|
VAERS ID: |
126160 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1999-07-09 |
Onset: | 1999-07-10 |
Days after vaccination: | 1 |
Submitted: |
1999-07-15 |
Days after onset: | 5 |
Entered: |
1999-07-20 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH |
4978252 / UNK |
LA / IM |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
596C6 / 1 |
RA / IM |
Administered by: Public Purchased by: Other Symptoms: Asthenia,
Hepatic function abnormal,
Leukocytosis,
Nausea,
Paraesthesia,
Paraesthesia oral SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: cliocin Current Illness: NONE Preexisting Conditions: NONE KNOWN Allergies: Diagnostic Lab Data: liver function panel-mildly elevated, CBC, UA, chemistry panel, elevated white count w/left shift CDC Split Type:
Write-up: 1day p/vax pt possibly had fever & chills; felt weak, nausea; in ER c/o tingling/numbness of hands, feet & mouth area; given IV fluids & adm to hosp; improved in less than 24 hrs; |
|
VAERS ID: |
126375 (history) |
Form: |
Version 1.0 |
Age: |
80.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 1999-05-04 |
Onset: | 1999-05-09 |
Days after vaccination: | 5 |
Submitted: |
1999-06-21 |
Days after onset: | 43 |
Entered: |
1999-07-27 |
Days after submission: | 36 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0761H / 1 |
- / IM A |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
N1034 / UNK |
- / SC A |
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH |
4978249 / 2 |
- / IM A |
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES |
P04825 / 2 |
- / IM A |
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES |
1001560 / 2 |
- / SC A |
Administered by: Private Purchased by: Private Symptoms: Anorexia,
Aspartate aminotransferase increased,
Asthenia,
Infection,
Red blood cell sedimentation rate increased,
Somnolence SMQs:, Liver related investigations, signs and symptoms (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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, 7 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Macrobid, Enduron, Tamoxifen Current Illness: none Preexisting Conditions: allergies: Floxin, Maxaquin & Doxycycline; h/o breast cancer, chronic UTI, polyp removal, HTN, hyst @ age 30, cataract surgery, squamous cell CA skin- removed from temple Allergies: Diagnostic Lab Data: SR=73; ALT=62;CBC=nl;TEE=neg; bacterial/fungal cx=neg; temporal artery bx=neg; abd/pelvic CT=neg; SR & LFT''s gradually responded CDC Split Type:
Write-up: 5day p/vax pt devel fever 100-101, weakness, loss of appetite, increased sleepiness & fatigue. sx continued x 3 wks; admitted to hosp; gradually recovering |
|
VAERS ID: |
126959 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Female |
Location: |
Nebraska |
Vaccinated: | 1999-05-14 |
Onset: | 1999-05-14 |
Days after vaccination: | 0 |
Submitted: |
1999-05-29 |
Days after onset: | 15 |
Entered: |
1999-08-06 |
Days after submission: | 69 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Arthralgia,
Petechiae,
Rash,
Thrombocytopenia,
Thrombocytopenic purpura SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Arthritis (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? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: parents/sister recv vax also; 1 sister having rash/joint pain other members fine~ ()~~~In Sibling Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: 5/28 plt <10,000;5/28 WBC=12.3, 5/29 8.3 CDC Split Type:
Write-up: w/in hrs p/vax pt devel rash on lower extremities then joint aches; petechia devel over body; pt admit to hosp w/acute ITP; tx w/IVIG x1 |
|
VAERS ID: |
127307 (history) |
Form: |
Version 1.0 |
Age: |
1.1 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1999-06-09 |
Onset: | 1999-07-25 |
Days after vaccination: | 46 |
Submitted: |
1999-08-13 |
Days after onset: | 19 |
Entered: |
1999-08-17 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
- / 1 |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 1 |
- / SC |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
1048H / 1 |
- / SC |
Administered by: Other Purchased by: Other Symptoms: Asthma,
Lung disorder,
Pneumonia,
Pyrexia SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Preexisting Conditions: diaper rash; diarrhea; oral candidiasis; otitis media; pediculosis capitis; upper respiratory infect Allergies: Diagnostic Lab Data: CDC Split Type: WAES99072041
Write-up: 7/25 pt hosp w/rt lower lobe pneumonia; records reveals pt presented w/congestion, wheezing, green exudates & fever; tx w/ATBs, pediazole, ibuprofen, Pedia-Pred & albuterol; |
|
VAERS ID: |
127623 (history) |
Form: |
Version 1.0 |
Age: |
33.0 |
Sex: |
Male |
Location: |
Massachusetts |
Vaccinated: | 1998-05-02 |
Onset: | 1998-05-24 |
Days after vaccination: | 22 |
Submitted: |
1999-08-21 |
Days after onset: | 454 |
Entered: |
1999-08-25 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
- / 2 |
- / IM |
Administered by: Military Purchased by: Military Symptoms: Amnesia,
Condition aggravated,
Coordination abnormal,
Depression,
Gait disturbance,
Multiple sclerosis,
Neuropathy,
Paraesthesia,
Pollakiuria,
Speech disorder,
Urinary incontinence SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (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: amoxicillin; allegra; Current Illness: 4/98 sinusitis, allergies-resolved Preexisting Conditions: slight lt hand numbness 7/97?; leg/foot numbness 4/98; rxn to Cleocin &/or APAP w/ codeine; neg family hx for neuro; mom has hypothyroidism; Allergies: Diagnostic Lab Data: lead testing = nl; blood work (B12-sed rate-ANA-RPR-folate-glucose-Lyme) = all nl; MRI-head-thoracic spine-abn area of T-2;galt-nl; all tests for peripheral neuro-nl;8/98 MRI scan head & spinal showed changes c/w MS; CDC Split Type:
Write-up: p/vax pt exp neuro sx: numbness in both feet, legs, arm, rt hand, abd; also enunciation impediments;dx: "secondary progressive" MS;pt speaking ability challenged considerably diplopia;UTI sx;urinary frequency & urgency;pt depressed |
|
VAERS ID: |
128333 (history) |
Form: |
Version 1.0 |
Age: |
6.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 1999-05-26 |
Onset: | 1999-08-21 |
Days after vaccination: | 87 |
Submitted: |
1999-09-15 |
Days after onset: | 25 |
Entered: |
1999-09-17 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Hepatitis,
Jaundice,
Malaise,
Urine analysis abnormal SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (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? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt non responder p/3 doses hep b vax;~ ()~~~In patient Other Medications: pt recv full course of Engerix-B; Current Illness: Preexisting Conditions: non responder p/Engerix-B vax; Allergies: Diagnostic Lab Data: 8/21/99 hep A IGG positive;8/31/99 hep A IGM negative;hep B core antibody negative;hep B surface antigen negative; CDC Split Type: 1999023210
Write-up: p/vax pt devel dark urine & general sx (NOS);pt referred to MD who dx hepatitis A in icteric phase of mild intensity w/o complications;reporter considers event to be disabling/incapacitating & r/t vax;pt not recovered; |
|
VAERS ID: |
130521 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Unknown |
Location: |
Alaska |
Vaccinated: | 1999-09-15 |
Onset: | 1999-09-15 |
Days after vaccination: | 0 |
Submitted: |
1999-10-27 |
Days after onset: | 42 |
Entered: |
1999-11-08 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
54986 / 2 |
- / - |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
4998137 / 1 |
- / - |
Administered by: Military Purchased by: Military Symptoms: Hypotension,
Leukopenia,
Malaise,
Myalgia,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (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: unk Current Illness: NONE Preexisting Conditions: unk Allergies: Diagnostic Lab Data: unk CDC Split Type: HQ3382225OCT199
Write-up: p/vax pt devel neutropenia, fever of 101, hypotension, gen malaise & myalgia & was hosp; |
|
VAERS ID: |
131442 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: | 1999-09-28 |
Onset: | 1999-09-29 |
Days after vaccination: | 1 |
Submitted: |
1999-11-22 |
Days after onset: | 54 |
Entered: |
1999-11-29 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 4 |
- / - |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 2 |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 4 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Anorexia,
Asthenia,
Bone marrow depression,
Coagulopathy,
Eye disorder,
Gastrointestinal disorder,
Hepatic failure,
Hepatitis,
Jaundice,
Vomiting SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haemorrhage laboratory terms (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Retinal disorders (broad), Myelodysplastic 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? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 35 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: magnesium;Actigal;Lactalose Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: vomited, yellow eyes, would not eat, not producing white cells, no clotting, jaundice, assumed hep;bile ducts damaged; tiredness;needs liver transplant-liver failure; |
|
VAERS ID: |
131632 (history) |
Form: |
Version 1.0 |
Age: |
7.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 1999-10-28 |
Onset: | 1999-10-28 |
Days after vaccination: | 0 |
Submitted: |
1999-10-29 |
Days after onset: | 1 |
Entered: |
1999-12-02 |
Days after submission: | 34 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4998234 / 1 |
RA / IM |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA548A4 / 1 |
RA / IM |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
4998088 / 1 |
LA / IM |
Administered by: Military Purchased by: Military Symptoms: Headache,
Vomiting SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 1 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: sulfa Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: h/a, n/v; |
|
VAERS ID: |
132314 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Male |
Location: |
Iowa |
Vaccinated: | 1999-11-08 |
Onset: | 1999-12-01 |
Days after vaccination: | 23 |
Submitted: |
1999-12-07 |
Days after onset: | 6 |
Entered: |
1999-12-17 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / SC |
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / SC |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
MO / PO |
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / SC |
Administered by: Military Purchased by: Military Symptoms: Petechiae,
Thrombocytopenic purpura SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Immune-mediated/autoimmune disorders (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? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: cbc,platelet ct noted to be 58,000 12/1/99,35,000 12/2/99,15,000 12/3/99,18,000 12/4/99,26,000 12/5/99. CDC Split Type:
Write-up: Idiopathic thrombocytopenia purpura, possibly related to receipt of numerous vaccines.Petechia on feet noted on PE. Responded to steroids w/slight resolution. |
|