|
| VAERS ID: |
26171 (history) |
| Form: |
Version 1.0 |
| Age: |
0.1 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1990-09-17 |
| Onset: | 1990-09-18 |
| Days after vaccination: | 1 |
| Submitted: |
1990-09-27 |
| Days after onset: | 9 |
| Entered: |
1990-10-03 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1380R / 2 |
- / SC |
Administered by: Private Purchased by: Private
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 patient
Other Medications: Given Recombivax 16AUG90, route SC, No Lot no. given.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt vaccinated with Recombivax developed fever of 104F at 4:50Pm irritable no vomitting, given Tylenol, temp at 5:50PM down to 100.4 next day temp 101. Rechecked on 20SEP90. |
|
| VAERS ID: |
26836 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Sex: |
Male |
| Location: |
Alaska |
| Vaccinated: | 1990-10-24 |
| Onset: | 1990-10-24 |
| Days after vaccination: | 0 |
| Submitted: |
1990-11-06 |
| Days after onset: | 13 |
| Entered: |
1990-11-28 |
| Days after submission: | 22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283913 / 1 |
RL / IM |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1880R / 2 |
LL / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
277941 / 1 |
MO / PO |
Administered by: Public Purchased by: Unknown
Symptoms: Convulsion,
Pyrexia,
Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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? No
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: Lumbar puncture - results normal
CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV/Recomb developed fever of 103, convulsions, fine tremor. |
|
| VAERS ID: |
27521 (history) |
| Form: |
Version 1.0 |
| Age: |
0.5 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 1991-01-15 |
| Onset: | 1991-01-15 |
| Days after vaccination: | 0 |
| Submitted: |
1991-01-16 |
| Days after onset: | 1 |
| Entered: |
1991-01-22 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
295973 / 3 |
LA / IM |
| HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
36560 / 3 |
RL / IM |
| HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M025FC / 2 |
RL / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
285951 / 3 |
MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Injection site oedema,
Injection site reaction,
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? No
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: Immediate rxn, moderate erythema & local swelling size of small orange, ice applied given Tylenol. Rxn at DPT site, HIB site & Hepatitis B site - same rxn for all, same tmt. |
|
| VAERS ID: |
31164 (history) |
| Form: |
Version 1.0 |
| Age: |
0.1 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1991-04-03 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (FOREIGN) / MERCK & CO. INC. |
- / 2 |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Erythema multiforme,
Rash
SMQs:, Severe cutaneous adverse reactions (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES90041041
Write-up: Two wks following 2nd vax pt developed rash w/target lesions; Dx of erythema multiforme was made; @ time of report the lesions had largly resolved; |
|
| VAERS ID: |
31415 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Sex: |
Male |
| Location: |
Alaska |
| Vaccinated: | 1991-02-28 |
| Onset: | 1991-03-28 |
| Days after vaccination: | 28 |
| Submitted: |
1991-06-13 |
| Days after onset: | 76 |
| Entered: |
1991-06-17 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
- / UNK |
- / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1726S / 1 |
- / - |
Administered by: Other Purchased by: Other
Symptoms: Drug ineffective,
Infection,
Meningitis
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-05-26
Days after onset: 58
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC Split Type: WAES91060089
Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91. |
|
| VAERS ID: |
31738 (history) |
| Form: |
Version 1.0 |
| Age: |
0.4 |
| Sex: |
Female |
| Location: |
Alaska |
| Vaccinated: | 1991-02-25 |
| Onset: | 1991-03-06 |
| Days after vaccination: | 9 |
| Submitted: |
1991-06-20 |
| Days after onset: | 105 |
| Entered: |
1991-06-24 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
- / 1 |
- / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. |
1726S / 1 |
- / - |
Administered by: Private Purchased by: Other
Symptoms: Bradycardia,
CSF test abnormal,
Condition aggravated,
Drug ineffective,
Hypotension,
Infection,
Pneumonia,
Pyrexia
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-04-10
Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC Split Type: WAES91060083
Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died; |
|
| VAERS ID: |
37777 (history) |
| Form: |
Version 1.0 |
| Age: |
0.1 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1991-07-08 |
| Onset: | 1991-11-04 |
| Days after vaccination: | 119 |
| Submitted: |
1991-12-02 |
| Days after onset: | 28 |
| Entered: |
1991-12-04 |
| Days after submission: | 2 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1581S / 2 |
- / - |
Administered by: Private Purchased by: Other
Symptoms: Ascites,
Coagulopathy,
Coma,
Hepatic failure,
Hepatic necrosis,
Hepatitis,
Infection,
Intracranial pressure increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1991-11-12
Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness:
Preexisting Conditions: Mom HBAg positive;
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES91110702
Write-up: Pt recvd 2nd dose of Hep B vax @ one month of age; subsequently, pt devel fulminant Hep B & was hospitalized for a liver transplant; In mid-November 91, pt died @ 5 months of age; |
|
| VAERS ID: |
38681 (history) |
| Form: |
Version 1.0 |
| Age: |
0.4 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 1991-03-21 |
| Onset: | 1991-06-27 |
| Days after vaccination: | 98 |
| Submitted: |
1991-11-18 |
| Days after onset: | 144 |
| Entered: |
1991-12-23 |
| Days after submission: | 35 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
586A4 / 3 |
- / IM A |
Administered by: Other Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU911241
Write-up: Pt recvd Engerix-B on 26APR90, 1JUN90, & 23OCT90 subsequently found neg anti-HBS p/3 doses @ 1mo, 2mo, & 6mo intervals; |
|
| VAERS ID: |
39747 (history) |
| Form: |
Version 1.0 |
| Age: |
0.5 |
| Sex: |
Female |
| Location: |
Hawaii |
| Vaccinated: | 1991-12-17 |
| Onset: | 1991-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
1991-12-23 |
| Days after onset: | 6 |
| Entered: |
1992-03-02 |
| Days after submission: | 70 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
304922 / 3 |
RL / - |
| HEP: HEP B (FOREIGN) / MERCK & CO. INC. |
0169T / 2 |
LL / - |
| HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M125HF / 3 |
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: runny nose past 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR, Blood test
CDC Split Type: HI9207
Write-up: Pt devel t102 fever aobut 5PM on day of immun which continued throughout next 48 hrs inspite of APAP, liquids, & frequent warm showers; Seen by MD 19DEC91 fever continued elevating to 104.8 & revisited MD; exam by MD 20DEC91 CXR & lab work; |
|
| VAERS ID: |
40280 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Sex: |
Male |
| Location: |
Massachusetts |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1992-03-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
- / 1 |
- / - |
| HIBV: HIB (HIBTITER) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness:
Preexisting Conditions: No relevant data;
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES91031289
Write-up: Pt recv 1st dose of Hep B vax/HIBTITER & devel urticaria; |
|
