|
VAERS ID: |
27289 (history) |
Form: |
Version 1.0 |
Age: |
1.2 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 1990-10-02 |
Onset: | 1990-10-13 |
Days after vaccination: | 11 |
Submitted: |
1990-11-21 |
Days after onset: | 39 |
Entered: |
1991-01-04 |
Days after submission: | 44 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M670FC / 1 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1488S / 1 |
LA / SC |
Administered by: Public Purchased by: Public Symptoms: Febrile convulsion SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: OH9054
Write-up: Pt vaccinated with HIB/MMR developed febrile seizures - hospitalized 13OCT90 x 3 days for observation. |
|
VAERS ID: |
27300 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Female |
Location: |
Louisiana |
Vaccinated: | 1990-12-13 |
Onset: | 1990-12-18 |
Days after vaccination: | 5 |
Submitted: |
1990-12-20 |
Days after onset: | 2 |
Entered: |
1991-01-04 |
Days after submission: | 15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
275970 / 4 |
RL / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0J11070 / 1 |
RA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1569S / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0613D / 3 |
MO / PO |
Administered by: Public Purchased by: Unknown Symptoms: Febrile convulsion,
Pyrexia SMQs:, Neuroleptic malignant syndrome (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)
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: Keflex Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: U/A - normal; Chest x-ray - normal; CBC - normal CDC Split Type: LA901210
Write-up: Pt vaccinated with DTP/OPV/MMR/HIB developed fever of 106, febrile seizure, no other illness reported. MD states received too many vaccines at one time & caused adverse reaction. Possible viral seizure but not r/o possible reaction to vax. |
|
VAERS ID: |
27394 (history) |
Form: |
Version 1.0 |
Age: |
1.6 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 1990-11-29 |
Onset: | 1990-12-04 |
Days after vaccination: | 5 |
Submitted: |
1990-12-18 |
Days after onset: | 14 |
Entered: |
1991-01-14 |
Days after submission: | 27 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH |
4908019 / UNK |
LA / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
01920168 / 1 |
RA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1414S / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
281925 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Febrile convulsion,
Otitis media SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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, ? days
Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89. Allergies: Diagnostic Lab Data: CDC Split Type: MO903
Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later |
|
VAERS ID: |
27507 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 1991-01-05 |
Onset: | 1991-01-05 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-01-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
293947 / 3 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1492S / 1 |
RL / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287949 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Pyrexia,
Rash,
Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (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? 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: Blood Cultures; CBC WBC 20,000 Spinal tap - negative CDC Split Type: VA91002
Write-up: Day of vac developed fever 103-104(F) lt leg at inj site red w/rash. Admitted to hosp. Tx w/IV & IM antibiotics. D/c''d on oral antibiotics 6JAN91. Rash fine red (like a hive) at inj site spread to lt buttock. 8Jan91, temp to 106.5 |
|
VAERS ID: |
27526 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 1990-12-22 |
Onset: | 1990-12-31 |
Days after vaccination: | 9 |
Submitted: |
0000-00-00 |
Entered: |
1991-01-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea,
Bronchitis,
Cardiac failure,
Coagulopathy,
Convulsion,
Infection,
Pharyngitis,
Pneumonia,
Pyrexia,
Rash,
Renal failure,
Sepsis,
Shock SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
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: WAES91010158
Write-up: Developed T,convuls&pneumonia.Hospitalized w/ septic shock, renal failure & disseminated intravascular coagulation.Develop rash&tracheitis.Culture-Staph aureus.Exp multiple system failure-renal/respiratory/metabolic/cardivascul.Died 11Jan91 |
|
VAERS ID: |
27530 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1990-11-13 |
Onset: | 1990-11-13 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-01-24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Anaphylactoid reaction,
Asthma,
Salivary hypersecretion SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: PPD Current Illness: Preexisting Conditions: asthma Allergies: Diagnostic Lab Data: CDC Split Type: WAES90120347
Write-up: Immediately after vac developed a burning & tightness in throat, wheezing & salivation. To ER treated for anaphylaxis w/ Epinephrine & diphenhydramine & unspecified steroids. Symptoms resolved w/in 1-2 hrs. MD felt condition due to vax. |
|
VAERS ID: |
27533 (history) |
Form: |
Version 1.0 |
Age: |
1.7 |
Sex: |
Unknown |
Location: |
Pennsylvania |
Vaccinated: | 1990-07-16 |
Onset: | 1990-08-16 |
Days after vaccination: | 31 |
Submitted: |
1991-01-22 |
Days after onset: | 159 |
Entered: |
1991-01-24 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0J11036 / UNK |
LA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0897F / 1 |
RA / SC |
Administered by: Private Purchased by: Private Symptoms: Aplastic anaemia SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Myelodysplastic 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, 7 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated w/MMR/HIB & 4 wks later developed aplastic anemia. |
|
VAERS ID: |
27548 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: | 1990-11-15 |
Onset: | 1990-11-25 |
Days after vaccination: | 10 |
Submitted: |
1991-01-08 |
Days after onset: | 44 |
Entered: |
1991-01-25 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285965 / 4 |
LL / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0A21133 / 1 |
RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1487S / 1 |
LA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287939 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Hypotonia,
Pyrexia SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: VA91004
Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days. |
|
VAERS ID: |
27641 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1991-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Epididymitis,
Orchitis SMQs:
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? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES91010686
Write-up: A MD reported 14yr old male revaccinated w/a booster dose of MMR developed epididymitis & orchitis. He was hospitalized & later recovered. |
|
VAERS ID: |
27648 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1990-11-05 |
Onset: | 1990-11-12 |
Days after vaccination: | 7 |
Submitted: |
1991-01-25 |
Days after onset: | 74 |
Entered: |
1991-01-30 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M030FC / 1 |
LA / SC |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1707S / 1 |
RA / SC |
Administered by: Private Purchased by: Private Symptoms: Apnoea,
Coma,
Convulsion,
Pyrexia,
Tremor SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (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, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII CDC Split Type:
Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely. |
|