|
| VAERS ID: |
26802 (history) |
| Form: |
Version 1.0 |
| Age: |
28.0 |
| Sex: |
Female |
| Location: |
Delaware |
| Vaccinated: | 1990-10-24 |
| Onset: | 1990-10-25 |
| Days after vaccination: | 1 |
| Submitted: |
1990-11-19 |
| Days after onset: | 25 |
| Entered: |
1990-11-27 |
| Days after submission: | 8 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
- / UNK |
LA / - |
Administered by: Private Purchased by: Other
Symptoms: Asthenia,
Neuropathy,
Pain,
Paraesthesia,
Pyrexia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: PCN, Codeine allergies
Allergies:
Diagnostic Lab Data: Post vaccine Peripheral Polyneuropathy
CDC Split Type:
Write-up: Pt vaccinated with MMR/Tetanus developed paresthesia of hands & feet w/numbness, fatigue, weakness, aches, fever 99.9. |
|
| VAERS ID: |
39772 (history) |
| Form: |
Version 1.0 |
| Age: |
49.0 |
| Sex: |
Male |
| Location: |
Georgia |
| Vaccinated: | 1992-01-16 |
| Onset: | 1992-01-26 |
| Days after vaccination: | 10 |
| Submitted: |
1992-02-25 |
| Days after onset: | 30 |
| Entered: |
1992-03-03 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. |
G01031 / UNK |
UN / SC |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
1F31063 / UNK |
UN / SC |
| TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
1K31145 / UNK |
UN / IM |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. |
120602A / UNK |
MO / PO |
| YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES |
1L21002 / UNK |
UN / SC |
Administered by: Unknown Purchased by: Unknown
Symptoms: Asthenia,
CSF test abnormal,
Diplopia,
Guillain-Barre syndrome,
Headache
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Ocular motility disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)
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, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC Split Type:
Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia |
|
| VAERS ID: |
37209 (history) |
| Form: |
Version 1.0 |
| Age: |
20.0 |
| Sex: |
Male |
| Location: |
New Jersey |
| Vaccinated: | 1992-02-17 |
| Onset: | 1992-02-18 |
| Days after vaccination: | 1 |
| Submitted: |
1992-02-19 |
| Days after onset: | 1 |
| Entered: |
1992-05-20 |
| Days after submission: | 90 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES |
- / UNK |
- / - |
| MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Military Purchased by: Military
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: UNK
Current Illness: NONE
Preexisting Conditions: pt had surgery on rt hip related to chondromalacia @ age of 9;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 892051005L
Write-up: pt devel numbness on rt side of body 24 hrs p/flu vax/DT/Meningococcal vax; pt was hospitalized due to adverse effect & was noted to be improving w/numbness currently localized to the rt leg; |
|
| VAERS ID: |
44216 (history) |
| Form: |
Version 1.0 |
| Age: |
34.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 1990-11-30 |
| Onset: | 1990-12-12 |
| Days after vaccination: | 12 |
| Submitted: |
0000-00-00 |
| Entered: |
1992-08-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| ADEN: ADENOVIRUS (TYPE 7, NO BRAND NAME) / PFIZER/WYETH |
4888220 / UNK |
- / - |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0511019 / UNK |
- / - |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
0D21085 / UNK |
- / - |
| MER: MEASLES + RUBELLA (MR-VAX II) / MERCK & CO. INC. |
0302R / UNK |
- / - |
| MU: MUMPS (MUMPSVAX I) / MERCK & CO. INC. |
02106 / UNK |
- / - |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0611C / UNK |
- / - |
| TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9L11011 / UNK |
- / - |
Administered by: Military Purchased by: Unknown
Symptoms: Asthenia,
Guillain-Barre syndrome,
Hypokinesia,
Laboratory test abnormal,
Pharyngitis
SMQs:, Agranulocytosis (broad), Peripheral neuropathy (narrow), Parkinson-like events (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 18 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Given 30NOV92 PPD Connaught Labs lot# 231712;and Bicyllin Wyth Lot# 2891626;
Current Illness:
Preexisting Conditions: hos of pos PPD;
Allergies:
Diagnostic Lab Data: IGM-17DEC90-abn consistent w/GBS;
CDC Split Type:
Write-up: 12DEC90 devel elevated weakness which began in feet & moved upwards; unable to walk, drops things; mild URI sx x 1 wk PTA; IGM-17DEC abn consistent w/GBS; plasmaphoresis x 5 exchgs; |
|
| VAERS ID: |
44800 (history) |
| Form: |
Version 1.0 |
| Age: |
40.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 1991-11-21 |
| Onset: | 1991-12-01 |
| Days after vaccination: | 10 |
| Submitted: |
1992-09-06 |
| Days after onset: | 279 |
| Entered: |
1992-09-10 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4918152 / 1 |
- / IM A |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. |
C1150 / 1 |
- / SC A |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
0M21074 / 1 |
- / SC A |
Administered by: Private Purchased by: Private
Symptoms: Chorioretinitis,
Conjunctivitis,
Optic neuritis,
Photophobia,
Pupillary disorder,
Retinal detachment,
Retinal disorder,
Visual field defect
SMQs:, Severe cutaneous adverse reactions (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Accidents and injuries (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Corneal disorders (broad), Retinal disorders (narrow), Conjunctival disorders (narrow), Ocular infections (narrow), Hypersensitivity (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE prior to onset began Nafaralin 1DEc & 14DEc d/c
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: inflammation resolved showed multiple bilat retinal defects;
CDC Split Type:
Write-up: 1DEC91 h/a, photophobia; 7DEC91 paralysis of rt pupil, adie''s pupil; pt seen in ER for unequal pupils to r/o aneurysm; inc chemosis; 20DEC91 impaired central vision, bilat, retinas showed mutiple serous detachments, bilat opic disc edema; |
|
| VAERS ID: |
49911 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 1993-02-01 |
| Onset: | 1993-02-01 |
| Days after vaccination: | 0 |
| Submitted: |
1993-02-10 |
| Days after onset: | 9 |
| Entered: |
1993-02-16 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dyspepsia,
Rash
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypersensitivity (narrow), 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: Donnatal & Maalox
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4663
Write-up: rash; erythematous rash on arms to tips of fingers, then on neck & face 1 hr p/vax; also had GI upset about 1/2 hr p/inject; |
|
| VAERS ID: |
50683 (history) |
| Form: |
Version 1.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 1992-08-28 |
| Onset: | 1992-08-31 |
| Days after vaccination: | 3 |
| Submitted: |
1993-03-04 |
| Days after onset: | 185 |
| Entered: |
1993-03-11 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
- / 1 |
- / - |
Administered by: Military Purchased by: Military
Symptoms: Headache,
Hypertension,
Nausea,
Nephrotic syndrome,
Oedema,
Renal impairment,
Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Proteinuria (broad), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: ATB @ time of vax;
Current Illness: n/a, hematuria & proteinuria suspected U
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: IVp neg; extensive blood &urine test, renal biopsy; 29SEP93 proved IgA nephropathy;
CDC Split Type:
Write-up: Pt recvd vax & exp n/v, hematuria & proteinuria; edema, h/a; dx IgAN, no hypertension but nephrotic synd; w/in 2 mos devel hypertension, renal function reportedly 50% destroyed; |
|
| 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; |
|
| VAERS ID: |
51414 (history) |
| Form: |
Version 1.0 |
| Age: |
38.0 |
| Sex: |
Male |
| Location: |
Alabama |
| Vaccinated: | 1991-01-01 |
| Onset: | 0000-00-00 |
| Submitted: |
1993-03-18 |
| Entered: |
1993-04-01 |
| Days after submission: | 14 |
| 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: Arthralgia,
Asthenia,
Dyspnoea,
Laboratory test abnormal,
Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), 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? Yes, 10 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: pt also recvd Anthrax vax;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Febrile agglutins pos; Typhoid 1:320; pos core HBAB; neg antibody HB; neg antigen HB; neg ted; neg ANA; neg RHF; neg stools ova & culture; neg oth agglut;
CDC Split Type:
Write-up: joint pain, fatigue & rash feet, dyspnea hosp FEB93 to MAR93; |
|
| VAERS ID: |
51415 (history) |
| Form: |
Version 1.0 |
| Age: |
41.0 |
| Sex: |
Female |
| Location: |
Alabama |
| Vaccinated: | 1991-01-01 |
| Onset: | 0000-00-00 |
| Submitted: |
1993-03-18 |
| Entered: |
1993-04-01 |
| Days after submission: | 14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH |
- / 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: Asthenia,
Dyspnoea,
Laboratory test abnormal,
Rash,
Red blood cell sedimentation rate increased
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), 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, 14 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pt recvd Anthrax & immune globulin;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ANA neg; neg RH, neg stools ova & cult; sed rate 76; pos Typhoid agglutin "H" 1:160, pos immunoplectrophoresis Poly clonal gamopathy;
CDC Split Type:
Write-up: rash feet & rt hand dyspnea & fatigue; |
|
