|
VAERS ID: |
27312 (history) |
Form: |
Version 1.0 |
Age: |
11.0 |
Sex: |
Female |
Location: |
Alabama |
Vaccinated: | 1990-12-10 |
Onset: | 1990-12-10 |
Days after vaccination: | 0 |
Submitted: |
1990-12-10 |
Days after onset: | 0 |
Entered: |
1991-01-07 |
Days after submission: | 28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1700S / 2 |
LA / SC |
Administered by: Other Purchased by: Public Symptoms: Dizziness,
Injection site hypersensitivity,
Nausea,
Rash,
Vasodilatation SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? 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: AL90008
Write-up: Became hot & dizzy w/ solid red rash over upper lt arm, nausea. Ice pack applied. BP 138/80; P 100; 10 min later BP 140/60; P 96 ; R 24. No SOB, Wheezing, rash becoming worse, extending to shoulder, cheeks, bilat temporal area, chest, etc. |
|
VAERS ID: |
27326 (history) |
Form: |
Version 1.0 |
Age: |
1.6 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 1990-12-21 |
Onset: | 1990-12-22 |
Days after vaccination: | 1 |
Submitted: |
1991-01-04 |
Days after onset: | 13 |
Entered: |
1991-01-07 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M0258C / 1 |
RA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
18805 / 1 |
LA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
291975 / 3 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Agitation,
Anorexia,
Crying,
Hyperkinesia,
Insomnia,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (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: Current Illness: rt serous otitis media Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Developed temp 103 (R) X 3 days, hyperactive, personality change, miserable, laying on floor screaming, arching back & crying. Could sleep no longer than 1 hr at a time during 3 days. Anorexic. |
|
VAERS ID: |
27330 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1990-12-28 |
Onset: | 1990-12-28 |
Days after vaccination: | 0 |
Submitted: |
1990-12-29 |
Days after onset: | 1 |
Entered: |
1991-01-07 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1891S / UNK |
RA / - |
Administered by: Private Purchased by: Private Symptoms: Convulsion,
Pallor,
Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: No prev hs of seizures problems. Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with MMR slumped to floor, had brief 45 sec twitching(tonic clonic) seizure type activity of face & shoulders. Pale. Awoke promptly was alert & oriented - no sequellae. Probable vasovagal syncope with seizure |
|
VAERS ID: |
27333 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-12-05 |
Onset: | 1990-12-06 |
Days after vaccination: | 1 |
Submitted: |
1990-12-12 |
Days after onset: | 6 |
Entered: |
1991-01-08 |
Days after submission: | 27 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / SCLAVO |
11CA1 / UNK |
LA / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1147S / UNK |
LA / - |
Administered by: Other Purchased by: Public Symptoms: Arthralgia,
Injection site reaction,
Oedema,
Pyrexia SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (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: Asthma, Hay fever Allergies: Diagnostic Lab Data: CDC Split Type: CA9021
Write-up: Pt vaccinated with DT/MMR developed swelling (extreme), erythema & pain around site of infection. Fever 99.4, arthralgias. |
|
VAERS ID: |
27334 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-12-18 |
Onset: | 1990-12-18 |
Days after vaccination: | 0 |
Submitted: |
1990-12-20 |
Days after onset: | 2 |
Entered: |
1991-01-08 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1483S / 2 |
- / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0620K / 3 |
MO / PO |
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO |
110A1 / 3 |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Pruritus,
Rash,
Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: PPD given same time, Parke-Davis, Lot 00550P Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: CA9022
Write-up: Pt vaccinated with OPV/TD/MMR/PPD approx 2 hrs after immunization broke out in welts over entire body which itched. Also rash pinkish & raised except areas of PPD where it is much darker red. |
|
VAERS ID: |
27335 (history) |
Form: |
Version 1.0 |
Age: |
6.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-12-19 |
Onset: | 1990-12-19 |
Days after vaccination: | 0 |
Submitted: |
1990-12-20 |
Days after onset: | 1 |
Entered: |
1991-01-08 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
287965 / 5 |
LA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1483S / 2 |
RA / SC |
Administered by: Public Purchased by: Public Symptoms: Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: PPD given at same time, Parke-Davis, Lot 00550P Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: CA9023
Write-up: 5 minutes after administering DTP, MMR and PPD child developed generalized urticarial rash that resolved spontaneously in 15 min. No SOB. No itching or other symptoms. |
|
VAERS ID: |
27340 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
Louisiana |
Vaccinated: | 1990-12-13 |
Onset: | 1990-12-13 |
Days after vaccination: | 0 |
Submitted: |
1990-12-17 |
Days after onset: | 4 |
Entered: |
1991-01-08 |
Days after submission: | 22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0213S / 1 |
LA / SC |
Administered by: Public Purchased by: Other Symptoms: Urticaria,
Vomiting SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In pt Excessive crying; 2 1/2mo/ DTP #1 also large local reaction.~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Erythromycin Allergies: Diagnostic Lab Data: CDC Split Type: LA90125
Write-up: Ten min after pt vac w/ MMR, dev. a welt about 1 inch above injection site. Notified MD ordered Benadryl, warm compresses & to watch child 30 min. 5 min later began to vomit more welts developed vomited once more. Seen by MD given Benadryl. |
|
VAERS ID: |
27343 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Hawaii |
Vaccinated: | 1990-08-03 |
Onset: | 1990-08-03 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1991-01-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1494S / 2 |
- / SC |
Administered by: Private Purchased by: Private Symptoms: Dizziness,
Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt fainted as walked toward door out of office. Momentarily felt dizzy - rested in office about 1/2 hr. Struck brow area, saw opthamologist - neg findings. |
|
VAERS ID: |
27352 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1990-12-06 |
Onset: | 1990-12-17 |
Days after vaccination: | 11 |
Submitted: |
1990-12-28 |
Days after onset: | 11 |
Entered: |
1991-01-09 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1569S / 2 |
- / SC |
Administered by: Public Purchased by: Public Symptoms: Arthralgia,
Cough,
Headache,
Injection site reaction,
Pyrexia,
Rash SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (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: CDC Split Type: TX903
Write-up: Pt vaccinated with MMR developed temp of 103 x 2 days, joint stiffness & soreness lasting several days, dry cough & headache, broke out in a rash, site of injection red & localized warmth. Rash subsiding. |
|
VAERS ID: |
27355 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 1990-11-12 |
Onset: | 1990-11-12 |
Days after vaccination: | 0 |
Submitted: |
1990-11-13 |
Days after onset: | 1 |
Entered: |
1991-01-10 |
Days after submission: | 58 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
283926 / 4 |
LA / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1493S / 1 |
RA / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0617H / 4 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Dysphagia,
Face oedema,
Salivary hypersecretion SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: TBST Current Illness: Preexisting Conditions: NKMA Allergies: Diagnostic Lab Data: CDC Split Type: TN911
Write-up: Approx 30 min after given DTP/OPV/MMR, pt developed swollen eyes. BP 94/60, p 64, difficulty swallowing, lips & face increased in swelling & child began drooling. |
|