|
| VAERS ID: |
75868 (history) |
| Form: |
Version 1.0 |
| Age: |
37.0 |
| Sex: |
Male |
| Location: |
Maryland |
| Vaccinated: | 1995-05-25 |
| Onset: | 1995-06-18 |
| Days after vaccination: | 24 |
| Submitted: |
1995-07-11 |
| Days after onset: | 23 |
| Entered: |
1995-07-13 |
| Days after submission: | 2 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
425A6 / UNK |
LA / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
659A / UNK |
RA / SC |
| TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
4E61168 / UNK |
RA / - |
Administered by: Public Purchased by: Unknown
Symptoms: Encephalitis,
Herpes zoster
SMQs:, Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? Yes
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:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: MD95025
Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95 |
|
| VAERS ID: |
77516 (history) |
| Form: |
Version 1.0 |
| Age: |
65.0 |
| Sex: |
Female |
| Location: |
Hawaii |
| Vaccinated: | 1995-06-05 |
| Onset: | 1995-07-18 |
| Days after vaccination: | 43 |
| Submitted: |
1995-09-15 |
| Days after onset: | 59 |
| Entered: |
1995-09-19 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA440A6 / 1 |
- / IM |
| IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
K0227 / UNK |
- / SC |
| PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
0536A / UNK |
- / SC |
| TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
51371053 / UNK |
- / IM |
| TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
MO / PO |
Administered by: Military Purchased by: Military
Symptoms: CSF test abnormal,
Guillain-Barre syndrome,
Hypokinesia,
Hypotonia,
Laryngospasm,
Movement disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 55 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: bipolar disorder
Allergies:
Diagnostic Lab Data: CSF protein 90%, no cells
CDC Split Type:
Write-up: 20JUL devel acute severe GBS; presently on ventilator day 55, no motor activity; in hosp 21JUL to present; |
|
| VAERS ID: |
77518 (history) |
| Form: |
Version 1.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 1995-04-03 |
| Onset: | 0000-00-00 |
| Submitted: |
1995-09-08 |
| Entered: |
1995-09-19 |
| Days after submission: | 11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
420A6 / 1 |
LA / IM |
Administered by: Private Purchased by: Unknown
Symptoms: Alanine aminotransferase increased,
Arthralgia,
Aspartate aminotransferase increased,
Diabetes mellitus,
Headache,
Hepatic function abnormal,
Hyperglycaemia,
Pyrexia
SMQs:, Liver related investigations, signs and symptoms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: SGOT 79; SGPT 1117; gamma gt 210; Blood sugar 533;
CDC Split Type:
Write-up: pt recv vax 3APR95 & devel arthralgia, fever, h/a & upon return to US was found to have DM; 14JUN95 was given meds; also had LFT-has diabetes mellitus |
|
| VAERS ID: |
81018 (history) |
| Form: |
Version 1.0 |
| Age: |
38.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 1995-06-07 |
| Onset: | 1995-06-15 |
| Days after vaccination: | 8 |
| Submitted: |
1995-09-15 |
| Days after onset: | 92 |
| Entered: |
1995-09-22 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA427A6 / 1 |
RA / IM |
Administered by: Other Purchased by: Other
Symptoms: Blood creatine phosphokinase increased,
Convulsion,
Hyperglycaemia,
Hyperuricaemia,
Laboratory test abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Tumour lysis 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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950056831
Write-up: pt recvd vax; 8 days later exp sz & was hosp; tx w/ anti convulsants including dilantin; sxs resolved w/in 24 hrs; |
|
| VAERS ID: |
77886 (history) |
| Form: |
Version 1.0 |
| Age: |
68.0 |
| Sex: |
Female |
| Location: |
Illinois |
| Vaccinated: | 1995-07-20 |
| Onset: | 1995-07-21 |
| Days after vaccination: | 1 |
| Submitted: |
1995-09-27 |
| Days after onset: | 68 |
| Entered: |
1995-10-03 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
420A6 / 2 |
- / IM |
Administered by: Private Purchased by: Private
Symptoms: Blood alkaline phosphatase increased,
Diarrhoea,
Gastrointestinal disorder,
Hepatic function abnormal,
Jaundice,
Neoplasm malignant,
Pruritus,
Urine analysis abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (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, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 1AUG95 BilTOT 7.8; SOGT 109; SGPT 277; ALKPH 388; 3AUG95 BILTOT 8.5; SGOT 113; SGPT 293; ALKPH 397; hepatitis screen neg;
CDC Split Type: 950074901
Write-up: pt recvd vax 20JUL95 & w/in 24-48hrs following vax exp itching, diarrhea, darker urine, & was jaundiced when examined; pt was found to have elevated liver enzymes 01AUG95;MD demonstrated evidence of bile duct obstruction-bile duct stricture |
|
| VAERS ID: |
80084 (history) |
| Form: |
Version 1.0 |
| Age: |
31.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 1995-12-01 |
| Onset: | 1995-12-01 |
| Days after vaccination: | 0 |
| Submitted: |
1995-12-12 |
| Days after onset: | 11 |
| Entered: |
1995-12-15 |
| Days after submission: | 3 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| CHOL: CHOLERA (USP) / PFIZER/WYETH |
4948171 / UNK |
RA / - |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
467AC / UNK |
LA / - |
Administered by: Private Purchased by: Private
Symptoms: Amnesia,
Convulsion,
Hypertonia,
Hypotension,
Pallor,
Syncope,
Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? Yes
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:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC Split Type:
Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84; |
|
| VAERS ID: |
80688 (history) |
| Form: |
Version 1.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
Alabama |
| Vaccinated: | 1995-12-15 |
| Onset: | 1995-12-22 |
| Days after vaccination: | 7 |
| Submitted: |
1995-12-24 |
| Days after onset: | 2 |
| Entered: |
1996-01-03 |
| Days after submission: | 10 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| CHOL: CHOLERA (USP) / PFIZER/WYETH |
4958031 / 1 |
LA / SC |
| FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
4958114 / 1 |
RA / IM |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
165A2 / 1 |
LA / IM |
| TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES |
K1160 / 1 |
RA / IM |
Administered by: Public Purchased by: Public
Symptoms: Convulsion,
Encephalopathy,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT neg, LP neg
CDC Split Type: AL9539
Write-up: 22DEC95 fever x 12k; 28DEC95 sz 9PM-fever encephalopathy |
|
| VAERS ID: |
81047 (history) |
| Form: |
Version 1.0 |
| Age: |
70.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 1995-09-01 |
| Onset: | 1995-09-01 |
| Days after vaccination: | 0 |
| Submitted: |
1995-09-20 |
| Days after onset: | 19 |
| Entered: |
1996-01-03 |
| Days after submission: | 105 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / IM |
Administered by: Public Purchased by: Other
Symptoms: Anorexia,
Depression,
Dyspepsia,
Eosinophilia,
Hepatic function abnormal,
Hyperhidrosis,
Nausea,
Pyrexia
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (broad), 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? No
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: liver enzymes elev
CDC Split Type: 950094501
Write-up: pt recvd vax;8 days later, elev liver enzymes, fever, n, noc sweats;to hosp; |
|
| VAERS ID: |
80969 (history) |
| Form: |
Version 1.0 |
| Age: |
76.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 1995-12-13 |
| Onset: | 1995-12-23 |
| Days after vaccination: | 10 |
| Submitted: |
1996-01-11 |
| Days after onset: | 19 |
| Entered: |
1996-01-22 |
| Days after submission: | 11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / - |
Administered by: Other Purchased by: Other
Symptoms: Coordination abnormal
SMQs:, Anticholinergic syndrome (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, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt also recvd cholera & typhoid vax
Current Illness:
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950143761
Write-up: pt recvd vax 13DEC95 & 10 days p/vax pt exp broad based ataxia & was hospitalized x 2 days;pt is currently being evaluated by neurologist & is receiving physical therapy;No further details are available @ this time; |
|
| VAERS ID: |
80977 (history) |
| Form: |
Version 1.0 |
| Age: |
49.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 1995-11-20 |
| Onset: | 1995-11-22 |
| Days after vaccination: | 2 |
| Submitted: |
1996-01-18 |
| Days after onset: | 57 |
| Entered: |
1996-01-22 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1530W / 1 |
RA / IM |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA425A6 / 1 |
LA / IM |
Administered by: Other Purchased by: Other
Symptoms: Colitis,
Phlebitis
SMQs:, Pseudomembranous colitis (broad), Thrombophlebitis (broad), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Immune-mediated/autoimmune disorders (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, 11 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pentasa;cortofoam enema
Current Illness: phlebitis, colitis
Preexisting Conditions: PCN allergy, ing heartbeat, colitis
Allergies:
Diagnostic Lab Data: doppler of lt leg, arteriogram showed no clot
CDC Split Type:
Write-up: pt states had phlebitis in lt leg 2 days p/vax;pt hospitalized 9DEC96 thru 11DEC96 & 15DEC95 thru 22DEC95;had colitis & placed on TPN;tx by MD; |
|
