|
VAERS ID: |
25003 (history) |
Form: |
Version 1.0 |
Age: |
0.8 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Days after vaccination: | 6 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259962 / 4 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
241950 / 4 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Delirium,
Hypokinesia,
Hypotonia SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
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:
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations. |
|
VAERS ID: |
25016 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1986-02-09 |
Onset: | 1986-02-09 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Electroencephalogram abnormal,
Grand mal convulsion,
Mental retardation severity unspecified,
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? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL CDC Split Type: 890282301
Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay. |
|
VAERS ID: |
25033 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-25 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271912 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Agitation,
Headache,
Pyrexia,
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), 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? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: 16May90 Oral polio vaccine Lederle 265-927 Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Elevated temp (as high as 104.3), headache, vomiting, irritable 40 hours. |
|
VAERS ID: |
25039 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Indiana |
Vaccinated: | 1990-06-14 |
Onset: | 1990-06-15 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9B11033 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Hypotonia,
Stupor SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia Allergies: Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg CDC Split Type:
Write-up: Hypotonia, Hyporesponsive reaction. |
|
VAERS ID: |
25102 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1981-12-09 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion,
Hemiplegia,
Mental retardation severity unspecified,
Personality disorder,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes
Recovered? No Office Visit? No
ER Visit? No
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: 8902947.01
Write-up: Plaintiffs allege that as a result of immunization in 1-DEC-81, healthy 20 month old suffered high fever & convulsions with resultant permanent paralysis of right extremities, mental retardation & behavioral problems. |
|
VAERS ID: |
25104 (history) |
Form: |
Version 1.0 |
Age: |
0.7 |
Sex: |
Female |
Location: |
Nebraska |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259966 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Gaze palsy,
Hypotonia,
Injury SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 8902951.01
Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor. |
|
VAERS ID: |
25137 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
262913 / UNK |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
05595/2414R / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
277943 / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Bradycardia,
Hypotension,
Stupor SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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? Yes, ? 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 HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS. |
|
VAERS ID: |
25140 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1989-10-11 |
Onset: | 1989-10-11 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256961 / UNK |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Agitation,
Apnoea,
Hypotension,
Hypotonia SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 8902436.01
Write-up: PT CRANKY NEXT 48 HRS AFTER IMMUN. BECAME LIMP AFTER 48 HRS. 3 EPISODES IN 3-4 HRS;MOTHER THOUGHT PT STOPPED BREATHING-NO COLOR CHANGE, NO SEIZURES, HOSPITALIZED-ABNORMAL PNEUMOGRAM. PT IMPROVED |
|
VAERS ID: |
25152 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 1989-10-25 |
Onset: | 1989-10-25 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256963 / UNK |
- / IM |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Agitation,
Cyanosis,
Platelet disorder,
Pyrexia,
Stupor,
Thrombocythaemia,
White blood cell disorder SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: ACETAMINOPHEN Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: ON ER ARRIVAL,WBC 28,300;PLATELET COUNT 783,000, SERUM SODIUM 130. OTHER LAB NORMAL. THESE LABS NORMALIZED WITHIN 24 HRS.CHILD FEBRILE 18 HRS. NO FURTHER NEUROLOGIC ABNORMALTIES. CDC Split Type: 8902659.01
Write-up: 4 HOURS AFTER DTP/MEASLES VAX, BECAME VERY IRRITABLE, THEN UNRESPONSIVE AND CYANOTIC. AFTER 1 MUN, BREATHING SEEMED TO RESUME,CONSCIOUSNESS GRADUALLY RETURNED NORM OVER SEV HRS.HOSPLZD: ABNORMAL WBC, PLATELETS AND SERUM SODIUM,FEBRILE 18HRS |
|
VAERS ID: |
25154 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1989-11-27 |
Onset: | 1989-11-27 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259966 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Pyrexia,
Screaming SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: N/A Current Illness: Preexisting Conditions: N/A Allergies: Diagnostic Lab Data: CT (BRAIN)-NORMAL; EEG-NORMAL; NEURO WATCH-NORMAL CDC Split Type: 8902842.01
Write-up: AFTER 1ST IMMUN DEVELOPED FEVER AND PERSISTANT SCREAMING FOR 3 HRS. HOSPITALIZED FOR ABSERVATION. DOING FINE AT TIME OF REPORT |
|