|
VAERS ID: |
118522 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: | 1999-01-06 |
Onset: | 1999-01-19 |
Days after vaccination: | 13 |
Submitted: |
1999-01-26 |
Days after onset: | 7 |
Entered: |
1999-02-01 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
1481E / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Diplopia,
Visual disturbance SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Hypoglycaemia (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: Other Medications: unk Current Illness: Preexisting Conditions: unk Allergies: Diagnostic Lab Data: CDC Split Type: WAES99011275
Write-up: pt recv vax 6JAN99 & presented w/diplopia that started very distal, seeing two lines, not one;this progressed to double vision for almost everything x/reading;this was considered to be a disabling event;Annual follow-up dated 11/27/00 provided no additional data. |
|
VAERS ID: |
118584 (history) |
Form: |
Version 1.0 |
Age: |
50.0 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 1997-05-19 |
Onset: | 1997-08-01 |
Days after vaccination: | 74 |
Submitted: |
1999-02-04 |
Days after onset: | 552 |
Entered: |
1999-02-08 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
2146A4 / 2 |
- / - |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
549A6 / 2 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Multiple sclerosis,
Myasthenic syndrome,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
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? No
Previous Vaccinations: UNK~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: MRI CDC Split Type:
Write-up: Pt recv vax on 5/19/97; on 8/1/97 pt exp tingling legs then weakness in left leg; dx=multiple sclerosis |
|
VAERS ID: |
119050 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Male |
Location: |
Utah |
Vaccinated: | 1998-11-23 |
Onset: | 1998-12-08 |
Days after vaccination: | 15 |
Submitted: |
1999-02-05 |
Days after onset: | 59 |
Entered: |
1999-02-17 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
2703B6 / UNK |
- / - |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0717H / UNK |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1007H / UNK |
- / - |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
0671H / UNK |
- / - |
Administered by: Public Purchased by: Public Symptoms: Condition aggravated,
Dermatitis bullous,
Infection,
Renal impairment SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Severe cutaneous adverse reactions (narrow), Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), 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? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient Other Medications: Cellcept, Prednisone, Prograf Current Illness: UNK Preexisting Conditions: Immunosuppression, renal transplant Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES98121486
Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99 |
|
VAERS ID: |
119776 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Female |
Location: |
Arizona |
Vaccinated: | 1999-02-19 |
Onset: | 1999-02-20 |
Days after vaccination: | 1 |
Submitted: |
1999-03-03 |
Days after onset: | 11 |
Entered: |
1999-03-08 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
0599H / 3 |
- / - |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0005H / 2 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Arthritis,
Laboratory test abnormal,
Pyrexia,
Red blood cell sedimentation rate increased,
Serum sickness,
Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (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? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Imipramine Current Illness: NONE Preexisting Conditions: allergy to (Ephalexin (facial swelling)); Allergies: Diagnostic Lab Data: mildly elevated ESR, negative ANA, negative RF, mildly elevated ASO titer, negative rapid strep test;nl EKG;nl CBC;nl electrolytes & BUN/Cr;nl UA; CDC Split Type: AZ9914
Write-up: 1 day p/vax had onset of urticarial rash;4 days p/had onset of multiple large joint arthritis (ankle, knees, hips, wrist) sx have persisted for 11 days so far;child has had intermittent fevers-picture is of serum sickness type rxn;Annual follow-up received on 11/08/00 provided no additional data. |
|
VAERS ID: |
120523 (history) |
Form: |
Version 1.0 |
Age: |
36.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1997-06-18 |
Onset: | 1997-06-22 |
Days after vaccination: | 4 |
Submitted: |
1999-03-18 |
Days after onset: | 634 |
Entered: |
1999-03-23 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
2186A4 / 1 |
LA / IM |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
539A6 / 1 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Abdominal pain,
Arthralgia,
Blood disorder,
Eye disorder,
Headache,
Hyperhidrosis,
Immune system disorder,
Myalgia,
Paraesthesia,
Rash SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: sore throat-didn''t feel well Preexisting Conditions: none Allergies: Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder CDC Split Type:
Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data. |
|
VAERS ID: |
121246 (history) |
Form: |
Version 1.0 |
Age: |
48.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1999-03-07 |
Onset: | 1999-03-28 |
Days after vaccination: | 21 |
Submitted: |
1999-04-10 |
Days after onset: | 12 |
Entered: |
1999-04-15 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
568A6 / UNK |
LA / IM |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Dyspnoea,
Haemolytic anaemia,
Jaundice,
Peripheral vascular disorder,
Red blood cell abnormality SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Haemolytic disorders (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), 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, 11 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test; CDC Split Type:
Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists |
|
VAERS ID: |
122165 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Washington |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1999-05-14 |
Entered: |
1999-05-17 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Anaphylactoid reaction,
Respiratory disorder SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Hypersensitivity (narrow), Respiratory failure (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: 19990108451
Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp; |
|
VAERS ID: |
122172 (history) |
Form: |
Version 1.0 |
Age: |
11.0 |
Sex: |
Female |
Location: |
Alaska |
Vaccinated: | 1998-10-15 |
Onset: | 1998-10-31 |
Days after vaccination: | 16 |
Submitted: |
1999-05-13 |
Days after onset: | 193 |
Entered: |
1999-05-17 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1141H / UNK |
LA / IM |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
1110H / 1 |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Abdominal pain,
Anaemia,
Anorexia,
Arthralgia,
Asthenia,
Dehydration,
Headache,
Hepatic function abnormal,
Influenza,
Laboratory test abnormal,
Lymphocytosis,
Muscle twitching,
Myalgia,
Nausea,
Personality disorder,
Pyrexia,
Vomiting,
Weight decreased SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: 4 or 5NOV blood work,UA nl;7DEC blood & urine nl;14DEC abd ultrasound,upper GI & small bowel nl;21DEC MRI head & abdomen nl;28DEC colonoscopy & endoscopy nl;EEG x 2 nl CDC Split Type:
Write-up: 31OCT, flu like illness,fever,abd pain, aching joints,vomiting;to MD on 4NOV or 5NOV;V cont w/ fatigue,can eat only popsicles & mom concerned about dehydration;4DEC new Sx:h/a,muscle aches,nausea;28DEC 15 # wt loss;twitch;Dx fibromyalgia |
|
VAERS ID: |
122251 (history) |
Form: |
Version 1.0 |
Age: |
38.0 |
Sex: |
Female |
Location: |
Kentucky |
Vaccinated: | 1998-04-23 |
Onset: | 1998-05-01 |
Days after vaccination: | 8 |
Submitted: |
1999-05-01 |
Days after onset: | 365 |
Entered: |
1999-05-20 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
2491B6 / 1 |
LA / - |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
542A6 / 1 |
RA / - |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Back pain,
Ecchymosis,
Hypertonia,
Muscle twitching,
Myasthenic syndrome,
Neuralgia,
Pain,
Paraesthesia,
Tremor,
Visual disturbance SMQs:, Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related conditions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal 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? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: some heart palpitations;possible seasonal allergies Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: sharp, stabbing facial pain (rt side of face along cheekbone);extreme fatigue, tingling, heaviness & numbness (nerve pain) bruising, tremors, electrical shocks lower back muscle, twitching, visual disturbances;muscle cramps |
|
VAERS ID: |
123217 (history) |
Form: |
Version 1.0 |
Age: |
35.0 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: | 1998-03-30 |
Onset: | 1998-04-21 |
Days after vaccination: | 22 |
Submitted: |
1999-05-28 |
Days after onset: | 402 |
Entered: |
1999-06-02 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER |
2512A2 / UNK |
- / - |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
55386 / UNK |
- / - |
TTOX: TETANUS TOXOID (NO BRAND NAME) / CONNAUGHT LABORATORIES |
7F91679 / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Laboratory test abnormal,
Malaise,
Myasthenic syndrome,
Neuritis,
Neuropathy,
Pain,
Post vaccination syndrome,
Pyrexia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)
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: NONE Allergies: Diagnostic Lab Data: EMG reveals Denervation of serratus anterior; CDC Split Type:
Write-up: fever, malaise followed by severe pain in shoulder area for 24hr, followed by weakness/fatigue in shoulder;EMG reveals rt long thoracic neuropathy/brachial neuritis;physical therapy not successful;Annual follow up / no additional data. |
|