| 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; |
