|
| VAERS ID: |
25001 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 1990-06-04 |
| Onset: | 1990-06-04 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9Q01042 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown
Symptoms: Agitation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Loud intense cry with screaming for 1 1/2 hrs. Seen next day, child normal. |
|
| VAERS ID: |
25003 (history) |
| Form: |
Version 1.0 |
| Age: |
0.8 |
| Sex: |
Male |
| Location: |
Texas |
| Vaccinated: | 1990-01-29 |
| Onset: | 1990-02-04 |
| Days after vaccination: | 6 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259962 / 4 |
- / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
241950 / 4 |
MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium,
Hypokinesia,
Hypotonia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
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: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations. |
|
| VAERS ID: |
25004 (history) |
| Form: |
Version 1.0 |
| Age: |
0.9 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1989-11-13 |
| Onset: | 1989-11-13 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
232961 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Chills,
Dermatitis contact,
Oedema genital,
Pelvic pain
SMQs:, Angioedema (broad), Hypersensitivity (narrow)
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: 890269201
Write-up: Pt developed chills for approx. 1 hr, felt achy all over, genital area turned red with some swelling, no pain 24 hrs later, now has pain in genital area. Genitals pain, swelling, redness for 8 days. Fever, dematitis contact, rigors |
|
| VAERS ID: |
25005 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| Sex: |
Unknown |
| Location: |
Oklahoma |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
247955 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Arthritis,
Injection site oedema,
Injection site reaction
SMQs:, Systemic lupus erythematosus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), 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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 890277901
Write-up: 7 patients within 2 weeks have reported joint pain & tenderness which radiated up to the shoulder, redness & slight swelling @ injection site, no treatment prescribed, 1 patient is due to visit a neurologist for shoulder. Vaccines routine |
|
| VAERS ID: |
25006 (history) |
| Form: |
Version 1.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 1989-11-17 |
| Onset: | 1989-11-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
247953 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Convulsion,
Dizziness
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: no hx of local or systemic rxns
Allergies:
Diagnostic Lab Data:
CDC Split Type: 890278001
Write-up: 16 yr old female feeling faint & then had seizure within a few min. /p Td/MMR immunization. MD is uncertain if seizure was due to hyperventilation episode. No treatment initiated. Pt asymptomatic. Vaccine given routine |
|
| VAERS ID: |
25007 (history) |
| Form: |
Version 1.0 |
| Age: |
39.0 |
| Sex: |
Unknown |
| Location: |
Oregon |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
229968 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Injection site inflammation,
Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (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: 900005902
Write-up: 2 or 3 patients who received immunization & developed swollen red arm. |
|
| VAERS ID: |
25008 (history) |
| Form: |
Version 1.0 |
| Age: |
75.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 1989-07-05 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
199602 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown
Symptoms: Injection site inflammation,
Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (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: 8901590.01
Write-up: Pt developed an inject site rxn. Aea was erthematous, hard & warm to touch several days /p immunization, treated w/ Benadryl. |
|
| VAERS ID: |
25009 (history) |
| Form: |
Version 1.0 |
| Age: |
3.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 1990-04-05 |
| Onset: | 1990-04-06 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0333P / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Deafness
SMQs:, Hearing impairment (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: recurrent otitis media, measles
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES90030661
Write-up: 15mon. male w/ hx of recurrent ear infections & measles in Feb. 89''. 5Apr89 was given MMR. Within 24 hrs /p vaccine, parents noted hearing deficit, confirmed by physician exam. |
|
| VAERS ID: |
25012 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Sex: |
Male |
| Location: |
Wisconsin |
| Vaccinated: | 1989-10-20 |
| Onset: | 1989-10-23 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
253963 / UNK |
RL / IM |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Hypotonia,
Monoplegia,
Neuropathy
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: xrays of left shoulder, clavicle, humerus & forearm - WNL
CDC Split Type: 890255101
Write-up: 3 days /p immun. infant only able to move fingers of left arm, no tone in arm. Immun. given in Right thigh/buttocks. Mononeuropathy left upper extremity. |
|
| VAERS ID: |
25013 (history) |
| Form: |
Version 1.0 |
| Age: |
0.4 |
| Sex: |
Unknown |
| Location: |
North Dakota |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-07-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown
Symptoms: Erythema multiforme,
Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (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? Yes
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: 8902746.01
Write-up: Pt received DTP/OPV vaccine developed rash in groin area, became wide spread, DX rash, erythema multiforme (E.R. report indicates due to OPV vaccine) At 6 mon. child received DTP w/ no problems. |
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