|
| VAERS ID: |
25009 (history) |
| Form: |
Version 1.0 |
| Age: |
3.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 1990-04-05 |
| Onset: | 1990-04-06 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0333P / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Deafness SMQs:, Hearing impairment (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: recurrent otitis media, measles Allergies: Diagnostic Lab Data: CDC Split Type: WAES90030661
Write-up: 15mon. male w/ hx of recurrent ear infections & measles in Feb. 89''. 5Apr89 was given MMR. Within 24 hrs /p vaccine, parents noted hearing deficit, confirmed by physician exam. |
|
| VAERS ID: |
25483 (history) |
| Form: |
Version 1.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1990-06-08 |
| Onset: | 1990-06-09 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site reaction,
Serum sickness SMQs:, 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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: ESR 9-JUN-90 NORMAL CDC Split Type: WAES90060411
Write-up: Dr. reported that his 12 yr old son was given a booster dose of Measles virus vaccine, live on 8-JUN-90 he experienced Arthus reaction consisting of synovitis of lt hip, inability to walk and pain at injection site. ESR was normal. |
|
| VAERS ID: |
25484 (history) |
| Form: |
Version 1.0 |
| Age: |
1.5 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
40967/2130R / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Pyrexia,
Rash maculo-papular,
Vasculitis SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES90040110
Write-up: 18month-old vaccinated w/MMR eighteen days after vaccination she developed a fever of 104 and macular rash of the face, torso & legs. The symptoms remitted spontaneously, recurred 2 wks later described as vasculitis. No further details. |
|
| VAERS ID: |
25487 (history) |
| Form: |
Version 1.0 |
| Age: |
1.5 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1990-02-16 |
| Onset: | 1990-03-17 |
| Days after vaccination: | 29 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
40967/2130R / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Pyrexia,
Rash maculo-papular SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: none CDC Split Type: WAES90040109
Write-up: 19 mon. male vaccinated /w MMRII vaccine. 17Mar90, developed a maculopapular rash of both arms, legs & cheek /w high fever. Rash became purpuric 2Apr90. Rash remitted spontaneously total duration 15-17 days. No further info. provided |
|
| VAERS ID: |
25554 (history) |
| Form: |
Version 1.0 |
| Age: |
10.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1990-06-07 |
| Onset: | 1990-06-20 |
| Days after vaccination: | 13 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
48381/0691S / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: Convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), 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: ~ ()~~~In patient Other Medications: unknown Current Illness: no relevant history Preexisting Conditions: Allergies: Diagnostic Lab Data: no relevant data CDC Split Type: WAES90060998
Write-up: R.Ph reported 10 y.o. was given vaccine & 13 days later had a seizure. |
|
| VAERS ID: |
25568 (history) |
| Form: |
Version 1.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 1990-05-26 |
| Onset: | 1990-05-28 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
1014S / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Grand mal convulsion SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), 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: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: no relevent history Allergies: Diagnostic Lab Data: MRI 19Jun90- normal, EEG 19Jun-90 minimal abnormality CDC Split Type: WAES90070154
Write-up: Pt vacc. /w Measles virus 26May90. A day & 1/2 /p vacc. pt had grand mal sizure. Pt in ER. 19Jul90 MRI scan and EEG demonstrated minimal abnormality. Additional info. requested. |
|
| VAERS ID: |
26211 (history) |
| Form: |
Version 1.0 |
| Age: |
1.3 |
| Sex: |
Female |
| Location: |
Minnesota |
| Vaccinated: | 1989-08-31 |
| Onset: | 1989-09-07 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-09-13 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
38091/0592P / UNK |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: Agitation,
Arthropathy,
Hypertonia,
Hypokinesia,
Hypotonia,
Leukopenia,
Mental retardation severity unspecified,
Pyrexia,
Rash maculo-papular,
Somnolence,
Speech disorder SMQs:, Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Hypokalaemia (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: hx of otitis media, pharyngitis Allergies: Diagnostic Lab Data: 8Sep89 WBC count-45000, 11Sep90 WBC count-2800, 11Sep89 platelet count- 80000 CDC Split Type: WAES90060279
Write-up: 15 mon. pt /w hx of OM & pharyngitis, vax /w MMRII dev fever, macular rash, WBC dec to 2800, dev stiffness legs, lethargy, irritability. Has severe dev delay w/ poor speech, fluct. muscle tone, po6r motor & head control, spacticity. |
|
| VAERS ID: |
26180 (history) |
| Form: |
Version 1.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 1972-11-29 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-10-03 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Abdominal pain,
Convulsion,
Dizziness,
Febrile convulsion,
Mental retardation severity unspecified,
Myasthenic syndrome,
Pallor,
Peptic ulcer,
Personality disorder,
Pyrexia,
Rash,
Rhinitis,
Salivary hypersecretion,
Skin discolouration,
Somnolence SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Convulsions (narrow), Malignancy related conditions (narrow), Gastrointestinal ulceration (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (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? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CBC 7DEC72 Normal; Urinalysis 7DEC72 Normal; EEG 5SEP73 Normal; EEG 74 Abnormal; EEG 76 Rt temporal lobe epileptogenic; CT scan 9Apr90 Normal; EEG clear Rt temporal focus. CDC Split Type: ARR49.786
Write-up: Pt vaccinated with MMR experienced severe teething & nasal congestion. High fever had a seizure lasted approx 30 to 60 min. Seen in ER w/temp of 104.4 rt sided weakness consistent w/Todds paralysis. See WORM for more details. |
|
| VAERS ID: |
26247 (history) |
| Form: |
Version 1.0 |
| Age: |
18.0 |
| Sex: |
Male |
| Location: |
Utah |
| Vaccinated: | 1989-05-22 |
| Onset: | 1989-07-15 |
| Days after vaccination: | 54 |
| Submitted: |
1990-10-09 |
| Days after onset: | 451 |
| Entered: |
1990-10-15 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0411R / UNK |
- / - |
Administered by: Other Purchased by: Unknown Symptoms: Diabetes mellitus SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), 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? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Confirmatory for diabetes mellitus CDC Split Type:
Write-up: Pt vaccinated with MMR developed insulin dependent diabetes mellitus 6 wks following MMR immunation. |
|
| VAERS ID: |
26358 (history) |
| Form: |
Version 1.0 |
| Age: |
1.3 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 1986-08-19 |
| Onset: | 1986-08-30 |
| Days after vaccination: | 11 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-10-26 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 2 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Bone disorder,
Encephalopathy,
Neuropathy,
Personality disorder,
Psychotic disorder SMQs:, Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hostility/aggression (broad), Chronic kidney disease (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: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES90091043
Write-up: Pt vaccinated MMR experienced nervous system damage which included encephalopathy, which resulted in internal, neurological, orthopeidc, psychological, & psychiatric injuries. |
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