|
VAERS ID: |
26790 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1990-04-11 |
Onset: | 1990-04-11 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown 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? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: No personal or family hx of convulsions. Allergies: Diagnostic Lab Data: CDC Split Type: 900107201
Write-up: Pt vaccinated with DTP and IPV and developed two convulsions. Unspecified focal neurologic signs & could not cry. LP normal. |
|
VAERS ID: |
27114 (history) |
Form: |
Version 1.0 |
Age: |
0.7 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1990-10-24 |
Onset: | 1990-10-24 |
Days after vaccination: | 0 |
Submitted: |
1990-10-31 |
Days after onset: | 7 |
Entered: |
1990-12-18 |
Days after submission: | 48 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
268912 / 2 |
LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
841022 / 2 |
RL / SC |
Administered by: Public Purchased by: Public Symptoms: Agitation,
Bronchitis,
Pain,
Pneumonia,
Pyrexia,
Rhinitis SMQs:, 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), 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? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: very mild cold symptoms Allergies: Diagnostic Lab Data: CDC Split Type: WI90042
Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia. |
|
VAERS ID: |
27604 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1991-01-07 |
Onset: | 1991-01-07 |
Days after vaccination: | 0 |
Submitted: |
1991-01-23 |
Days after onset: | 16 |
Entered: |
1991-01-28 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0G11097 / 2 |
RL / - |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
841122 / 1 |
LL / - |
Administered by: Private Purchased by: Private Symptoms: Injection site reaction,
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: Recent DEC90 Bronchiolitis Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site. |
|
VAERS ID: |
28130 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1990-04-10 |
Onset: | 1990-04-10 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-02-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
256962 / UNK |
- / - |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
841012 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Diarrhoea,
Malaise,
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: No illness following 2 previous immunizations Allergies: Diagnostic Lab Data: CDC Split Type: 900162810
Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days. |
|
VAERS ID: |
28903 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 1991-02-05 |
Onset: | 1991-02-05 |
Days after vaccination: | 0 |
Submitted: |
1991-02-06 |
Days after onset: | 1 |
Entered: |
1991-03-08 |
Days after submission: | 30 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
293948 / 4 |
RL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
841028 / 3 |
LL / SC |
Administered by: Public Purchased by: Public Symptoms: Asthenia,
Otitis media,
Pruritus,
Pyrexia,
Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: Current Illness: "runny nose from teething" Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work CDC Split Type: PA9160
Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx. |
|
VAERS ID: |
29292 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Maryland |
Vaccinated: | 1991-02-25 |
Onset: | 1991-02-25 |
Days after vaccination: | 0 |
Submitted: |
1991-03-13 |
Days after onset: | 16 |
Entered: |
1991-03-22 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0C21045 / 1 |
- / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M560FP / 1 |
- / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
841024 / 1 |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Crying,
Screaming SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (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: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: none CDC Split Type: MD91028
Write-up: Pt had unconsolable crying episode lasting more than 3 hrs. Drs encouraged parents to keep pt on Tylenol q4h due to unusual & high pitched crying spells that wk (25Feb-29Feb) |
|
VAERS ID: |
29797 (history) |
Form: |
Version 1.0 |
Age: |
0.6 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 1991-02-22 |
Onset: | 1991-03-04 |
Days after vaccination: | 10 |
Submitted: |
1991-03-05 |
Days after onset: | 1 |
Entered: |
1991-04-08 |
Days after submission: | 33 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271965 / 2 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M210EP / 1 |
LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
841024 / 2 |
RA / SC |
Administered by: Public Purchased by: Public Symptoms: Agitation,
Cough,
Otitis media SMQs:, Anaphylactic reaction (broad), 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? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: Well Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: GA9137
Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form; |
|
VAERS ID: |
30355 (history) |
Form: |
Version 1.0 |
Age: |
0.5 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1991-01-28 |
Onset: | 0000-00-00 |
Submitted: |
1991-03-19 |
Entered: |
1991-05-09 |
Days after submission: | 50 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0F11073 / 3 |
LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
- / UNK |
MO / PO |
Administered by: Military Purchased by: Military 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:
Write-up: Urticarial rash - hives trunk & neck; |
|
VAERS ID: |
30860 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1991-04-22 |
Onset: | 1991-04-22 |
Days after vaccination: | 0 |
Submitted: |
1991-05-09 |
Days after onset: | 17 |
Entered: |
1991-05-28 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21044 / 2 |
LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M115HA / 2 |
RL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
841212 / 2 |
- / SC A |
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: Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Fever to 106 & mild irritability several hrs p/immun; Given acetaminophen; In office the following morning temp 101, exam otherwise normal; |
|
VAERS ID: |
30903 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 1991-05-06 |
Onset: | 1991-05-07 |
Days after vaccination: | 1 |
Submitted: |
1991-05-09 |
Days after onset: | 2 |
Entered: |
1991-05-30 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH |
TR1212B / 1 |
LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
841122 / 1 |
RL / SC |
Administered by: Public Purchased by: Public Symptoms: Agitation 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Alupent 2cc (10mg/5ml) TID Current Illness: NONE Preexisting Conditions: asthma Allergies: Diagnostic Lab Data: CDC Split Type: MI9135
Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted; |
|