|
VAERS ID: |
107965 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1998-02-05 |
Onset: | 1998-02-09 |
Days after vaccination: | 4 |
Submitted: |
1998-02-12 |
Days after onset: | 3 |
Entered: |
1998-03-05 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
547A1 / 1 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
443673 / UNK |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Encephalitis,
Grand mal convulsion,
Headache SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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, 4 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: none Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 898051004L
Write-up: pt recv vax & exp h/a which persisted for 3 days;pt then had a grand mal sz & was hosp;analysis of CSF obtained from LP led to the dx of mild encephalitis;pt was disch from hosp & as of 12FEB was recovering slowly; |
|
VAERS ID: |
108704 (history) |
Form: |
Version 1.0 |
Age: |
40.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1996-09-26 |
Onset: | 1996-09-26 |
Days after vaccination: | 0 |
Submitted: |
1998-03-17 |
Days after onset: | 537 |
Entered: |
1998-03-19 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Dizziness,
Eye disorder,
Muscle twitching SMQs:, Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve Allergies: Diagnostic Lab Data: CDC Split Type: 19980039171A
Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx; |
|
VAERS ID: |
108895 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1998-02-05 |
Onset: | 1998-02-09 |
Days after vaccination: | 4 |
Submitted: |
1998-03-24 |
Days after onset: | 43 |
Entered: |
1998-03-26 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
547A1 / 1 |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
443673 / 1 |
MO / PO |
Administered by: Other Purchased by: Other Symptoms: Encephalitis,
Grand mal convulsion,
Headache SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: LP positive for encephalitis; CDC Split Type: 19980072401
Write-up: pt recv vax & w/in 24hr had a h/a which persisted 3 days;pt then had a grand mal sz & was hosp;LP & analysis of the cerebrospinal fluid led to the dx of mild encephalitis;pt disch from hosp 12FEB98 & recovering slowly; |
|
VAERS ID: |
109864 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Female |
Location: |
Connecticut |
Vaccinated: | 1998-04-07 |
Onset: | 1998-04-08 |
Days after vaccination: | 1 |
Submitted: |
1998-04-17 |
Days after onset: | 9 |
Entered: |
1998-04-21 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0771E / 1 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Laboratory test abnormal,
Petechiae,
Thrombocytopenia SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations: No relevant data;~ ()~~~In patient Other Medications: unk Current Illness: Preexisting Conditions: unk Allergies: Diagnostic Lab Data: CDC Split Type: WAES98040819
Write-up: pt recv vax 7APR98 & 9APR98 pt reported petechia which was subsequently dx as idiopathic thrombocytopenia when pt was hosp the same day;it is not known if the pt has been discharged; |
|
VAERS ID: |
110784 (history) |
Form: |
Version 1.0 |
Age: |
29.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1998-04-17 |
Onset: | 1998-04-17 |
Days after vaccination: | 0 |
Submitted: |
1998-05-08 |
Days after onset: | 21 |
Entered: |
1998-05-13 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
- / 2 |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Bronchitis,
Cough,
Dehydration,
Headache,
Lung disorder,
Pneumonia,
Pyrexia,
Respiratory disorder SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 3 days
Extended hospital stay? No
Previous Vaccinations: No relevant data;~ ()~~~In patient Other Medications: Acyclovir;Vancenase;Allegra;Ibuporfen;Indinavir sulfate;Lamivudine;Septra;Zidovudine; Current Illness: Preexisting Conditions: Kaposi''s sarcoma;Salmonella infect;allerg rhinitis;antihuman immunodeficiency virus antibody positive;asthma;folliculitis;herpes genitalis;herpes zoster;major depression;migraine;nasal congestion;neutropenia; Allergies: Diagnostic Lab Data: CXR abn but r/o PCP;blood cult results pending;WBC nl;WBC nl;sputum results pending;blood CD4 count 18%; CDC Split Type: WAES98041901
Write-up: pt felt feverish;also devel h/a & a cough w/some chest congestion;19APR98 still feverish, h/a, chest congestion worsened;20APR98 T102 to ER;pt adm to hosp 21APR98 w/dehydration;dx bronchitis w/directives to r/o pneumonia, PCP, TB |
|
VAERS ID: |
111397 (history) |
Form: |
Version 1.0 |
Age: |
60.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 1998-03-23 |
Onset: | 1998-03-23 |
Days after vaccination: | 0 |
Submitted: |
1998-06-02 |
Days after onset: | 70 |
Entered: |
1998-06-04 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / UNK |
- / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES |
M12791 / UNK |
- / IM A |
Administered by: Unknown Purchased by: Unknown 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? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: (personal) scapulohumeral myofibrosis Allergies: Diagnostic Lab Data: CDC Split Type: U199800262
Write-up: pt recv vax 23MAR98 & exp a few hr later, paralysis of the lt deltoid;tx w/physiotherapy & vitamin B complex;30APR98 EMG was still pathological; |
|
VAERS ID: |
112051 (history) |
Form: |
Version 1.0 |
Age: |
43.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1996-08-05 |
Onset: | 1996-08-08 |
Days after vaccination: | 3 |
Submitted: |
1998-06-22 |
Days after onset: | 683 |
Entered: |
1998-06-23 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
490A6 / 4 |
LA / - |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
06010 / 1 |
LA / - |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
L1108 / 2 |
LA / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. |
01020 / 2 |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Anorexia,
Asthenia,
Back pain,
Depressed level of consciousness,
Diarrhoea,
Dizziness,
Gastrointestinal haemorrhage,
Infection,
Laryngospasm,
Malaise,
Nausea,
Nervousness,
Oedema peripheral,
Pain,
Tachycardia,
Thinking abnormal,
Vasodilatation SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal haemorrhage (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4 Allergies: Diagnostic Lab Data: 11/96 tests taken-all normal CDC Split Type:
Write-up: 3 days post vax pt felt fatigue, diff in sitting still; |
|
VAERS ID: |
112298 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
Indiana |
Vaccinated: | 1998-06-16 |
Onset: | 1998-06-18 |
Days after vaccination: | 2 |
Submitted: |
1998-07-01 |
Days after onset: | 13 |
Entered: |
1998-07-02 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / - |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Laryngospasm,
Pyrexia,
Renal impairment,
Urticaria SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tumour lysis 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? 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: CDC Split Type: 19980162591
Write-up: pt recv vax 16JUN98 & approx 6hr later 16JUN98 pt devel hives & throat constriction;pt was taken to ER;17JUN98 pt went back to work, but became tired & went home early;T104 18JUN98;pt kidneys reportedly were not functioning properly; |
|
VAERS ID: |
112468 (history) |
Form: |
Version 1.0 |
Age: |
67.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1997-05-19 |
Onset: | 1997-05-20 |
Days after vaccination: | 1 |
Submitted: |
1998-07-07 |
Days after onset: | 413 |
Entered: |
1998-07-13 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
503B6 / 1 |
- / - |
Administered by: Public Purchased by: Private Symptoms: Coordination abnormal,
Gait disturbance,
Hypertonia,
Hypokinesia,
Myalgia,
Myasthenic syndrome,
Paraesthesia,
Paralysis SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: Extreme use of alcohol 40 yrs; Allergies: Diagnostic Lab Data: all tests showed no noticable problem CDC Split Type:
Write-up: w/in 24hr p/vax arm hurt, then chest, feet & legs;on 4th day went to hosp because legs were paralyzed;stayed 7 days & released w/walker;now yr later legs numb, tingly & very unsteady; |
|
VAERS ID: |
112651 (history) |
Form: |
Version 1.0 |
Age: |
33.0 |
Sex: |
Male |
Location: |
Nebraska |
Vaccinated: | 1997-12-09 |
Onset: | 1998-01-31 |
Days after vaccination: | 53 |
Submitted: |
1998-07-13 |
Days after onset: | 162 |
Entered: |
1998-07-16 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0755E / 1 |
- / - |
Administered by: Other Purchased by: Public Symptoms: Drug ineffective,
Hepatitis,
Infection,
Malaise SMQs:, Hepatitis, non-infectious (narrow), Lack of efficacy/effect (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: No relevant data;~ ()~~~In patient Other Medications: unk Current Illness: Preexisting Conditions: unk Allergies: Diagnostic Lab Data: 31JAN98 diagnostic lab positive hepatitis antibody titer; CDC Split Type: WAES98051110
Write-up: pt recv vax 9DEC97 & 6JAN98 pt left US to visit Finland, Estonia & Russia & returned home 24JAN98;approx 31JAN98 pt became ill was hosp dx w/hepatitis A;dx established on basis of an antibody rise to hep a virus; |
|