-28, Days after vaccination: 1
Gender:Female  Submitted:1995-11-17, Days after onset: 50
Location:North Dakota  Entered:1995-11-27, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: group C strep & pharyngitis
Preexisting Conditions: NONE
Diagnostic Lab Data: beta hemolytic group C strep 29SEP95;
CDC 'Split Type': ND95021
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0621B1 RA
Administered by: Private     Purchased by: Private
Symptoms: Asthma, Condition aggravated, Dysphagia, Dyspnoea, Myalgia, Pharyngitis, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: 12hrs p/vax devel SOB w/wheezing, fever 102.9 w/dysphagia, sore throat, neck pain, myalgias, syncope episode

VAERS ID:82225 (history)  Vaccinated:1995-06-03
Age:16.0  Onset:1995-06-06, Days after vaccination: 3
Gender:Female  Submitted:0000-00-00
Location:Ohio  Entered:1995-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: EEG-abn
CDC 'Split Type': WAES95060334
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.    
Administered by: Private     Purchased by: Other
Symptoms: Convulsion, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt recvd vax 3JUN95 & 6JUN95 pt exp tremor;follow up from the pts MD indicated that pt exp sz activity;EEG suggested that pt had a long standing undetected abn;

VAERS ID:79855 (history)  Vaccinated:1995-11-16
Age:16.0  Onset:1995-11-17, Days after vaccination: 1
Gender:Female  Submitted:1995-11-17, Days after onset: 0
Location:Alabama  Entered:1995-12-04, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: upper resp illness
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0406B0 A
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pruritus, Rash, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: rash/hives-woke up around 7AM on 17NOV95 w/rash & hives-treated w/DPH;18NOV95 cont w/hives/itching--hands/feet swelling;19NOV95 cont hives/itching--hands/feet swells

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