|
VAERS ID: |
26004 (history) |
Form: |
Version 1.0 |
Age: |
10.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1990-09-12 |
Onset: | 1990-09-12 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0438S / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthma,
Dyspnoea,
Face oedema SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt recvd MMR vax in past /w no allergic response~ ()~~~In patient Other Medications: TB skin test 12Sep90 Current Illness: Preexisting Conditions: no hx of dru allergies, Allergies: Diagnostic Lab Data: Admission VS BP 112/62, T 98.9, P 114, R 22 CDC Split Type:
Write-up: Immed /p adm of MMR vax, pt developed SOB, wheezing & angioedema (swollen eyes & nasal edema) Pt was adm Epinephrine /w positive results, transported via ambulance to ER & recvd Diphenhydramine & ice packs applied to eyes |
|
VAERS ID: |
26005 (history) |
Form: |
Version 1.0 |
Age: |
3.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1990-08-28 |
Onset: | 1990-08-28 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1470S / UNK |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: Dyspnoea,
Urticaria,
Vasodilatation SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: ANTIHISTAMINE ORDER BY MD PER PHONE CALL Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: PT VACCINATED WITH MMR DEVELOPED WELTS & FLUSHED SKIN ON ARM, FACE & EARS APPROX 1 HR AFTER VAX. MOM CALLED MD HE ORDER ANTIHISTAMINE; PT ALSO HAD DIFFICULTY BREATHING. |
|
VAERS ID: |
26007 (history) |
Form: |
Version 1.0 |
Age: |
4.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-09-06 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
OB11061 / UNK |
- / SC |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
14995 / UNK |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0612H / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Nuchal rigidity,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: 10SEP90 SPINAL TAP 17 WBC 1 RBC PR 20 PO 4 CULTURES - NEGATIVE CDC Split Type:
Write-up: PT VACCINATED WITH DTP/MMR/OPV DEVELOPED FEVER, STIFF NECK |
|
VAERS ID: |
26020 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1990-09-04 |
Onset: | 1990-09-05 |
Days after vaccination: | 1 |
Submitted: |
1990-09-14 |
Days after onset: | 9 |
Entered: |
1990-09-21 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
0F11081 / 4 |
RA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 2 |
LA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / 4 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Injection site reaction,
Pyrexia,
Somnolence SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Tylenol given for T & discomfort Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm |
|
VAERS ID: |
26027 (history) |
Form: |
Version 1.0 |
Age: |
1.4 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 1990-09-12 |
Onset: | 1990-09-12 |
Days after vaccination: | 0 |
Submitted: |
1990-09-13 |
Days after onset: | 1 |
Entered: |
1990-09-21 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M030FC / UNK |
- / IM A |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1705S / 1 |
- / SC A |
Administered by: Private Purchased by: Public Symptoms: Agitation,
Anorexia,
Injection site reaction,
Rash,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no previous reaction~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Shot lt arm red, the day /p red streak from shot to elbow, throwing up. Won''t eat or anything. Real cranky, erythematous skin, Rxn to MMR |
|
VAERS ID: |
26078 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1990-08-16 |
Onset: | 1990-08-16 |
Days after vaccination: | 0 |
Submitted: |
1990-09-17 |
Days after onset: | 32 |
Entered: |
1990-09-24 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0692S / 1 |
- / SC |
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
287962 / UNK |
- / A |
Administered by: Private Purchased by: Private Symptoms: Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Hx of prior syncope x2 Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting. |
|
VAERS ID: |
26088 (history) |
Form: |
Version 1.0 |
Age: |
6.0 |
Sex: |
Unknown |
Location: |
Indiana |
Vaccinated: | 1990-09-12 |
Onset: | 1990-09-13 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-24 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0988S295 / 2 |
- / IM |
Administered by: Private Purchased by: Private Symptoms: Confusional state,
Convulsion,
Tremor SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (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? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: electrolytes, Glucose, CBC - Normal CDC Split Type:
Write-up: Pt vaccinated with MMR 24 hrs later child began shaking, became disoriented, school nurse reported "seizure like" activity. No fever. No urination. Electrolytes, Glucose, CBC checked. All normal. |
|
VAERS ID: |
26102 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Oklahoma |
Vaccinated: | 1990-08-21 |
Onset: | 1990-09-03 |
Days after vaccination: | 13 |
Submitted: |
0000-00-00 |
Entered: |
1990-09-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283913 / 3 |
RL / IM |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
M66FB / 1 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
12925 / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
277942 / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Agitation,
Confusional state,
Gait disturbance,
Skin discolouration,
Somnolence,
Vomiting SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk Current Illness: none WIC recert. Preexisting Conditions: 10/89 Sizemore, PA no known allergies Allergies: Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90 CDC Split Type:
Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands |
|
VAERS ID: |
26122 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-07-20 |
Onset: | 1990-08-29 |
Days after vaccination: | 40 |
Submitted: |
1990-09-06 |
Days after onset: | 8 |
Entered: |
1990-09-27 |
Days after submission: | 21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Orchitis,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Viral Cultures of blood & Urine pending At LA County Urology lab. CDC Split Type:
Write-up: Pt vaccinated w/MMR developed bilateral orchitis one mo folowing MMR vaccination. Temp 101 L testicle 1XN size tender. Also tender epididymison on lt. Seen by Dr 29AUG90 treated w/Motrin & bactrim DS; F-UP 6SEP90 complete resolution. |
|
VAERS ID: |
26126 (history) |
Form: |
Version 1.0 |
Age: |
75.0 |
Sex: |
Female |
Location: |
Hawaii |
Vaccinated: | 1990-06-07 |
Onset: | 1990-07-24 |
Days after vaccination: | 47 |
Submitted: |
1990-09-24 |
Days after onset: | 62 |
Entered: |
1990-09-28 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
06953 / UNK |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Arthralgia,
Arthritis,
Arthropathy,
Osteoarthritis,
Synovitis SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Enduronyl, Slow-K Current Illness: Intolerant of asirin Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with MMR & experienced acute pain in rt hand & fingers w/stiffness dx as acute tendino arthritis & prescribed Prednisone covered by Ampicillin. See WORM for more details. |
|