VAERS ID: |
80084 (history) |
Form: |
Version 1.0 |
Age: |
31.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1995-12-01 |
Onset: | 1995-12-01 |
Days after vaccination: | 0 |
Submitted: |
1995-12-12 |
Days after onset: | 11 |
Entered: |
1995-12-15 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
CHOL: CHOLERA (USP) / PFIZER/WYETH |
4948171 / UNK |
RA / - |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
467AC / UNK |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Amnesia,
Convulsion,
Hypertonia,
Hypotension,
Pallor,
Syncope,
Tachycardia SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: none Current Illness: none Preexisting Conditions: pcn allergy; Allergies: Diagnostic Lab Data: none CDC Split Type:
Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84; |