|
VAERS ID: |
51416 (history) |
Form: |
Version 1.0 |
Age: |
34.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1993-03-19 |
Entered: |
1993-04-01 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS |
- / UNK |
- / - |
CHOL: CHOLERA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Abdominal pain,
Arthralgia,
Asthenia,
Laboratory test abnormal SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: pos febrile aggluttines Typhoid H 1:320 dil; pos rest; neg ANA, Neg RHF, neg sed; CDC Split Type:
Write-up: abdo pain, fatigue, joint pain; hosp 18MAR93; |
|
VAERS ID: |
54662 (history) |
Form: |
Version 1.0 |
Age: |
20.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1993-05-17 |
Onset: | 1993-06-01 |
Days after vaccination: | 15 |
Submitted: |
0000-00-00 |
Entered: |
1993-07-15 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
ADEN: ADENOVIRUS (TYPE 4, NO BRAND NAME) / PFIZER/WYETH |
4928031 / UNK |
MO / PO |
ADEN: ADENOVIRUS (TYPE 7, NO BRAND NAME) / PFIZER/WYETH |
4928030 / UNK |
MO / PO |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
2J31137 / UNK |
- / - |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
2L41074 / UNK |
- / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
667M3 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Guillain-Barre syndrome,
Hypertonia,
Hypokinesia,
Myasthenic syndrome,
Neuropathy,
Pharyngitis,
Rhinitis,
Sinusitis SMQs:, Agranulocytosis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Oropharyngeal infections (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: PPD Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CSF stains/cultures/cell count/protein/glucose= nl; Brain & cervical MRI x/for pansinusitis; Thyroid function-nl; ANA-nl; Nerve conduction studies suggesting polyneuropathy w/some aspects of GBS; CDC Split Type:
Write-up: pt recvd vax on 17MAY93 & noticed bilateral calf cramping & weakness on 1JUN93; weakness progressed until by 4JUN was unable to walk; had some milder upper extremity weakness too; c/o upper respiratory-like sxs; |
|
VAERS ID: |
57798 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 1993-11-05 |
Onset: | 1993-11-12 |
Days after vaccination: | 7 |
Submitted: |
1993-11-23 |
Days after onset: | 11 |
Entered: |
1993-12-02 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
ADEN: ADENOVIRUS (TYPE 4, NO BRAND NAME) / PFIZER/WYETH |
4928172 / UNK |
MO / PO |
ADEN: ADENOVIRUS (TYPE 7, NO BRAND NAME) / PFIZER/WYETH |
4928174 / UNK |
MO / PO |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
3J41143 / UNK |
- / IM |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
3C51059 / UNK |
- / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0896W / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0677M / UNK |
MO / PO |
Administered by: Military Purchased by: Military Symptoms: Guillain-Barre syndrome,
Myasthenic syndrome SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: URI/sore throat 2 weeks prior to onset; Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CSF was "negative"; tox screen, heavy metal screen, electrolytes: neg; CDC Split Type:
Write-up: Pt recvd routine initial battery of vaxs for recruits; on 12NOV93 devel leg weakness which quickly progressed to point of being unable to stand; arms also became weakened; was hosp & plasmapheresed; condition improved greatly; dx: GBS; |
|
VAERS ID: |
58373 (history) |
Form: |
Version 1.0 |
Age: |
29.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1993-01-23 |
Onset: | 1993-01-25 |
Days after vaccination: | 2 |
Submitted: |
1993-12-01 |
Days after onset: | 310 |
Entered: |
1993-12-22 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
MEN: MENINGOCOCCAL (MENOMUNE-A/C) / CONNAUGHT LTD. |
- / UNK |
- / - |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown 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? 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: mp significant growth w/blood & urine cultures; CDC Split Type:
Write-up: pyrogenic react suspected due to vax administrered 2 days prior for past splenectomy prophylaxis; |
|
VAERS ID: |
73179 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 1995-03-08 |
Onset: | 1995-03-14 |
Days after vaccination: | 6 |
Submitted: |
1995-04-05 |
Days after onset: | 21 |
Entered: |
1995-04-13 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
CHOL: CHOLERA (USP) / PFIZER/WYETH |
4948064 / 1 |
LA / SC |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
4J61039 / 1 |
RA / SC |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
4948085 / 1 |
LA / SC |
Administered by: Public Purchased by: Private Symptoms: Coma,
Convulsion,
Diarrhoea,
Hypokinesia,
Myasthenic syndrome,
Pyrexia,
Somnolence,
Speech disorder SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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, 6 days
Extended hospital stay? No
Previous Vaccinations: denied~ ()~~~In patient Other Medications: Gamma globulin by Armour,lot #M6301 Current Illness: denied Preexisting Conditions: denied Allergies: Diagnostic Lab Data: spinal tap, blood tests,stool cultures,urine test; CDC Split Type: VA95017
Write-up: pt recvd vax;p/18 hrs of flight pt v,T 104-105;tx by local PMD;severe d,lethargic,unconscious,gen convuls;to hosp x 6 days;convuls,mostly rt sided;@ time of disch,had slurred speech,rt eye did not blink,rt hand weakness;unable to stand/walk |
|
VAERS ID: |
79652 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1993-09-01 |
Onset: | 1993-09-01 |
Days after vaccination: | 0 |
Submitted: |
1995-11-22 |
Days after onset: | 812 |
Entered: |
1995-11-27 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Amblyopia,
Arrhythmia,
Asthenia,
Back pain,
Condition aggravated,
Headache,
Myalgia,
Thinking abnormal SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tendinopathies and ligament 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: ~ ()~~~In patient Other Medications: Current Illness: recovering from mono Preexisting Conditions: allergies since childhood Allergies: Diagnostic Lab Data: blood tests available CDC Split Type:
Write-up: pt recvd vax & exp extreme fatigue & weakness, back pain, h/a daily, achey, irregular heartbeats, sweats, blurrey vision, diff w/concentration |
|
VAERS ID: |
97017 (history) |
Form: |
Version 1.0 |
Age: |
48.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 1997-03-27 |
Onset: | 1997-03-27 |
Days after vaccination: | 0 |
Submitted: |
1997-04-08 |
Days after onset: | 11 |
Entered: |
1997-04-21 |
Days after submission: | 13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
6L81419 / UNK |
- / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Cellulitis,
Hypokinesia,
Injection site hypersensitivity,
Injection site oedema,
Injection site pain,
Leukocytosis,
Pain SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ~ ()~~~In patient Other Medications: pt recv HIB in rt deltoid IM pt had no rxn to this vaccine; Current Illness: Preexisting Conditions: pt given vaccine d/t splenectomy MAR88;allergies percocet, ASA, PCN, codeine; Allergies: Diagnostic Lab Data: WBC 27MAR prior to vaccine 10.6;39MAR=14.7;2APR 9.9 CDC Split Type:
Write-up: pt recv vax 27MAR97 & w/in 24hr pt reported noted swelling, pain, erythema @ site of meningococcal vax;pt was treated w/4 doses of IV ATB & oral ATB;cellulitis spread from axilla region to elbow;cont pain & limited mobility; |
|
VAERS ID: |
99146 (history) |
Form: |
Version 1.0 |
Age: |
7.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 1997-06-05 |
Onset: | 1997-06-06 |
Days after vaccination: | 1 |
Submitted: |
1997-06-13 |
Days after onset: | 7 |
Entered: |
1997-06-23 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
442089 / 1 |
LA / - |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
5M71104 / 1 |
RA / - |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
435966 / 1 |
RA / - |
Administered by: Public Purchased by: Public Symptoms: Myalgia,
Oedema peripheral,
Pyrexia,
Vasodilatation SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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, 2 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: pre surgical procedure (splenectomy) Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: OH97039
Write-up: pre surgical procedure (splenectomy) vaccines sore arm w/swelling & redness (rt) fever (no recorded); |
|
VAERS ID: |
99821 (history) |
Form: |
Version 1.0 |
Age: |
32.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1996-05-30 |
Onset: | 1996-05-30 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1997-07-07 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (FOREIGN) / MERCK & CO. INC. |
2371A2 / UNK |
- / - |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
6K81357 / UNK |
- / - |
TYP: TYPHOID VI POLYSACCHARIDE (ACETONE INACTIVATED DRIED) / PFIZER/WYETH |
4968083 / UNK |
- / - |
Administered by: Military Purchased by: Military Symptoms: Chills,
Hypotension,
Pyrexia SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (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? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Thyroid vax given 30MAY96;PPD also given Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: hypotension, fever, chills 85/30; |
|
VAERS ID: |
101323 (history) |
Form: |
Version 1.0 |
Age: |
33.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1997-07-25 |
Onset: | 1997-07-25 |
Days after vaccination: | 0 |
Submitted: |
1997-07-29 |
Days after onset: | 4 |
Entered: |
1997-08-08 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
2371A / UNK |
- / IM |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
6K81357 / UNK |
- / SC |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
4968083 / UNK |
- / SC |
Administered by: Military Purchased by: Military Symptoms: Chills,
Dizziness,
Headache,
Hypotension,
Laboratory test abnormal,
Palpitations,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: PPD by Connaught lot# 244711/244211 given 25JUL97; Current Illness: NONE Preexisting Conditions: PMH for ulcer vomitted old blood in college; Allergies: Diagnostic Lab Data: 25JUL97 1700 albumin 2.7;PO4 0.7, Ca++ 7.9;CK 307;Mg++ 1.2;Hepatic panal nl;LP nl; CDC Split Type:
Write-up: pt recv vax 25JUL97 & to clinic w/ c/o dizziness, chills, n/v & h/a, palpitations;given NS, BP 66/29;adm to hosp given med; |
|