|
VAERS ID: |
113424 (history) |
Form: |
Version 1.0 |
Age: |
23.0 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 1998-08-01 |
Onset: | 1998-08-04 |
Days after vaccination: | 3 |
Submitted: |
1998-08-06 |
Days after onset: | 2 |
Entered: |
1998-08-14 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
2565A4 / 1 |
RL / IM |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
564B6 / 1 |
RL / IM |
JEV: JAPANESE ENCEPHALITIS (J-VAX) / CONNAUGHT LABORATORIES |
164A / 1 |
LA / SC |
RAB: RABIES (IMOVAX ID) / PASTEUR MERIEUX INST. |
M1053 / 1 |
RA / ID |
Administered by: Public Purchased by: Private Symptoms: Cough,
Face oedema,
Hypoxia,
Leukocytosis,
Pyrexia SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: ALLERGIC TO PENICILLIN-HIVES Allergies: Diagnostic Lab Data: Chest X-ray-neg; Peak flow-45%, 75% after Albuterol, WBC-12,7;no eosinophils, normal differential CDC Split Type:
Write-up: On 8/1/98 pt recv vax; on 8/4/98 pt exp facial edema lt side; tx=Benadryl, Prednisone. On 8/5/98 pt exp rt and lt side facial edema, cough, down peak flow, fever, and chilling. Pt hosp 2 days. Pt tx=I.V. Albuterol steroids,antihistamine. |
|
VAERS ID: |
113666 (history) |
Form: |
Version 1.0 |
Age: |
36.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1997-07-01 |
Onset: | 0000-00-00 |
Submitted: |
1998-08-20 |
Entered: |
1998-08-27 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
- / 1 |
- / - |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Abdominal pain,
Amnesia,
Arthralgia,
Hepatomegaly,
Hyperbilirubinaemia,
Myalgia,
Paraesthesia,
Rash SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: sore throat-moderate Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: lots of blood work indicate abn liver functions; CDC Split Type:
Write-up: joint & muscular pain-severe began w/in a wk of vax;numbness of limbs;swelling of liver-elevated bilirubin-abd pain & short term memory loss, h/a, rash & some itching; |
|
VAERS ID: |
113911 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: | 1997-07-01 |
Onset: | 1997-08-01 |
Days after vaccination: | 31 |
Submitted: |
0000-00-00 |
Entered: |
1998-09-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 2 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Gastrointestinal carcinoma SMQs:, Non-haematological malignant tumours (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1997-10-11
Days after onset: 71
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Zocar Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt recv vax DEC96 & JUL97 blood work in MAR showed no sign of disease;cancer of colon w/advanced metastases to liver detected in AUG because of rapid onset, want this on record; |
|
VAERS ID: |
114730 (history) |
Form: |
Version 1.0 |
Age: |
28.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 1998-09-29 |
Onset: | 1998-09-30 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1998-10-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
553A6 / UNK |
RA / IM |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
0937650 / UNK |
LA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0777A / UNK |
- / - |
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES |
090540 / UNK |
RA / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Back pain,
Chills,
Headache,
Influenza,
Nausea,
Neck pain,
Paraesthesia,
Pruritus SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (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: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: approx 10-15min p/vax noted stuffy nose, h/a, & drainage down the back of throat;itchiness & watering rt eye & tingling along top of rt hand & along fingertips of rt hand;chills,nausea;throbbing pain of skull & spine & shoulder;flu like sx; |
|
VAERS ID: |
115471 (history) |
Form: |
Version 1.0 |
Age: |
50.0 |
Sex: |
Female |
Location: |
Alabama |
Vaccinated: | 1998-09-11 |
Onset: | 1998-09-21 |
Days after vaccination: | 10 |
Submitted: |
1998-10-01 |
Days after onset: | 10 |
Entered: |
1998-10-30 |
Days after submission: | 29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
84A4 / UNK |
RA / IM |
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES |
PO3232 / UNK |
RA / IM |
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES |
0960540 / UNK |
RA / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Guillain-Barre syndrome SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), 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, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: NONE Preexisting Conditions: lt mastectomy Allergies: Diagnostic Lab Data: CDC Split Type: AL9812
Write-up: pt dx of GBS onset 10 days p/vax per MD; |
|
VAERS ID: |
116516 (history) |
Form: |
Version 1.0 |
Age: |
30.0 |
Sex: |
Female |
Location: |
Oklahoma |
Vaccinated: | 1998-09-24 |
Onset: | 1998-09-25 |
Days after vaccination: | 1 |
Submitted: |
1998-11-10 |
Days after onset: | 46 |
Entered: |
1998-11-19 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
584A4 / 1 |
LA / IM |
Administered by: Other Purchased by: Public Symptoms: Dyspnoea,
Laryngospasm,
Urticaria SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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: PCN Allergies: Diagnostic Lab Data: NONE CDC Split Type: OK9843
Write-up: onset of hives upon arising-called hlth dept 8AM-told to see pvt MD;traveled to pvt MD 12 miles from work-throat was swelling & had difficulty breathing-meds administered & rxn resolved; |
|
VAERS ID: |
117197 (history) |
Form: |
Version 1.0 |
Age: |
28.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1998-11-15 |
Onset: | 1998-11-24 |
Days after vaccination: | 9 |
Submitted: |
1998-12-01 |
Days after onset: | 7 |
Entered: |
1998-12-08 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH |
FAV034 / 1 |
- / - |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
- / - |
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Military Purchased by: Military Symptoms: Chills,
Ear disorder,
Headache,
Hyperhidrosis,
Meningitis,
Neck pain,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Zyrtec Current Illness: NONE Preexisting Conditions: seasonal allergies, migraines Allergies: Diagnostic Lab Data: cerebrospinal fluid cult negative;blood cult negative; hearing test-absent auditory reflexes & nerve damage, hearing normal CDC Split Type:
Write-up: severe h/a, neck pain, meningitis;hosp x 3 days;fever 102.6, sweating & chills; |
|
VAERS ID: |
117525 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Male |
Location: |
Idaho |
Vaccinated: | 1998-02-11 |
Onset: | 1998-08-01 |
Days after vaccination: | 171 |
Submitted: |
1998-10-22 |
Days after onset: | 82 |
Entered: |
1998-12-21 |
Days after submission: | 60 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
2506A4 / 1 |
RA / IM |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
545B6 / 1 |
LA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0900E / UNK |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0765L / UNK |
MO / PO |
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
7F91700 / UNK |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Diarrhoea,
Drug ineffective,
Hepatitis,
Vomiting SMQs:, Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: pt recv hep b vax by SKB lot# 2506A4 given 11MAR98 Current Illness: NONE Preexisting Conditions: hospitalized DEC97 for 3 days;DEC97 for low grade fever 100-101; Allergies: Diagnostic Lab Data: CDC Split Type: ID98048
Write-up: mom reported pt dx w/hepatitis yesterday;pt had severe diarrhea & vomiting in AUG;saw MD in Mexico transferred to hosp in CA 1OCT;dehydrated, ultra sound, blood test, stool samples;MD dx hep a 21OCT98; |
|
VAERS ID: |
117593 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 1998-08-28 |
Onset: | 1998-08-29 |
Days after vaccination: | 1 |
Submitted: |
1998-11-10 |
Days after onset: | 73 |
Entered: |
1998-12-22 |
Days after submission: | 42 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH |
453846 / 3 |
LL / - |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0720H / 1 |
RL / - |
Administered by: Public Purchased by: Public Symptoms: Dermatitis bullous,
Myasthenic syndrome,
Rash SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Malignancy related conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: TX98176
Write-up: pt recv vax 28AUG98 & next day woke up w/a blister/redness about an adult closed hand size & weakness to lt leg pt was eval by MD;adm to hosp; |
|
VAERS ID: |
118069 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Male |
Location: |
Mississippi |
Vaccinated: | 1997-02-01 |
Onset: | 1997-03-19 |
Days after vaccination: | 46 |
Submitted: |
1999-01-05 |
Days after onset: | 657 |
Entered: |
1999-01-12 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
- / 2 |
- / - |
Administered by: Other Purchased by: Other Symptoms: Asthma,
Depression,
Hypertonia,
Lung disorder,
Mania,
Pain,
Pneumonia,
Pulmonary oedema,
Thinking abnormal SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (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: pt exp fever, stomach cramps & diarrhea w/dose 1 hep A;~ ()~~~In patient Other Medications: NONE Current Illness: Preexisting Conditions: unk Allergies: Diagnostic Lab Data: CDC Split Type: WAES98121980
Write-up: 19MAR97 pt devel fluid in the lungs;SEP97 exp signs of depression;pt also exp pain in lungs & muscle cramps;also exp two episodes of pneumonia;became manic;dx bipolar disorder;dx asthma; |
|