|
VAERS ID: |
158724 (history) |
Form: |
Version 1.0 |
Age: |
38.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 2000-07-06 |
Onset: | 2000-07-06 |
Days after vaccination: | 0 |
Submitted: |
2000-08-10 |
Days after onset: | 35 |
Entered: |
2000-08-11 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
- / UNK |
- / SC |
TYP: TYPHOID VI POLYSACCHARIDE (ACETONE INACTIVATED DRIED) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Military Purchased by: Military Symptoms: Blood creatine phosphokinase increased,
Cardiomyopathy,
Dyspepsia,
Dyspnoea,
Electrocardiogram abnormal,
Hypoxia,
Influenza like illness SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)
Life Threatening? Yes
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: UNK Current Illness: UNK Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: blood creatine phosphokinase elevated; echocardiogram showed sever left ventricular dysfunction CDC Split Type: HQ9503207AUG2000
Write-up: Same day post vax, this pt presented to a medical center with flu-like symptoms and epigastric burning. He was treated with ranitidine. His symptoms worsened, he developed shortness of breath, was hospitalize in ICU with a dx of dilated cardiomyopathy. He required balloon pump support and will require a heart transplant. |
|
VAERS ID: |
159964 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Male |
Location: |
Kentucky |
Vaccinated: | 2000-08-03 |
Onset: | 2000-08-03 |
Days after vaccination: | 0 |
Submitted: |
2000-09-10 |
Days after onset: | 38 |
Entered: |
2000-09-21 |
Days after submission: | 11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
- / 5 |
- / - |
MEN: MENINGOCOCCAL (MENOMUNE-A/C) / CONNAUGHT LTD. |
- / 1 |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 3 |
- / SC |
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
- / 7+ |
- / IM |
Administered by: Military Purchased by: Military Symptoms: Bradyphrenia,
Chills,
Convulsion,
Dizziness,
Eye disorder,
Eye pain,
Fatigue,
Headache,
Malaise,
Memory impairment,
Pain,
Pyrexia,
Somnolence SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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, 12 days
Extended hospital stay? No
Previous Vaccinations: fever, swelling~DTP (no brand name)~5~5.00~In Patient Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: LP CDC Split Type:
Write-up: On the evening of 8/3, the pt began experiencing body aches and feeling bad, he experienced achiness, cold chills, dizziness and headaches. Symptoms worsened. On 8/6/00 the pt was admitted to the infirmary with a fever of 103.5. On 8/7 the fever was 102.6. After night time dose of Motrin on 8/7, his temp the following morning was 97.3. He was discharged from the infirmary and given a bottle of 800mg Motrin. He continued to feel bad and took Motrin every 6-8 hours. On 8/10 after eating breakfast and taking Motrin he began having seizures. He had 35-40 seizures from 8/10 to 8/17. Also he experienced pain in his eyes, fatigue, sleepiness, eyes are sensitive to light, cannot think clearly and cannot remember things. Diagnosed with epilepsy. Follow up on 10/12/2000: "The immunization clinic told us that they do not track lot numbers. We cannot supply this information." |
|
VAERS ID: |
160698 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
Nebraska |
Vaccinated: | 2000-07-14 |
Onset: | 2000-08-01 |
Days after vaccination: | 18 |
Submitted: |
2000-10-13 |
Days after onset: | 73 |
Entered: |
2000-10-18 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
UA130AA / 1 |
LA / SC |
Administered by: Private Purchased by: Private Symptoms: Arthralgia,
Bacterial infection,
Meningitis,
Musculoskeletal stiffness,
Myalgia,
Pyrexia,
Rash macular,
Syncope,
Viral infection SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: acne Vulgaris Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: WBC - 845, neutrophils - 85, lymphocytes - 7, monocytes - 8, protein 172, glucose 68, CDC Split Type: U2000007310
Write-up: On 8/1/00 approximately 2 weeks post vax, the pt developed a fever, myalgia, stiff neck and arthralgias. After approximately 24 hours of developing the above symptoms, the pt developed a diffuse non-pruritic macular rash on her lower legs, which spread to her abdomen and upper extremities. The pt was seen initially in the clinic and thought to have a viral infection and symptomatic care was advised at that time. Over the next 48 hours the pt symptoms increased in severity and the pt experienced a syncopal episode. She was then seen in the ER and that time transferred to the hospital where she underwent a lumbar puncture. The pt was diagnosed with bacterial meningitis and treated accordingly. After treatment with Ceftriaxone, ampicillin and doxycycline, the pt improved significantly over the following 3 days. Being the Listeria was not grown out in the lab, ampicillin was discontinued and the pt was continued on the ceftriaxone and doxycycline. The work up for bacterial meningitin lower then the WBC counts and LP puncture results were all negative with all cultures were negative. It is of interest that the pt had been on Amoxicillin for the past 3 years for treatment of Acne Vulgaris. Also the pt had recently been on a camping trip and exposed to many different farm animals soon after the vax was given. She was also checked for Rocky Mountain spotted fever, Lyme disease and other viral and opportunistic illness. The pt has made a complete recovery and is doing well currently. |
|
VAERS ID: |
162973 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 2000-11-20 |
Onset: | 2000-11-20 |
Days after vaccination: | 0 |
Submitted: |
2000-11-28 |
Days after onset: | 8 |
Entered: |
2000-12-04 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
7346AA / 1 |
LA / SC |
Administered by: Other Purchased by: Private Symptoms: Chest pain,
Conduction disorder,
Dyspnoea,
Palpitations SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: UNK CDC Split Type: U2000008600
Write-up: It was reported that an 18 year old female pt received a Menomune A/C/Y/W-335 vaccination on 11/20/00. The pt presented to the ER with chest pain, palpitations and shortness of breath. Pt was dx''d with "WPW (Wolff-Parkinson-White) Syndrome". No further information known at the present time. Pt presently remains hospitalized. From F/U received on 5/9/01, it was reported that the pt''s recovery status is unknown. "No further information available regarding this pt or this case". |
|
VAERS ID: |
164653 (history) |
Form: |
Version 1.0 |
Age: |
38.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 2000-07-06 |
Onset: | 2000-07-06 |
Days after vaccination: | 0 |
Submitted: |
2001-01-08 |
Days after onset: | 186 |
Entered: |
2001-01-11 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
- / UNK |
- / SC |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Military Purchased by: Military Symptoms: Cardiomyopathy,
Dyspepsia,
Dyspnoea,
Influenza like illness SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (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: UNK Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: UNK CDC Split Type: U2001000310
Write-up: The pt complained of flu like symptoms and epigastric burning. He was treated with ranitidine. His symptoms worsened and he developed shortness of breath. He was hospitalized in intensive care at a tertiary care center on 8/2/00 with a diagnosis of dilated cardiomyopathy. He required balloon pump support and will require a heart transplant. |
|
VAERS ID: |
165159 (history) |
Form: |
Version 1.0 |
Age: |
40.0 |
Sex: |
Male |
Location: |
Guam |
Vaccinated: | 1998-11-12 |
Onset: | 1998-11-27 |
Days after vaccination: | 15 |
Submitted: |
0000-00-00 |
Entered: |
2001-01-24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / SC |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
MO / PO |
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
Administered by: Military Purchased by: Military Symptoms: Headache,
Hypertension,
Pyrexia,
Renal disorder SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: high fever, severe headache Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: The pt experienced a high fever and a sever headache within a few days following each shot. The headache was on and off from the 1st shot given. On 1/99 the pt was treated for end stage renal disease. Diagnosis also included severe hypertension. |
|
VAERS ID: |
167891 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 2000-11-08 |
Onset: | 2000-11-30 |
Days after vaccination: | 22 |
Submitted: |
2001-03-29 |
Days after onset: | 119 |
Entered: |
2001-03-28 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (MENOMUNE-A/C) / CONNAUGHT LTD. |
7129AF / 1 |
- / IM |
Administered by: Other Purchased by: Private Symptoms: Asthenia,
Movement disorder,
Paralysis SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Other Medications: Current Illness: NONE Preexisting Conditions: Chronic tonsillitis Allergies: Diagnostic Lab Data: Chemistry Proteins, CBC, MRI of the brain, C-Spine, EEG, Echocardiogram, X-Rays of the abdomen & lungs, EKG x 2. CDC Split Type:
Write-up: This patient had sudden episodes of severe weakness to the point of total paralysis, being unable to use his extremities or able to sit up on her own lasting 1 1/2 - 2 hours. These started approx 2 weeks post-vaccination and continued through early to mid February 2001. |
|
VAERS ID: |
170356 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 2000-03-06 |
Onset: | 2000-04-14 |
Days after vaccination: | 39 |
Submitted: |
2001-05-23 |
Days after onset: | 404 |
Entered: |
2001-05-30 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
UA160AA / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Meningitis SMQs:, Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2000-04-14
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: None Preexisting Conditions: Chronic back pain, atherosclerosis Hx of nasal allergy, periodic HTN, rectal polyps, Hepatitis B, and ETOH abuse Allergies: Diagnostic Lab Data: Autopsy-lobes have yellow green opacified material present, consistent with purulent meningitis process. CDC Split Type: U2001007430
Write-up: It was reported that an adult male pt received a Menomune A/C/Y/W-135 vaccination on 3/6/00. Reportedly, the pt died on 4/14/00. dx''d with purulent meningitis. Autopsy done at medical examiner''s office. Further medical follow-up is requested and ongoing. On 05/22/2001, the autopsy and medical examiners reports were received. Autopsy report revealed the following findings from the head and central nervous system. "The leptomeninges overlying the frontal lobes have yellow-green opacified material present, consistent with purulent meningitis process." From the correspondence received from a physician it was stated "This case was associated with large numbers of gram positive diplococci having the morphology consistent with S. pneumonia. A silver stain and a PAS did not support the presence of any other organism." |
|
VAERS ID: |
171019 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Female |
Location: |
South Carolina |
Vaccinated: | 2000-10-02 |
Onset: | 2001-05-27 |
Days after vaccination: | 237 |
Submitted: |
2001-06-01 |
Days after onset: | 5 |
Entered: |
2001-06-11 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEN: MENINGOCOCCAL (MENOMUNE-A/C) / CONNAUGHT LTD. |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Bacterial infection,
Meningitis SMQs:, Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
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: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Cultures show strain of bacteria to be Neisseria Meningitidis Group B CDC Split Type:
Write-up: On 05/31/2001 this patient''s mother called to report that this patient came down with bacterial meningitis on 05/27/01. |
|
VAERS ID: |
172283 (history) |
Form: |
Version 1.0 |
Age: |
41.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 2001-05-30 |
Onset: | 2001-06-01 |
Days after vaccination: | 2 |
Submitted: |
2001-06-20 |
Days after onset: | 19 |
Entered: |
2001-06-21 |
Days after submission: | 1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
0193K / 1 |
RA / IM |
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
UA410AA / UNK |
LA / SC |
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER |
U0377AA / UNK |
LA / IM |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER |
R0826 / UNK |
RA / IM |
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER |
UA440AA / UNK |
RA / SC |
Administered by: Private Purchased by: Private Symptoms: Hypertension,
Lymphadenopathy,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
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? No
Previous Vaccinations: Other Medications: polio vaccine was also given on 5/30/01 Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: chest x-ray, CBC, blood sugar, thyroid - all normal CDC Split Type:
Write-up: On 6/1/01 the pt experienced severely swollen lymph nodes and a temp of 104 for 5 days. On 6/13/01 blood pressure was 190/100 and remains very high. Blood pressure was normal on the day of vaccines. |
|