National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 80084

Government Disclaimer on use of this data



Case Details

VAERS ID: 80084 (history)  
Form: Version 1.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:1995-12-01
Onset:1995-12-01
   Days after vaccination:0
Submitted: 1995-12-12
   Days after onset:11
Entered: 1995-12-15
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (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), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
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:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=80084


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166