|
VAERS ID: |
132938 (history) |
Form: |
Version 1.0 |
Age: |
32.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1999-10-01 |
Onset: | 1999-10-28 |
Days after vaccination: | 27 |
Submitted: |
1999-12-22 |
Days after onset: | 55 |
Entered: |
1999-12-30 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
70A6 / UNK |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
05435 / UNK |
- / SC |
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH |
4988034 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Dizziness,
Fatigue,
Hypoaesthesia,
Hypotension,
Paraesthesia,
Presyncope,
Tachycardia,
Tremor SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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, 9 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: TiH Table Test CDC Split Type:
Write-up: Tachycardia, low blood pressure, near syncope, tremors, numbness, lightheadedness, severe weakness, fatigue. Dx''d with postural tachycardia syndrome. Came on suddenly and without warning within a month of vaccination.60 day follow-up / no additional data. Follow-up: 2/8/00 - 1440 - Call to pt to ask if she had received, signed, and mailed consent form back to us. Could not leave message - house keeper does not speak English. 2/9/00 - 8:20 - Call to pt - left message on answering service requesting a call back. 2/11/00 - 1005 - Call to pt -She had misplaced consent sheet, but has now found it and will sign and return it now. |
|
VAERS ID: |
133237 (history) |
Form: |
Version 1.0 |
Age: |
52.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1999-04-22 |
Onset: | 1999-04-29 |
Days after vaccination: | 7 |
Submitted: |
2000-01-10 |
Days after onset: | 256 |
Entered: |
2000-01-12 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
547A1 / 1 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Ageusia,
Parosmia SMQs:, Taste and smell 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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 2000000072
Write-up: 4/22/99, the pt rcvd the vaccine, on 4/29/99 the pt experienced anosmia and ageusia. The MD reports that these events resulted in permanent disability. |
|
VAERS ID: |
133593 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2000-01-13 |
Onset: | 2000-01-14 |
Days after vaccination: | 1 |
Submitted: |
2000-01-14 |
Days after onset: | 0 |
Entered: |
2000-01-31 |
Days after submission: | 17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
103BJ / 1 |
LA / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
NO7272 / UNK |
LA / SC |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
1014J / 2 |
RA / SC |
Administered by: Public Purchased by: Public Symptoms: Myasthenic syndrome,
Myelitis SMQs:, Malignancy related conditions (narrow), Immune-mediated/autoimmune disorders (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: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: CA000003
Write-up: Transverse myelitis with bilateral leg weakness. Developed 12 hrs after vax. |
|
VAERS ID: |
133789 (history) |
Form: |
Version 1.0 |
Age: |
82.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 2000-01-26 |
Onset: | 2000-01-27 |
Days after vaccination: | 1 |
Submitted: |
2000-02-03 |
Days after onset: | 7 |
Entered: |
2000-02-08 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
1935H / UNK |
UN / IM |
Administered by: Other Purchased by: Other Symptoms: Cardiac arrest SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (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, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Vitamins Current Illness: Preexisting Conditions: Unknown Allergies: Diagnostic Lab Data: No enxyme or EKG evidence of myocardial infarction. CDC Split Type: WAES00012633
Write-up: Information has been received from a physician concerning her father, an 82 year old male who on 26-JAN-2000 was vaccinated with VAQTA vaccine inactivated. Concommitant medication included a daily vitamin. On 27-JAN-2000 the patient experienced cardiac arrest. He was ''brought back to life, a code was performed, and he was rushed to the nearest hospital". He remained hospitalized at the time of the report and was stable. Cardiac arrest was considered life-threatening. No further information is available. |
|
VAERS ID: |
150477 (history) |
Form: |
Version 1.0 |
Age: |
44.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1999-12-15 |
Onset: | 2000-01-25 |
Days after vaccination: | 41 |
Submitted: |
2000-03-24 |
Days after onset: | 59 |
Entered: |
2000-03-28 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
570B6 / 1 |
- / IM |
Administered by: Public Purchased by: Other Symptoms: Anaemia,
Anorexia,
Blood albumin decreased,
Dehydration,
Enzyme abnormality,
Erythema multiforme,
Hepatomegaly,
Hepatosplenomegaly,
Hyperplasia,
Lymphadenopathy,
Pain,
Pyrexia,
Rash,
Rash macular,
Red blood cell sedimentation rate increased,
Splenomegaly,
Thrombocytopenia,
Viral infection SMQs:, Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Dehydration (narrow), 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, 7 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Paxil Current Illness: NONE Preexisting Conditions: Mild depression. No additional past medically or allergy history. Allergies: Diagnostic Lab Data: CBC - mild anemia, AST-8xnml , decreased albumin, skin biopsy, sedimentation rate of 39, Liver function test-10xnml, CDC Split Type: 20000044082
Write-up: Possible viral infection, possible drug reaction, erythema multiforme. January, 2000 pt developed some posterior cervical adenopathy that was painless. One lymph node from back of neck was subsequently and showed reactive hyperplasia. 01/25 lymphadenopathy reported became widespread and painful. She experienced anorexia, and developed rash on trunk and arms, a fever of 102. 01/29 pt admitted to hospital due to dehydration, continued fevers, generalized severe painful lymphadenopathy, mildly enlarged and tender liver and spleen, elevated liver enzymes, decreased albumin, and macular rash - confluent over 80% of body, face and feet. Skin biopsy revealed erythema multiforme. Also mild thrombocytopenia. Husband noted that she was improving. She completely recovery around 02/15. Discharge diagnosis was rash, fever, lymphadenopathy, and hepatosplenomegaly of unknown etiology, possibly viral infection although drug reaction is possible. During hospital stay, pt received fluids and medications for pain and itching. |
|
VAERS ID: |
150480 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Female |
Location: |
Oklahoma |
Vaccinated: | 1999-09-14 |
Onset: | 1999-09-14 |
Days after vaccination: | 0 |
Submitted: |
2000-03-22 |
Days after onset: | 190 |
Entered: |
2000-03-28 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
3075 / 2 |
LA / IM |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
114HJ / 1 |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Dyspnoea,
Pain SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Other Medications: Current Illness: recovering from pneumonia Preexisting Conditions: asthma, hx of grand mal seizures Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt''s lungs hurt bad, hurt to breath, and then couldn''t breath 2 hours post vax. Pt was taken to ER and admitted to hospital. Put tube in throat so she could breath then gave her a shot to reduce swelling. Took tube out 15 minutes after shot was given. |
|
VAERS ID: |
150622 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Female |
Location: |
Kansas |
Vaccinated: | 2000-01-24 |
Onset: | 2000-01-24 |
Days after vaccination: | 0 |
Submitted: |
2000-01-28 |
Days after onset: | 4 |
Entered: |
2000-03-31 |
Days after submission: | 63 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
576B9 / 1 |
LA / IM |
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0950740 / UNK |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Aggression,
Belligerence,
Convulsion,
Disorientation,
Fall,
Headache,
Heart rate increased,
Hypertension,
Intracranial pressure increased,
Muscle rigidity,
Muscle twitching,
Syncope,
Tremor,
Vomiting SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (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: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: KS200005
Write-up: Before leaving the clinic, the pt fainted and collapsed, falling backwards onto the floor. The pt was lying on the floor with symptoms of a seizure. Trembling and twitching were occurring of the hands and neck. The pt''s face was rigid and both eyes were open. The duration of this episode was approximately 1 minute. Subsequently, the pt became combative (kept trying to get up), belligerent, and displayed disorientation as she did not recall getting vaccinations or where she was. Blood pressure was 130/80, pulse 100 and regular, pupils equal, and skin was warm and dry. Pt had a complaint of a headache. The pt was detained for approximately 15 minutes until symptoms improved. The pt left will all symptoms gone except the belligerent attitude. The parent was compliant with referral to the hospital emergency room so the pt may be examined by a physician. Following the exam the pt was sent home. The pt was doing well until about 10:00 PM when she started vomiting and had a complaint of a headache. She was taken back to the ER assessed and transported to a hospital in another city. It was reported she had surgery to relieve inter-cranial pressure. On 1/25/00, the pts father reported she was doing "OK" since the surgery. |
|
VAERS ID: |
150966 (history) |
Form: |
Version 1.0 |
Age: |
15.0 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: | 2000-02-22 |
Onset: | 2000-02-26 |
Days after vaccination: | 4 |
Submitted: |
2000-03-06 |
Days after onset: | 9 |
Entered: |
2000-04-14 |
Days after submission: | 38 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0745J / 1 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Dehydration,
Headache,
Papilloedema,
Pyrexia,
Vomiting SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CSF-nml, spinal tap-neg, Blood culture-neg, CIF-nml, MRI-nml CDC Split Type:
Write-up: Pt experienced severe headache, fever, chills for 7 days. Pt also experienced papilledema and dehydration and vomiting for 2-3 days. |
|
VAERS ID: |
151801 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 2000-04-29 |
Onset: | 2000-04-29 |
Days after vaccination: | 0 |
Submitted: |
2000-05-04 |
Days after onset: | 5 |
Entered: |
2000-05-10 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
639A4 / 1 |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
133J / 2 |
- / SC |
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
U0003BA / 2 |
- / IM |
Administered by: Military Purchased by: Military Symptoms: Dyspnoea,
Pallor,
Urticaria SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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, 1 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: Latex, Benadryl Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Urticaria, dyspnea, pallor, approximately 15 minutes, post vax. Treated with epinephrine, IM, and Atarax, albuterol and Solu-Medrol in ER all in right deltoid. Follow-up with allergist is recommended. |
|
VAERS ID: |
152152 (history) |
Form: |
Version 1.0 |
Age: |
68.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 1999-04-29 |
Onset: | 0000-00-00 |
Submitted: |
2000-03-07 |
Entered: |
2000-05-19 |
Days after submission: | 72 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
- / 1 |
- / IM |
HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0884H / 1 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Liver function test abnormal SMQs:, Liver related investigations, signs and symptoms (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, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Tenormin, Detrol Current Illness: Preexisting Conditions: hepatitis C Allergies: Diagnostic Lab Data: hepatic function test - worsening CDC Split Type: WAES99060885
Write-up: Following vaccines, the pt experienced a worsening of liver function tests and was hospitalized. Therapy with tolterodine and atenolol were discontinued. The elevated LFT''s persisted for two months before the pt recovered and the levels returned to baseline. No further information is available. |
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