|
VAERS ID: |
90593 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1996-09-12 |
Onset: | 1996-09-19 |
Days after vaccination: | 7 |
Submitted: |
1996-09-30 |
Days after onset: | 11 |
Entered: |
1996-10-08 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
0128D / UNK |
LA / IM |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
0597D / UNK |
GM / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0746B08 / UNK |
MO / PO |
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
6F81202 / UNK |
GM / IM |
Administered by: Private Purchased by: Other Symptoms: Paralysis SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: unk Current Illness: NONE Preexisting Conditions: unk Allergies: Diagnostic Lab Data: unk CDC Split Type:
Write-up: PARALYSIS LEGS & ARMS 20SEP96;pt recv vax 12SEP96;rx ?-different facility; |
|
VAERS ID: |
90660 (history) |
Form: |
Version 1.0 |
Age: |
20.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1996-07-22 |
Onset: | 1996-07-23 |
Days after vaccination: | 1 |
Submitted: |
1996-08-28 |
Days after onset: | 36 |
Entered: |
1996-10-11 |
Days after submission: | 44 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA488A6 / 1 |
- / L |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
4958044 / 2 |
- / L |
Administered by: Public Purchased by: Public Symptoms: Abdominal pain,
Dehydration,
Vomiting SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: labs nl CDC Split Type: PA9650
Write-up: abd pain, vomiting, p/vax & a/adm to hosp;4 days later IV hydration much improved-hosp for 2 days; |
|
VAERS ID: |
90836 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1996-09-04 |
Onset: | 1996-09-24 |
Days after vaccination: | 20 |
Submitted: |
1996-10-03 |
Days after onset: | 9 |
Entered: |
1996-10-22 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA498A2 / 1 |
- / IM A |
Administered by: Private Purchased by: Private Symptoms: Anaemia,
Haemolytic anaemia,
Hypochromic anaemia,
Jaundice SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Haemolytic disorders (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Systemic lupus erythematosus (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests; CDC Split Type:
Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0; |
|
VAERS ID: |
92042 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Female |
Location: |
North Dakota |
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-16 |
Days after vaccination: | 0 |
Submitted: |
1996-10-30 |
Days after onset: | 14 |
Entered: |
1996-11-18 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / UNK |
- / - |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Military Purchased by: Military Symptoms: Headache,
Hypotension,
Laboratory test abnormal,
Pyrexia,
Sepsis,
Shock,
Tachycardia,
Vomiting SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Vitamin B complex multivitamin Current Illness: unk Preexisting Conditions: Allergies: Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2; CDC Split Type: 896304020L
Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp; |
|
VAERS ID: |
93230 (history) |
Form: |
Version 1.0 |
Age: |
43.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1996-10-23 |
Onset: | 1996-11-09 |
Days after vaccination: | 17 |
Submitted: |
1996-12-08 |
Days after onset: | 29 |
Entered: |
1996-12-24 |
Days after submission: | 16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
497B6 / 1 |
RA / IM |
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
6A81015 / UNK |
- / IM |
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. |
14279 / UNK |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Abdominal pain,
Diarrhoea,
Drug ineffective,
Infection,
Pruritus,
Rash SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: none Current Illness: none Preexisting Conditions: none known Allergies: Diagnostic Lab Data: CDC Split Type: CA960147
Write-up: pt took oral typhoid starting 23oct96; 09nov96 pt had sx of rash in armpits, inner legs and a skin graft. Rash was itchy; also had abdominal cramping & some diarrhea. no fever. MD in singapore said it was salmonella typhi & gave me |
|
VAERS ID: |
93692 (history) |
Form: |
Version 1.0 |
Age: |
29.0 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 1996-12-02 |
Onset: | 0000-00-00 |
Submitted: |
1996-12-31 |
Entered: |
1997-01-08 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Anaphylactoid reaction,
Confusional state,
Haematuria,
Infection,
Laboratory test abnormal,
Pneumonia,
Thrombocytopenic purpura,
Vomiting SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: plate <10000; Creat elevated;HCT 13; CDC Split Type: 960199531
Write-up: pt recv vaxx 2DEC96;pt exp gross hematuria, fever, nausea, vomit, abd pain & confusion;pt hosp & was found p/work-up to have thrombocytopenic purpura; |
|
VAERS ID: |
94837 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1997-01-17 |
Onset: | 1997-01-17 |
Days after vaccination: | 0 |
Submitted: |
1997-01-21 |
Days after onset: | 4 |
Entered: |
1997-02-11 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
CHOL: CHOLERA (USP) / PFIZER/WYETH |
4958186 / 3 |
- / - |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / - |
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
6A81017 / 2 |
- / - |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
4968082 / 2 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Back pain,
Dehydration,
Diarrhoea,
Headache,
Neck pain,
Pain,
Pharyngitis,
Pyrexia SMQs:, Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NKA Allergies: Diagnostic Lab Data: 4 tubes of blood according to pt CDC Split Type: GA97002
Write-up: fever 105, dehydration, pain neck, shoulders, severe h/a (burning), back (kidney level[waist), legs arms, sore throat, diarrhea & vomiting;adm to hosp 19JAN97 given IVF pain meds; |
|
VAERS ID: |
95859 (history) |
Form: |
Version 1.0 |
Age: |
67.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 1996-07-24 |
Onset: | 1996-08-10 |
Days after vaccination: | 17 |
Submitted: |
1997-03-12 |
Days after onset: | 214 |
Entered: |
1997-03-18 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA493A4 / 2 |
- / - |
Administered by: Public Purchased by: Private Symptoms: Bradycardia,
Coronary artery disease,
Coronary artery occlusion,
Hypokinesia,
Hypotension,
Myalgia,
Red blood cell sedimentation rate increased,
Vasculitis SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Sed rate taken 3JAN97 27;sed rate retaken 20FEB97 now at 5;ultra sound NIVA arteries # hosp 8JAN97; CDC Split Type:
Write-up: aches & pain in upper arm (muscle area) approx 10-15 days;aches & pain cont in arms (shoulder to hands) extend depends on exertion of arms;unable to get pulse or BP reading either arm;blockage determined in artery;vasculitis; |
|
VAERS ID: |
96427 (history) |
Form: |
Version 1.0 |
Age: |
63.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1997-01-23 |
Onset: | 1997-02-10 |
Days after vaccination: | 18 |
Submitted: |
1997-03-07 |
Days after onset: | 25 |
Entered: |
1997-03-24 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
504B6 / 1 |
- / IM |
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Gait disturbance,
Guillain-Barre syndrome,
Hypertension,
Laboratory test abnormal,
Myasthenic syndrome,
Paraesthesia,
Thrombocythaemia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Demyelination (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: 970031771
Write-up: pt recv vax JAN97 & the weekend of 8FEB97 pt suffered a h/a & BP was sky high;pt was seen in ER 13FEB97 dx w/GBS & hosp; |
|
VAERS ID: |
96862 (history) |
Form: |
Version 1.0 |
Age: |
15.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1997-01-31 |
Onset: | 1997-01-31 |
Days after vaccination: | 0 |
Submitted: |
1997-03-18 |
Days after onset: | 46 |
Entered: |
1997-04-11 |
Days after submission: | 23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
189A2 / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Dyspnoea,
Face oedema,
Oedema,
Pain,
Vasodilatation SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type: CA970018
Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER; |
|