Already in VAERS on 12/31/2003 |
| VAERS ID: |
51148
|
Vaccinated: |
1993-02-20 |
| Age: |
54.6 |
Onset: |
1993-02-21 |
| Gender: |
Male |
Submitted: |
1993-03-16 |
| Location: |
D.C. |
Entered: |
1993-03-30 |
|
| Life Threatening? Yes |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? Yes, days: 4 |
| Extended hospital stay? No |
| Previous Vaccinations: |
| Other Medications: Pt recvd Immune Globulin by Armour Pharm co lot# F15907; Lopressor |
| Current Illness: |
| Preexisting Conditions: pt has hx of hypertrophic cardiomyopathy; |
| Diagnostic Lab Data: |
| CDC 'Split Type': |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| MEN: MENOMUNE A/C/Y/W |
CONNAUGHT LABS |
2K41040 |
|
IM |
A |
| TYP: TYPHOID |
WYETH |
4928055 |
|
SC |
A |
| YF: YELLOW FEVER |
CONNAUGHT LABS |
2H31154 |
|
IM |
A |
|
| Administered by: Military
Purchased by: Unknown |
| Symptoms: CHILLS, FEVER, DYSPNEA, ASTHENIA |
| Write-up: Pt devel fever, chills, SOB & weakness, 24 hrs p/vax; |
|
|
Changed on 12/8/2009 |
| VAERS ID: |
51148 Before
After
|
Vaccinated: |
1993-02-20 |
| Age: |
54.6 |
Onset: |
1993-02-21 |
| Gender: |
Male |
Submitted: |
1993-03-16 |
| Location: |
D.C. |
Entered: |
1993-03-30/1993-03-25 |
|
| Life Threatening? Yes |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? Yes, days: 4 |
| Extended hospital stay? No |
| Previous Vaccinations: |
| Other Medications: Pt recvd Immune Globulin by Armour Pharm co lot# F15907; Lopressor |
| Current Illness: |
| Preexisting Conditions: pt has hx of hypertrophic cardiomyopathy; |
| Diagnostic Lab Data: |
CDC 'Split Type':
(blank)
893075002E |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| MEN: MENOMUNE A/C/Y/W/MENINGOCOCCAL (MENOMUNE) |
CONNAUGHT LABS/CONNAUGHT LABORATORIES |
2K41040 |
|
IM |
A |
| TYP: TYPHOID/TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) |
WYETH/WYETH PHARMACEUTICALS, INC |
4928055 |
|
SC |
A |
| YF: YELLOW FEVER/YELLOW FEVER (YF-VAX) |
CONNAUGHT LABS/CONNAUGHT LABORATORIES |
2H31154 |
|
IM |
A |
|
| Administered by: Military
Purchased by: Unknown/Military |
| Symptoms: Asthenia, Chills, Dyspnoea, Pyrexia, CHILLS, FEVER, DYSPNEA, ASTHENIA |
| Write-up: Pt devel fever, chills, SOB & weakness, 24 hrs p/vax; |
|
|
Changed on 1/5/2010 |
| VAERS ID: |
51148 Before
After
|
Vaccinated: |
1993-02-20 |
| Age: |
54.6/54.0 |
Onset: |
1993-02-21 |
| Gender: |
Male |
Submitted: |
1993-03-16 |
| Location: |
D.C. |
Entered: |
1993-03-25 |
|
| Life Threatening? Yes |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? Yes, days: 4 |
| Extended hospital stay? No |
Previous Vaccinations:
~ ()~ ~~In patient |
| Other Medications: Pt recvd Immune Globulin by Armour Pharm co lot# F15907; Lopressor |
| Current Illness: |
| Preexisting Conditions: pt has hx of hypertrophic cardiomyopathy; |
| Diagnostic Lab Data: |
| CDC 'Split Type': 893075002E |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| MEN: MENINGOCOCCAL (MENOMUNE) |
CONNAUGHT LABORATORIES |
2K41040 |
|
IM |
A/ |
| TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) |
WYETH PHARMACEUTICALS, INC |
4928055 |
|
SC |
A/ |
| YF: YELLOW FEVER (YF-VAX) |
CONNAUGHT LABORATORIES |
2H31154 |
|
IM |
A/ |
|
| Administered by: Military
Purchased by: Military |
| Symptoms: Asthenia, Chills, Dyspnoea, Pyrexia |
| Write-up: Pt devel fever, chills, SOB & weakness, 24 hrs p/vax; |
|
|
Changed on 8/31/2010 |
| VAERS ID: |
51148 Before
After
|
Vaccinated: |
1993-02-20 |
| Age: |
54.0 |
Onset: |
1993-02-21 |
| Gender: |
Male |
Submitted: |
1993-03-16 |
| Location: |
D.C. |
Entered: |
1993-03-25 |
|
| Life Threatening? Yes |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? Yes, days: 4 |
| Extended hospital stay? No |
| Previous Vaccinations: ~ ()~ ~~In patient |
| Other Medications: Pt recvd Immune Globulin by Armour Pharm co lot# F15907; Lopressor |
| Current Illness: |
| Preexisting Conditions: pt has hx of hypertrophic cardiomyopathy; |
| Diagnostic Lab Data: |
| CDC 'Split Type': 893075002E |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| MEN: MENINGOCOCCAL (MENOMUNE) |
CONNAUGHT LABORATORIES |
2K41040 |
|
IM |
|
| TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) |
WYETH PHARMACEUTICALS, INC/PFIZER/WYETH |
4928055 |
|
SC |
|
| YF: YELLOW FEVER (YF-VAX) |
CONNAUGHT LABORATORIES |
2H31154 |
|
IM |
|
|
| Administered by: Military
Purchased by: Military |
| Symptoms: Asthenia, Chills, Dyspnoea, Pyrexia |
| Write-up: Pt devel fever, chills, SOB & weakness, 24 hrs p/vax; |
|
|
