|
VAERS ID: |
25635 (history) |
Form: |
Version 1.0 |
Age: |
15.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1990-06-18 |
Onset: | 1990-07-01 |
Days after vaccination: | 13 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0435S / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Anaemia,
Antinuclear antibody,
Asthenia,
Leukocytosis,
Malaise,
Pharyngitis,
Pyrexia,
Rash maculo-papular,
Red blood cell sedimentation rate increased,
Syncope,
White blood cell disorder SMQs:, Torsade de pointes/QT prolongation (broad), Agranulocytosis (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: WBC-4,800 6/18/90; Hematocrit-41 6/18/90; Hematocrit-40 7/90; WBC-21,000 7/90, Granulocytes-80 7/90 Lymphocytes-20 7/90; ESR-83 7/7/90; WBC-20,000 7/7/90; hematocrit-30; Monospot-negative 7/90 CDC Split Type: WAES90070297
Write-up: Pt vax w/MMRII on 4JUL90 dev T of 104 & sore throat, she fainted & dev a macular rash on both thighs; She exp weakness & pain.F/U 12MAR91: SXS INCLUDED T 104, SORE THROAT, MAC RASH, FAINTED, WBC 21,000 W/ LEFT SHIFT, ANA +, ESR 83, HCT 30. |
|
VAERS ID: |
25656 (history) |
Form: |
Version 1.0 |
Age: |
4.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-07-17 |
Onset: | 1990-07-17 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES90070777
Write-up: MD reported 4 1/2 yr old vaccinated with MMR on 17-JUL-90 developed a fever varying between 105 & 106 degrees F four to five hrs after vaccination. Pt was hospitalized. At time of report fever persisted. No reaction to first MMR. |
|
VAERS ID: |
25682 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-07-06 |
Onset: | 1990-07-17 |
Days after vaccination: | 11 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1226S / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Conjunctivitis,
Pyrexia,
Rash,
Rash maculo-papular,
Stevens-Johnson syndrome,
Stomatitis SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Cortisporin otic dr., polymyxin B sulf-neomycin, sulf-hydrocortison, alcohol-propylene, glycol-polysorbate-80-thimerosal Current Illness: external otitis Preexisting Conditions: otitis, recurrent external Allergies: Diagnostic Lab Data: CDC Split Type: WAES90070926
Write-up: Pt vaccinated /w MMR 2 wks following vaccination pt developed Stevens-Johnson syndrome & was hospitalized. 17Jul90 developed rash on chest,trunk, palms of the hands, face & upper & lower extremities. Low grade fever /w cracked lips & mouth. |
|
VAERS ID: |
25887 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Male |
Location: |
Indiana |
Vaccinated: | 1990-08-31 |
Onset: | 1990-09-01 |
Days after vaccination: | 1 |
Submitted: |
1990-09-07 |
Days after onset: | 6 |
Entered: |
1990-09-11 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
A021092 / UNK |
- / A |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1501S / UNK |
- / A |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0618L / 3 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? 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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CBC normal except deficiency, glucose normal , electrolytes normal, cat normal CDC Split Type:
Write-up: Pt vaccinated with MMR/HIB/OPV developed febrile seizure requiring hospital admission approx 24 hrs after vax. /w HIB, MMR, & oral Polio. Released next day & only treament was observation. |
|
VAERS ID: |
25941 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 1990-02-12 |
Onset: | 1990-02-18 |
Days after vaccination: | 6 |
Submitted: |
1990-09-10 |
Days after onset: | 203 |
Entered: |
1990-09-13 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / IM L |
Administered by: Private Purchased by: Private Symptoms: Agitation,
Convulsion,
Hypokinesia,
Muscle twitching,
Pyrexia,
Somnolence SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: EEG normal; Spinal tap normal CDC Split Type:
Write-up: Pt vaccinated with MMR 7 day later developed irritability, fever 103AX, decreased alertness with seizure like activity with arm twitching & lethargy. |
|
VAERS ID: |
26211 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 1989-08-31 |
Onset: | 1989-09-07 |
Days after vaccination: | 7 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
38091/0592P / UNK |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: Agitation,
Arthropathy,
Hypertonia,
Hypokinesia,
Hypotonia,
Leukopenia,
Mental retardation severity unspecified,
Pyrexia,
Rash maculo-papular,
Somnolence,
Speech disorder SMQs:, Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: hx of otitis media, pharyngitis Allergies: Diagnostic Lab Data: 8Sep89 WBC count-45000, 11Sep90 WBC count-2800, 11Sep89 platelet count- 80000 CDC Split Type: WAES90060279
Write-up: 15 mon. pt /w hx of OM & pharyngitis, vax /w MMRII dev fever, macular rash, WBC dec to 2800, dev stiffness legs, lethargy, irritability. Has severe dev delay w/ poor speech, fluct. muscle tone, po6r motor & head control, spacticity. |
|
VAERS ID: |
25922 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1990-08-14 |
Onset: | 1990-08-24 |
Days after vaccination: | 10 |
Submitted: |
1990-09-08 |
Days after onset: | 15 |
Entered: |
1990-09-14 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M205EP / UNK |
- / SC A |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1494S / UNK |
- / SC A |
Administered by: Private Purchased by: Private Symptoms: Convulsion,
Pallor,
Pyrexia,
Rash,
Rash maculo-papular,
Stupor SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, 9 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90. Allergies: Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine. CDC Split Type:
Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM. |
|
VAERS ID: |
25955 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1990-07-23 |
Onset: | 1990-08-01 |
Days after vaccination: | 9 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Public Purchased by: Unknown Symptoms: Ecchymosis,
Petechiae SMQs:, Haemorrhage terms (excl laboratory terms) (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, 3 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Platelet count down to 2,000 CDC Split Type:
Write-up: ITP- /w clinical signs evident by approx. 1 mon. /p vaccination. Bruises, petechiae, No frank bleeding |
|
VAERS ID: |
25961 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-08-18 |
Onset: | 1990-08-23 |
Days after vaccination: | 5 |
Submitted: |
1990-09-06 |
Days after onset: | 14 |
Entered: |
1990-09-17 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
2074R / 2 |
- / SC A |
Administered by: Private Purchased by: Private Symptoms: Apnoea,
Cardiac arrest,
Laboratory test abnormal,
Pain SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Sickle Cell Disease/Anemia Allergies: Diagnostic Lab Data: WBC - 8,000 on admission CDC Split Type:
Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90. |
|
VAERS ID: |
25966 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
North Carolina |
Vaccinated: | 1990-09-06 |
Onset: | 1990-09-07 |
Days after vaccination: | 1 |
Submitted: |
1990-09-07 |
Days after onset: | 0 |
Entered: |
1990-09-17 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283971 / 4 |
LL / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
2269R / UNK |
LA / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
277940 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Convulsion,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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: pt also rec''d tine test, lt forearm at same time as vax. Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: LP Normal, EEG Normal, MRI Normal CDC Split Type:
Write-up: Pt vaccinated with MMR/DPT/OPV/Tine test had tonic-clonic seizures (X4) beginning 3:00 am to 7:30 am on 7SEP90. Max. T 101.8 per parents. @ ER T 101.7. Longest seizure about 2 min. |
|