|
VAERS ID: |
26498 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: | 1988-03-28 |
Onset: | 1988-03-28 |
Days after vaccination: | 0 |
Submitted: |
1990-10-30 |
Days after onset: | 946 |
Entered: |
1990-11-05 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / 4 |
- / L |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
- / UNK |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / 4 |
MO / PO |
Administered by: Private Purchased by: Other Symptoms: Anorexia,
Dehydration,
Diabetes mellitus,
Dyspnoea,
Hypotonia,
Influenza,
Insomnia,
Pyrexia,
Screaming,
Somnolence SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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, 7 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Septra Current Illness: Otitis media - resolving Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV/HIB 8 hrs following injections pt crying steadily & limp unable to stand or sit even propped up. Mentally quite "spacey" temp 101F on acetaminophen all night & sleep was disturbed. see WORM for more details. |
|
VAERS ID: |
26621 (history) |
Form: |
Version 1.0 |
Age: |
1.3 |
Sex: |
Female |
Location: |
North Dakota |
Vaccinated: | 1990-10-30 |
Onset: | 1990-10-30 |
Days after vaccination: | 0 |
Submitted: |
1990-11-08 |
Days after onset: | 9 |
Entered: |
1990-11-13 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
OF11073 / 4 |
RL / SC |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
8L01022 / 1 |
LL / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
281933 / 4 |
MO / PO |
Administered by: Military Purchased by: Unknown Symptoms: Convulsion,
Pyrexia,
Somnolence SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (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? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: Tylenol Current Illness: Cold symptoms without fever Preexisting Conditions: Allergies: Diagnostic Lab Data: EEG Relatively normal 8 days after 1st seizure. CDC Split Type:
Write-up: Pt vax /w DTP/OPV/HIB/TB TINE TEST /w in 4 hrs pt had grand mal seizure, T was 100.6. Became very lethargic brought to ER then again seizure; admit to Hosp. Seizured again 5 days later 3 times w/no Increase temp. |
|
VAERS ID: |
27059 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 1990-12-03 |
Onset: | 1990-12-04 |
Days after vaccination: | 1 |
Submitted: |
1990-12-12 |
Days after onset: | 8 |
Entered: |
1990-12-17 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
289901 / 1 |
- / IM L |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
MI90FD / 1 |
- / L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
291966 / 1 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Cardiac arrest,
Coagulopathy,
Convulsion SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (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, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: heart murmur Allergies: Diagnostic Lab Data: Can be obtained at Valley Medical Center, Renton WA, or at Children''s Orthopedic Hospital. CDC Split Type:
Write-up: Pt vaccinated with DTP/OPV/HIB developed desiminated intravascular coagulation, emergency resuscitation. Under Intensive care. |
|
VAERS ID: |
27142 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 1990-03-12 |
Onset: | 1990-12-04 |
Days after vaccination: | 267 |
Submitted: |
0000-00-00 |
Entered: |
1990-12-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
289901 / UNK |
- / IM L |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M190FD / UNK |
- / IM L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
291966 / UNK |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Coagulopathy,
Shock SMQs:, Anaphylactic reaction (narrow), Haemorrhage laboratory terms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: USD, Hernia repair Allergies: Diagnostic Lab Data: intensive care CDC Split Type:
Write-up: Cardo vascular collapse, DIC |
|
VAERS ID: |
28812 (history) |
Form: |
Version 1.0 |
Age: |
0.7 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1990-12-18 |
Onset: | 1990-12-18 |
Days after vaccination: | 0 |
Submitted: |
1991-01-02 |
Days after onset: | 15 |
Entered: |
1991-03-04 |
Days after submission: | 61 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M195FD / 1 |
RL / IM |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
1464S / 1 |
LL / - |
Administered by: Private Purchased by: Private Symptoms: Apnoea,
Cardiac arrest,
Cardiac failure SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Ferinsol, Diuril until 17DEC; Nebs: Ventolin/Mucomyst Current Illness: BPD, S/P G-Tube placement Preexisting Conditions: 25 wk premie w/h/o BPD, Cardiorespiratory arrest; S/P tracheostomy, sepsis, blood trnafusions, subglottis stenosis. Allergies: Diagnostic Lab Data: ABG=6.8; PCO2=30; PO2=185; base excess of 25.8; saturated of 97.8%. Lytes p/med NA=141, K=3.1, CO2=2.4, cl=111; Glucose=486; temp 95.4; HR-166 CDC Split Type:
Write-up: @ 1030PM, monitor went off for heart & respirations; no palpable pulse; appeared to be in asystole. Rec''d Atropine & Epinephrine, bicarb; a second dose of epi & bicarb were also administered @ 10:39, faint fem pulse present; 1 BrS @ 1041 |
|
VAERS ID: |
29200 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 1990-12-04 |
Onset: | 1990-12-07 |
Days after vaccination: | 3 |
Submitted: |
1991-03-14 |
Days after onset: | 97 |
Entered: |
1991-03-19 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0B21173 / UNK |
- / IM L |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M205FE / UNK |
- / IM L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
289937 / UNK |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Crying,
Hypotonia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NOONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: High pitch crying rt p/receiving shots; 2 episodes of limpness 3 day & 7 days taken to ER both times afterwards. |
|
VAERS ID: |
30289 (history) |
Form: |
Version 1.0 |
Age: |
0.3 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 1991-02-11 |
Onset: | 1991-02-11 |
Days after vaccination: | 0 |
Submitted: |
1991-04-15 |
Days after onset: | 62 |
Entered: |
1991-05-03 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
291928 / 2 |
- / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M165FW / 2 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
293293 / 2 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Anorexia,
Hypotonia,
Hypoventilation,
Rash,
Sepsis,
Shock,
Stupor SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 39 days
Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: Screamed first 6 wks of life; Put on goat''s milk; Allergies: Diagnostic Lab Data: P/shot had blood test for allergies; irregularities knees, tibias final dx meningococcal sepsis; Culture + CDC Split Type: OH91042
Write-up: Non-responsive, anorexic 4PM w/shallow breathing unresponsive body covered w/rash 7PM glassy eyed & floppy; Taken to ER adm in shock w/sepsis; recd APAP was intubated; lost all her toes, fingers & thumb on rt hand; One joint off 2 fingers; |
|
VAERS ID: |
30442 (history) |
Form: |
Version 1.0 |
Age: |
0.9 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1991-04-12 |
Entered: |
1991-05-13 |
Days after submission: | 31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
- / 3 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Convulsion,
Muscle spasms SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), 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? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Anticonvulsant medication Current Illness: NONE Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: EEG CDC Split Type: 910078301
Write-up: Infant experienced infantile spasms following 1st HIBTITER; MD recognized sx 6 to 8 wk p/immun; Infant was afeb p/immun; Referred to Peds neurologist; Pt has since rec''d 2nd & 3rd HIBTITER had 3-4 sz p/3rd; |
|
VAERS ID: |
30443 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
New York |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
1991-04-12 |
Entered: |
1991-05-13 |
Days after submission: | 31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
- / 1 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Muscle spasms SMQs:, Dystonia (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: UNK~ ()~~~In patient Other Medications: Anticonvulsant medication Current Illness: NONE Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: EEG CDC Split Type: 910078302
Write-up: Infant experienced infantile spasms following HIBTITER; However, MD did not recognize sx until 6 to 8 wks p/immun; Infant was afeb & referred to a Peds Neurologist; |
|
VAERS ID: |
31009 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Male |
Location: |
South Dakota |
Vaccinated: | 1990-02-13 |
Onset: | 1990-02-17 |
Days after vaccination: | 4 |
Submitted: |
1991-05-18 |
Days after onset: | 454 |
Entered: |
1991-06-05 |
Days after submission: | 18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
241920 / 4 |
- / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
- / 1 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
247945 / 3 |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Autism,
Pyrexia,
Somnolence,
Speech disorder SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CXR- normal; Strep test - negative; Blood bacteria culture - negative; CDC Split Type:
Write-up: 4days post vax devl running fever; to ER t104 & very lathargic; several tests for various things & couldn''t find anything wrong; given antibiotics as precaution; then lost speech & was dx w/autism in DEC90; |
|