|
VAERS ID: |
25009 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1990-04-05 |
Onset: | 1990-04-06 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0333P / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Deafness SMQs:, Hearing impairment (narrow)
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: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: recurrent otitis media, measles Allergies: Diagnostic Lab Data: CDC Split Type: WAES90030661
Write-up: 15mon. male w/ hx of recurrent ear infections & measles in Feb. 89''. 5Apr89 was given MMR. Within 24 hrs /p vaccine, parents noted hearing deficit, confirmed by physician exam. |
|
VAERS ID: |
25020 (history) |
Form: |
Version 1.0 |
Age: |
4.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1990-06-14 |
Onset: | 1990-06-14 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1227S / UNK |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: Asthma,
Face oedema,
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? 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: Subcut- Epinephrine, Bendryl & Solumedrol IV Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Urticaria, wheezy, & periorbital edema which abated /p administration of subcut. epinephrine, Bendryl IV, Solumendrol IV |
|
VAERS ID: |
25072 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-06-03 |
Onset: | 1990-06-05 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Abdominal pain,
Blood amylase increased,
Enzyme abnormality,
Pancreatitis SMQs:, Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: no relevant hx Allergies: Diagnostic Lab Data: Lab test serum amylase 6Jun90 - 2000 CDC Split Type: WAES90060353
Write-up: Pt developed abdominal pain & 6Jun90 admitted to hosp. DX pancreatisis & required surgery |
|
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: |
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: |
25431 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1990-06-05 |
Onset: | 1990-06-05 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1388R / UNK |
- / 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? 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: LUMBAR PUNCTURE NEGATIVE ,CTSCAN HEAD- NEGATIVE, UBC 4,300 CDC Split Type:
Write-up: 6 HRS AFTER VACCINE, FEVER AND SEIZURE(LEFT FOCAL SEIZURE) |
|
VAERS ID: |
25287 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 1990-06-20 |
Onset: | 1990-06-28 |
Days after vaccination: | 8 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
279946 / UNK |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1227S / UNK |
- / SC |
Administered by: Private 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Past history of seizure /w fever Allergies: Diagnostic Lab Data: Normal electrolytes, CBC serum glucose & calcium CDC Split Type:
Write-up: Tonic seizure activity involving the rt leg & arm. Head & eyes drawn to rt |
|
VAERS ID: |
25483 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-06-08 |
Onset: | 1990-06-09 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site reaction,
Serum sickness SMQs:, Hypersensitivity (narrow)
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: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: ESR 9-JUN-90 NORMAL CDC Split Type: WAES90060411
Write-up: Dr. reported that his 12 yr old son was given a booster dose of Measles virus vaccine, live on 8-JUN-90 he experienced Arthus reaction consisting of synovitis of lt hip, inability to walk and pain at injection site. ESR was normal. |
|
VAERS ID: |
25484 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
40967/2130R / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia,
Rash maculo-papular,
Vasculitis SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)
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: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES90040110
Write-up: 18month-old vaccinated w/MMR eighteen days after vaccination she developed a fever of 104 and macular rash of the face, torso & legs. The symptoms remitted spontaneously, recurred 2 wks later described as vasculitis. No further details. |
|
VAERS ID: |
25485 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 1990-02-26 |
Onset: | 1990-03-10 |
Days after vaccination: | 12 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
409672130R / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Hepatic function abnormal,
Pyrexia,
Rash maculo-papular,
Vasculitis SMQs:, Liver related investigations, signs and symptoms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: no relevant hx Allergies: Diagnostic Lab Data: WBC- 37,700, platlets- 379,000, LDH- 1,000, SGOT- 50, sepsis work-up was neg. Additional lab data on WORM CDC Split Type: WAES90031176
Write-up: 12 days/p vaccination, developed maculopapular rash on face, arms & legs. Became jumpy fussy, had fever 104 F- hospitalized, sysmtoms persisted for approx. 4 wks, subsequently rash became pigmented, DX as vasculitis |
|