|
VAERS ID: |
25682 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: | 1990-07-06 |
Onset: | 1990-07-17 |
Days after vaccination: | 11 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1226S / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Conjunctivitis,
Pyrexia,
Rash,
Rash maculo-papular,
Stevens-Johnson syndrome,
Stomatitis SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Conjunctival disorders (narrow), Ocular infections (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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Cortisporin otic dr., polymyxin B sulf-neomycin, sulf-hydrocortison, alcohol-propylene, glycol-polysorbate-80-thimerosal Current Illness: external otitis Preexisting Conditions: otitis, recurrent external Allergies: Diagnostic Lab Data: CDC Split Type: WAES90070926
Write-up: Pt vaccinated /w MMR 2 wks following vaccination pt developed Stevens-Johnson syndrome & was hospitalized. 17Jul90 developed rash on chest,trunk, palms of the hands, face & upper & lower extremities. Low grade fever /w cracked lips & mouth. |
|
VAERS ID: |
25696 (history) |
Form: |
Version 1.0 |
Age: |
1.8 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1990-05-14 |
Onset: | 1990-05-15 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
OB11061 / UNK |
- / IM L |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0890S / UNK |
- / IM L |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Injection site pain,
Injection site reaction,
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: Ceclor Current Illness: Ear infection took Ceclor 5/7 -5/14 Preexisting Conditions: Infectious Mono in January 1990 Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Pt vaccinated with DTP/MMR/OPV and developed a fever of 104.2; Temp decreased with tylenol and ice pack; Pain and swelling of leg site |
|
VAERS ID: |
25730 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Female |
Location: |
Tennessee |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. |
1D155 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Lymphadenopathy,
Myalgia,
Nausea,
Pharyngitis,
Rash SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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: Pt vaccinated with Measles Vaccine experienced rash 11 days; also had sore throat, acthing, nausea and swollen glands which were still present 15 days days after receiving vaccin. |
|
VAERS ID: |
25789 (history) |
Form: |
Version 1.0 |
Age: |
1.5 |
Sex: |
Female |
Location: |
Indiana |
Vaccinated: | 1990-07-27 |
Onset: | 1990-08-04 |
Days after vaccination: | 8 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
14795 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Anorexia,
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? 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: Pt vaccinated with MMR on 27JUL90 on 4AUG90 developed fever 101-104, very red & pronounced macular rash over trunk, abdomen & upper extremities, decreased appetite, refusing to eat per mom. Lasted til 10AUG90 when temp decreased & rash fad |
|
VAERS ID: |
25792 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1990-08-07 |
Onset: | 1990-08-07 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
10215 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Arthralgia,
Osteoarthritis,
Rash SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: Lyme test - negative CDC Split Type:
Write-up: Rash on arm, joints swollen, aches. |
|
VAERS ID: |
25814 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: | 1990-08-08 |
Onset: | 1990-08-08 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
15255 / UNK |
- / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthma SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: BP 118/40 CDC Split Type:
Write-up: Received MMR from MSD - developed wheezing within 5 minutes. |
|
VAERS ID: |
25817 (history) |
Form: |
Version 1.0 |
Age: |
2.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 1990-06-22 |
Onset: | 1990-06-30 |
Days after vaccination: | 8 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
265938 / 4 |
- / - |
MEA: MEASLES (NO BRAND NAME) / MERCK & CO. INC. |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
MO / PO |
Administered by: Private Purchased by: Unknown Symptoms: Asthenia,
Convulsion,
Pyrexia,
Rash SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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? 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 hx of seizures in siblings/parents. 1 cousin had convulsions /w high fever. Allergies: Diagnostic Lab Data: CDC Split Type: 9001348.01
Write-up: Approx. 8 days /p DTP/OPV/MMR immun., child experienced a fever 101T, rash on face & chest, seizure (1 episode) & fatigue for 24 hrs. |
|
VAERS ID: |
25819 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1990-06-15 |
Onset: | 1990-06-26 |
Days after vaccination: | 11 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1227S / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Arthritis,
Back pain,
Malaise,
Pharyngitis,
Pyrexia SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Arthritis (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: Current Illness: Preexisting Conditions: Juvenile rheumatoid arthritis Allergies: Diagnostic Lab Data: CDC Split Type: WAES90080353
Write-up: Pt with juvenile rheumatoid arthritis vaccinated with MMR developed body aches, fever, sore throat, back pain, and arthritic symptoms which were thought to be a recurrence of juvenile rhematoid arthritis. |
|
VAERS ID: |
25820 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 1990-07-16 |
Onset: | 1990-08-05 |
Days after vaccination: | 20 |
Submitted: |
0000-00-00 |
Entered: |
1990-08-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Alanine aminotransferase increased,
Aspartate aminotransferase increased,
Headache,
Hepatitis,
Malaise,
Myalgia,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: SGOT - 182, SGPT elevated and serum alkaline phosphatase was normal. CDC Split Type: WAES90080653
Write-up: Pt vaccinated with MMR on 16JUL90. Subsequently experienced malaise, headache and myalgia and was hospitalized on 5AUG90 for fever and hepattis. Additional details being requested. |
|
VAERS ID: |
25826 (history) |
Form: |
Version 1.0 |
Age: |
5.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1990-08-26 |
Onset: | 1990-08-28 |
Days after vaccination: | 2 |
Submitted: |
1990-08-30 |
Days after onset: | 2 |
Entered: |
1990-09-04 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
271915 / UNK |
RA / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
06962 / 2 |
LA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
00052004 / 5 |
MO / PO |
Administered by: Private Purchased by: Private Symptoms: Cough,
Injection site mass,
Injection site reaction,
Productive cough,
Pyrexia,
Rhinitis,
Vasodilatation SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: URI 1 wk befor by hx reveals after react Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Area around DTP 6cm X 7cm rash w/ hyperthermia elevated fever 101 27AUG90, by 28AUG90 warm soaks, upper arm erythema - cold compress gone by 29AUG90; Cough with clear nasal drainage fever 103.5by 28AUG90. 29AUG90 a febrile cough decreased. |
|