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Found 29227 cases where Vaccine is MMR and ER Visit

Case Details (Sorted by VAERS ID)

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VAERS ID: 25826 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1990-08-26
Onset:1990-08-28
   Days after vaccination:2
Submitted: 1990-08-30
   Days after onset:2
Entered: 1990-09-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271915 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 06962 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 00052004 / 5 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Cough, Injection site mass, Injection site reaction, Productive cough, Pyrexia, Rhinitis, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI 1 wk befor by hx reveals after react
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Area around DTP 6cm X 7cm rash w/ hyperthermia elevated fever 101 27AUG90, by 28AUG90 warm soaks, upper arm erythema - cold compress gone by 29AUG90; Cough with clear nasal drainage fever 103.5by 28AUG90. 29AUG90 a febrile cough decreased.


VAERS ID: 25876 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Kansas  
Vaccinated:1990-08-29
Onset:1990-09-05
   Days after vaccination:7
Submitted: 1990-09-06
   Days after onset:1
Entered: 1990-09-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 14955 / UNK - / L

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR developed rash, blotchy on face trunk, temp 101 extremities - macular


VAERS ID: 25887 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Indiana  
Vaccinated:1990-08-31
Onset:1990-09-01
   Days after vaccination:1
Submitted: 1990-09-07
   Days after onset:6
Entered: 1990-09-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES A021092 / UNK - / A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1501S / UNK - / A
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618L / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC normal except deficiency, glucose normal , electrolytes normal, cat normal
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB/OPV developed febrile seizure requiring hospital admission approx 24 hrs after vax. /w HIB, MMR, & oral Polio. Released next day & only treament was observation.


VAERS ID: 25955 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-07-23
Onset:1990-08-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Unknown
Symptoms: Ecchymosis, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Platelet count down to 2,000
CDC Split Type:

Write-up: ITP- /w clinical signs evident by approx. 1 mon. /p vaccination. Bruises, petechiae, No frank bleeding


VAERS ID: 25960 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Kentucky  
Vaccinated:1990-08-31
Onset:1990-09-08
   Days after vaccination:8
Submitted: 1990-09-11
   Days after onset:3
Entered: 1990-09-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 16985 / UNK RA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Convulsion, Otitis media, 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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Healthy Child
Allergies:
Diagnostic Lab Data: EEG - Normal 10SEP90
CDC Split Type:

Write-up: Pt vaccinated with MMR experienced generalized seizure associated with fever - otitis media 8 days after MMR administration.


VAERS ID: 25961 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated:1990-08-18
Onset:1990-08-23
   Days after vaccination:5
Submitted: 1990-09-06
   Days after onset:14
Entered: 1990-09-17
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 2 - / SC A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain
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 (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC Split Type:

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


VAERS ID: 25966 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: North Carolina  
Vaccinated:1990-09-06
Onset:1990-09-07
   Days after vaccination:1
Submitted: 1990-09-07
   Days after onset:0
Entered: 1990-09-17
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283971 / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2269R / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277940 / 3 MO / PO

Administered by: Public       Purchased by: Public
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? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt also rec''d tine test, lt forearm at same time as vax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LP Normal, EEG Normal, MRI Normal
CDC Split Type:

Write-up: Pt vaccinated with MMR/DPT/OPV/Tine test had tonic-clonic seizures (X4) beginning 3:00 am to 7:30 am on 7SEP90. Max. T 101.8 per parents. @ ER T 101.7. Longest seizure about 2 min.


VAERS ID: 25968 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:1990-08-17
Onset:1990-08-18
   Days after vaccination:1
Submitted: 1990-09-13
   Days after onset:26
Entered: 1990-09-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 14735 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Hepatitis, Nausea, Pharyngitis, Vomiting
SMQs:, Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Mild cold symptom
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Following MMR had URI symptom including N/V/D. Evaluation on 24AUG90 showed abd soft with mild generalized tenderness. GI liver enlargement noted. 1cm below ribs.


VAERS ID: 25981 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1990-09-05
Onset:1990-09-06
   Days after vaccination:1
Submitted: 1990-09-12
   Days after onset:6
Entered: 1990-09-20
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site reaction
SMQs:

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR developed swelling & tenderness of side.


VAERS ID: 25985 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: California  
Vaccinated:1990-08-30
Onset:1990-09-07
   Days after vaccination:8
Submitted: 1990-09-17
   Days after onset:10
Entered: 1990-09-20
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FB / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 05605 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed fussiness, clinginess & increased sleepiness. Evaluated in office 12SEP without other signs suggestive of infection date of immunization 30AUG90


VAERS ID: 26004 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Female  
Location: Illinois  
Vaccinated:1990-09-12
Onset:1990-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0438S / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Face oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response~ ()~~~In patient
Other Medications: TB skin test 12Sep90
Current Illness:
Preexisting Conditions: no hx of dru allergies,
Allergies:
Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22
CDC Split Type:

Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes


VAERS ID: 26088 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Unknown  
Location: Indiana  
Vaccinated:1990-09-12
Onset:1990-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0988S295 / 2 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Confusional state, Convulsion, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: electrolytes, Glucose, CBC - Normal
CDC Split Type:

Write-up: Pt vaccinated with MMR 24 hrs later child began shaking, became disoriented, school nurse reported "seizure like" activity. No fever. No urination. Electrolytes, Glucose, CBC checked. All normal.


VAERS ID: 26138 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: California  
Vaccinated:1990-09-13
Onset:1990-09-14
   Days after vaccination:1
Submitted: 1990-09-19
   Days after onset:5
Entered: 1990-10-01
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 5 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1226 / 2 LA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site oedema, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/DTP developed severe swelling X reddness at vaccine site (4X10CM area).


VAERS ID: 26149 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Michigan  
Vaccinated:1990-09-25
Onset:1990-09-25
   Days after vaccination:0
Submitted: 1990-09-26
   Days after onset:1
Entered: 1990-10-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Public
Symptoms: Gaze palsy, Pyrexia, Rash, Somnolence, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC - WBC 6.8; HIH 11.9/35; Lytes,CA,GLU- NL; Viral throat cult pending
CDC Split Type:

Write-up: Pt vaccinated with HIBtiter/MMR administered at approx 1130AM on 25SEP90 8:30PM - mother reported rt leg shaking, then whole body shaking & eyes rolled back. Afterwards drowsy, temp 104F at that time. temp folowing day 100. Developed rash.


VAERS ID: 26184 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated:1990-09-17
Onset:1990-09-19
   Days after vaccination:2
Submitted: 1990-10-01
   Days after onset:12
Entered: 1990-10-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11072 / 5 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1473S / 2 - / IM A
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 608C3 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt also rec''d TB on same date as vax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV/MMR/TB on 17SEP90 on 18SEP90 developed erythema 5X5 around rt upper arm - lungs clear- heart normal sinus rhythm - Benedryl - cool packs no need for further MMR immunization.


VAERS ID: 26195 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Arkansas  
Vaccinated:1990-08-06
Onset:1990-08-23
   Days after vaccination:17
Submitted: 1990-10-04
   Days after onset:42
Entered: 1990-10-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281944 / 3 MO / PO
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M185EA / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1240S / 1 - / IM

Administered by: Public       Purchased by: Other
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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? No
Previous Vaccinations: In Brother Adverse Event- Seizure X2, @ 2mo & 4mo, DTP, 1st, 2nd.~ ()~~~In Sibling
Other Medications: pt also rec''d TB tine on same date as other vax.
Current Illness:
Preexisting Conditions: Bilateral Otitis Media/LUL pneumonia 12/89; impetigo 7/90
Allergies:
Diagnostic Lab Data: EEG-normal, CT of head-normal
CDC Split Type:

Write-up: Pt vaccinated w/MMR/OPV/HIB/TB Tine developed tonic/clonic generalized seizure w/out fever occured within 17 days of receiving lst MMR, 3rd OPV, HIB Vac, TB tine test.


VAERS ID: 26226 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1990-08-21
Onset:1990-09-11
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1495S / UNK RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Headache, Malaise, Nausea, Orchitis, Pain, Pharyngitis
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR developed headache, sore throat, aching all over, testicle rt & lt pain, nausea off and on and some dizziness. Went to Dr''s office X 2.


VAERS ID: 26298 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Arizona  
Vaccinated:1990-10-09
Onset:1990-10-10
   Days after vaccination:1
Submitted: 1990-10-10
   Days after onset:0
Entered: 1990-10-19
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11096 / UNK LL / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11202 / UNK RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9A11072 / UNK RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1500S / UNK RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 61764 / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Febrile convulsion
SMQs:, Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 101.4 & Seizure. C/O feeling tired, has been less active than norm today. Pt had DTP, MMR, HIB, vacines yesterday.


VAERS ID: 26317 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: New York  
Vaccinated:1990-10-10
Onset:1990-10-10
   Days after vaccination:0
Submitted: 1990-10-18
   Days after onset:8
Entered: 1990-10-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 5 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1313S / 2 - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Cough, Hypersensitivity, Rhinitis, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Anaphalaxis type rxn @ time of vacc.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated /w DTP/MMR developed acute allergic rxn involving diffuse urticaria, rhinonlea, sneezing, cough & wheezing within 60 sec of inject. Pt required Epinephrine & Diphenydramine inject.


VAERS ID: 26406 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Texas  
Vaccinated:1990-09-27
Onset:1990-10-10
   Days after vaccination:13
Submitted: 1990-10-24
   Days after onset:14
Entered: 1990-10-29
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283971 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1313S / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275935 / 4 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Arthralgia, Arthritis, Injection site abscess, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: mild reactive arrvoys
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/DTP/OPV experienced fever 103, generalized rash, Lt knee arthralgia/arthritis, flare up of eczema, abscess at injection.


VAERS ID: 26488 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Maryland  
Vaccinated:1990-10-29
Onset:1990-10-29
   Days after vaccination:0
Submitted: 1990-10-31
   Days after onset:2
Entered: 1990-11-05
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1313S / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: very mild viral URI.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR pt lungs were clear before the MMR was given. Within 2 1/2 hrs had moderately severe wheezing. This resolved with Epinephrine. pt has no hx of asthma.


VAERS ID: 26633 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Iowa  
Vaccinated:1990-08-15
Onset:1990-08-19
   Days after vaccination:4
Submitted: 1990-10-05
   Days after onset:47
Entered: 1990-11-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0066S / UNK LA / SC

Administered by: Other       Purchased by: Public
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: 2 previous febrile siezures
Allergies:
Diagnostic Lab Data:
CDC Split Type: IA90001

Write-up: Pt vaccinated with MMR 4 days after inject given - temp 103 & grand mal seizure.


VAERS ID: 26671 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Virginia  
Vaccinated:1990-11-07
Onset:1990-11-07
   Days after vaccination:0
Submitted: 1990-11-09
   Days after onset:2
Entered: 1990-11-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11835 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Born with split in upper gum
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA90043

Write-up: Pt vaccinated with DTP/OPV/HIB/MMR broke out in big splotches all over & was having a little trouble breathing. Advised to take child to ER where she was treated w/Benadryl & Epinephrine Given Pediapred & Benadryl PO on discharge.


VAERS ID: 26678 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Michigan  
Vaccinated:1990-11-01
Onset:1990-11-02
   Days after vaccination:1
Submitted: 1990-11-02
   Days after onset:0
Entered: 1990-11-19
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TRI212A / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2365R / 1 RA / SC

Administered by: Public       Purchased by: Public
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC-SGOT, Electrolytes, Blood Culture
CDC Split Type: MI9001

Write-up: Pt vax with DTP/MMR 3 doses of Tylenol throughout noc had convulsion this am T 105 rectally. this AM Tylenol, Advil T 103 at 8:00. @ 8:40 T 99.


VAERS ID: 26679 (history)  
Form: Version 1.0  
Age: 23.0  
Sex: Male  
Location: Virginia  
Vaccinated:1990-10-29
Onset:1990-11-04
   Days after vaccination:6
Submitted: 1990-11-12
   Days after onset:8
Entered: 1990-11-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Lymphadenopathy, Pyrexia, Sialoadenitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: HCT44, WBC 4400, 50S, 3 BAS, 37 Lymphs, 7Atys, 5MON,14 Esophils
CDC Split Type: VA90044

Write-up: Pt vaccinated with MMR developed low grade fever, mild parotid swelling of lids& anterior cervical adenopathy 5 days after MMR given.


VAERS ID: 26696 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1990-11-05
Onset:1990-11-05
   Days after vaccination:0
Submitted: 1990-11-08
   Days after onset:3
Entered: 1990-11-21
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2669R / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283945 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Hypotonia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA901

Write-up: Pt vaccinated with OPV/DTP/MMR developed fever to 105F, irritability, vomiting, limp lasting a couple of days.


VAERS ID: 26698 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Male  
Location: Utah  
Vaccinated:1990-11-14
Onset:1990-11-14
   Days after vaccination:0
Submitted: 1990-11-15
   Days after onset:1
Entered: 1990-11-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 05887M / UNK - / IM A
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO A108A22 / UNK - / IM A

Administered by: Other       Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/TD Post vaccination hypotension & bradycardia 30 seconds after MMR 90 seconds after TD.


VAERS ID: 26717 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Colorado  
Vaccinated:1990-10-29
Onset:1990-10-29
   Days after vaccination:0
Submitted: 1990-11-19
   Days after onset:21
Entered: 1990-11-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1486S / 2 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Anaphylactoid reaction, Cough, Dizziness, Dyspnoea, Face oedema, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR experienced light headedness within 15 min facial swelling, coughy, difficulty breathing & rash. Given O2 Epi, Benedryl, solumedrol. Admitted overnight.


VAERS ID: 26719 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Louisiana  
Vaccinated:1990-11-07
Onset:1990-11-07
   Days after vaccination:0
Submitted: 1990-11-08
   Days after onset:1
Entered: 1990-11-26
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275970 / 4 LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0613D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Chills, Convulsion, Cyanosis, Diarrhoea, Gaze palsy, Rash
SMQs:, Anaphylactic reaction (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: nasal congestion
Preexisting Conditions: Dust-Stuffed animals-carpets-animals/allergies numerous om
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA90109

Write-up: Pt vaccinated with HIB/OPV/DTP/MMR developed chills, shiver, lips turned blue, eyes rolled to back, jerk & shake, convuls, rash, diarrhea.


VAERS ID: 26810 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated:1990-11-07
Onset:1990-11-07
   Days after vaccination:0
Submitted: 1990-11-20
   Days after onset:13
Entered: 1990-11-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1568S / 2 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR developed extreme sleepiness. Father took child to ER facility. Exam negative. Rechecked in Dr.''s office late afternoon. Exam negative.


VAERS ID: 26811 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: New York  
Vaccinated:1990-11-14
Onset:1990-11-15
   Days after vaccination:1
Submitted: 1990-11-19
   Days after onset:4
Entered: 1990-11-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Gait disturbance, Lymphadenopathy, Rash maculo-papular
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Triaminicol; Amoxicillin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed warmness & crying, unsteady gait, falling lasted 24 hrs; morbiliform rash with post occip nodes.


VAERS ID: 26835 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Texas  
Vaccinated:1990-11-15
Onset:1990-11-16
   Days after vaccination:1
Submitted: 1990-11-20
   Days after onset:4
Entered: 1990-11-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FC / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


VAERS ID: 26850 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-07-25
Onset:1990-07-30
   Days after vaccination:5
Submitted: 1990-11-26
   Days after onset:119
Entered: 1990-11-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 04365 / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Injection site abscess, Injection site reaction
SMQs:

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Culture of drainage material - negative
CDC Split Type: AL900002

Write-up: Pt vaccinated with MMR experienced pain, swelling, increased warmth & abscess formation at immunization site. 5 days after receiving MMR vaccine she was seen at the Hosp ER & the abscess was drained 30JUL90.


VAERS ID: 26852 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1990-11-08
Onset:1990-11-08
   Days after vaccination:0
Submitted: 1990-11-13
   Days after onset:5
Entered: 1990-11-30
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Screaming
SMQs:, Hostility/aggression (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? No
Previous Vaccinations: Screaming, temp 105, 5mo, DTP, 2nd dose~ ()~~~In patient
Other Medications:
Current Illness: Well
Preexisting Conditions: Allergies to milk Polymox, Erythromycin
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA902

Write-up: Pt vaccinated with DTP/MMR experienced screaming for 2 days, adm. acetaminophen as directed - symptoms relieved "some what" mother states child would "grab head". Ears checked by MD 10NOV90. no sign of infection.


VAERS ID: 26873 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Texas  
Vaccinated:1990-11-21
Onset:1990-11-29
   Days after vaccination:8
Submitted: 1990-11-29
   Days after onset:0
Entered: 1990-12-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1884S / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Well check up
Preexisting Conditions: allergic to Rondec Dm
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with HIB/MMR developed temp 104.2 R this am at home, temp 103.6 ax in office 1130AM, Tylenol, baths, push fluids.


VAERS ID: 26877 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Male  
Location: New York  
Vaccinated:1990-11-26
Onset:1990-11-26
   Days after vaccination:0
Submitted: 1990-11-27
   Days after onset:1
Entered: 1990-12-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1054S / 2 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Laryngospasm
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Dystonia (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Eczema, asthma at 3-4 yrs age
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR developed acute onset of bronchio & laryngospasm 1/2 hr after vaccine. SC Eprinephrine & Benadyrl.


VAERS ID: 26905 (history)  
Form: Version 1.0  
Age: 26.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1990-11-12
Onset:1990-11-13
   Days after vaccination:1
Submitted: 1990-12-04
   Days after onset:21
Entered: 1990-12-06
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 2 LA / SC

Administered by: Private       Purchased by: Other
Symptoms: Asthenia, Headache, Infection, Influenza, Injection site reaction, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test done at hosp - normal results
CDC Split Type:

Write-up: Pt vaccinated with MMR developed flu-like symptoms - severe headache, fever of 101.5, weakness, no energy, where shot adm doubled in size & was hot to touch w/red discoloration. Rash over entire body dx as measles 13 days /p shot was adm.


VAERS ID: 26911 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: South Dakota  
Vaccinated:1990-11-20
Onset:1990-11-21
   Days after vaccination:1
Submitted: 1990-11-29
   Days after onset:8
Entered: 1990-12-07
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1187S / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Conjunctivitis, Cough, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Colic, GER
Allergies:
Diagnostic Lab Data: 23NOV90-CBC & Nasalpharyngeal culture - URI w/haemophulus, Influenza type B. Started on Bactrim for URI, BR
CDC Split Type: SD90007

Write-up: Pt vaccinated with MMR/HIB developed fever of 104 (R), eyes matted shut, cough, & loss of appetite.


VAERS ID: 26912 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Virginia  
Vaccinated:1990-11-14
Onset:1990-11-15
   Days after vaccination:1
Submitted: 1990-11-29
   Days after onset:14
Entered: 1990-12-07
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1334S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287930 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Febrile convulsion, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA90046

Write-up: Pt vaccinated with DTP/MMR/OPV experienced "shaking" episode & was hot; Rectal Temp 104; Seen by MD exam was normal & described episode as a questionable febrile seizure.


VAERS ID: 26957 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Washington  
Vaccinated:1990-11-10
Onset:1990-11-19
   Days after vaccination:9
Submitted: 1990-12-01
   Days after onset:12
Entered: 1990-12-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 07415 / 1 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 - / SC A

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Cyanosis, Gaze palsy, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


VAERS ID: 26959 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:1990-11-09
Onset:1990-11-18
   Days after vaccination:9
Submitted: 1990-12-03
   Days after onset:15
Entered: 1990-12-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2131R / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 498061 / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Pain, Pharyngitis, Pyrexia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with TD/MMR developed body aches, fever x 4 days. Sore throat.


VAERS ID: 26998 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: North Carolina  
Vaccinated:1990-11-02
Onset:1990-11-04
   Days after vaccination:2
Submitted: 1990-11-06
   Days after onset:2
Entered: 1990-12-14
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21092 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0696S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0613K / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Asthma, Bronchiolitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), 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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC90005

Write-up: Pt vaccinated with DTP/OPV/MMR/HIB became irritable, crying, wheezing, fever 101, Taken to ER; breathing was stabilized transferred to another hosp dx bronchiolitis not believed to be vaccine related.


VAERS ID: 27067 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New Jersey  
Vaccinated:1990-11-02
Onset:1990-11-09
   Days after vaccination:7
Submitted: 1990-12-13
   Days after onset:34
Entered: 1990-12-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1525S / 1 LA / SC

Administered by: Private       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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vax w/ MMR/Prohibit 1W p/MMR seizures, fever 104 x 2 lasting 10 min each DX OM in ER. F/U 19MAR91: HAS HAD SZ SINCE, D/T VIRAL ILLNESS, NOT VAX RELATED. PRESENTLY OK & DOING WELL.


VAERS ID: 27074 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Mississippi  
Vaccinated:1990-11-15
Onset:1990-11-15
   Days after vaccination:0
Submitted: 1990-11-19
   Days after onset:4
Entered: 1990-12-17
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285967 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0016S / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283939 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS904

Write-up: Pt vaccinated w/DTP/OPV/MMR developed temp during night after injection called clinic referred to ER. admitted to hosp & placed under seizure precautions.


VAERS ID: 27084 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:1990-11-28
Onset:1990-11-28
   Days after vaccination:0
Submitted: 1990-12-06
   Days after onset:8
Entered: 1990-12-17
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1490S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Headache, Malaise, Vasodilatation
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allergy screening - age 8
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI9008

Write-up: Pt vaccinated with MMR developed headache, face flushed, not feelling well, throat feeling tight & difficulty breathing.


VAERS ID: 27085 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Michigan  
Vaccinated:1990-11-01
Onset:1990-11-07
   Days after vaccination:6
Submitted: 1990-11-08
   Days after onset:1
Entered: 1990-12-17
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212A / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1241S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0617F / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Headache, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI9009

Write-up: Pt vaccinated with DTP/OPV/MMR developed fever 102, vomiting, loss of appetite, body aches, headaches, sought ER treatment for vomiting.


VAERS ID: 27090 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-11-08
Onset:1990-11-08
   Days after vaccination:0
Submitted: 1990-12-10
   Days after onset:32
Entered: 1990-12-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 2 - / SC

Administered by: Other       Purchased by: Public
Symptoms: Injection site reaction, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL90006

Write-up: Pt "itching all over" starting 1/2 hr after vaccination. 10CM area of induration around injection site. Epinephrine 0.3mg given SQ & transported to MD.


VAERS ID: 27091 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-11-15
Onset:1990-11-15
   Days after vaccination:0
Submitted: 1990-11-19
   Days after onset:4
Entered: 1990-12-17
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1704S / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: allergy shots
Current Illness:
Preexisting Conditions: within past yr - allergy to egg white, wheat, dust, other
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9010

Write-up: Pt vaccinated with MMr 1/2 hr after vaccine c/o shortness of breath & lightheadness. No unusal breath sounds heard but Benadryl & Epinepherine given as a precaution w/ child''s hx of allergies.


VAERS ID: 27092 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-12-04
Onset:1990-12-04
   Days after vaccination:0
Submitted: 1990-12-07
   Days after onset:3
Entered: 1990-12-17
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M755ER / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 02135 / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277949 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Pyrexia, Somnolence, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: PA9011

Write-up: Pt. given DTP, MMR, OPV & Hib-titre on 04Dec90. Rec''d Acetaminophen every 4 hrs after immuniz. Behavior changed noticeably at 8pm same day, became lethargic, irritable w/ some occas "jerkiness" of limbs. Awoke w/ T104.5(R), fever cont''d.


VAERS ID: 27098 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: New York  
Vaccinated:1990-12-13
Onset:1990-12-13
   Days after vaccination:0
Submitted: 1990-12-14
   Days after onset:1
Entered: 1990-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1881S / 2 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthma, Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Proventil
Current Illness:
Preexisting Conditions: Hx mild asthma, no egg allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR 15 min after administration developed urticaria, respiratory distress, wheezing treated w/Epi x2 & Proventil.


VAERS ID: 27103 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-09-07
Onset:1990-09-16
   Days after vaccination:9
Submitted: 1990-11-15
   Days after onset:60
Entered: 1990-12-18
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1228S / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Had lst seizure 31MAY90 unassociated w/vaccine.
Allergies:
Diagnostic Lab Data:
CDC Split Type: WI90049

Write-up: Pt vaccinated with MMR/HBCV developed seizure - MD felt the seizure was due to a high fever caused by a viral infection.


VAERS ID: 27105 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Wisconsin  
Vaccinated:1990-11-27
Onset:1990-11-28
   Days after vaccination:1
Submitted: 1990-11-29
   Days after onset:1
Entered: 1990-12-18
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1341S / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Convulsion, Lymphadenopathy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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? No
Previous Vaccinations: Increased Temp; 6mos; DTP, 3 doses.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR-OK; 10.3-WBC, 56 Lymph, 13.0 Hgb, 37 Hct, 44 PMndiff, platelet adequate-done 29NOV90 8AM.
CDC Split Type: WI90052

Write-up: Pt vaccinated w/HIB/MMR developed temp 103.2 24 hrs after inject, irritable, refused liquids - saw MD 3PM; 4PM started on Ceclor no local reddness or edema at injection site, lymph nodes enlarged in neck area. Also had seizure and vomit.


VAERS ID: 27107 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-09-24
Onset:1990-10-08
   Days after vaccination:14
Submitted: 1990-11-01
   Days after onset:24
Entered: 1990-12-18
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Lymphadenopathy
SMQs:, Arthritis (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest-xray -negative; Monospot - negative;
CDC Split Type: WI90044

Write-up: Pt vaccinated with MMR noted palpable node rt groin 2 wks after shot. Saw MD node rt groin non palpable but node palpable lt axilla. On F/U node receded. Afebrile throughout this episode. Experienced some joint pain in wrists & knees.


VAERS ID: 27108 (history)  
Form: Version 1.0  
Age: 1.38  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-08-22
Onset:1990-08-30
   Days after vaccination:8
Submitted: 1990-10-31
   Days after onset:62
Entered: 1990-12-18
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0066S / 1 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Diarrhoea, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (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? No
Previous Vaccinations: In pt; mild fever; 4 & 6 mo; DTP; 2nd & 3rd~ ()~~0.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test
CDC Split Type: WI90043

Write-up: Pt vaccinated with MMR/HIB 1wk later developed high fever 103.6, rash, diarrhea, vomiting for 5 days. ER - Tylenol.


VAERS ID: 27109 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-11-13
Onset:1990-11-14
   Days after vaccination:1
Submitted: 1990-11-21
   Days after onset:7
Entered: 1990-12-18
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0063S / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 244921 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Headache
SMQs:

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Dr. - ordered tests
CDC Split Type: WI90050

Write-up: Pt vaccinated with TD/MMR developed headache beginning in the AM of 14NOV90; Saw MD advised muscle relaxant & a tension reliever.


VAERS ID: 27119 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Maryland  
Vaccinated:1990-10-25
Onset:1990-10-26
   Days after vaccination:1
Submitted: 1990-11-09
   Days after onset:14
Entered: 1990-12-19
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13135 / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (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, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC-Negative; CT Scan - Normal
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed acute cerebella ataxia, maculopapular rash, fever of 102.


VAERS ID: 27150 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Virginia  
Vaccinated:1990-11-26
Onset:1990-11-27
   Days after vaccination:1
Submitted: 1990-12-05
   Days after onset:8
Entered: 1990-12-21
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site oedema, Injection site reaction, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA90048

Write-up: Day /p receiving vax developed swelling (2"diameter), redness & warmth @ site of inject. Cold compresses & Tylenol


VAERS ID: 27172 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: North Carolina  
Vaccinated:1990-12-04
Onset:1990-12-07
   Days after vaccination:3
Submitted: 1990-12-14
   Days after onset:7
Entered: 1990-12-26
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 06965 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281924 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Otitis media, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Upper respiratory infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 16,100; 57 seg, 4 bands, 2 eos, 36 lymphs, 1 mono; Blood culture - negative
CDC Split Type:

Write-up: Pt vaccinated with DTP/MMR/OPV on 4DEC90 URI noted w/temp 100.8; Presented to ER w/temp 104.5 & otitis media.


VAERS ID: 27173 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Mississippi  
Vaccinated:1990-12-14
Onset:1990-12-16
   Days after vaccination:2
Submitted: 1990-12-18
   Days after onset:2
Entered: 1990-12-26
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC 17DEC90
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed fever 104.


VAERS ID: 27175 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-11-15
Onset:1990-11-25
   Days after vaccination:10
Submitted: 1990-11-26
   Days after onset:1
Entered: 1990-12-26
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Arthralgia, Osteoarthritis, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL90007

Write-up: Pt vaccinated with MMR developed large welts 1/2 to 1 cm all over body painful swollen joints - extensive. Low grade fever. Rx Epinephrine , Hydrocortisone cream, Dyx Modrol IM, Atarax PRN itching.


VAERS ID: 27235 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Female  
Location: Georgia  
Vaccinated:1990-11-14
Onset:1990-11-25
   Days after vaccination:11
Submitted: 1990-11-26
   Days after onset:1
Entered: 1990-12-31
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1228S / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA902

Write-up: Pt vaccinated with MMR developed a fine rash & low grade fever. Seen by MD dx vaccine reaction.


VAERS ID: 27237 (history)  
Form: Version 1.0  
Age: 9.0  
Sex: Female  
Location: Georgia  
Vaccinated:1990-11-27
Onset:1990-11-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Epinephrine 1:1000; Benadryl given after vac. for rxn
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA904

Write-up: Pt vaccinated with MMR developed erythematous rash, c/o itching, Seen in ER; BP 108/74 Given Epinephrine then BP 110/68 given Bendryl.


VAERS ID: 27244 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:1990-11-16
Onset:1990-12-02
   Days after vaccination:16
Submitted: 1990-12-17
   Days after onset:15
Entered: 1990-12-31
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Osteoarthritis, Pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Arthritis (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA90497

Write-up: MMR 16NOV90, on 02DEC90 developed general aches, joint pain, swollen knees, hands stiff & sore; URI. 10DEC90, sx''s improving.


VAERS ID: 27247 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-11-16
Onset:1990-11-23
   Days after vaccination:7
Submitted: 1990-12-05
   Days after onset:12
Entered: 1990-12-31
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17045 / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Erythromycin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9014

Write-up: Pt vaccinated w/MMR 16NOV90; developed fever 102, rash red face to entire body 23NOV90.


VAERS ID: 27253 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:1990-12-19
Onset:1990-12-19
   Days after vaccination:0
Submitted: 1990-12-19
   Days after onset:0
Entered: 1990-12-31
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1054S / 2 RA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908219 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Chest pain, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acne
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with MMR/DT within 5 min developed chest tightness, nausea, exam revealed decreased BS, diffuse wheezing, VS stable, Administered Epinephrine/Alupent/Oxygen.


VAERS ID: 27283 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Oregon  
Vaccinated:1990-11-28
Onset:1990-12-05
   Days after vaccination:7
Submitted: 1990-12-12
   Days after onset:7
Entered: 1991-01-02
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Osteoarthritis, Pyrexia, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR902

Write-up: Pt vacc. w/ DTP/MMR/HIB/OPV. Same day had a few red spots on abd. W/in a few days rash increased & went from white to purple- like a bruise. Fever 12/10-12/11 w/ swollen ankles/wrists AM of 12/11. PMD said rash looked like viral hives.


VAERS ID: 27289 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Ohio  
Vaccinated:1990-10-02
Onset:1990-10-13
   Days after vaccination:11
Submitted: 1990-11-21
   Days after onset:39
Entered: 1991-01-04
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1488S / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH9054

Write-up: Pt vaccinated with HIB/MMR developed febrile seizures - hospitalized 13OCT90 x 3 days for observation.


VAERS ID: 27293 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Ohio  
Vaccinated:1990-11-06
Onset:1990-11-26
   Days after vaccination:20
Submitted: 1990-12-03
   Days after onset:7
Entered: 1991-01-04
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / 1 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0066S / 1 - / L

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Malaise, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH9058

Write-up: Pt vaccinated with MMR/HIB TITER developed fever, listless x 2 days (102); 30NOV brokeout w/rash became cranky, arching her back. Dx virus.


VAERS ID: 27300 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Louisiana  
Vaccinated:1990-12-13
Onset:1990-12-18
   Days after vaccination:5
Submitted: 1990-12-20
   Days after onset:2
Entered: 1991-01-04
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275970 / 4 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1569S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0613D / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (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)

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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Keflex
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: U/A - normal; Chest x-ray - normal; CBC - normal
CDC Split Type: LA901210

Write-up: Pt vaccinated with DTP/OPV/MMR/HIB developed fever of 106, febrile seizure, no other illness reported. MD states received too many vaccines at one time & caused adverse reaction. Possible viral seizure but not r/o possible reaction to vax.


VAERS ID: 27312 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-12-10
Onset:1990-12-10
   Days after vaccination:0
Submitted: 1990-12-10
   Days after onset:0
Entered: 1991-01-07
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1700S / 2 LA / SC

Administered by: Other       Purchased by: Public
Symptoms: Dizziness, Injection site hypersensitivity, Nausea, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL90008

Write-up: Became hot & dizzy w/ solid red rash over upper lt arm, nausea. Ice pack applied. BP 138/80; P 100; 10 min later BP 140/60; P 96 ; R 24. No SOB, Wheezing, rash becoming worse, extending to shoulder, cheeks, bilat temporal area, chest, etc.


VAERS ID: 27340 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Louisiana  
Vaccinated:1990-12-13
Onset:1990-12-13
   Days after vaccination:0
Submitted: 1990-12-17
   Days after onset:4
Entered: 1991-01-08
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 LA / SC

Administered by: Public       Purchased by: Other
Symptoms: Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Previous Vaccinations: In pt Excessive crying; 2 1/2mo/ DTP #1 also large local reaction.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Erythromycin
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA90125

Write-up: Ten min after pt vac w/ MMR, dev. a welt about 1 inch above injection site. Notified MD ordered Benadryl, warm compresses & to watch child 30 min. 5 min later began to vomit more welts developed vomited once more. Seen by MD given Benadryl.


VAERS ID: 27355 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1990-11-12
Onset:1990-11-12
   Days after vaccination:0
Submitted: 1990-11-13
   Days after onset:1
Entered: 1991-01-10
   Days after submission:58
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1493S / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0617H / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dysphagia, Face oedema, Salivary hypersecretion
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: TBST
Current Illness:
Preexisting Conditions: NKMA
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN911

Write-up: Approx 30 min after given DTP/OPV/MMR, pt developed swollen eyes. BP 94/60, p 64, difficulty swallowing, lips & face increased in swelling & child began drooling.


VAERS ID: 27357 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Female  
Location: Tennessee  
Vaccinated:1990-11-13
Onset:1990-11-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 16965 / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Amblyopia, Dizziness, Hyperhidrosis, Shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Optic nerve disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN913

Write-up: Pt vaccinated with MMR became dizzy, had blurred vision, sweated profusely, started "going into shock", Given O2 & IV by paramedics, taken to Hosp. Pt reports she was all right after 2 hours. Pt okay after 2 hrs.


VAERS ID: 27360 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Georgia  
Vaccinated:1990-10-22
Onset:1990-11-01
   Days after vaccination:10
Submitted: 1990-11-13
   Days after onset:12
Entered: 1991-01-10
   Days after submission:58
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 08985 / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Nausea, Pyrexia, Rash, Rhinitis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Previous Vaccinations: In pt; 23SEP87;3mos; DTP; 1 dose~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allergic to pertussis
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA9011

Write-up: 10 days after vaccination, developed temp 104, w/nausea & vomiting. Seen by MD fine rash on chest, stomach, & face also cold symptoms. Given Amocillin. Mom states throat & ears are neg. MD not sure it was due to immunization.


VAERS ID: 27364 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Georgia  
Vaccinated:1990-11-30
Onset:1990-12-05
   Days after vaccination:5
Submitted: 1990-12-10
   Days after onset:5
Entered: 1991-01-10
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 3 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1039S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public       Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA9016

Write-up: Pt vaccinated with OPV/DTP/MMR developed all over rash & red rt arm on side where shot given. Also experienced itching.


VAERS ID: 27366 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-12-22
Onset:1990-12-22
   Days after vaccination:0
Submitted: 1990-12-26
   Days after onset:4
Entered: 1991-01-10
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291978 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Allergic to amoxicillin - hive reaction
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA911

Write-up: Parent reported child felt warm & had a low grade temp 100.4 for 2 days after immuniz then no fever X24 hrs. On 12-22 T=102.4 to 105.2 in spite of Tylenol q4h. To ER, no other cause for fever found. Sponged, d/c''d w/ Tylenol & Advil.


VAERS ID: 27372 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Michigan  
Vaccinated:1990-11-13
Onset:1990-11-16
   Days after vaccination:3
Submitted: 1990-12-13
   Days after onset:27
Entered: 1991-01-11
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1415S / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Infection, Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: dry skin lt axilla
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI9012

Write-up: Pt vaccinated with MMR developed red spots on lt arm from elbow to axilla & lt side of upper body from axilla to waist. Family DR dx as "shingles".


VAERS ID: 27383 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Female  
Location: Alabama  
Vaccinated:1990-12-05
Onset:1990-12-07
   Days after vaccination:2
Submitted: 1991-01-13
   Days after onset:37
Entered: 1991-01-14
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 235934 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M755EN / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1696S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285958 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Convulsion, Influenza, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), 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), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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? No
Previous Vaccinations: In pt; Temp 102, screaming; 7 wk; DTP; 1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Not to receive Pertussis
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL91001

Write-up: Developed temp 104.6, irritable, crying, rash. Mom states child had a mild seizure, had a history of seizure in past when had increased temp. Dx = had a viral infection.


VAERS ID: 27394 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Missouri  
Vaccinated:1990-11-29
Onset:1990-12-04
   Days after vaccination:5
Submitted: 1990-12-18
   Days after onset:14
Entered: 1991-01-14
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908019 / UNK LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281925 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Febrile convulsion, Otitis media
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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: In pt; 7mo; DTP;3~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


VAERS ID: 27395 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1990-12-11
Onset:1990-12-11
   Days after vaccination:0
Submitted: 1991-01-04
   Days after onset:24
Entered: 1991-01-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0696S / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622K / 3 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Rash, Somnolence, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC91001

Write-up: Pt vaccinated with DTP/OPV/MMR developed jerking, shaking movements, blotched skin, very sleepy.


VAERS ID: 27440 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Kentucky  
Vaccinated:1990-11-29
Onset:1990-11-29
   Days after vaccination:0
Submitted: 1990-12-11
   Days after onset:12
Entered: 1991-01-16
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 14935 / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283950 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Ear disorder, Oedema, Pain, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: In sister, @ 5 mon., to DTP, 1st dose of series, high screaming~ ()~~~In Sibling
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: KY917

Write-up: Extremely red, sore, swollen arm, T 105.4 the 11th day, PMD Rx antibiotic but found no infection-some fluid behind ear, T 103 the 12th day.


VAERS ID: 27446 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Ohio  
Vaccinated:1990-12-04
Onset:1990-12-05
   Days after vaccination:1
Submitted: 1990-12-17
   Days after onset:12
Entered: 1991-01-17
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4898106 / 3 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1665R / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281930 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, Otitis media, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: In pt, fever & otitis med approx 1 wk p/ vac @ 9 mo DPT/OPV. 2nd dose in series~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH9067

Write-up: After 2nd DTP (3-6-90) pt had T 105, MD saw pt, Dx otitis media Roseola, pt on Ceclor, MD advised DT only. After this dose (#3) DT/OPV/HIB/TTine, pt had swollen eyelids /w bruising underneath, swollen rt cheek, MD feels vaxs caused rxns


VAERS ID: 27484 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Washington  
Vaccinated:1990-09-29
Onset:1990-09-29
   Days after vaccination:0
Submitted: 1991-01-03
   Days after onset:96
Entered: 1991-01-18
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277944 / 3 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Supraventricular tachycardia
SMQs:, Supraventricular tachyarrhythmias (narrow)

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? No
Previous Vaccinations: In pt; fever 103; DTP;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG-PAT suggestive of SA node re-entry or possible SA node dyspunct
CDC Split Type:

Write-up: Pt 3 mo post repair of tetrology of fallot developed P.A.T. requiring Inderal following immunization.


VAERS ID: 27485 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:1990-10-25
Onset:0000-00-00
Submitted: 1991-01-11
Entered: 1991-01-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Public
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Pregnancy 2wks
Preexisting Conditions: Pt has hx of twins in family could explain possible early blighted gestation.
Allergies:
Diagnostic Lab Data: Pelvic Sonogram indicated abnormal gestation prob at 5-6wks.
CDC Split Type:

Write-up: Pt vaccinated w/MMR not aware that she was 2 wks pregnant. Subsequent sonogram showed a subchorionic bleed or residual of blighted gestation. Fetus died at 9 1/2 - 10 wks.


VAERS ID: 27488 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: North Carolina  
Vaccinated:1990-08-15
Onset:1990-08-17
   Days after vaccination:2
Submitted: 1991-01-10
   Days after onset:146
Entered: 1991-01-18
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283971 / 2 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 212311 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0610B / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Hypertonia, Otitis media, Pain, Pharyngitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Oropharyngeal infections (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), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: cleft lip - repaired AUG89
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed convulsions within 48 hrs, inner ear infection, sore throat, upper respiratory infection within 7-14 days, Stiff rt leg painful unable to move within 3wks -lasted 4 to 6 wks.


VAERS ID: 27497 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Iowa  
Vaccinated:1991-01-09
Onset:1991-01-10
   Days after vaccination:1
Submitted: 1991-01-11
   Days after onset:1
Entered: 1991-01-22
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275969 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0555S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283944 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: DR diagnosed "hives."
CDC Split Type: IA91001

Write-up: Day after vac, babysitter noted welts all over child - notified parents & said child had a high temp. When parent got child to MD shortly after - MD documented afebrile. Child had generalized welts- welts gone by 11JAN.


VAERS ID: 27507 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Virginia  
Vaccinated:1991-01-05
Onset:1991-01-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287949 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Cultures; CBC WBC 20,000 Spinal tap - negative
CDC Split Type: VA91002

Write-up: Day of vac developed fever 103-104(F) lt leg at inj site red w/rash. Admitted to hosp. Tx w/IV & IM antibiotics. D/c''d on oral antibiotics 6JAN91. Rash fine red (like a hive) at inj site spread to lt buttock. 8Jan91, temp to 106.5


VAERS ID: 27530 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:1990-11-13
Onset:1990-11-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaphylactoid reaction, Asthma, Salivary hypersecretion
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: PPD
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES90120347

Write-up: Immediately after vac developed a burning & tightness in throat, wheezing & salivation. To ER treated for anaphylaxis w/ Epinephrine & diphenhydramine & unspecified steroids. Symptoms resolved w/in 1-2 hrs. MD felt condition due to vax.


VAERS ID: 27535 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-12-12
Onset:1990-12-22
   Days after vaccination:10
Submitted: 1991-01-10
   Days after onset:19
Entered: 1991-01-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277949 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9111

Write-up: Pt vaccinated w/DTP/MMR/OPV/HIB developed intermittent rash beginning 22DEC90. Rash on buttocks & back. Red & blotchy. Slighly raised. Rash is less pronounced but still present 10JAN91.


VAERS ID: 27538 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Georgia  
Vaccinated:1990-12-13
Onset:1990-12-14
   Days after vaccination:1
Submitted: 1990-12-19
   Days after onset:5
Entered: 1991-01-25
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12295 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608L / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Dizziness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Vestibular disorders (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Acute bilateral otitis media R/O strep
CDC Split Type: GA9020

Write-up: Pt vaccinated w/OPV/MMR/HBVC mother states on 13DEC90 PM - fever 101.6, dizzy - irritable taken to ER.


VAERS ID: 27541 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Male  
Location: Georgia  
Vaccinated:1990-12-04
Onset:1990-12-06
   Days after vaccination:2
Submitted: 1990-12-06
   Days after onset:0
Entered: 1991-01-25
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Being treated for unk allergies, IGE levels elevated.
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA9023

Write-up: Pt vaccinated w/OPV/MMR developed fever of 103, c/o of feeling achey in extremities. Given Tylenol 6AM.


VAERS ID: 27545 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-01-14
Onset:1991-01-14
   Days after vaccination:0
Submitted: 1991-01-18
   Days after onset:4
Entered: 1991-01-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626M / 5 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site pain, Pain, Pharyngitis, Pyrexia, Sinusitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9112

Write-up: Pt vaccinated w/DTP/OPV/MMR developed pain at inject site, fever 101 to 103, 17Jan jaw hurt, 18Jan T still 101-103 /w pt on Tylenol,taken to MD dx tonsillitis & sinusitis. MD said fever not due to immunizations.


VAERS ID: 27548 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Virginia  
Vaccinated:1990-11-15
Onset:1990-11-25
   Days after vaccination:10
Submitted: 1991-01-08
   Days after onset:44
Entered: 1991-01-25
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287939 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Hypotonia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


VAERS ID: 27607 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Texas  
Vaccinated:1991-01-09
Onset:1991-01-13
   Days after vaccination:4
Submitted: 1991-01-17
   Days after onset:4
Entered: 1991-01-28
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / SCLAVO 125A1 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FE / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1502S / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623D / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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? No
Previous Vaccinations: In pt; fever 103-104, unconsolable crying; 10 wk; DTP; 1 dose.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Valve in heart open @ birth on ventilator & meds given to close defective valve.
Allergies:
Diagnostic Lab Data: 1st visit WBC; 2nd visit - Chest x-ray, Spinal Tap- all negative.
CDC Split Type:

Write-up: Pt vaccinated w/DT/OPV/MMR/HIB developed fever began Sunday -103-104 couldn''t bring down, unconsolable to ER- WBC done exam by MD all neg poss MMR rxn, Monday fever spiked to 105.3 back to ER sp tap/CXR - neg home w/supportive measures.


VAERS ID: 27611 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Arizona  
Vaccinated:1991-01-21
Onset:1991-01-21
   Days after vaccination:0
Submitted: 1991-01-22
   Days after onset:1
Entered: 1991-01-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1974S / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622L / 4 MO / PO

Administered by: Private       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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: TB by Merieux Lot#E01525 in lt arm given 21Jan91
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated w/DTP/OPV/HIB/TB/MMR evening of immunization pt had a seizure & fever of 104 & was treated at Hosp.


VAERS ID: 27614 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Texas  
Vaccinated:1991-01-16
Onset:1991-01-16
   Days after vaccination:0
Submitted: 1991-01-18
   Days after onset:2
Entered: 1991-01-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619A / 3 MO / PO

Administered by: Public       Purchased by: Other
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated w/DTP/HIB/MMR/OPV as reported by phone by MD at Hosp 4-6 hrs after administration. Temp of 103, possible seizure activity.


VAERS ID: 27624 (history)  
Form: Version 1.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:1991-01-04
Onset:1991-01-22
   Days after vaccination:18
Submitted: 1991-01-23
   Days after onset:1
Entered: 1991-01-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1693S / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Given Engerix-B-SMithKline;IM;Lot#-630A4;LA;0dose;22JAN91.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated w/MMR developed diffuse arthralgias & myalgias. Tx anti-inflamatory meds. Bed rest.


VAERS ID: 27632 (history)  
Form: Version 1.0  
Age: 26.0  
Sex: Female  
Location: Tennessee  
Vaccinated:1990-09-07
Onset:1990-09-21
   Days after vaccination:14
Submitted: 1991-01-24
   Days after onset:125
Entered: 1991-01-28
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0435S / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Arthralgia, Arthritis, Pain
SMQs:, Systemic lupus erythematosus (broad), Arthritis (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Had SEd Rate done @ place of employment - SED RATE - normal
CDC Split Type: TN9113

Write-up: Arthralgia/arthritis; inflamation of joints; pain in joints, esp knees early AM & evening, also ankles, shoulder & back. 26OCT90 pt better but still has problem w/knealing; 28DEC90 All sx subsided by latter NOV90.


VAERS ID: 27633 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-01-03
Onset:1991-01-10
   Days after vaccination:7
Submitted: 1991-01-14
   Days after onset:4
Entered: 1991-01-28
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1696S / 1 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: dust allergy until around age 8 months
Allergies:
Diagnostic Lab Data: CXR, Urine test, & Blood work done was only told child had ear infection mom reports (saw DR in ER)
CDC Split Type: TN9114

Write-up: 10JAN91 at 1PM child began running a T 101.6-102.6(AX) given Tylenol at 2PM. 5PM made a groaning sound & began seizuring. Seizure lasted about 3mins & child then vomited once. Pt taken to ER & T was 103.6(R). DX ear infect. 11Jan91 loose stools.


VAERS ID: 27643 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1990-12-04
Onset:1990-12-10
   Days after vaccination:6
Submitted: 1990-12-11
   Days after onset:1
Entered: 1991-01-29
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275970 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615L / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cellulitis, Ecchymosis, Injection site oedema, Injection site reaction, Pyrexia, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10DEC CBC 12.2
CDC Split Type: LA910100

Write-up: 4DEC90 PM - low grade fever to 101; Lt leg mildly red, warm, sore. 10DEC90 lt leg became very swollen "baseball size" purple-red w/ inc warmth & tenderness no inc systemic fever- dx cellulitis & hematoma.


VAERS ID: 27651 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: New Hampshire  
Vaccinated:1991-01-04
Onset:1991-01-16
   Days after vaccination:12
Submitted: 1991-01-22
   Days after onset:6
Entered: 1991-01-30
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1494S / 1 - / SC A

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Anorexia, Face oedema, Lymphadenopathy, Pyrexia, Somnolence
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: 3 wks on Ceclor/Suprex started 14DEC90. Tine test 4JAN91 ID forearm Lederle
Current Illness:
Preexisting Conditions: eye problems
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Drowsy for 3 days (sleeping -$g 15 hrs/day a/onset of acute sx 16JAN91. Evening hrs face became swollen, temp 103.4, began moaning, stopped eating. Seen by MD 19JAN91 dx w/cervical adonitis treated w/Augmentin sx dissipating 21JAN91.


VAERS ID: 27652 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Virginia  
Vaccinated:1991-01-25
Onset:1991-01-26
   Days after vaccination:1
Submitted: 1991-01-28
   Days after onset:2
Entered: 1991-01-30
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21000 / 4 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / 1 - / SC L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624D / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amacil-mail for ears
Current Illness: mild ear fluid/amacil mait
Preexisting Conditions: nka med/wheeze bronchitis
Allergies:
Diagnostic Lab Data: CBC done in ER/ normal
CDC Split Type:

Write-up: Seen in ER for febrile inc temp seizure next day after inject given day before. Lab work done - treated in ER & released home.


VAERS ID: 27661 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Georgia  
Vaccinated:1990-12-10
Onset:1990-12-19
   Days after vaccination:9
Submitted: 1990-12-31
   Days after onset:12
Entered: 1991-01-30
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Gaze palsy, Pyrexia, Rash, Tremor, Vasodilatation
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypersensitivity (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: ~ ()~~~In patient
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


VAERS ID: 27663 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-01-14
Onset:1991-01-22
   Days after vaccination:8
Submitted: 1991-01-23
   Days after onset:1
Entered: 1991-01-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1891S / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Cyanosis, Febrile convulsion, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NJ913

Write-up: 22JAN febrile seizure - turned blue/convulsed, 21JAN child shook all over- mom thought it was just chills.


VAERS ID: 27664 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1991-01-16
Onset:1991-01-17
   Days after vaccination:1
Submitted: 1991-01-22
   Days after onset:5
Entered: 1991-01-30
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 3 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1373S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Oedema, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), 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? No
Previous Vaccinations: In brother; Crying; 4mos; DTP; 2dose~ ()~~~In Sibling
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC 1300, Whie count, CXR- normal
CDC Split Type: NJ914

Write-up: Seizures, fever 102, redness & swelling of rt upper arm.


VAERS ID: 27703 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated:1990-12-05
Onset:1990-12-06
   Days after vaccination:1
Submitted: 1990-12-06
   Days after onset:0
Entered: 1991-02-01
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 265938 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1415S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0617H / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Oedema, Pain, Rash, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: only migraine headaches
Allergies:
Diagnostic Lab Data:
CDC Split Type: NYS91007

Write-up: 6CM x 7CM redness, increased warmth, pain, swelling.


VAERS ID: 27708 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Mississippi  
Vaccinated:1991-01-16
Onset:1991-01-18
   Days after vaccination:2
Submitted: 1991-01-24
   Days after onset:6
Entered: 1991-02-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1696S / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291945 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Peritonitis, Pyrexia, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Gastrointestinal perforation (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Chronic kidney disease (narrow), Tumour lysis 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: dialysis
Current Illness:
Preexisting Conditions: kidney abnormalities complete renal failure
Allergies:
Diagnostic Lab Data: Peritonitis
CDC Split Type: MS913

Write-up: Pt temp elevated 101-102 18-20JAN cont 98 to 100 24JAN91 brief screaming periods dx peritonitis. Peritoneal dialysis. hyaline membrane @ birth; suffers from complete renal failure req dialysis; MD does not believe vax related.


VAERS ID: 27709 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Oregon  
Vaccinated:1991-01-17
Onset:1991-01-18
   Days after vaccination:1
Submitted: 1991-01-23
   Days after onset:5
Entered: 1991-02-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0060S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR912

Write-up: Child had temp of 104 to 105 for 2 days p/2nd immun given. Mom took child to ER & general Practitioner fever subsided by Sunday night 20JAN91.


VAERS ID: 27716 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Missouri  
Vaccinated:1991-01-10
Onset:1991-01-16
   Days after vaccination:6
Submitted: 1991-01-18
   Days after onset:2
Entered: 1991-02-04
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 4 GM / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1417S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291978 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cyst, Epididymitis, Infection, Lymphadenopathy, Orchitis, Otitis media, Pyrexia, Scrotal oedema
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: In sister, /w MMR, had lymph node swelling in neck /p vax~ ()~~~In Sibling
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO915

Write-up: Child woke up AM of 16JAN91 w/fever, swelling of scrotum & bilateral inguinal lymph nodes. Fever to 103. Seen by MD dx w/orchitis & ear infect given Augmentin for ear infect. Dx w/uremia from MMR resulting in a epididmitis & hydrocele.


VAERS ID: 27717 (history)  
Form: Version 1.0  
Age: 27.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-01-04
Onset:1991-01-14
   Days after vaccination:10
Submitted: 1991-01-30
   Days after onset:16
Entered: 1991-02-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1713S / 1 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Headache, Influenza, Nuchal rigidity, Oedema, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MS914

Write-up: Pt felt stiffness & swelling in neck on 14JAN91 tx by MD on 15JAN91 temp to 103 developed headache & some diarrhea on 18JAN91. Dx acute viral synd possibly related to MMR vax. Pt saw neurologist no neurological abnorms. Cleared for work


VAERS ID: 27720 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-01-16
Onset:1991-01-16
   Days after vaccination:0
Submitted: 1991-01-17
   Days after onset:1
Entered: 1991-02-04
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / 2 LA / SC

Administered by: Public       Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: r/o scoliosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9122

Write-up: Broke out w/rash 830PM 16JAN91 - itching.


VAERS ID: 27725 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Wisconsin  
Vaccinated:1990-12-19
Onset:1990-12-25
   Days after vaccination:6
Submitted: 1991-01-03
   Days after onset:9
Entered: 1991-02-04
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1694S / 1 LL / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Agitation, Headache, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28DEC90 CBC w/diff = WBC 7100; Band = 9; Segs= 35; Lymphs = 54
CDC Split Type: WI91005

Write-up: On 25DEC90 became cranky, feverish, holding head as if a headache, achy. Was given Panodol or Tylenol q 4 hrs; On 28DEC90 sx continued, temp to 103.6, cheeks blotchy red w/ 1 red spot on arm. Child taken to MD 28DEC90.


VAERS ID: 27726 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Wisconsin  
Vaccinated:1991-01-21
Onset:1991-01-21
   Days after vaccination:0
Submitted: 1991-01-22
   Days after onset:1
Entered: 1991-02-04
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471S / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor
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), Generalised convulsive seizures following immunisation (narrow), 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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC Split Type: WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


VAERS ID: 27746 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:1990-11-16
Onset:1990-11-25
   Days after vaccination:9
Submitted: 1991-01-04
   Days after onset:40
Entered: 1991-02-05
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 656 / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Chills, Injection site reaction, Lymphadenopathy, Muscle twitching, Neck pain, Vasodilatation
SMQs:, Dyskinesia (broad), Dystonia (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Blood pressure med
Current Illness:
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data: Physical exam only
CDC Split Type: CA9112

Write-up: 25NOV inject site redness & lump; 27NOV "felt hot" chills, sore & tender inject site; pain in lt side of neck & lt arm; joint pain lt elbow & lt shoulder; twitching & jerking w/chill; 26NOV swollen gland lt side of neck. MD visit; See WORM


VAERS ID: 27753 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Male  
Location: Michigan  
Vaccinated:1990-12-20
Onset:0000-00-00
Submitted: 1991-01-28
Entered: 1991-02-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1342S / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Conjunctivitis, Cough, Diarrhoea, Epistaxis, Hepatic function abnormal, Mouth ulceration, Nausea, Pyrexia, Rash, Rhinitis, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (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, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Seldane in the summer
Current Illness:
Preexisting Conditions: Hayfever, sinus problems
Allergies:
Diagnostic Lab Data: SGOT elevated at 125, SPGT elevated at 137, LDH elevated at 527 CPK elevated at 808. Urinalysis showed .1% glucose & trace protein.
CDC Split Type:

Write-up: Febrile exanthem; 4 days prior to admission nausea, vomiting & diarrhea. 1 day prior to admission generalized erythematous rash beginning on extremities & progressing to trunk; Epistaxis & rhinorrhea w/mild cough. Febrile to 101.9; Conjuct.


VAERS ID: 27776 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:1990-10-15
Onset:1990-10-29
   Days after vaccination:14
Submitted: 1991-01-30
   Days after onset:93
Entered: 1991-02-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0562S / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Myasthenic syndrome, Oedema peripheral, Pain, Paraesthesia, Tenosynovitis
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (narrow)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen hands,numbness, pain in fingers & wrist aching, weakness, difficulty turning on or holding phone. At night hands fall asleep & splints worn for 2 wks & 2 days. Dx Carpal Tunnel synd. middle finger still numb.


VAERS ID: 27778 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Indiana  
Vaccinated:1991-01-10
Onset:1991-01-20
   Days after vaccination:10
Submitted: 1991-01-25
   Days after onset:5
Entered: 1991-02-06
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9J11028 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Conjunctivitis, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conjunctival disorders (narrow), Ocular infections (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: IN9102

Write-up: 2.5 days rash (25 small splatches); 101 temp prior to rash (2 day fever); conjunctivitis.


VAERS ID: 27780 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1990-08-29
Onset:1990-09-04
   Days after vaccination:6
Submitted: 1990-12-18
   Days after onset:105
Entered: 1991-02-06
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11036 / 1 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1499S / 1 - / SC A

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Muscle twitching
SMQs:, Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CAT Scan & bloodwork normal
CDC Split Type: MD90122

Write-up: Acute cerebellar ataxia onset 4SEP90 started w/head twitching,loss of balance, then was unable to walk. Admit hosp 7Sep90 & D/C 10Sep90, still under treatment.


VAERS ID: 27785 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Washington  
Vaccinated:1991-01-08
Onset:1991-01-08
   Days after vaccination:0
Submitted: 1991-01-10
   Days after onset:2
Entered: 1991-02-06
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 2 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622K / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA91507

Write-up: Crying on arrival & cried whole visit nurse noted slight pinkness @ inject site rt arm, blotchy pinkish red rash upper chest, upper back & cheeks. Rash faded in 20mins in MD office.


VAERS ID: 27789 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Ohio  
Vaccinated:1990-12-14
Onset:1990-12-22
   Days after vaccination:8
Submitted: 1990-12-26
   Days after onset:4
Entered: 1991-02-06
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0066S / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Pharyngitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH91001

Write-up: Rash, fever (102-103) sore throat to ER 22DEC90; MD gave prescription for Ceclor, strep type sx to diagnostic test.


VAERS ID: 27794 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Illinois  
Vaccinated:1991-01-22
Onset:1991-01-30
   Days after vaccination:8
Submitted: 1991-02-02
   Days after onset:3
Entered: 1991-02-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / UNK - / SC

Administered by: Private       Purchased by: Unknown
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? 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: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC Split Type:

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


VAERS ID: 27815 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Michigan  
Vaccinated:1991-01-25
Onset:1991-01-29
   Days after vaccination:4
Submitted: 1991-01-31
   Days after onset:2
Entered: 1991-02-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1921S / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Ecchymosis, Petechiae, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC: platelets less than 10,000
CDC Split Type:

Write-up: Thrombocytopenia, cause petechiae all over the body, ecchymosis on tibia 5 days post vax. Referred to hosp.


VAERS ID: 28061 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: California  
Vaccinated:1991-02-05
Onset:1991-02-05
   Days after vaccination:0
Submitted: 1991-02-06
   Days after onset:1
Entered: 1991-02-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 4 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M035FF / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1571S / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283941 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Cyanosis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Done at Lodi memorial Hosp.
CDC Split Type:

Write-up: 1 1/2 hrs post vax temp soared to 103.5 pt began shuddering, retained conciousness, became cyanotic & mottled, used O2 x 1hr, fully recovered.


VAERS ID: 28085 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Ohio  
Vaccinated:1991-01-23
Onset:1991-01-30
   Days after vaccination:7
Submitted: 1991-01-31
   Days after onset:1
Entered: 1991-02-13
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 4 LL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618F / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH91009

Write-up: Fever to 104; convuls- apnea, Seen in ER by family MD


VAERS ID: 28095 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-01-17
Onset:1991-01-26
   Days after vaccination:9
Submitted: 1991-02-11
   Days after onset:16
Entered: 1991-02-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1715S / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Febrile convulsion, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: No
Preexisting Conditions: Premature 34wk
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Febrile sz few min duration 9 days after MMR-PROHIBIT vax;PE 26JAN91 indicated fever, fussiness,pinpoint exanthema primarily on torso and extremeties


VAERS ID: 28096 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Indiana  
Vaccinated:1991-01-18
Onset:1991-01-19
   Days after vaccination:1
Submitted: 1991-02-04
   Days after onset:16
Entered: 1991-02-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR x2; blood test, urine test, WBC; & BP= normal
CDC Split Type: IN9103

Write-up: Fever - 106 19JAN91; 20JAN91 102; puffy face; vomited x1.


VAERS ID: 28101 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: West Virginia  
Vaccinated:1991-01-15
Onset:1991-01-28
   Days after vaccination:13
Submitted: 1991-01-30
   Days after onset:2
Entered: 1991-02-14
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2168S / 2 RA / SC

Administered by: Other       Purchased by: Public
Symptoms: Cough, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: no
Current Illness: no
Preexisting Conditions: "allergies"
Allergies:
Diagnostic Lab Data: 29JAN91 CBC - ATYP High 4.0%, MCV Low 76.3; All else within normal range
CDC Split Type: WV912

Write-up: Mom states child coughed a lot on 28JAN91 & had temp to 102 oral that PM. Took to MD 29JAN91 & started Amoxicillin & Naldelate. Highest temp was 103 oral 29JAN91. Sx improved 30JAN91 temp 99 oral 1FEB91 father states child has recovered.


VAERS ID: 28104 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Alaska  
Vaccinated:1990-05-03
Onset:1990-06-01
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / SCLAVO 108A2 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / UNK - / -

Administered by: Other       Purchased by: Unknown
Symptoms: Deafness
SMQs:, Hearing impairment (narrow)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Audiograms - FTA -Negative
CDC Split Type:

Write-up: Bilateral 20-25 dB sensorineural hearing loss; onset approx 1 month p/immunization.


VAERS ID: 28183 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1990-02-13
Onset:1990-02-15
   Days after vaccination:2
Submitted: 1990-09-17
   Days after onset:213
Entered: 1991-02-11
   Days after submission:147
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256965 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2062P / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253944 / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site reaction, Otitis media, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 900167006

Write-up: CDC reports: 4 yo child developed a fever to 105 & local rxn 2 days following DTP/OPV/MMR, Seen in ER- 2nd day p/immun - fever to 105, 1 1/2 days later fever 103.4 exam revealed lt ear infection. Antibiotic prescribed ill for 6 days.


VAERS ID: 28199 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: South Carolina  
Vaccinated:1989-09-30
Onset:1989-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 20711 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Influenza, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: Mom of child reports temp of 104 w/last DTp w/o medical treatment.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Child is being checked for sickle cell.
CDC Split Type: 900170105

Write-up: Child experienced fever to 106 < 24 hrs p/DTP/MMR immun on 30SEP89 & screaming for $g 4 hrs. To ER; 10OCT89 pt still has low grade fever-on antibiotics. 26OCT89 still running low fever. MD suspects child has virus. Not to rec''d DTP again.


VAERS ID: 28244 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Arizona  
Vaccinated:1990-01-16
Onset:1990-01-22
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256957 / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1661R / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253948 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Pain
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In pt; swelling & soreness @ site of inject; DTP~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: no hx of convulsions in pt, siblings, or parents
Allergies:
Diagnostic Lab Data: EEG & lumbar pucture normal
CDC Split Type: 900174203

Write-up: CDC Reports:2 yo child recvd DTP/OPV/MMR 16Jan90. 22Jan90 had pain in hands & experienced seizure. On 3Feb90 had 2 seizures, taken to ER & was started on Phenobarbital,


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: 28330 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Louisiana  
Vaccinated:1991-01-31
Onset:1991-01-31
   Days after vaccination:0
Submitted: 1991-01-31
   Days after onset:0
Entered: 1991-02-15
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275970 / 4 - / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0G11070 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0612A / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site reaction, Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mother denied illness on fever
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA910206

Write-up: Red rash on lt hand, large red spot on rt leg, Told by nurse rxn to DTP, T.C. to mother @ 2pm, rash has disappeared given oral Atarax q6h for this use until, rash resolved


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: 28337 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Nevada  
Vaccinated:1990-12-04
Onset:1990-12-14
   Days after vaccination:10
Submitted: 1990-12-19
   Days after onset:5
Entered: 1990-12-28
   Days after submission:9
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. 1343S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 620F4 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: NV9004

Write-up: developed fever, morbiliform rash, face then neck, chest, back. Approx 10 days /p receiving MMR/DPT


VAERS ID: 28341 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:1991-01-25
Onset:1991-01-31
   Days after vaccination:6
Submitted: 1991-02-05
   Days after onset:5
Entered: 1991-02-18
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1704S / 1 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxicillin finished 22Jan91
Current Illness: S/P ear infection.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NYS91011

Write-up: 31Jan91 developed increased T 102, 1Feb91 increased T 103.8, Seen by MD, Amoxicillin started


VAERS ID: 28348 (history)  
Form: Version 1.0  
Age: 29.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:1991-01-28
Onset:1991-02-01
   Days after vaccination:4
Submitted: 1991-02-11
   Days after onset:10
Entered: 1991-02-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1715S / 1 RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MMR given 28Jan91, 1Feb91 pt developed progressively increasing temperature & on 8Feb91 developed macular rash over body surface. IGg, IGm done & awaiting results presently.


VAERS ID: 28351 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Washington  
Vaccinated:1990-12-03
Onset:1990-12-03
   Days after vaccination:0
Submitted: 1991-02-08
   Days after onset:67
Entered: 1991-02-18
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622K / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cough, Lymphadenopathy, Pharyngitis, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood culture-nl, WA-nl, CBC-nl except WBC 16.9 (nl is 5-13), differential-nl, Throat cx-nl
CDC Split Type:

Write-up: cough & T onset 1 hr /p vax. T up to 104, vomiting X several hrs, T lasted days, saw MD 5Dec. Throat red, enlarged anterior nodes, cough, T noted in chart. MD states UNK whether T & other illness symptoms related to vax. Recommends DT.


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: 28364 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: California  
Vaccinated:1991-01-24
Onset:1991-02-02
   Days after vaccination:9
Submitted: 1991-02-04
   Days after onset:2
Entered: 1991-02-18
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 287965 / 4 LA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1335S / UNK RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291977 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Myalgia, Otitis media, Pyrexia, Rash, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Gantrisin for chronic ear infect X 3 wks
Current Illness: none
Preexisting Conditions: chronic ear infections
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA9120

Write-up: Sat night approx 12 MN developed rash-small red dots on face& T of 104-105. 4Feb saw MD & DX /w otitis & is currently being TX /w Pediazole. Pt had some vomiting & extreme muscle aches. 6Feb continues to have increase T & muscle aches


VAERS ID: 28365 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:1991-01-28
Onset:1991-01-28
   Days after vaccination:0
Submitted: 1991-01-29
   Days after onset:1
Entered: 1991-02-18
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 3 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Febrile convulsion
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), 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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: CA9121

Write-up: inconsolable crying /p by febrile seizure (T 105), neg-URI, neg-OM, neg-S/Sx menigitis. F/U 30Jan91 "Ok" T.C.


VAERS ID: 28369 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Idaho  
Vaccinated:1991-01-31
Onset:1991-01-31
   Days after vaccination:0
Submitted: 1991-01-31
   Days after onset:0
Entered: 1991-02-18
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1415S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID91008

Write-up: 3 1/2 hrs /p vax, pt woke up & was very quiet,eyes appeared "glassy" she would seem to be dozing off & would startle awake, legs would tremble like seizure, mom gave Tylenol, Seen by MD, DX:somnolenscent start & advised no more pertussis.


VAERS ID: 28389 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-01-16
Onset:1991-01-17
   Days after vaccination:1
Submitted: 1991-01-24
   Days after onset:7
Entered: 1991-02-21
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site oedema, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE DONE
CDC Split Type: PA9138

Write-up: Swelling & reddness @ inject site - rt arm started 18JAN91.


VAERS ID: 28398 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Texas  
Vaccinated:1991-01-10
Onset:1991-01-10
   Days after vaccination:0
Submitted: 1991-01-15
   Days after onset:5
Entered: 1991-02-22
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283973 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1569S / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618C / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pruritus, Pyrexia, Tachycardia, Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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? No
Previous Vaccinations: In pt; slight fever; DTP; 1st dose.~ ()~~~In patient
Other Medications:
Current Illness: minor cold, no fever, no medicines
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX9101

Write-up: W/in 5 mi of vax face became flushed, even into hairline, began to itch around neck. Splotchy areas appeared around the areas of itching. P 140, Temp 99.8 @ 215. Given Benadryl monitored TC to MD advised to be seen today by private MD.


VAERS ID: 28401 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Texas  
Vaccinated:1991-01-03
Onset:1991-01-09
   Days after vaccination:6
Submitted: 1991-01-21
   Days after onset:12
Entered: 1991-02-22
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1569S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Headache, Mouth ulceration, Otitis media, Pharyngitis, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), 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? No
Previous Vaccinations: In brother; Fever, flu-like sx, 6mo, DTP; 2nd or 3rd dose.~ ()~~~In Sibling
Other Medications: Tylenol, Ceclor, Dimetane
Current Illness: Possible Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX9104

Write-up: 9JAN91 fever 104.8 - seen in ER & dx w/otitis media - Ceclor; 11JAN91 MD - tonsilitis & tx /w shot of Penicillin; 13JAN91 Saw MD performed a strep screen; pt c/o sores in mouth. c/o head hurting; poor appetite; Fever of 102.


VAERS ID: 28405 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Ohio  
Vaccinated:1991-02-05
Onset:1991-02-13
   Days after vaccination:8
Submitted: 1991-02-15
   Days after onset:2
Entered: 1991-02-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1488S / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Infection, Pneumonia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: cutting molars; ear redness/infect?
Preexisting Conditions: Undescended testicle
Allergies:
Diagnostic Lab Data: CXR for Pneumonia
CDC Split Type: OH91013

Write-up: 13FEB-fever 103; sponge bath, temp reduced to 99, back up to 104 in 2-3 hrs; 14FEB fever 105.5; TC MD advised sponge bath, Tylenol; Seen in ER; dx viremia. 14FEB-present - Amoxicillin 3x/day, pediaprophen & pediatric tylenol.


VAERS ID: 28424 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1991-01-14
Onset:1991-02-09
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Conjunctivitis, Cough, Hepatocellular damage, Lymphadenopathy, Otitis media, Petechiae, Pharyngitis, Pyrexia, Rash, Rash maculo-papular, Spleen disorder
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Delayed physical & motor development/anemia
Allergies:
Diagnostic Lab Data: CBC-mono test, throat culture, H&H- 10.9/32.2, WBC-18,600, SEGS-10, Lymph-81, Mono-6, Bands-3, platlets-179,000
CDC Split Type:

Write-up: Fever, rash, pharyngitis, otitis media, exanthem on soft palate, maculo papular rash on face, trunk & extremities. Few petechia sub mandibular lymphadenopathy, liver 2 cm down, spleen tip 1 cm down, injected conjunctivitis, cough


VAERS ID: 28431 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Texas  
Vaccinated:1991-01-15
Onset:1991-01-23
   Days after vaccination:8
Submitted: 1991-02-05
   Days after onset:13
Entered: 1991-02-25
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283973 / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1569S / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626H / 4 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Convulsion, Cough, Dyspnoea, Nausea, Otitis media, Pneumonia, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough 7 days /p immun.- increased fever 1 degree, day /p (T 103.9)- respiratory difficulty-Weds 23Jan had convulsion- took to PRMH, DX:/w pneumonia & otitis media- put on Ceclor, N & V started 3Feb91


VAERS ID: 28443 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Georgia  
Vaccinated:1991-01-02
Onset:1991-01-03
   Days after vaccination:1
Submitted: 1991-01-15
   Days after onset:12
Entered: 1991-02-25
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650F / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Diarrhoea, Nausea, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: PPD given 2Jan91 ParkeDavis;Lot # 013600P; Lt forearm;0 previous dose
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: T 100.7 (R), P-156, R-36
CDC Split Type: GA9110

Write-up: nausea, vomiting, lethargy, diarrhea


VAERS ID: 28446 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Georgia  
Vaccinated:1991-01-29
Onset:1991-01-29
   Days after vaccination:0
Submitted: 1991-01-30
   Days after onset:1
Entered: 1991-02-25
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1228S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Theudore, Proventil for asthma prn
Current Illness: none
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: none
CDC Split Type: GA9113

Write-up: Extreme Temp requiring visit to ER,T 106 @ home- T 105 @ ER. 6Feb91 child doing well. No new fever or problems per nurse. Pertussis rxn


VAERS ID: 28456 (history)  
Form: Version 1.0  
Age: 34.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-01-31
Onset:1991-02-08
   Days after vaccination:8
Submitted: 1991-02-19
   Days after onset:11
Entered: 1991-02-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0022S / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1713S / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Lymphadenopathy, Pharyngitis, Pruritus, Sialoadenitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Calan for BP ASA
Current Illness: none
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: none
CDC Split Type: MS916

Write-up: lymphadenopathy, parotitis, sore throat, fatigue, itching, began 8Feb91 & got worse, started Amoxicillin 500 mg tid 11Feb91, Sx resolved except for one lymphnode which is enlarged 19Feb91


VAERS ID: 28463 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-01-10
Onset:1991-01-10
   Days after vaccination:0
Submitted: 1991-01-28
   Days after onset:18
Entered: 1991-02-25
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 287965 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291947 / 5 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cough, Injection site hypersensitivity, Oedema, Otitis media, Pharyngitis, Pyrexia, Rash, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: TN9116

Write-up: Lt arm swollen,T 102, rash @ inject site,ER Dr''s Dx: ear infection, tonsillitis & placed pt on ear drops,Tylenol 10Jan91, Lt arm stayed swelled for 7 days,coughed & vomited X 2 days,had general rash 7 days /p inject,tonsills out now per mom


VAERS ID: 28466 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-01-25
Onset:1991-01-25
   Days after vaccination:0
Submitted: 1991-02-01
   Days after onset:7
Entered: 1991-02-25
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0617K / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Pyrexia, Somnolence, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: TN9119

Write-up: 200 pm pt started to cry & all 4 extremities shake /w quivering of mouth, felt warm & /p 1-2 min went to sleep,went to MD''s ofc-T 104.7.Given Tylenol ggts kept there until T went down to 102.Rest of day slept,T controlled /w meds,next am ok


VAERS ID: 28467 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-01-22
Onset:1991-01-30
   Days after vaccination:8
Submitted: 1991-02-04
   Days after onset:5
Entered: 1991-02-25
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0617K / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9120

Write-up: T 103 rash all over body, fever 103-reaction to MMR vax, rash cleared up 4 days later


VAERS ID: 28475 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:1990-11-02
Onset:1990-11-23
   Days after vaccination:21
Submitted: 1991-02-15
   Days after onset:84
Entered: 1991-02-25
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 RA / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Arthralgia, Arthritis, Neuralgia, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA91510

Write-up: had T 99.6, pain in joints, inflammation of joints (redness, swelling, tenderness), Seen by MD, neuritis, neuralgia, paresthesias


VAERS ID: 28480 (history)  
Form: Version 1.0  
Age: 23.0  
Sex: Female  
Location: Colorado  
Vaccinated:1991-02-21
Onset:1991-02-22
   Days after vaccination:1
Submitted: 1991-02-22
   Days after onset:0
Entered: 1991-02-26
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0J21036 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1486S / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275926 / UNK - / -

Administered by: Military       Purchased by: Unknown
Symptoms: Nausea, Neuropathy, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Tingling & numbness lt side of body, face to foot. Good movement, grasps = bilat. CMS intact. Also c/o n/v p/lunch. Had DT, MMR & OPV 21FEB91, onset sx about 24 hrs later; DX Sensory neuropraxia 2 degree mumps immun.


VAERS ID: 28487 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Arizona  
Vaccinated:1991-02-12
Onset:1991-02-13
   Days after vaccination:1
Submitted: 1991-02-19
   Days after onset:6
Entered: 1991-02-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285967 / 5 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1312S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 5 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site inflammation, Injection site mass, Injection site oedema, Injection site reaction, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AZ9105

Write-up: 1st night p/immun temp 105 orally given tylenol, fever down to 101.5 orally. Arm inflamed & red, swollen & hard. Taken to urgent care tx Benadryl & topical cortisone.


VAERS ID: 28508 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-01-29
Onset:1991-02-08
   Days after vaccination:10
Submitted: 1991-02-13
   Days after onset:5
Entered: 1991-02-28
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Insomnia, Lymphadenopathy, Otitis media, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), 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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: teething & slight cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA9149

Write-up: Irritability on 5FEB91- poor sleeping-screamed 8FEB91 & to ER; Fever 102.5(r) x 3 days better 9FEB91 AM-rash on stomach 8FEB91 spread to neck & down to knees. Gone 13FEB91. Glands swollen 8FEB91 x 1-2days. Also ear infection.


VAERS ID: 28524 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: North Carolina  
Vaccinated:1991-02-20
Onset:1991-02-21
   Days after vaccination:1
Submitted: 1991-02-22
   Days after onset:1
Entered: 1991-03-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622K / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: 29JAN91 hosp admission for ? sz activity
Allergies:
Diagnostic Lab Data: tap in ER
CDC Split Type: NC91012

Write-up: Parent noted fever @ home on 20FEB91 p/immun. 21FEB91 child was brought to ER p/parent noted sz like activity @ home; Seen by MD temp 39.4C.


VAERS ID: 28550 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-04-17
Onset:1990-04-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8L01023 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1687R / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Influenza, Pyrexia, Rash
SMQs:, Anaphylactic reaction (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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC Split Type: CO3588

Write-up: Temp of 104F; Taken to MD; Dx viral synd; sz on 28APR90; past hx of rash;


VAERS ID: 28744 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Alabama  
Vaccinated:1991-02-12
Onset:1991-02-12
   Days after vaccination:0
Submitted: 1991-02-21
   Days after onset:9
Entered: 1991-03-04
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281947 / 5 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1897S / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285958 / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site reaction
SMQs:

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Benedryl, Tylenol
Current Illness: URI-DX 11Feb91
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL91002

Write-up: Pt began c/o pain @ inject site immediately /p injection. Mom noticed swelling & redness almost instantly. Swelling & redness increased over night.


VAERS ID: 28748 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:1991-02-06
Onset:1991-02-13
   Days after vaccination:7
Submitted: 1991-02-14
   Days after onset:1
Entered: 1991-03-04
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1335S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620K / 1 MO / PO
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 110A1 / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site mass, Injection site oedema, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: CA9124

Write-up: 13Feb91 sudden swelling developed @ inject site, developing into a knot, rash localized on rt arm also developed. No SOB, diaphoresis, shock. Development of rash & swelling was sudden & frighten mom. Pt taken to ER & given Benadryl.


VAERS ID: 28751 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: California  
Vaccinated:1991-02-01
Onset:1991-02-01
   Days after vaccination:0
Submitted: 1991-02-13
   Days after onset:12
Entered: 1991-03-04
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 287965 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0A21092 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623E / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: CA9124

Write-up: Mom states pt had bumps on chest 1Feb91,/p recvd immun. Rash moved to arms &stomach was pink & looked like goose bumps, on the 7th got more rash-had been in sun 2 days before &got rash around neck, all over x/ legs & face. MD felt unrelated


VAERS ID: 28756 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Florida  
Vaccinated:1991-02-05
Onset:1991-02-11
   Days after vaccination:6
Submitted: 1991-02-20
   Days after onset:9
Entered: 1991-03-04
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285966 / 2 LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21092 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0490S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281940 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: In brother;retractive airway;4 mons;DTP; 1st st~ ()~~~In Sibling
Other Medications: Pen VK given on 11Feb91 EM/RM, Benadryl
Current Illness: none
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: 27Feb91 Ms Welter states child has recovered.
CDC Split Type: FL91008

Write-up: Pt developed rash 6Feb91 on lt leg, rash con''t to spread over body ea day.Pt''s face became swollen &fever inc,brought him to Hlth Unit to have rash checked. 11Feb91 T 100.4 (O) &Dr''s exam-patchy rash on face,trunk,extrem,perorbit edema,-ER


VAERS ID: 28757 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Idaho  
Vaccinated:1991-01-14
Onset:1991-01-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 5 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 2 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 2 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Nausea, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: ID91009

Write-up: c/o T 103.6, nausea, diarrhea, head-toe rash. MD states they were all rxns to DTP/MMR/HIB/TOPV given 1 wk ago


VAERS ID: 28765 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:1990-11-28
Onset:1990-12-06
   Days after vaccination:8
Submitted: 1990-12-17
   Days after onset:11
Entered: 1991-03-04
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0696S / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0617H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Leukocytosis, 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: hx of frequent ear infections, bilat myringotomy done 13Nov90
Allergies:
Diagnostic Lab Data: mother reports WBC of 21,000
CDC Split Type: NYS91014

Write-up: 8 days /p immun /w MMR/OPV, pt was in care of babysitter, dev a T of 102 & seizure occurred as per account of babysitter, taken to ER & MD called to ER, MD RX Amoxicillin 250 mg po tid X 10 days, Mom reports WBC count 21,000.


VAERS ID: 28767 (history)  
Form: Version 1.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:1990-12-06
Onset:1990-12-15
   Days after vaccination:9
Submitted: 1990-12-17
   Days after onset:2
Entered: 1991-03-04
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Headache, Injection site reaction, Oedema, Pain, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NYS91016

Write-up: local rxn, lt arm, pain, swelling, redness, T $g 100 F, pain in joints, severe headache.


VAERS ID: 28768 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: New York  
Vaccinated:1990-12-11
Onset:1990-12-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M730FA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 14129 / UNK LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279936 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Pyrexia, Stupor
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NYS91017

Write-up: T 104.9 F, convulsions X1, marked alteration in LOC-child not responsive to mother.


VAERS ID: 28774 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Oregon  
Vaccinated:1991-02-11
Onset:1991-02-16
   Days after vaccination:5
Submitted: 1991-02-20
   Days after onset:4
Entered: 1991-03-04
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Lymphadenopathy, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none as of 21Feb91
CDC Split Type: OR914

Write-up: Sat-16Feb91 @ 2000 low grade T, Sun-17Feb T 102, Mon-18Feb T 105.5, Tues-19Feb to MD T 101 & swollen glands, acts like she hurts all over, Wed-20Feb T 101, Thurs-21Feb afebrile, 0 rash yet.


VAERS ID: 28776 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-01-30
Onset:1991-02-01
   Days after vaccination:2
Submitted: 1991-02-11
   Days after onset:10
Entered: 1991-03-04
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: PA9151

Write-up: large raised, swollen area''s of forehead, back, hip, abdomen & marked swelling of both hands. Started on 1Feb91 & resolved by 10Feb91, Rx /w Benadryl


VAERS ID: 28780 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Utah  
Vaccinated:1991-01-22
Onset:1991-02-01
   Days after vaccination:10
Submitted: 1991-02-05
   Days after onset:4
Entered: 1991-03-04
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2125R / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Otitis media, Pneumonia, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Panadol (liq. acetaminphen)
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR, Blood cultures, WBC count (ok)
CDC Split Type: UT915

Write-up: Started /w cough 31Jan91, by 6 pm 1Feb91 fever spiked to 106. Seen in ER-bathed to decrease fever, blood cultures-neg, CXR-"some" pneumonia. Rash covering body. Ears infected, Ceclor given. Sent home. Seen again in ER 3Feb91 for T 104


VAERS ID: 28782 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Utah  
Vaccinated:1991-02-05
Onset:1991-02-05
   Days after vaccination:0
Submitted: 1991-02-11
   Days after onset:6
Entered: 1991-03-04
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1335S / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291945 / 3 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Otitis media, 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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: UT917

Write-up: mom stated child had a seizure about 30 min. /P receiving immun. stated she took pt to "night time" Pediatrics & T was 104. Treated for T states father. Also "ears were blocked" according to father


VAERS ID: 28785 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Washington  
Vaccinated:1991-01-02
Onset:1991-01-16
   Days after vaccination:14
Submitted: 1991-01-30
   Days after onset:14
Entered: 1991-03-04
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Herpes simplex, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: chronic skin rashes-not specific
Allergies:
Diagnostic Lab Data: CBC
CDC Split Type: WA91512

Write-up: taken to MD for skin rash 14 days /p immun & T. Started on abd, chest, arms, face red raised 1-2 cm red patches, given Benadryl by MD, lab work done, also has possible herpes simplex on face


VAERS ID: 28786 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Washington  
Vaccinated:1991-02-05
Onset:1991-02-06
   Days after vaccination:1
Submitted: 1991-02-06
   Days after onset:0
Entered: 1991-03-04
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OTC infant Tylenol
Current Illness:
Preexisting Conditions: 36 wk gestation-aspiration complication-Icteric @ birth, twin birth
Allergies:
Diagnostic Lab Data: MD states croup -not vaccine related
CDC Split Type: WA91513

Write-up: child awoke early am , coughing crying apparent difficulty breathing, transported per ambulance to Hosp. /w mild resp. distress.


VAERS ID: 28842 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Maryland  
Vaccinated:1991-01-04
Onset:1991-01-04
   Days after vaccination:0
Submitted: 1991-01-04
   Days after onset:0
Entered: 1991-03-06
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M720EJ / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1334S / 1 RA / SC

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Injection site hypersensitivity, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MD91014

Write-up: Developed slight erythema, small hives appeared; child crying; MD notified immediately, Benadryl elixir ordered given immediately. Also deloped splotchy areas on both legs, both sides of face & reddened areas. P/ Benadryl erythema dec''d


VAERS ID: 28848 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:1991-02-12
Onset:1991-02-22
   Days after vaccination:10
Submitted: 1991-02-26
   Days after onset:4
Entered: 1991-03-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 630A4 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1338S / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Arthropathy, Chills, Headache, Lymphadenopathy, Osteoarthritis, Pain, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA91514

Write-up: Dev T of 100, headache, chills, gen''l aches, & swollen glands esp. behind rt ear. On 23FEB91 started w/fine red rash on face, neck, stomach. 24FEB91 rash inc & was more prominent w/ itching. Swollen painful knees & hips, stiffness.


VAERS ID: 28850 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Washington  
Vaccinated:1991-02-21
Onset:1991-02-21
   Days after vaccination:0
Submitted: 1991-02-28
   Days after onset:7
Entered: 1991-03-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293978 / 2 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295929 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Diarrhoea, Headache, Pyrexia, Renal pain, Urine analysis abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Amoxicillin for 10 days for UTI finished the 1 wk before sx
Current Illness: none
Preexisting Conditions: seafood, bee sting allergies
Allergies:
Diagnostic Lab Data: Neutropenia SGOT 116, SGPT 223, ALP 333, GGT 75, Direct Bili 1.1, Indirect Bili 1.7, Hep A&B screen negative, Hep C screen & mono screen ordered, 0 results yet-Hep screen & mono screen 25Feb91 are neg as of 28Feb91
CDC Split Type: WA91516

Write-up: 21Feb91 245 pm spiked T 103.4 /w vomiting seen in ER then admit, had diarrhea orange stool & urine, c/o headache, stomachache & sore kidneys, given Ampicillian 425 mg IV q8hrs, Gentomycin 40 mg IV q8hrs-0 meds on discharge.


VAERS ID: 28852 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-11-13
Onset:1990-11-21
   Days after vaccination:8
Submitted: 1991-02-12
   Days after onset:83
Entered: 1991-03-06
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0612C / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Gaze palsy, Otitis media, 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), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: all normal/negative blood tests(CBC, electrolytes, blood glucose, BUN, blood cultures, spinal tap
CDC Split Type: PA9145

Write-up: Day of vax dev 101 F over 1st 24 hrs,controlled /w APAP & resolved /p 1 day, well until 21Nov90 dev T 103.5 lasted through nite,Called MD 22Nov90 said"prob from MMR"@ 10 am eyes rolled back &had sz,to ER & dx Lt OM. Had T since w/o sz.


VAERS ID: 28853 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-01-28
Onset:1991-02-15
   Days after vaccination:18
Submitted: 1991-02-19
   Days after onset:4
Entered: 1991-03-06
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293940 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Conjunctivitis, Lymphadenopathy, Oedema, Otitis media, Pyrexia, Rash, Rhinitis, Somnolence, Vasodilatation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9154

Write-up: Rash started behind ears on 15FEB91 moved to eyebrows, face, chest, back, abd, legs, & buttocks. Temp to 100 (forehead strep) was beet red & puffy; Enlarged glands behind ears. Cranky & slept a lot. Also ear infect & Conjunctivitis, coryza.


VAERS ID: 28858 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Female  
Location: West Virginia  
Vaccinated:1991-02-08
Onset:1991-02-18
   Days after vaccination:10
Submitted: 1991-02-28
   Days after onset:10
Entered: 1991-03-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 630A4 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258S / UNK LA / SC

Administered by: Public       Purchased by: Private
Symptoms: Cellulitis, Headache, Infection, Lymphadenopathy, Neck pain, Pain, Paraesthesia, Pyrexia, Rash maculo-papular, Sialoadenitis
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Birth Control Ortho Novum 777
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Pannicullitis
CDC Split Type:

Write-up: 18FEB neck pain, headache, & T 101.4; 19FEB TO ER dx full blown mumps w/parotitis both sides, pain & knots in neck; 20FEB measles-like rash fr head to mid chest; 23FEB knots on palms hand & fingers. painful w/tingling, burning. Panniculitis


VAERS ID: 28859 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated:1990-08-06
Onset:1990-08-11
   Days after vaccination:5
Submitted: 1991-03-01
   Days after onset:202
Entered: 1991-03-06
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0696S / 2 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Infection, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: In pt; 5yo; MMR; 1 dose.~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MMRI 7JUL86
CDC Split Type:

Write-up: Prolonged malaise, fevers, fungal skin infections.


VAERS ID: 28864 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Ohio  
Vaccinated:1991-02-13
Onset:1991-02-25
   Days after vaccination:12
Submitted: 1991-02-26
   Days after onset:1
Entered: 1991-03-07
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 - / SC L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 1 - / SC L

Administered by: Public       Purchased by: Public
Symptoms: Pharyngitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), 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? No
Previous Vaccinations: IN brother Same as pt occurred about 5 yrs ago~ ()~~~In Sibling
Other Medications:
Current Illness: "red throat" neg for strep
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH91017

Write-up: 13FEB MMR & BHI administered; 22FEB elevated temp (not measured); 23FEB temp 105; 23 & 24FEB temp 106; 25FEB rash on trunk, face, & neck, red throat (negative for strep);


VAERS ID: 28869 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Ohio  
Vaccinated:1991-02-01
Onset:1991-02-11
   Days after vaccination:10
Submitted: 1991-02-20
   Days after onset:9
Entered: 1991-03-07
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0066S / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Infection, 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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 12FEB91 Culture positive for strep
CDC Split Type: OH91022

Write-up: 11FEB9 3AM sz. Temp 104 (ax) by ambulance attendant; parent noted child was asymptomatic, other than "Feeling warm", prior to convulsion. Pt was not hospitalized. Rx w/Tylenol per parent.


VAERS ID: 28884 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Georgia  
Vaccinated:1991-02-04
Onset:1991-02-19
   Days after vaccination:15
Submitted: 1991-03-01
   Days after onset:10
Entered: 1991-03-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), 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? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE AT TIME OF VACCINE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Requesting records from PMD
CDC Split Type: GA9120

Write-up: 4FEB91 developed rash on bottom x 3 days; on 19FEB91 woke up 11PM crying; mom states pt had elevated temp; 21FEB91 to 23FEB91 not checked w/thermometer. 23FEB91 had fine rash from head to toe & itching.


VAERS ID: 28885 (history)  
Form: Version 1.0  
Age: 1.31  
Sex: Male  
Location: Georgia  
Vaccinated:1991-02-22
Onset:1991-02-22
   Days after vaccination:0
Submitted: 1991-03-02
   Days after onset:8
Entered: 1991-03-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0625C / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), 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? No
Previous Vaccinations: NONE~ ()~~0.00~Patient
Other Medications: NONE
Current Illness: slight cough
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Went to ER
CDC Split Type: GA9121

Write-up: Child kept crying & gasping for breath; Advised to go to ER; Next day child fine; Had elevated temp the night before of 100; ER PMD stated he had a common rxn to immun.


VAERS ID: 28886 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Georgia  
Vaccinated:1991-02-08
Onset:1991-02-16
   Days after vaccination:8
Submitted: 1991-03-01
   Days after onset:13
Entered: 1991-03-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Nausea, Rash, Skin nodule, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC 6.5 - 13.4/39.2 32.8L/67.G; PET 259K; Lungs clear; abd OK; SM PC LNs; neck supp;
CDC Split Type: GA9122

Write-up: 15mo developed rash 1 wk p/MMR; knots on back of head & behind rt ear. rash x 2 days fever 101 x 3 day & N & V, sometimes whiny; Looks like measles rash.


VAERS ID: 28889 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Georgia  
Vaccinated:1991-02-22
Onset:1991-02-23
   Days after vaccination:1
Submitted: 1991-02-25
   Days after onset:2
Entered: 1991-03-08
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Eye pain, Headache, Pain, Pallor, Pharyngitis, Pyrexia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypotonic-hyporesponsive episode (broad), 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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: GA9126

Write-up: SAT 4PM mom checked temp - 102.6 c/o hurting all over & headache.Taken to ER; MD said tonsils were red gave Amoxicillin to take 1 tsp TID & Tylenol q 4 hrs. Saturday nite temp to 103 c/o eyes burning & Sunday better still had low grade temp


VAERS ID: 28891 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:1991-02-21
Onset:1991-02-22
   Days after vaccination:1
Submitted: 1991-02-27
   Days after onset:5
Entered: 1991-03-08
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1490S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI9109

Write-up: Child reports developing itching in area of inject site day following receipt of vax. Itching progressed to entire body & when scratched redness & hives developed. Seen by MD who felt was allergic rxn to egg & child not in danger.


VAERS ID: 28896 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New Jersey  
Vaccinated:1991-02-19
Onset:1991-02-27
   Days after vaccination:8
Submitted: 1991-02-28
   Days after onset:1
Entered: 1991-03-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Oedema, Pyrexia, Rash, Rhinitis, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NJ916

Write-up: child awoke during night w/temp 104.3, runny nose, vomiting, edematous swollen, faint rash.


VAERS ID: 28897 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1991-01-23
Onset:1991-02-08
   Days after vaccination:16
Submitted: 1991-03-05
   Days after onset:25
Entered: 1991-03-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1490S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Delirium, Pallor, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONe
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NJ917

Write-up: Pale, red specks, "swelling of brain"


VAERS ID: 28899 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-11-27
Onset:1990-12-06
   Days after vaccination:9
Submitted: 1991-02-01
   Days after onset:57
Entered: 1991-03-08
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 RA / SC

Administered by: Public       Purchased by: Private
Symptoms: Convulsion, Pyrexia, Rash
SMQs:, Anaphylactic reaction (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), Hypersensitivity (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WNL - CBC, UR, CXR
CDC Split Type: PA9156

Write-up: Rash, high fever (? degree), sz;


VAERS ID: 28901 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-02-23
Onset:1991-02-23
   Days after vaccination:0
Submitted: 1991-02-28
   Days after onset:5
Entered: 1991-03-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1897S / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Dizziness, Eye pain, Headache, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Prozac 20 mg qd
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA9158

Write-up: Dizzy, muscle aches, malaise, headache, eyes hurt.


VAERS ID: 29105 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-02-15
Onset:1991-02-22
   Days after vaccination:7
Submitted: 1991-03-01
   Days after onset:7
Entered: 1991-03-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1696S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291945 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: MS9110

Write-up: Pt had elevated temp 22FEB91 x 3 days (101.2)R 1x when mom checked temp; low grade temp during day & elevated more @ night. On 24FEB91 broke out w/rash all over. Raised bumps which turned to large whelps if got hot. Seen by MD 26FEB91.


VAERS ID: 29106 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: Oklahoma  
Vaccinated:1991-02-28
Onset:1991-02-28
   Days after vaccination:0
Submitted: 1991-03-01
   Days after onset:1
Entered: 1991-03-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 740EN / 1 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1694S / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK918

Write-up: Pt refuses to walk swelling to toes on rt leg.


VAERS ID: 29114 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-02-13
Onset:1991-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1991-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 287964 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2269 / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295932 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Cough, Epistaxis, Otitis media, Pyrexia, Vomiting, Weight decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amox for Otitis
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA9163

Write-up: 15FEB- fever, dec appetite, wt loss, cough, nose bleed x 2d, vomiting; Seen 21FEB temp 102.4(R) - otitis.


VAERS ID: 29115 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-02-15
Onset:1991-02-24
   Days after vaccination:9
Submitted: 1991-03-01
   Days after onset:5
Entered: 1991-03-12
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 287964 / 2 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1502S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 289936 / 2 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Otitis media, Pyrexia, Rash maculo-papular, Rhinitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA9164

Write-up: Fever to 102 x 3d starting 24DEC rash x 1d - mac/pap, on chest & face. No conjunctivitis, no cough, no koplik''s; minimal coryza lt otitis rx Amox


VAERS ID: 29120 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Minnesota  
Vaccinated:1991-02-15
Onset:1991-02-26
   Days after vaccination:11
Submitted: 1991-03-05
   Days after onset:7
Entered: 1991-03-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES ND11000 / UNK - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Encephalitis, Grand mal convulsion, Meningitis, Rash, Somnolence, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: Septra
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - 73% lymph; Viral cultures & titer pending
CDC Split Type:

Write-up: 26FEB91 rash starting on face - extremities; 1MAR91 lethargy, sz, changing MS admitted - tx w/Rocephin; 2MAR91 status epilepticus-intubation x 24 hrs; 5MAR91 complete recovery & home: DX: Probable meningo-encephalitis w/sz.


VAERS ID: 29134 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Minnesota  
Vaccinated:1991-02-28
Onset:1991-02-28
   Days after vaccination:0
Submitted: 1991-02-28
   Days after onset:0
Entered: 1991-03-13
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 2 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620D / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood & urine C&S
CDC Split Type:

Write-up: Febrile seizure;


VAERS ID: 29140 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Maine  
Vaccinated:1991-02-28
Onset:1991-03-01
   Days after vaccination:1
Submitted: 1991-03-08
   Days after onset:7
Entered: 1991-03-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1497S / 2 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: ME91002

Write-up: 1Mar91-headache T-104 F orally vomiting, 2Mar91-ER visit-, T 102, 3Mar91-T 102 F, 4Mar91-T 102 F, 5Mar91 T 102 F, 6Mar91-T 101 F, 7Mar91-normal


VAERS ID: 29142 (history)  
Form: Version 1.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:1991-02-13
Onset:1991-02-14
   Days after vaccination:1
Submitted: 1991-02-14
   Days after onset:0
Entered: 1991-03-14
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1890S / 1 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Pain
SMQs:, Guillain-Barre syndrome (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? No
Previous Vaccinations:
Other Medications: Oral contraceptive, MMR 9Jan91 given
Current Illness: None
Preexisting Conditions: Rheumatoid arthritis, gestational diabetes May89-Dec89
Allergies:
Diagnostic Lab Data: Sent to Hospital
CDC Split Type: NYS91022

Write-up: Rt side of face & rt ear painful (constant) unrelieved by Tylenol-feels very weak. Pain started 14Feb91 1230 am.


VAERS ID: 29153 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Minnesota  
Vaccinated:1990-11-19
Onset:1990-11-24
   Days after vaccination:5
Submitted: 1990-11-30
   Days after onset:6
Entered: 1991-03-15
   Days after submission:105
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M755EN / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MN90005

Write-up: Dev temp 103 5 days p/inject. Rash on tummy began on 26NOV90; MD on 28NOV90 was started on antibiotic. Md does not feel rxn was r/t immun.


VAERS ID: 29155 (history)  
Form: Version 1.0  
Age: 20.0  
Sex: Female  
Location: Minnesota  
Vaccinated:1990-12-12
Onset:1990-12-12
   Days after vaccination:0
Submitted: 1990-12-13
   Days after onset:1
Entered: 1991-03-15
   Days after submission:92
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0213S / 2 LA / -
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0E21103 / 6 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Injection site oedema, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MN90007

Write-up: Swollen @ site; sore arm; fever- no treatment given.


VAERS ID: 29158 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Minnesota  
Vaccinated:1990-10-24
Onset:1990-11-01
   Days after vaccination:8
Submitted: 1990-11-13
   Days after onset:12
Entered: 1991-03-15
   Days after submission:122
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2127R / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: NONE KNOWN~ ()~~~In patient
Other Medications: NONE
Current Illness: cough fr bronchitis w/onset 11OCT90
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MN90010

Write-up: Onset of fever 1NOV90 peaked @ 103 on 2NOV90. Seen @ MD on 2NOV90; Started on antibiotics & Ventolin syrup. Hospitalized 1 day 12OCT90.


VAERS ID: 29161 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Minnesota  
Vaccinated:1990-09-27
Onset:1990-10-16
   Days after vaccination:19
Submitted: 1991-01-25
   Days after onset:101
Entered: 1991-03-15
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2270R / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283952 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood & urine tests done - mom states that MD did not inform her than any abnormal
CDC Split Type: MN90013

Write-up: Petechiae developed first on face-spread to abd & then head-to-toe w/exception of scalp-started to fade by 3rd day. Md told mom that petechiae probably result of rubella component of MMR vax.


VAERS ID: 29165 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Minnesota  
Vaccinated:1990-12-10
Onset:1990-12-16
   Days after vaccination:6
Submitted: 1990-12-18
   Days after onset:2
Entered: 1991-03-15
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1333R / 1 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Pharyngitis, Pyrexia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Tonsillitis
CDC Split Type: MN90014

Write-up: Temp 104 16DEC90 still present, given Tylenol every 4 hrs. PHN instructed her to contact MD. Rec''d shot MMR on 10DEC90. Dx w/tonsillitis.


VAERS ID: 29181 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: California  
Vaccinated:1991-02-26
Onset:1991-03-02
   Days after vaccination:4
Submitted: 1991-03-12
   Days after onset:10
Entered: 1991-03-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1929S / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Cough, Pyrexia, Rash, Rhinitis, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Tb Monovacc;Rt forearm;0 previous doses;26Feb91
Current Illness: none
Preexisting Conditions: Septra for otitis media 7Feb91-21Feb91
Allergies:
Diagnostic Lab Data: needs time for followup, none
CDC Split Type:

Write-up: Rash started(guesstimate)2Mar-3Mar91, persisted as hives to 12Mar91, diaper dermatitis(responding to Lotrimin) developed, cold & cough started approx 6Mar91, fever 8Mar&9Mar, exam in ofc 12Mar91-$gdiffuse urticaria;rhinorrhea;cough;afebrile;


VAERS ID: 29182 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New York  
Vaccinated:1991-02-12
Onset:1991-02-12
   Days after vaccination:0
Submitted: 1991-03-12
   Days after onset:28
Entered: 1991-03-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 3 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195FD / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2127R / 1 - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Convulsion, Pyrexia, Stupor
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? No
Previous Vaccinations: unknown~ ()~~~In patient
Other Medications: Albuterol, Aldactone, Lasix
Current Illness: none
Preexisting Conditions: myotonic dystrophy
Allergies:
Diagnostic Lab Data: EEG-normal
CDC Split Type:

Write-up: 5 hrs /p DTP T went to 102-found unresponsive /c fixed stare-heart rate & resp normal-remained thus X 1 hr- T brought down & he became postictal thereafter. EEG 2 wks later-normal. No further seizures.


VAERS ID: 29183 (history)  
Form: Version 1.0  
Age: 27.0  
Sex: Female  
Location: Missouri  
Vaccinated:1991-01-03
Onset:1991-01-04
   Days after vaccination:1
Submitted: 1991-01-08
   Days after onset:4
Entered: 1991-03-18
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1417S / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Malaise, Pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO9120

Write-up: Malaise, throat-pain swallowing, blood pressure 120/70, Temp 98.8


VAERS ID: 29184 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-02-01
Onset:1991-02-03
   Days after vaccination:2
Submitted: 1991-03-07
   Days after onset:32
Entered: 1991-03-18
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1054S / 2 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Chills, Leukocytosis, Meningitis, Nausea, Pain, Purpura, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: DX: anaphylactic purpura-had aching joints, blood culture DX: Niseria meningitis /p hospitalization, WBC-28000
CDC Split Type: TN9139

Write-up: 2 days /p vax had T of 103-chilling,nausea-vomiting&raised pink patch on lt leg,sore to touch,given Fenergan/Tylenol,in night inc T 104-gave tepid bath/Tylenol/Fenergan,had purpura in lt groin-went to ER/admit,purpura on legs/hands/shoulder


VAERS ID: 29186 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-02-28
Onset:1991-03-04
   Days after vaccination:4
Submitted: 1991-03-05
   Days after onset:1
Entered: 1991-03-18
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1710S / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Oedema, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: slight cold-no fever
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: TN9137

Write-up: Woke up am of 3-4 /c hands swollen (worse on lt) rash of hands, legs, trunk, abdomen(worse on extremities); itching all over. Was seen in ER 8:25 pm on 3-4 was given Benedryl po; instructed 25-50mg PO q8 hrs.


VAERS ID: 29188 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-02-21
Onset:1991-02-22
   Days after vaccination:1
Submitted: 1991-03-04
   Days after onset:10
Entered: 1991-03-18
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 6 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / 3 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 293925 / 5 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Gait disturbance, Influenza, Malaise, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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? No
Previous Vaccinations: In brother;legs paralyzed for a while drags on foot when runs;$g 2yr;DPT/OPV;3rd~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9135

Write-up: Pt had T & malaise X 3 days-saw MD 25Feb-DX : /w flu-Started c/o of legs hurting walking on tip toes 27Feb-T.C.to mother 4Mar91-states still c/o legs hurting-said Dr. felt like flu had settled in her legs.


VAERS ID: 29189 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-02-28
Onset:1991-02-28
   Days after vaccination:0
Submitted: 1991-03-01
   Days after onset:1
Entered: 1991-03-18
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / 2 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0625B / 5 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: tomatoes
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9134

Write-up: Mom came back to clinic room for nurse to see child, dark red splotches around mouth,c/o itching around mouth,was able to talk&no SOB noted.Tongue was not swollen,told to stay 10 mins,during that time the redness faded.Rash came back-to ER.


VAERS ID: 29190 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Tennessee  
Vaccinated:1990-12-13
Onset:1990-12-13
   Days after vaccination:0
Submitted: 1991-03-01
   Days after onset:78
Entered: 1991-03-18
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1054S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Influenza, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE KNOWN
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Lab WBC 29.0 (NL 5.4-17.4); CBC, Chem 6 Mom reports elevated WBC
CDC Split Type: TN9133

Write-up: Child developed fever of 103.5 which eventually responded temp. to tylenol suppositories; @ midnight, fever up to 106.5, seen in ER; Given ice bath, alcohol bath & "an adult dose of Tylenol suppositories. MD thought viral infect w/vax rxn.


VAERS ID: 29192 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Tennessee  
Vaccinated:1991-01-25
Onset:1991-01-27
   Days after vaccination:2
Submitted: 1991-02-22
   Days after onset:26
Entered: 1991-03-18
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626M / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Crying, Diarrhoea, Gaze palsy, Hypokinesia, Hypotonia, Influenza, Otitis media, Rash, Screaming, Vasodilatation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9131

Write-up: AWOKE 1-2AM 27JAN91 W/CRYING 8AM BECAME CONSTANT SCREAMING DESCRIBED AS "STRANGE & HIGH PITCHED" MO STATES CHILD FELT WARM BUT DID NOT CHECK TEMP-SPONGED CHILD DOWN-LIMP & EYES ROLLED BACK IN HEAD-NO JERKING MVMT; TO ER-DX FLU; SEE WORM


VAERS ID: 29194 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-01-15
Onset:1991-01-24
   Days after vaccination:9
Submitted: 1991-02-12
   Days after onset:19
Entered: 1991-03-18
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Influenza, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: STREP TEST - NEGATIVE
CDC Split Type: TN9129

Write-up: HAD RASH OVER ENTIRE BODY-HAD FEVER 103-105; NO SZ- HAD COLD LIKE SX STARTING 1 DAY BEFORE RASH STARTED; APPETITE DEC.; PLAYED ALRIGHT; SEEN BY MD 26jan91; MD STATED UNUSUALLY SEVERE RXN TO THE MMR.


VAERS ID: 29197 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Tennessee  
Vaccinated:1990-12-26
Onset:1990-12-28
   Days after vaccination:2
Submitted: 1990-12-28
   Days after onset:0
Entered: 1991-03-18
   Days after submission:80
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 2 LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1412S / UNK RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0625B / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Convulsion, Gaze palsy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9126

Write-up: GMOM REPORTS THAT CHILD WAS "FEVERISH" ON 27DEC; ON MORNING OF 28DEC90, HAD CONVULS (HEAD BACK, EYES ROLLED BACK STOPPED BREATHING), WAS TAKEN TO ER- TEMP 104.6(R), WAS GIVEN 02.


VAERS ID: 29203 (history)  
Form: Version 1.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:1991-02-26
Onset:1991-02-26
   Days after vaccination:0
Submitted: 1991-03-06
   Days after onset:8
Entered: 1991-03-19
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1890S / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Movement disorder, Pain, Rash, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt lethargic night of adm.; 4 days later pt noted rash w/difficulty raising arm; again felt lethargic w/inc pain; Seen in ER-afebrile, diarrhea x 3 days.


VAERS ID: 29215 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Washington  
Vaccinated:1991-02-21
Onset:1991-03-01
   Days after vaccination:8
Submitted: 1991-03-07
   Days after onset:6
Entered: 1991-03-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2169S / 1 LA / -

Administered by: Private       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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI of brain; EEG
CDC Split Type: WA91525

Write-up: 9 days p/vax pt developed fever accompanied by rt focal sz; she had nl MRI study, EEG is pending.


VAERS ID: 29216 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Washington  
Vaccinated:1991-03-07
Onset:1991-03-07
   Days after vaccination:0
Submitted: 1991-03-07
   Days after onset:0
Entered: 1991-03-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 4 LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1338S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620L / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: cutting teeth
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WA91524

Write-up: Temp 104.3 this am, emesis x 2, lethargic, at 0800 7MAR91 put in tepid water bath to cool. Pt unable to keep Tylenol down since the 0200 7MAR91 dose. Will give pedialyte & see MD.


VAERS ID: 29218 (history)  
Form: Version 1.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:1991-02-01
Onset:1991-02-13
   Days after vaccination:12
Submitted: 1991-03-04
   Days after onset:19
Entered: 1991-03-19
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1920S / UNK - / SC

Administered by: Other       Purchased by: Public
Symptoms: Back pain, Eye pain, Headache, Neuralgia, Optic neuritis
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Ocular infections (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? No
Previous Vaccinations: unknown~ ()~~~In patient
Other Medications: none known
Current Illness: none
Preexisting Conditions: allergic to animal dander
Allergies:
Diagnostic Lab Data: CT scan on about 15FEB- normal
CDC Split Type: WA91522

Write-up: 7FEB91 experienced neuralgia lt forearm & lower back area; 13FEB91 severe headache progressing to OD pain dx''d as optic neuritis;


VAERS ID: 29222 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: North Carolina  
Vaccinated:1991-02-21
Onset:1991-02-21
   Days after vaccination:0
Submitted: 1991-02-22
   Days after onset:1
Entered: 1991-03-20
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622M / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: NC91017

Write-up: child developed urticarial rash consisting of red wheals on face to neck occurring 10-12 hrs /p immun. given. Child had no other sx or abnormalities on exam & rash subsided immediately /p giving oral diphenhydramine


VAERS ID: 29228 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Michigan  
Vaccinated:1991-02-12
Onset:1991-02-13
   Days after vaccination:1
Submitted: 1991-03-05
   Days after onset:20
Entered: 1991-03-20
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1711S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Otitis media, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 5Mar91 P.C. to mom-ok now, no T, eating , sleeping well-reck due on ears 13Mar91
CDC Split Type: MI9113

Write-up: 13Feb91 to Pvt MD for inc fever-which rebounded when off Tylenol. DX: ear infection, antibiotics given-MD felt not related to vax-30Feb91 4pm, went to ER due to recurrent T, antibiotic changed, 27FEB91 to MD, repeated antibiotic for ears


VAERS ID: 29229 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: West Virginia  
Vaccinated:1991-02-14
Onset:1991-02-17
   Days after vaccination:3
Submitted: 1991-03-08
   Days after onset:19
Entered: 1991-03-20
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2247S / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Infection, Otitis media
SMQs:

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? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: WV914

Write-up: 3 days /p immun, DX case of Mumps by MD, 20 days /p immun, DX case of bilat otitis media-placed on antibiotic by MD, pt had no prior hx of otitis media


VAERS ID: 29232 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-03-05
Onset:1991-03-05
   Days after vaccination:0
Submitted: 1991-03-05
   Days after onset:0
Entered: 1991-03-20
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1498S / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Hypotonia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinat