|
| VAERS ID: |
25011 (history) |
| Form: |
Version 1.0 |
| Age: |
5.0 |
| Gender: |
Female |
| Location: |
Foreign |
| Vaccinated: | 1989-08-24 |
| Onset: | 1989-08-24 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Convulsion,
Pyrexia,
Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx in the pregnacy, neonatal period, family or past hx
Allergies:
Diagnostic Lab Data: SMAC, CBC - WNL, Lumbar puncture, Urine - WNL, Blood culture- WNL, Viral titers - no infection by echovirus, resp. syncytial virus, mumps or enterovirus. CT - WNL
CDC Split Type: EBWWMA010932
Write-up: Approx. 1 hr /p Engerix-B vaccine given became febrile, convulsion. Hospitalized 24Aug89 w/ vomiting. |
|
| VAERS ID: |
25012 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Gender: |
Male |
| Location: |
Wisconsin |
| Vaccinated: | 1989-10-20 |
| Onset: | 1989-10-23 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
253963 / UNK |
RL / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Hypotonia,
Monoplegia,
Neuropathy
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: xrays of left shoulder, clavicle, humerus & forearm - WNL
CDC Split Type: 890255101
Write-up: 3 days /p immun. infant only able to move fingers of left arm, no tone in arm. Immun. given in Right thigh/buttocks. Mononeuropathy left upper extremity. |
|
| VAERS ID: |
25013 (history) |
| Form: |
Version 1.0 |
| Age: |
0.4 |
| Gender: |
Unknown |
| Location: |
North Dakota |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Erythema multiforme,
Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), 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:
CDC Split Type: 8902746.01
Write-up: Pt received DTP/OPV vaccine developed rash in groin area, became wide spread, DX rash, erythema multiforme (E.R. report indicates due to OPV vaccine) At 6 mon. child received DTP w/ no problems. |
|
| VAERS ID: |
25014 (history) |
| Form: |
Version 1.0 |
| Age: |
0.4 |
| Gender: |
Unknown |
| Location: |
South Carolina |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259965 / 2 |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Agitation,
Anorexia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 8902804.01
Write-up: 4 month old infant received 2nd immunization & became very irritable, fussy & refused to eat. w/ 1st imminization, infant was fussy for about 3 days. |
|
| VAERS ID: |
25015 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Gender: |
Unknown |
| Location: |
Georgia |
| Vaccinated: | 1989-11-01 |
| Onset: | 1989-11-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Injection site mass,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type: 8902805.01
Write-up: vaccine contained large amount of sediment which will not resuspend. Also, reporter states that he has not seen an increase in the number of reactions; however, he has noted more severity of local rxns, more than nl temp and knot under skn |
|
| VAERS ID: |
25016 (history) |
| Form: |
Version 1.0 |
| Age: |
0.3 |
| Gender: |
Female |
| Location: |
Georgia |
| Vaccinated: | 1986-02-09 |
| Onset: | 1986-02-09 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Electroencephalogram abnormal,
Grand mal convulsion,
Mental retardation severity unspecified,
Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (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? 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC Split Type: 890282301
Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay. |
|
| VAERS ID: |
25017 (history) |
| Form: |
Version 1.0 |
| Age: |
35.0 |
| Gender: |
Female |
| Location: |
Colorado |
| Vaccinated: | 1989-07-19 |
| Onset: | 1989-07-21 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
241916 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown
Symptoms: Cellulitis,
Injection site reaction
SMQs:
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 8901682.01
Write-up: pt deveolped cellulitis at injection site within 48 hrs p/ immun., mass was not drained or cultured, however is was fluctuant, seen in ER treated w/ with Cirpo & warm compresses, returned to ER for pain, asymptomatic on 4th day. |
|
| VAERS ID: |
25018 (history) |
| Form: |
Version 1.0 |
| Age: |
30.0 |
| Gender: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 1989-07-07 |
| Onset: | 1989-07-10 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
199602 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown
Symptoms: Injection site inflammation,
Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (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:
CDC Split Type: 8901590.02
Write-up: pt developed an injection site reaction resulting in a mass 4 cm in diameter, area was erythematous, warm to touch & firm, treated with Atarax, resolved |
|
| VAERS ID: |
25019 (history) |
| Form: |
Version 1.0 |
| Age: |
0.8 |
| Gender: |
Male |
| Location: |
North Carolina |
| Vaccinated: | 1990-06-08 |
| Onset: | 1990-06-08 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271967 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Received DTP on 8JUN90 & had prolonged fever for a week''s time |
|
| VAERS ID: |
25020 (history) |
| Form: |
Version 1.0 |
| Age: |
4.0 |
| Gender: |
Female |
| Location: |
New York |
| Vaccinated: | 1990-06-14 |
| Onset: | 1990-06-14 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1227S / UNK |
- / SC |
Administered by: Private Purchased by: Unknown
Symptoms: Asthma,
Face oedema,
Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Subcut- Epinephrine, Bendryl & Solumedrol IV
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Urticaria, wheezy, & periorbital edema which abated /p administration of subcut. epinephrine, Bendryl IV, Solumendrol IV |
|
