VAERS ID: |
25068 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
Oregon |
Vaccinated: | 1990-01-25 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
585A4 / 3 |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Drug ineffective,
Encephalitis SMQs:, Lack of efficacy/effect (narrow), Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: no hx of allergies Allergies: Diagnostic Lab Data: 10Jan90 titier test - nonresponder, Herpes varicella was recovered from the brain CDC Split Type: EBU900170
Write-up: nonresponder to a previous 3 dose series with MSD vaccine, encephalitis, Herpes varicella recovered from the brain |