| VAERS ID: |
133914 (history) |
| Form: |
Version 1.0 |
| Age: |
36.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 1987-03-01 |
| Onset: | 1987-03-12 |
| Days after vaccination: | 11 |
| Submitted: |
2000-02-04 |
| Days after onset: | 4712 |
| Entered: |
2000-02-14 |
| Days after submission: | 10 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / IM |
| MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES |
- / UNK |
UN / SC |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
UN / SC |
| OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
MO / PO |
| TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 3 |
UN / IM |
Administered by: Military Purchased by: Military
Symptoms: Agitation,
Anxiety,
Asthenia,
Colonoscopy,
Dehydration,
Diarrhoea,
Infection,
Myalgia,
Pain,
Pericarditis,
Psychiatric evaluation,
Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (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), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 40 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC Split Type:
Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given. |
