| VAERS ID: |
51148 (history) |
| Form: |
Version 1.0 |
| Age: |
54.0 |
| Sex: |
Male |
| Location: |
D.C. |
| Vaccinated: | 1993-02-20 |
| Onset: | 1993-02-21 |
| Days after vaccination: | 1 |
| Submitted: |
1993-03-16 |
| Days after onset: | 23 |
| Entered: |
1993-03-25 |
| Days after submission: | 9 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
2K41040 / UNK |
- / IM A |
| TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
4928055 / UNK |
- / SC A |
| YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES |
2H31154 / UNK |
- / IM A |
Administered by: Military Purchased by: Military
Symptoms: Asthenia,
Chills,
Dyspnoea,
Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), 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, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pt recvd Immune Globulin by Armour Pharm co lot# F15907; Lopressor
Current Illness:
Preexisting Conditions: pt has hx of hypertrophic cardiomyopathy;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893075002E
Write-up: Pt devel fever, chills, SOB & weakness, 24 hrs p/vax; |
