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This is VAERS ID 28336

Case Details

VAERS ID: 28336 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:1991-01-04
Onset:1991-01-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest pain, Dyspnoea, Electrocardiogram abnormal, Pericardial effusion, Pericarditis, Red blood cell sedimentation rate increased
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), 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: Zantac, ASA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES91020460

Write-up: Pt vax /w Hepatitis B vaccine. Within 2 weeks of vax pt was hospitalized /w pericarditis. Additional info has been requested.


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