|
VAERS ID: |
28320 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
New Hampshire |
Vaccinated: | 1991-01-28 |
Onset: | 1991-02-05 |
Days after vaccination: | 8 |
Submitted: |
1991-02-12 |
Days after onset: | 7 |
Entered: |
1991-02-15 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1492S / UNK |
LA / - |
Administered by: Other Purchased by: Public Symptoms: Meningitis SMQs:, Noninfectious meningitis (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, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: None Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: lumbar puncture CDC Split Type:
Write-up: Dx of viral menigitis 6Feb91. |
|
VAERS ID: |
28334 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Male |
Location: |
Missouri |
Vaccinated: | 1991-01-18 |
Onset: | 1991-01-24 |
Days after vaccination: | 6 |
Submitted: |
1991-02-05 |
Days after onset: | 12 |
Entered: |
1991-02-15 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
285920 / 4 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1481S / 1 |
RL / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
287951 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Anaemia,
Bone marrow depression,
Convulsion,
Infection,
Pyrexia SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), 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), Myelodysplastic syndrome (broad), 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: Preexisting Conditions: Allergies: Diagnostic Lab Data: Lab results. U of mo hosital, MD feels child had virus infect 2+ mos ago which caused marrow shutdown CDC Split Type: MO918
Write-up: 7 days p/vax, T up to 102 relieved by Tylenol 25JAN91, sz 26JAN91 seen in ER. Extremely low red count, seen by MD 28JAN91. Red count low-bone marrow shutdown. Result viral infect 2-3 mos ago. |
|
VAERS ID: |
28355 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1991-01-21 |
Onset: | 1991-01-29 |
Days after vaccination: | 8 |
Submitted: |
1991-02-15 |
Days after onset: | 17 |
Entered: |
1991-02-18 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
22345 / 1 |
- / SC |
Administered by: Other Purchased by: Private 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: unknown~ ()~~~In patient Other Medications: none Current Illness: none Preexisting Conditions: unknown Allergies: Diagnostic Lab Data: Unknown-in patient record not available to me. CDC Split Type:
Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture. |
|
VAERS ID: |
28417 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1991-01-28 |
Onset: | 1991-02-03 |
Days after vaccination: | 6 |
Submitted: |
1991-02-19 |
Days after onset: | 16 |
Entered: |
1991-02-25 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
0C21132 / 1 |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0560S / 1 |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Erythema multiforme,
Lacrimal disorder,
Petechiae,
Purpura,
Pyrexia,
Rash maculo-papular,
Thrombocytopenia,
Thrombocytopenic purpura SMQs:, Severe cutaneous adverse reactions (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (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, 4 days
Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient Other Medications: Current Illness: otitis media(?) Preexisting Conditions: none Allergies: Diagnostic Lab Data: platelet count low 55,000 CDC Split Type:
Write-up: Petechiae-$gpurpura, DX: Idiopathic thrombocytopenic purpura or erthema multiforme, had T of 101-102, runny eyes, measles type rash starting 1FEb con''t into above symptoms 2Feb /w purpura on 3Feb. |
|
VAERS ID: |
28434 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: | 1990-12-17 |
Onset: | 1990-12-30 |
Days after vaccination: | 13 |
Submitted: |
1991-01-22 |
Days after onset: | 23 |
Entered: |
1991-02-25 |
Days after submission: | 34 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M030FC / 1 |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0896S / 1 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Cellulitis,
Conjunctivitis,
Eye disorder,
Infection SMQs:, Severe cutaneous adverse reactions (broad), Corneal disorders (broad), Retinal disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (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, 3 days
Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient Other Medications: Current Illness: none Preexisting Conditions: hx of recurring otitis;croup Allergies: Diagnostic Lab Data: blood cultures CDC Split Type: CO916
Write-up: Lt eye swelling /w rapid progression on 31Dec. Taken to ER & subsequently hospitalized /w orbital cellulitis. Blood cultures showed hemophaelis influenzae |
|
VAERS ID: |
28500 (history) |
Form: |
Version 1.0 |
Age: |
1.6 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1991-01-22 |
Onset: | 1991-01-22 |
Days after vaccination: | 0 |
Submitted: |
1991-02-26 |
Days after onset: | 35 |
Entered: |
1991-02-28 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21044 / 4 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M670FH / 1 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
2258S / 1 |
LA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
285948 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Dyspnoea,
Grand mal convulsion SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: under investigation CDC Split Type:
Write-up: Status epilepticus approx 60 min. Intubated. Intensive care unit. |
|
VAERS ID: |
28501 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-10-29 |
Onset: | 1990-11-03 |
Days after vaccination: | 5 |
Submitted: |
1991-02-13 |
Days after onset: | 102 |
Entered: |
1991-02-28 |
Days after submission: | 15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0M11148 / 4 |
LL / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0I11070 / 1 |
RL / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
15685 / 1 |
LA / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0620C / 3 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Dyspnoea,
Grand mal convulsion SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: had c/o headache since fall on 5OCT Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal. CDC Split Type:
Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants. |
|
VAERS ID: |
28763 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
Nebraska |
Vaccinated: | 1991-02-19 |
Onset: | 1991-02-20 |
Days after vaccination: | 1 |
Submitted: |
1991-02-21 |
Days after onset: | 1 |
Entered: |
1991-03-04 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283926 / 4 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0896S / 1 |
RL / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
291944 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Convulsion,
Gaze palsy,
Otitis media,
Pyrexia,
Somnolence 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), Ocular motility disorders (narrow), 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, 1 days
Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient Other Medications: NONE Current Illness: no fever--up/about/active playing Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal CDC Split Type: NE911
Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect |
|
VAERS ID: |
28812 (history) |
Form: |
Version 1.0 |
Age: |
0.7 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1990-12-18 |
Onset: | 1990-12-18 |
Days after vaccination: | 0 |
Submitted: |
1991-01-02 |
Days after onset: | 15 |
Entered: |
1991-03-04 |
Days after submission: | 61 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M195FD / 1 |
RL / IM |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
1464S / 1 |
LL / - |
Administered by: Private Purchased by: Private Symptoms: Apnoea,
Cardiac arrest,
Cardiac failure SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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 (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Ferinsol, Diuril until 17DEC; Nebs: Ventolin/Mucomyst Current Illness: BPD, S/P G-Tube placement Preexisting Conditions: 25 wk premie w/h/o BPD, Cardiorespiratory arrest; S/P tracheostomy, sepsis, blood trnafusions, subglottis stenosis. Allergies: Diagnostic Lab Data: ABG=6.8; PCO2=30; PO2=185; base excess of 25.8; saturated of 97.8%. Lytes p/med NA=141, K=3.1, CO2=2.4, cl=111; Glucose=486; temp 95.4; HR-166 CDC Split Type:
Write-up: @ 1030PM, monitor went off for heart & respirations; no palpable pulse; appeared to be in asystole. Rec''d Atropine & Epinephrine, bicarb; a second dose of epi & bicarb were also administered @ 10:39, faint fem pulse present; 1 BrS @ 1041 |
|
VAERS ID: |
28820 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Female |
Location: |
Oregon |
Vaccinated: | 1991-01-30 |
Onset: | 1991-01-31 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1991-03-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
291931 / 5 |
RL / - |
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Anorexia,
Fibrosis tendinous,
Myositis,
Oedema,
Osteoarthritis,
Pyrexia,
Vasodilatation SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (narrow), Tendinopathies and ligament 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? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: NO INFO~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Culture - negative CDC Split Type:
Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE. |
|