|
VAERS ID: |
27661 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1990-12-10 |
Onset: | 1990-12-19 |
Days after vaccination: | 9 |
Submitted: |
1990-12-31 |
Days after onset: | 12 |
Entered: |
1991-01-30 |
Days after submission: | 30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
281945 / 4 |
LA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1229S / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0619D / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Dyspnoea,
Gaze palsy,
Pyrexia,
Rash,
Tremor,
Vasodilatation SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypersensitivity (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: GA9026
Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red. |
|
VAERS ID: |
27688 (history) |
Form: |
Version 1.0 |
Age: |
35.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1991-01-02 |
Onset: | 1991-01-02 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-01-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1336S / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Hypersensitivity,
Myasthenic syndrome,
Pain SMQs:, Angioedema (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? No Office Visit? No
ER Visit? No
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: WAES91010511
Write-up: pt had pain in arms & muscle weakness in arms & legs. 4Jan91 hospitalized to R/O GBS. Neuro consult revealed pt did not have GBS & was D/C 7Jan91. MD felt sxs d/t vaccination w/ MMR. |
|
VAERS ID: |
27726 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1991-01-21 |
Onset: | 1991-01-21 |
Days after vaccination: | 0 |
Submitted: |
1991-01-22 |
Days after onset: | 1 |
Entered: |
1991-02-04 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283913 / 1 |
RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1471S / 1 |
- / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0615D / 1 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Convulsion,
Somnolence,
Stupor SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis CDC Split Type: WI91006
Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER |
|
VAERS ID: |
27753 (history) |
Form: |
Version 1.0 |
Age: |
33.0 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 1990-12-20 |
Onset: | 0000-00-00 |
Submitted: |
1991-01-28 |
Entered: |
1991-02-05 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1342S / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Conjunctivitis,
Cough,
Diarrhoea,
Epistaxis,
Hepatic function abnormal,
Mouth ulceration,
Nausea,
Pyrexia,
Rash,
Rhinitis,
Vomiting SMQs:, Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), 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, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Seldane in the summer Current Illness: Preexisting Conditions: Hayfever, sinus problems Allergies: Diagnostic Lab Data: SGOT elevated at 125, SPGT elevated at 137, LDH elevated at 527 CPK elevated at 808. Urinalysis showed .1% glucose & trace protein. CDC Split Type:
Write-up: Febrile exanthem; 4 days prior to admission nausea, vomiting & diarrhea. 1 day prior to admission generalized erythematous rash beginning on extremities & progressing to trunk; Epistaxis & rhinorrhea w/mild cough. Febrile to 101.9; Conjuct. |
|
VAERS ID: |
27780 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 1990-08-29 |
Onset: | 1990-09-04 |
Days after vaccination: | 6 |
Submitted: |
1990-12-18 |
Days after onset: | 105 |
Entered: |
1991-02-06 |
Days after submission: | 50 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0J11036 / 1 |
- / IM A |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1499S / 1 |
- / SC A |
Administered by: Private Purchased by: Private Symptoms: Coordination abnormal,
Muscle twitching SMQs:, Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (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, 3 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CAT Scan & bloodwork normal CDC Split Type: MD90122
Write-up: Acute cerebellar ataxia onset 4SEP90 started w/head twitching,loss of balance, then was unable to walk. Admit hosp 7Sep90 & D/C 10Sep90, still under treatment. |
|
VAERS ID: |
27794 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 1991-01-22 |
Onset: | 1991-01-30 |
Days after vaccination: | 8 |
Submitted: |
1991-02-02 |
Days after onset: | 3 |
Entered: |
1991-02-07 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M090FF / UNK |
LA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1901S / UNK |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: Convulsion,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Hypoglycaemia (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: ~ ()~~~In patient Other Medications: Current Illness: URI Preexisting Conditions: recurrent otitis media Allergies: Diagnostic Lab Data: CSF - no growth; EEG - pending CDC Split Type:
Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration. |
|
VAERS ID: |
27815 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 1991-01-25 |
Onset: | 1991-01-29 |
Days after vaccination: | 4 |
Submitted: |
1991-01-31 |
Days after onset: | 2 |
Entered: |
1991-02-08 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1921S / 1 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Ecchymosis,
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? 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: CBC: platelets less than 10,000 CDC Split Type:
Write-up: Thrombocytopenia, cause petechiae all over the body, ecchymosis on tibia 5 days post vax. Referred to hosp. |
|
VAERS ID: |
28123 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Female |
Location: |
Oklahoma |
Vaccinated: | 1990-02-06 |
Onset: | 1990-02-06 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256962 / UNK |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1334R / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0599B / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Rash SMQs:, Anaphylactic reaction (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? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: No illness following previous immunization. Allergies: Diagnostic Lab Data: CDC Split Type: 900162803
Write-up: CDC reports: 17 mo child developed a rash following DTP/OPV/MMR immun; Hospitalized 1 day. |
|
VAERS ID: |
28149 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Female |
Location: |
Louisiana |
Vaccinated: | 1990-01-24 |
Onset: | 1990-01-24 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256965 / UNK |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
2064P / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0542B / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), 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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: No illness following previous immunizations, no hx of convuls in pt, siblings, or parents. Allergies: Diagnostic Lab Data: EEG-WNL CDC Split Type: 900163003
Write-up: 17 mo child developed fever to 103 & four convulsive episodes following DTP/OPV/MMR immunization. Hospitalized, EEG within normal limits according to pt mom. Pt on no anti-sz meds, duration of illness 4 days. |
|
VAERS ID: |
28173 (history) |
Form: |
Version 1.0 |
Age: |
1.8 |
Sex: |
Female |
Location: |
Alabama |
Vaccinated: | 1989-10-23 |
Onset: | 1989-10-23 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256962 / UNK |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1661R / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
253944 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: No hx of convuls in pt, hx of convuls in siblings & parents unknown. Allergies: Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal CDC Split Type: 900165901
Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal. |
|