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From the 1/14/2022 release of VAERS data:

Found 933 cases where Vaccine is 6VAX-F or ADEN or ADEN_4_7 or ANTH or BCG or CEE or CHOL or DF or DPIPV or DPP or DT or DTAP or DTAPH or DTAPHEPBIP or DTAPIPV or DTAPIPVHIB or DTIPV or DTOX or DTP or DTPHEP or DTPHIB or DTPIHI or DTPIPV or DTPPHIB or DTPPVHBHPB or EBZR or FLU(H1N1) or FLU3 or FLU4 or FLUA3 or FLUA4 or FLUC3 or FLUC4 or FLUN(H1N1) or FLUN3 or FLUN4 or FLUR3 or FLUR4 or FLUX or FLUX(H1N1) or H5N1 or HBHEPB or HBPV or HEP or HEPA or HEPAB or HEPATYP or HIBV or HPV2 or HPV4 or HPV9 or HPVX or IPV or JEV or JEV1 or JEVX or LYME or MEA or MEN or MENB or MENHIB or MER or MM or MMR or MMRV or MNC or MNQ or MNQHIB or MU or MUR or OPV or PER or PLAGUE or PNC or PNC10 or PNC13 or PPV or RAB or RUB or RV or RV1 or RV5 or RVX or SMALL or SSEV or TBE or TD or TDAP or TDAPIPV or TTOX or TYP or UNK or VARCEL or VARZOS or YF and Symptom is Acute endocarditis or Atypical mycobacterium pericarditis or Autoimmune myocarditis or Bacterial pericarditis or Carditis or Endocarditis or Endocarditis bacterial or Endocarditis enterococcal or Endocarditis noninfective or Endocarditis staphylococcal or Endocarditis viral or Eosinophilic myocarditis or Fungal endocarditis or Giant cell myocarditis or Hypersensitivity myocarditis or Immune-mediated myocarditis or Lupus endocarditis or Lyme carditis or Meningococcal carditis or Myocarditis or Myocarditis bacterial or Myocarditis infectious or Myocarditis post infection or Myocarditis septic or Myopericarditis or Pericarditis or Pericarditis constrictive or Pericarditis infective or Pericarditis lupus or Pericarditis meningococcal or Pericarditis rheumatic or Pericarditis tuberculous or Pleuropericarditis or Purulent pericarditis or Streptococcal endocarditis or Subacute endocarditis or Viral myocarditis or Viral pericarditis and Vaccination Date from '1990-01-01' to '2020-11-30'

Government Disclaimer on use of this data

Table

   
Event OutcomeCountPercent
Death9510.18%
Permanent Disability454.82%
Office Visit293.11%
Emergency Room36839.44%
Emergency Doctor/Room596.32%
Hospitalized55058.95%
Hospitalized, Prolonged202.14%
Recovered30933.12%
Life Threatening14415.43%
Not Serious849%
TOTAL† 1,703† 182.53%
† Because some cases have multiple vaccinations and symptoms, a single case can account for multiple entries in this table. This is the reason why the Total Count is greater than 933 (the number of cases found), and the Total Percentage is greater than 100.



Case Details

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VAERS ID: 25611 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-06-29
Onset:1990-06-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Conduction defects (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC Split Type: WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


VAERS ID: 26803 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1990-11-01
Onset:1990-11-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / UNK RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Atrial flutter, Cough, Myalgia, Pericarditis, Pneumonia, Pyrexia, Right ventricular failure
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC Split Type:

Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF.


VAERS ID: 27227 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Female  
Location: Maine  
Vaccinated:1990-11-01
Onset:1990-11-10
   Days after vaccination:9
Submitted: 1990-12-18
   Days after onset:38
Entered: 1990-12-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


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.


VAERS ID: 29812 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Texas  
Vaccinated:1991-03-06
Onset:1991-03-08
   Days after vaccination:2
Submitted: 1991-03-11
   Days after onset:3
Entered: 1991-04-08
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome
SMQs:, Cardiomyopathy (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


VAERS ID: 31288 (history)  
Form: Version 1.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated:1990-05-03
Onset:1990-05-13
   Days after vaccination:10
Submitted: 1991-06-12
   Days after onset:395
Entered: 1991-06-14
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 1987R / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Asthenia, Bradycardia, Dyspnoea, Hypokinesia, Myalgia, Myocarditis, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES91051727

Write-up: Pt experienced fatigue & SOB was hospitalized on 21MAY90 for a wk; tentative dx of viral myocarditis was made; Also experienced arthritic pain;


VAERS ID: 32297 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-04-25
Onset:1991-04-27
   Days after vaccination:2
Submitted: 1991-05-08
   Days after onset:11
Entered: 1991-07-08
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298913 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627K / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cardiomegaly, Cerebral ischaemia, Hepatosplenomegaly, Infection, Myocarditis, Pneumonia, Screaming, Supraventricular tachycardia
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 3MAR91 dx viral synd; 12MAR91 resolved viral synd; nasal congestion;
Allergies:
Diagnostic Lab Data: Autopsy by Hosp
CDC Split Type: TN9194

Write-up: Pt was irritable & cried & cried all day; Ambulance called but not taken to Hosp; Later seen in ER & died; MD states death had to do w/chambers of the heart & mixing of blood Death certificate states cardiac failure;


VAERS ID: 32317 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Michigan  
Vaccinated:1990-12-28
Onset:1991-01-25
   Days after vaccination:28
Submitted: 1991-07-01
   Days after onset:156
Entered: 1991-07-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 2 - / L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EP / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 289935 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Pallor, Pericarditis, Sepsis, Skin discolouration, Tachycardia
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: mild runny nose/well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood Culture - positive for HIB; (Beta lactamase - positive) Bacterial antigen for HIB on pericardial fluid;
CDC Split Type:

Write-up: Admitted 25JAN91 w/H. influenzae type B pericarditis; Pt was pale, tachycardic, mottled & toxic appearing; Required intensive care management including emergent pericardial tap & later pericardial window for drainage of purulent fluids;


VAERS ID: 32499 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-08-20
Onset:1991-01-14
   Days after vaccination:147
Submitted: 1991-04-22
   Days after onset:97
Entered: 1991-07-12
   Days after submission:81
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271954 / 2 - / -

Administered by: Private       Purchased by: Private
Symptoms: Globulins decreased, Immune system disorder, Myocarditis, Paralysis flaccid, Poliomyelitis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 90 days
   Extended hospital stay? No
Previous Vaccinations: Pt exp fever x 24hrs p/2nd dose of OPV @ 3.5mo;~ ()~~~In patient
Other Medications:
Current Illness: Fever x 24hrs p/2nd dose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture bopsy reveals polio type 2;
CDC Split Type: PA91225

Write-up: Pt vaxed w/ 1st & 2nd dose;of DTP/OPV on 29JUN90 &20AUG90 respectively & exp viral myocarditis 14JAN91 admitted to Hosp; Culture biopsy reveals polio type 2, now has flaccid paralysis & graft versus host disease; Dx w/hypogammaglobulinemia;


VAERS ID: 34134 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:1991-05-10
Onset:1991-05-23
   Days after vaccination:13
Submitted: 1991-08-19
   Days after onset:88
Entered: 1991-08-23
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 715A4 / UNK RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthritis, Encephalitis, Guillain-Barre syndrome, Hepatocellular damage, Meningitis, Pericarditis, Serum sickness
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (narrow), Noninfectious meningitis (narrow), Demyelination (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU910754

Write-up: Allergic to Hep vax, appears like rheumatoid arthritis, conjunctivitis, dehydrated, emotional trauma encephalitis like sx, enlarged joints, enlarged lymph glands, face eczema, flat irregular red rash, GI upset, hypoxemia; Detailed see WORM


VAERS ID: 42586 (history)  
Form: Version 1.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:1992-03-25
Onset:1992-04-25
   Days after vaccination:31
Submitted: 1992-06-03
   Days after onset:39
Entered: 1992-06-08
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RUB: RUBELLA (MERUVAX II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Arthritis, Dyspnoea, Leukocytosis, Myalgia, Pericarditis, Pleural effusion, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (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: Proventil inhaler
Current Illness:
Preexisting Conditions: Hodgkin''s disease; postpartum; asthma
Allergies:
Diagnostic Lab Data: culture-neg; Thoracocentesis-revealed an exudate type fluid;WBC count elevated;
CDC Split Type: WAES92050570

Write-up: Pt recvd Rubella vax on 25MAR92 & approx 4 wks p/vax pt exp fever, aches, arthritis, arthralgias, SOB, bilateral pleural effusions, & pericarditis; pt hospitalized; fever;


VAERS ID: 43166 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:1992-05-08
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. K4709 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac failure, Endocarditis, Infection
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-06-13
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: UNK
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: Autopsy planned;
CDC Split Type: WAES92060551

Write-up: Pt recvd MMR vax on 8MAY92 & devel bacterial endocarditis complicated by heart failure & was hospitalized; 13JUN92 pt died due to bacterial endocarditis complicated by heart failure; autopsy is planned;


VAERS ID: 46154 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1992-02-18
Onset:1992-03-16
   Days after vaccination:27
Submitted: 1992-10-02
   Days after onset:199
Entered: 1992-10-13
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 308925 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M5070HJ / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646K / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Bronchitis, Myocarditis, Sudden infant death syndrome
SMQs:, Cardiomyopathy (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-03-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE were performed immed p/vax was given;
CDC Split Type: TX92201

Write-up: no evident signs of reaction post vax; pt died on 16MAR92 was reported a SIDS death;


VAERS ID: 46159 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:1992-09-29
Onset:1992-10-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1992-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M125JD / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 326976 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Myocarditis, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up:


VAERS ID: 46809 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Oregon  
Vaccinated:1992-09-22
Onset:1992-09-27
   Days after vaccination:5
Submitted: 1992-10-02
   Days after onset:5
Entered: 1992-11-09
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316915 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0655A / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Atelectasis, Cardiac failure, Endocarditis, Infection, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-09-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Digoxin, Iron fero-sul, amoxicillin;
Current Illness:
Preexisting Conditions: persistent aortic murmur, s/p aritical aortic stenosis relieved by commisurotomy, anemia-persistent;
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: OR9255

Write-up: No adverse event; probable aortic stenosis-autopsy pending;


VAERS ID: 47087 (history)  
Form: Version 1.0  
Age: 48.0  
Sex: Male  
Location: Connecticut  
Vaccinated:1992-06-23
Onset:1992-06-29
   Days after vaccination:6
Submitted: 1992-11-03
   Days after onset:127
Entered: 1992-11-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Arrhythmia, Pericarditis, Pyrexia, Red blood cell sedimentation rate increased, Ventricular extrasystoles
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: friction rub, echocardiogram, elevated ESR;
CDC Split Type:

Write-up: pericarditis w/fever & arrhythmias (PVC''s) 4 wks duration until complete recovery;


VAERS ID: 47474 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Female  
Location: Maine  
Vaccinated:1992-11-05
Onset:0000-00-00
Submitted: 1992-11-09
Entered: 1992-11-25
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928115 / UNK - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Endocarditis, Influenza, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? Yes
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: hodgkins disease/asplenic
Preexisting Conditions: pt had hodgkins disease & is asplenic;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 892315007E

Write-up: pt recvd flu vax & devel flu-like sx; the following morning pt collapsed & was adm to the hosp; pt is on a respirator & is critically ill;


VAERS ID: 50007 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-02-25
Onset:1992-04-18
   Days after vaccination:53
Submitted: 1992-07-10
   Days after onset:83
Entered: 1993-01-29
   Days after submission:203
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. E0876 / 3 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Laboratory test abnormal, Pericarditis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4228

Write-up: fever & vomiting 1 wk p/receiving 3 doses of vax; dx as pericarditis; 10JUL92 phone f/u w/plasma center indicater tiem of vax was greater than 1.5 mo a/onset of sx;


VAERS ID: 50659 (history)  
Form: Version 1.0  
Age: 57.0  
Sex: Male  
Location: Michigan  
Vaccinated:1992-11-09
Onset:1992-11-16
   Days after vaccination:7
Submitted: 1993-02-19
   Days after onset:95
Entered: 1993-03-10
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928222 / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Blood alkaline phosphatase increased, Endocarditis, Hypochromic anaemia, Hypoproteinaemia, Myalgia, Polyarteritis nodosa, Red blood cell sedimentation rate increased, Vasculitis
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (broad), Interstitial lung disease (broad), Biliary system related investigations, signs and symptoms (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: vasotec
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Hemoglobin 8; Sed rate 130; Albumin-2.1; Aklaline Phos mild elevation; SGOT mile elevation; SGPT mild elevation; cult-sputum, blood, urine; muscle biopsy-necrotizing vasculitis of medium arteries; Immune complexes;
CDC Split Type: 893054003E

Write-up: pt recvd flu vax NOV92 & 1 wk later pt devel a sore throat & cervical lymphadenopathy; 2 wks following vax had fever & chills, & cough; anemic, myalgias;


VAERS ID: 52338 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Colorado  
Vaccinated:1993-03-10
Onset:1993-03-16
   Days after vaccination:6
Submitted: 1993-04-19
   Days after onset:33
Entered: 1993-05-03
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41127 / 1 RL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0891T / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M585JD / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0668M / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Lung disorder, Lymphadenopathy, Pericarditis, Petechiae, Pneumonia, Pulmonary haemorrhage, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (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: CO93030

Write-up: poss SIDS, bronchopneumonio, mild, respiratory, edema & endocarditis;


VAERS ID: 53485 (history)  
Form: Version 1.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:1993-04-30
Onset:1993-05-02
   Days after vaccination:2
Submitted: 1993-05-25
   Days after onset:23
Entered: 1993-06-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1552V / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anxiety, Bronchitis, Cardiomegaly, Dyspnoea, Lung disorder, Myocarditis, Pericardial effusion, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-05-08
   Days after onset: 6
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: on 2MAY93 or 3MAY93 commented of not feeling well; went to ER on 6MAY93 w/cough & sore throat; given Bi-cillin & cough rxn w/Codeine; called in sick to work w/virus on 7MAY93; dec 8MAY93;


VAERS ID: 57317 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: Ohio  
Vaccinated:1993-10-20
Onset:0000-00-00
Submitted: 1993-10-29
Entered: 1993-11-12
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41062 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M01JL / 3 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Infection, Myocarditis, Pneumonia, Spleen disorder
SMQs:, Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH93086

Write-up: unk


VAERS ID: 57571 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Georgia  
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted: 1993-09-28
Entered: 1993-11-22
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-08-14
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


VAERS ID: 58384 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:1993-10-13
Onset:1993-11-29
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41148 / UNK - / IM

Administered by: Military       Purchased by: Military
Symptoms: Endocarditis, Haematemesis, Haemorrhage, Infection, Leukopenia, Lymphadenopathy, Necrosis, Pneumonia
SMQs:, Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: waiting on drug screen
CDC Split Type: CO5196

Write-up: found dead in apartment, no suspicious circumstances. Autopsy results: lymphoma; no known cause of death.


VAERS ID: 58574 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1993-10-01
Onset:1993-10-27
   Days after vaccination:26
Submitted: 1993-12-22
   Days after onset:56
Entered: 1993-12-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Unknown
Symptoms: Antinuclear antibody, Arthralgia, Electrocardiogram abnormal, Pericardial effusion, Pericarditis, Red blood cell sedimentation rate increased
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Arthritis (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: definitively pos ANA, inc ESR-responsing to steroid;
CDC Split Type:

Write-up: arthralgias progressive over 2 wks; dec voltage on ECG; echocardiogram pricardial effusion; tx w/Pred;


VAERS ID: 60237 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-09-30
Onset:1993-10-27
   Days after vaccination:27
Submitted: 1994-02-08
   Days after onset:104
Entered: 1994-03-03
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Chest pain, Infection, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt has a history of ischemic heart diaseas, status post myocardial infarction & coronary artery bypass graft in 1984; had recurrent congestive heart failure, gout, hypothyroidism, & chronic renal insufficiency w/serum creatinine 1.5-2.0;
Allergies:
Diagnostic Lab Data: EKG-ventricular conduction delay (unchanged from usual); Serum creatinine-1.9;
CDC Split Type: 894046010J

Write-up: pt recvd vax 30SEP93 & 4NOV93 presented w/ a wk history of chest discomfort; PE had a new pericardial friction rub; EKG was unchanged; pt was treated w/ASA & improved; reporter states that viral pericarditis was not ruled out in this pt;


VAERS ID: 60238 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-09-24
Onset:1993-11-13
   Days after vaccination:50
Submitted: 1994-02-08
   Days after onset:87
Entered: 1994-03-03
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Blood lactate dehydrogenase increased, Chest pain, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Infection, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG-diffuse ST elevation & PR depression;
CDC Split Type: 894046011J

Write-up: pt recvd vax 24SEP93 & was adm to hosp on 15NOV93 w/a 2 day history of atypical chest pain; PE did not have a pericardial friction rub, but EKG showed sl elevation in the inferior & lateral leads; reporter states viral pericarditis not r/o


VAERS ID: 60239 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1993-10-06
Onset:1993-11-02
   Days after vaccination:27
Submitted: 1994-02-08
   Days after onset:98
Entered: 1994-03-03
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Cardiomegaly, Chest pain, Electrocardiogram ST segment elevation, Electrocardiogram T wave inversion, Electrocardiogram abnormal, Infection, Pericarditis, Pulmonary embolism
SMQs:, Cardiac failure (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of metastic renal cell carcinoma, w/metastasis to the lung, brain, & bones; last course of chemotherapy SEP93 had to be terminated due to lethargy & anorexia;
Allergies:
Diagnostic Lab Data: echocardiogram-no pericardial effusion, mild lt artial enlargement; EKG-diffuse ST elevation & t wave inversion; Thyroid function tests-nl; Renal function Tests-nl;
CDC Split Type: 894046009J

Write-up: pt recvd vax 6OCT93 & adm to hosp 2NOV93 w/c/o pleuritic lt sided chest pain; pericardial friction rub was noted on physical exam; electrocardiogram showed new diffuse ST elevation & t wave inversion; mild EKG changes remained;


VAERS ID: 61685 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:1993-10-04
Onset:1993-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1994-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 3J41146 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd flu vax & devel non-serious self-limiting pericarditis & was adm to hosp;


VAERS ID: 62010 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:1993-08-25
Onset:1993-08-25
   Days after vaccination:0
Submitted: 1994-04-19
   Days after onset:237
Entered: 1994-04-22
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Cardiac failure, Diarrhoea, Hyperventilation, Infection, Myocarditis, Oedema peripheral, Pneumonia, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1993-09-10
   Days after onset: 16
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SEP93 Culture Enterobacter Cloacae
CDC Split Type: WAES94031491

Write-up: Pt recvd vax & 2 hrs later pt''s leg was swollen to the size of a nickel & had a sl fever; pt then developed sl diarrhea & was taken to ER-dehydration; pt vomited; appeared to be in colic-like pain; breathing was rapid & fever 104; bluish


VAERS ID: 62195 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Female  
Location: New Mexico  
Vaccinated:1994-04-01
Onset:1994-04-02
   Days after vaccination:1
Submitted: 1994-04-20
   Days after onset:17
Entered: 1994-04-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0891W / UNK RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Headache, Malaise, Pericarditis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fam hx unknown~ ()~~~In patient
Other Medications: Nordette, Dimetapp;
Current Illness: n/a
Preexisting Conditions: Allergies: iodine dye, Demerol, ASA, Betadine, NSAIDS, Toradol, morphine, sulfa;
Allergies:
Diagnostic Lab Data: EKG nl; ECHO nl; O2 sat nl;
CDC Split Type:

Write-up: 1APR: received vax; APR2 & APR3: fever, malaise, h/a, resolved; 13APR: chest pain, SOB intermit; 14APR to ER w/persistent c/o''s; dx: pericarditis; question of relationship to previous MMR vax; by 17APR94 sxs resolved;


VAERS ID: 62422 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:1993-10-05
Onset:1993-10-08
   Days after vaccination:3
Submitted: 1994-04-29
   Days after onset:203
Entered: 1994-05-03
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Endocarditis, Infection, Influenza
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-24
   Days after onset: 167
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: began having periodic flu like dx 3 days p/vax & cont on & off until pt died; from viral endocarditis;


VAERS ID: 63901 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Georgia  
Vaccinated:1994-03-11
Onset:1994-03-25
   Days after vaccination:14
Submitted: 1994-05-03
   Days after onset:38
Entered: 1994-06-29
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 352915 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0457W / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M015JL / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0699B / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Infection, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-03-25
   Days after onset: 0
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA94049

Write-up: SIDS


VAERS ID: 69234 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Female  
Location: Idaho  
Vaccinated:1994-10-31
Onset:1994-11-01
   Days after vaccination:1
Submitted: 1994-11-02
   Days after onset:1
Entered: 1994-12-05
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4F51165 / 1 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Ear disorder, Infection, Myalgia, Oedema peripheral, Pain, Paraesthesia, Pericarditis, Pneumonia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: drug allergies: codeine, morphine;
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID94067

Write-up: pt recvd vax; next day arm swollen; 2nd day swelling spread to axilla & breast,fingers tingling arm throbbing, painfull to touch axilla area;


VAERS ID: 76136 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1993-11-10
Onset:1993-11-13
   Days after vaccination:3
Submitted: 1995-07-19
   Days after onset:612
Entered: 1995-07-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Back pain, Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Arthritis (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? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: na~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: na
Allergies:
Diagnostic Lab Data: numerous blood tests;
CDC Split Type: NC95077

Write-up: pt recv vax; devel pain in shoulder which in days to come traveled to back then chest; hosp for heart condition; "pericarditis" resulting in disability;


VAERS ID: 77214 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New Jersey  
Vaccinated:1995-08-10
Onset:1995-08-13
   Days after vaccination:3
Submitted: 1995-08-29
   Days after onset:16
Entered: 1995-09-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426149 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1660A2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0727B / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Arrhythmia, Myocarditis
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG, Echocardiopthia
CDC Split Type:

Write-up: myocarditis/arrhythmia occurred 4 days p/vax; admitted to ICU; treated w/pressure support & antiarrhythmics


VAERS ID: 77666 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: North Carolina  
Vaccinated:1995-08-07
Onset:1995-08-30
   Days after vaccination:23
Submitted: 1995-09-05
   Days after onset:6
Entered: 1995-09-26
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4M51065 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1162A / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LD / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0716M / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Haemorrhage, Pericarditis, Petechiae, Pulmonary oedema, Right ventricular failure, Stupor, Sudden infant death syndrome, Vasodilatation
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-08-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: functional heart murmur; hx poor wt gain-resolving
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NC95093

Write-up: was found unresponsive & bleeding out of mouth by mom while both were in bed time approx 3Am as reported by mom;


VAERS ID: 77841 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1995-07-21
Onset:1995-07-24
   Days after vaccination:3
Submitted: 1995-09-27
   Days after onset:65
Entered: 1995-10-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP293 / 5 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1042A / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 717D3 / 4 - / -

Administered by: Private       Purchased by: Public
Symptoms: Carditis, Infection, Pharyngitis, Pyrexia, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal infections (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax 21JUL-synd of fever, red throat; rapid strep positive late in illness; ? mild carditis; ? mild atypical RF


VAERS ID: 78972 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Georgia  
Vaccinated:1995-10-11
Onset:1995-10-18
   Days after vaccination:7
Submitted: 1995-10-24
   Days after onset:6
Entered: 1995-11-16
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0213A / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Adrenal insufficiency, Apnoea, Cardiac arrest, Coagulopathy, Haemorrhage, Meningitis, Myocarditis, Petechiae, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood culture positive Neisseria meningitis
CDC Split Type: GA95179

Write-up: 13OCT95 pt returned for PPD check & was having no problems;18OCT95 woke up vomiting, had elevated temp & weakness;In full arrest on arrival @ ER;deceased;blood culture & preliminary autopsyconfirm meningococcal meningitis


VAERS ID: 81460 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: New Jersey  
Vaccinated:1995-11-06
Onset:1995-11-11
   Days after vaccination:5
Submitted: 1996-01-25
   Days after onset:75
Entered: 1996-01-30
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00785P / 1 - / IM A

Administered by: Private       Purchased by: Other
Symptoms: Atrial fibrillation, Cough, Infection, Pericarditis, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), 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? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: hx of hypercholesterolemia
Allergies:
Diagnostic Lab Data: abn EKG noted
CDC Split Type: 0010150950295

Write-up: pt recvd vax 6NOV95 & 11NOV95 exp fever, cough & dx w/pneumonia 21NOV95;dx w/pericarditis 22NOV95 & hospitalized 2DEC95 w/carditis, pneumonitis & atrial fibrillation


VAERS ID: 85027 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Washington  
Vaccinated:1996-02-26
Onset:1996-02-29
   Days after vaccination:3
Submitted: 1996-03-29
   Days after onset:29
Entered: 1996-04-22
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH - / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Atrial fibrillation, Chest pain, Infection, Influenza, Myocarditis, Pleural effusion, Respiratory disorder, Right ventricular failure
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (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, 19 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Aleve tablets oral conjugated estrogens tablets oral
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR-lt pleural effusion;MI work-up MI ruled out;
CDC Split Type: 896094007L

Write-up: pt recv vax 26FEB96 3 days later devel chest heaviness,cough & shoulder pain;MD dx flu upon returning from a trip on 3MAR96 pt c/o inc resp distress;pt hosp;CXR revealed a large lt-sided pleural effusion;dx myocarditis,pericarditis,CHF


VAERS ID: 87553 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: California  
Vaccinated:1996-01-21
Onset:1996-02-05
   Days after vaccination:15
Submitted: 1996-07-02
   Days after onset:147
Entered: 1996-07-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Face oedema, Hepatocellular damage, Hepatomegaly, Pericardial effusion, Pericarditis, Pyrexia, Rash maculo-papular, Vasculitis
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vasculitis (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: OM, bronchitis;anemia
Allergies:
Diagnostic Lab Data: sed rate elevated
CDC Split Type: WAES96061813

Write-up: pt recv vax 21JAN96 & 5FEB96 pt exp fluid surrounding heart, swollen liver, high fever, sever abd pain, rash red in color like little pin pricks & serious dry skin & was hosp;sx include red swollen lips, t;conjunctivitis;mac pap rash;


VAERS ID: 94662 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: South Carolina  
Vaccinated:1996-12-20
Onset:1996-12-20
   Days after vaccination:0
Submitted: 1996-12-31
   Days after onset:11
Entered: 1997-02-06
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 2 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-12-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


VAERS ID: 97293 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Wisconsin  
Vaccinated:1997-04-23
Onset:1997-04-23
   Days after vaccination:0
Submitted: 1997-04-29
   Days after onset:6
Entered: 1997-05-01
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M035PE / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1002D / UNK RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Cardiomegaly, Dyspnoea, Hyperventilation, Infection, Myocarditis, Paralysis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG, WBC 7.9, CBC, viral titers;
CDC Split Type:

Write-up: 48hr SOB, enlarged heart, tachycardia;dx viral myocarditis;ventilated, intubated, paralyzed; poss cardiac trans;MD feel events temp related;


VAERS ID: 100032 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Male  
Location: New York  
Vaccinated:1996-10-15
Onset:1996-10-30
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 1997-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96111222

Write-up: pt recv vax 15OCT96 & 2wk p/vax pt devel pericarditis;tx w/Indomethacin & became much better;


VAERS ID: 102669 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1996-11-18
Onset:1996-11-24
   Days after vaccination:6
Submitted: 1997-09-23
   Days after onset:302
Entered: 1997-09-25
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 6L71174 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0517D / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M230NB / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 747F6 / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Cardiomegaly, Cardiomyopathy, Hormone level abnormal, Lung disorder, Myocarditis, Renal tubular disorder, Shock, Tachycardia
SMQs:, Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tubulointerstitial diseases (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 120 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: UNKNOWN
Allergies:
Diagnostic Lab Data: 26NOV96 TSH 0.4 low; T4 4.7 low;25NOV96 nasopharyngeal aspirate positive coxcackie group b virus;CXR asymetric;Urine screen amino aciduria;cardiac catheterization;endomyocardial biopsy endocardial fibroelastosis;blood cult negative;
CDC Split Type: WAES97070787

Write-up: pt recv vax 18NOV96 & 24NOV96 pt to ER in clinical shock, w/ tachycardia;diagnostic test echocardiogram revealed mitral regurgitation, poorly thin walled dilated heart;dx viral myocarditis vs congenital cardiomyopathy & pulmonary edema;


VAERS ID: 103382 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Michigan  
Vaccinated:1996-01-01
Onset:1997-07-25
   Days after vaccination:571
Submitted: 1997-10-13
   Days after onset:80
Entered: 1997-10-23
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Brain oedema, Cardiomyopathy, Delirium, Hepatomegaly, Infection, Influenza, Myocarditis, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-07-28
   Days after onset: 3
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:
Allergies:
Diagnostic Lab Data: viral serology echo/coxsackie virus positive;
CDC Split Type: WAES97100278

Write-up: pt recv vax 1996 & 25JUL97 pt exp flu-like sx & was hosp & was dead by 28JUL97;it was reported that the COD was originally thought to be Reye''s synd but it was discovered child had cardiomyopathy (swelling);lab revealed +echovirus


VAERS ID: 106164 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: New York  
Vaccinated:1997-12-08
Onset:1997-12-14
   Days after vaccination:6
Submitted: 1998-01-02
   Days after onset:19
Entered: 1998-01-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0352E / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Blood disorder, Cardiovascular disorder, Dermatitis bullous, Drug ineffective, Endocarditis, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Lack of efficacy/effect (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES97121242

Write-up: pt recv vax 8DEC97 & 14DEC97 pt devel a varicella type rash, greater than 50 lesions w/a gen distribution (15-20 over chest, 15-20 over back, 5 on each arm, 5 on each leg, 8 in diaper area);18DEC97 pt hosp w/staphylococcal bacteremia;


VAERS ID: 107852 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1997-02-19
Onset:1997-03-01
   Days after vaccination:10
Submitted: 1998-02-23
   Days after onset:359
Entered: 1998-02-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Arrhythmia, Brain oedema, Cardiac arrest, Hepatic function abnormal, Hypoxia, Infection, Myocardial fibrosis, Myocarditis
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98012678

Write-up: pt recv vax 24FEB97 & 1MAR97 pt died of a cardiac death;f/u was recv from MD:the autopsy showed myocardial fibrosis, so MD concluded the pt must have had a viral myocarditis;


VAERS ID: 111826 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Ohio  
Vaccinated:1998-05-19
Onset:1998-05-23
   Days after vaccination:4
Submitted: 1998-06-09
   Days after onset:17
Entered: 1998-06-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


VAERS ID: 111980 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1998-05-11
Onset:1998-05-15
   Days after vaccination:4
Submitted: 1998-06-04
   Days after onset:20
Entered: 1998-06-19
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 1 RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC Split Type:

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


VAERS ID: 115028 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Texas  
Vaccinated:1998-09-09
Onset:0000-00-00
Submitted: 1998-10-06
Entered: 1998-10-16
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0939790 / 1 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0112H / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0963420 / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Coronary artery disease, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, Thrombocythaemia, Vasculitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Vasculitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EHCO +enlarged WBC 9.9;ESR 104, coronaries, pl 516;
CDC Split Type:

Write-up: pt presented w/fever w/in hr of vax;hosp 48hr p/onset;eval revealed probable Kawasaki''s disease w/coronary artery enlargement, inc ESR, persistent T, myocarditis resolved w/IVIG/ASA;


VAERS ID: 115171 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:1998-06-09
Onset:1998-06-27
   Days after vaccination:18
Submitted: 1998-10-09
   Days after onset:104
Entered: 1998-10-22
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2513A2 / 1 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0602E / 2 LL / SC
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 451463 / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Cardiovascular disorder, Enteritis, Laboratory test abnormal, Nuchal rigidity, Osteoarthritis, Pericarditis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific inflammation (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (narrow), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? Yes
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: DDAVP
Current Illness: parent denies
Preexisting Conditions: allergic to red dye & bees;
Allergies:
Diagnostic Lab Data: r/o lyme disease & meningitis;
CDC Split Type: OH98071

Write-up: 18 days p/vax pt had T102-104;temp for 4mos, rash, stiff neck, joint swelling & pain (ongoing);hosp;pericarditis in AUG w/abn ECHO regarding two valves;dx systemic juvenile enteritis;


VAERS ID: 115526 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: Georgia  
Vaccinated:1998-10-07
Onset:1998-10-08
   Days after vaccination:1
Submitted: 1998-10-28
   Days after onset:20
Entered: 1998-11-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0906E / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Endocarditis, Infection, Laboratory test abnormal, Lung disorder, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: allergy;hemodialysis;skin graft;
Allergies:
Diagnostic Lab Data: 15OCT98 CXR rt upper lobe infiltrate;blood cult negative;WBC count 10,000;
CDC Split Type: WAES98101444

Write-up: pt recv vax 7OCT98 & 13OCT98 pt to ER w/several day hx of T103;CXR revealed rt upper lobe infiltrate;adm to hosp;cough, myalgia, MD felt had bacterial endocarditis;


VAERS ID: 115913 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Female  
Location: Missouri  
Vaccinated:1998-10-28
Onset:1998-10-28
   Days after vaccination:0
Submitted: 1998-10-30
   Days after onset:2
Entered: 1998-11-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 021198P / 2 - / IM

Administered by: Other       Purchased by: Private
Symptoms: Apnoea, Malaise, Myocarditis, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unk
Preexisting Conditions: allergic to PCN
Allergies:
Diagnostic Lab Data: drug toxicology drawn in ER;
CDC Split Type: FLU89171098

Write-up: pt recv vax 6-8AM & on 28OCT98 pt vomited 10min later felt bad;went home & cont c/o not feeling well next day;drove husband to work & when arrived in parking lot lost consciousness & stopped breathing;


VAERS ID: 120142 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1998-10-20
Onset:1998-11-06
   Days after vaccination:17
Submitted: 1999-03-03
   Days after onset:117
Entered: 1999-03-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 975790 / 2 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Back pain, Chest pain, Collagen disorder, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hay fever
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA9904

Write-up: pt recv vax 20OCT98 & 3MAR99 reported: c/o back pain 6NOV--7NOV w/increasing intensity on 8NOV;c/o chest pain;adm to hosp 9NOV98 w/dx of pericarditis;states MD feels there was a direct correlation between the flu vax & pericarditis;Annual follow-up received on 12/21/00 provides no additional data.


VAERS ID: 120450 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Alabama  
Vaccinated:1999-03-10
Onset:1999-03-13
   Days after vaccination:3
Submitted: 1999-03-18
   Days after onset:5
Entered: 1999-03-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 865A2 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0734E / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 79413 / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 10524 / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Hepatomegaly, Laboratory test abnormal, Lymphadenopathy, Myocarditis, Neoplasm, Pneumonia, Pyrexia, Splenomegaly, Vaginal haemorrhage, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Non-haematological tumours of unspecified malignancy (narrow), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: lt lung culture:Viridans Streptococcus, 2 colonies Candida, Haemophilus, beta lactamase+; rt lung culture: haemophilus, beta lactamase+; Blood culture: Staphylococcus epidermidis
CDC Split Type: AL9904

Write-up: hx of pt arriving in ER in full arrest & expired @ hosp;sl bloody vaginal discharge noted in ER;


VAERS ID: 121576 (history)  
Form: Version 1.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1999-03-24
Onset:1999-04-12
   Days after vaccination:19
Submitted: 1999-04-22
   Days after onset:10
Entered: 1999-04-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM 120B9 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Chest pain, Gastrointestinal disorder, Headache, Hyperlipidaemia, Hypertension, Nausea, Oesophagitis, Pain, Pericarditis, Sleep disorder
SMQs:, Acute pancreatitis (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Lipodystrophy (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec;Ogen;
Current Illness:
Preexisting Conditions: allergic to amoxicillin, allergic to morphine (life-threatening), allergic PCN (rash, hives), allergic to sulfa (life threating), alllergic to xylocaines, back problems, lyme disease x 2, stomach problems;ulcerative colitis;appendectomy;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19990091641

Write-up: 12APR99 pt exp crushing sensation in chest;seen in ER & transferred to another hosp poss heart involved;pt in critical care unit until cardiac catheterization done(neg);pain, h/a, nauseated;sleeps 20 hr day;tests on liver & pancreas neg


VAERS ID: 122256 (history)  
Form: Version 1.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:1998-09-10
Onset:1998-09-21
   Days after vaccination:11
Submitted: 1999-03-30
   Days after onset:190
Entered: 1999-05-20
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2565A4 / 1 - / IM A

Administered by: Unknown       Purchased by: Public
Symptoms: Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Tetracycline 250mg bid x 1year
Current Illness: NONE
Preexisting Conditions: heart murmer @ birth
Allergies:
Diagnostic Lab Data: ECG, CXR both WNL;friction rub on physical
CDC Split Type:

Write-up: 21SEP98 fullness/pain on inspiration;seen in clinic found to have friction rub dx w/pericarditis;


VAERS ID: 126072 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Missouri  
Vaccinated:1998-11-04
Onset:1999-05-24
   Days after vaccination:201
Submitted: 1999-07-15
   Days after onset:52
Entered: 1999-07-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Drug ineffective, Endocarditis, Infection, Pyrexia, Rash maculo-papular, Sepsis
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (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, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99070637

Write-up: approx 6mos p/vax pt exp varicella lesions w/fever & extreme irritability;hosp 5/27/99; dx w/group A streptococcal sepsis & aortic valve endocarditis s/p varicella; Annual follow-up received on 11/27/00 provided no additional data.


VAERS ID: 128065 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1999-06-10
Onset:1999-07-22
   Days after vaccination:42
Submitted: 1999-08-06
   Days after onset:15
Entered: 1999-09-07
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1399H / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Ascites, Coordination abnormal, Coronary artery thrombosis, Ear pain, Encephalitis, Generalised oedema, Headache, Hypertonia, Hypokinesia, Infection, Meningitis, Myalgia, Myocarditis, Neck pain, Neuropathy, Otitis externa, Otitis media, Sepsis, Splenomegaly, Thinking abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-08-01
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MMR & Td in ''98 w/o problem; none
Current Illness: none
Preexisting Conditions: Lorabid & PCN allergies; severe ear infections, usually otitis externa, H/A for many years, controlled w/ ibuprofen; no sz hx
Allergies:
Diagnostic Lab Data: CSF-no growth p/72hr;blood culture-no growth p/48hr; CT-nl; MRI-lt mastoiditis; CSF gram stain smear-mod. segmented WBC-no organisms
CDC Split Type: PA9956

Write-up: pt seen by FMD c/o lt ear pain; dx: otitis externa;7/26 c/o lt ear pain;h/a;off balance;dx OM;tx:Bactrim DS; 7/28-severe h/a,neck pain;difficulty walking;change in mental status,+ Kernig''s sign;hosp;IV Claforan, Vanco, Acyclovir; expired 8/


VAERS ID: 128435 (history)  
Form: Version 1.0  
Age: 39.0  
Sex: Male  
Location: Delaware  
Vaccinated:1999-03-29
Onset:1999-04-07
   Days after vaccination:9
Submitted: 1999-09-15
   Days after onset:161
Entered: 1999-09-23
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER FAV043 / 4 - / -

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Asthenia, Headache, Lung disorder, Myocarditis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Arthritis (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp lung & sinus infect & tired w/anthrax vax #3;~ ()~~~In patient
Other Medications: Claritin;vancenase;Celebrex;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CK, ANA, OCMP ME, RF/RA, CARE PNL;
CDC Split Type:

Write-up: joint pain gradual onset on knee-ongoing;wrist pain (sharp) p/vax;serious lung & sinus infect;required periods of long ATB tx;tired;pt exp myocongestion;low grade fever, h/a since 6/99;pt had systemic rxn;


VAERS ID: 128585 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:1999-09-15
Onset:1999-09-16
   Days after vaccination:1
Submitted: 1999-09-21
   Days after onset:5
Entered: 1999-09-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0063AA / UNK LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Carditis, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: lt arm redness & itchy;tender;


VAERS ID: 129134 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Virginia  
Vaccinated:1999-09-09
Onset:1999-09-29
   Days after vaccination:20
Submitted: 1999-10-04
   Days after onset:5
Entered: 1999-10-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-09-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC Split Type:

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


VAERS ID: 129444 (history)  
Form: Version 1.0  
Age: 28.0  
Sex: Male  
Location: Delaware  
Vaccinated:1999-05-03
Onset:1999-05-10
   Days after vaccination:7
Submitted: 1999-10-07
   Days after onset:150
Entered: 1999-10-18
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 4 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Abscess, Cellulitis, Endocarditis, Infection
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: IPPD test 6/23/99
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt seen by Md for perirectal abscess, placed on ATB;saw MD on 7/9/99 for mult abscess;hosp on that date;determined that infect had spread to heart, hosp;IV ATB for 5wk;dx cellulitis, endocarditis, perirectal abscess;


VAERS ID: 130907 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1999-10-18
Onset:1999-10-20
   Days after vaccination:2
Submitted: 1999-10-29
   Days after onset:9
Entered: 1999-11-18
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0132AA / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Collagen disorder, Pericarditis, Pleural disorder
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR, echocardiagram;EKG
CDC Split Type: NC99088

Write-up: pt seen 1sx w/pericarditis, pruritus & costochondritis;ER visit x 2 10/21/99;MD visit 10/22/99;


VAERS ID: 131697 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1999-09-13
Onset:1999-09-20
   Days after vaccination:7
Submitted: 1999-11-18
   Days after onset:59
Entered: 1999-12-02
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV037 / 1 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Atrial fibrillation, Cardiomyopathy, Cardiovascular disorder, Electrocardiogram abnormal, Hypokinesia, Laboratory test abnormal, Myocarditis, Rash maculo-papular, Rash pustular
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 10/22/99 EKG-rapid afib;10/29/99 MUGA-EF 53%/WL wall motor;10/23/99 ECHO mild dilated Cm/EF approx 40%/global hypokinesia;
CDC Split Type:

Write-up: p/vax 1wk later the appearance of macular-papular rash w/pustules ro rt inner thighs-self-limited x 1wk;did not seek medical attention;10/22/99 adm to hosp w/atrial fibrillation & probable myocarditis dilated cardiomyopathy;


VAERS ID: 132620 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Washington  
Vaccinated:1999-10-25
Onset:1999-11-22
   Days after vaccination:28
Submitted: 1999-12-10
   Days after onset:18
Entered: 1999-12-20
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 46130 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. U0130AA / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Pericarditis, Pleural disorder, Rheumatoid arthritis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Solumedrol,Prednisone
Current Illness: NONE
Preexisting Conditions: Systemic onset juvenile rheumoatoid arthritis
Allergies:
Diagnostic Lab Data: Blood tests, chest xray
CDC Split Type:

Write-up: 1 mon after vax pt had major flare & systemic onset juvenile rheumatoid arthritis w/ pleuritis & pericarditis requiring corticosteroid treatment.


VAERS ID: 152330 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Connecticut  
Vaccinated:1999-06-08
Onset:1999-07-15
   Days after vaccination:37
Submitted: 2000-05-23
   Days after onset:313
Entered: 2000-05-25
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Influenza like illness, Pericarditis, Viral infection
SMQs:, Systemic lupus erythematosus (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: allergies
Allergies:
Diagnostic Lab Data: Chest X-ray revealed fluid around heart and lower portion of lungs.
CDC Split Type: 20000142031

Write-up: On approximately, 7/15/1999, the vaccinee began to experience flu-like symptoms. In early August, 1999, it was "obvious" to the reporter that her husband''s illness was "more serious than (the reporter and her husband) had thought." The vaccinee called his physician and was advised to have an immediate chest x-ray. When the physician compared it to the previous one of 2 years earlier, it was "obvious that something was wrong", as there was "fluid around his heart and at the lower porion of his lungs." He was hospitalized on 8/11/99 and released on 8/14/99. Cardiologist dx''d the pt as having pericarditis due to a viral infection. The vaccinee has been reportedly advised to forego the third dose of Lymerix. The most recent information, received on 5/15/2000, reports the condition of the vaccinee as unknown.


VAERS ID: 153870 (history)  
Form: Version 1.0  
Age: 31.0  
Sex: Male  
Location: Iowa  
Vaccinated:2000-05-15
Onset:2000-05-17
   Days after vaccination:2
Submitted: 2000-05-22
   Days after onset:5
Entered: 2000-06-09
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4988032 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest pain, Fatigue, Influenza like illness, Laboratory test abnormal, Myocarditis, Nausea, Pain in jaw, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Osteonecrosis (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:
Other Medications: Ointment to foot
Current Illness: wound on foot
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Trop 26.8 on 5/20/2000; 21.9 on 5/19.... Myoglobin 185 on 5/19, Cardiac Cath on 5/22/2000 showed normal coronaries.
CDC Split Type:

Write-up: Two days, post vax, complained of flu-like symtoms, fatigue, nausea, low grade fever and on 5/19/2000 pt experienced chest discomfort substernal and radiating to jaw. Rated 4/10. Dx Myocarditis.


VAERS ID: 165708 (history)  
Form: Version 1.0  
Age: 8.0  
Sex: Male  
Location: New York  
Vaccinated:2001-01-26
Onset:2001-01-26
   Days after vaccination:0
Submitted: 2001-01-29
   Days after onset:3
Entered: 2001-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1475K / 3 - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Myocarditis, Pyrexia, Upper respiratory tract infection, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-01-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI, ? Viral.
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC; BMP MG PHOS were to be done that day
CDC Split Type:

Write-up: Autopsy pending = Final cause of death. Most likely acute myocarditis. Questionable viral awaiting final culture results. Child has mild temperature 100., and URI. Autopsy states cause of death as myocarditis.


VAERS ID: 165631 (history)  
Form: Version 1.0  
Age: 0.9  
Sex: Male  
Location: Wisconsin  
Vaccinated:1999-04-05
Onset:0000-00-00
Submitted: 2001-02-05
Entered: 2001-02-07
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 888A2 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Brain oedema, Influenza like illness, Myocarditis, Viral infection
SMQs:, Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: 20010027841

Write-up: Report 20010027841 describes acute viral myocarditis and diffuse brain swelling in an 11 month old male. This report was received from an attorney, and the attorney''s "medical expert", and has not been verified by a physician or other health professional. The vaccinee and his family had no history of drug allergies or vaccine reactions. The vaccinee was healthy with no prior or current illness. He was taking no medications except for the vaccines listed below. On 04/05/1999, the vaccinee received vaccinations of IPV OPV, and Hib (reportedly non-Smithkline Beecham products) in addition to Infanrix. On 04/05/1999, the vaccinee received the unspecified dose of Infanrix. At an unspecified time thereafter, the vaccinee developed flu-like symptoms (nos). His symptoms worsened, and he was transported to the hospital on 04/11/1999. During transport, the vaccine "coded" and could not be resuscitated. He was pronounced dead on arrival at the hospital. An autopsy revealed acute myocarditis and diffuse brain swelling. Reportedly, post-mortem viral titers were "uninformative" (nos). The reporter indicated that he believed that the events were most likely related to the OPV / IPV vaccinations, and not to Infanrix. Cause of death given as acute viral myocarditis. Also, there was brain swelling.


VAERS ID: 166188 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Female  
Location: Kansas  
Vaccinated:2000-11-21
Onset:2000-11-23
   Days after vaccination:2
Submitted: 2001-02-20
   Days after onset:89
Entered: 2001-02-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0414BB / 2 - / IM

Administered by: Other       Purchased by: Private
Symptoms: Back pain, Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Desogen
Current Illness: NONE
Preexisting Conditions: Allergy to Biaxin
Allergies:
Diagnostic Lab Data: Echocardiogram; CAT Scan of chest; Chest X-ray; CBC; Lupus test
CDC Split Type:

Write-up: Approx. 2 days, post vax, the pt reached down to pick up child and felt a popping sensation. Resulted in pericarditis possibly. Fluid between lung and chest wall (left). Signs and symptoms continued: Hurts when you supine. Placed on steroids and Vioxx. Pain through my rib cage on left side. Amoxicillin on 2/20/01.


VAERS ID: 172888 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Illinois  
Vaccinated:2001-06-05
Onset:2001-06-15
   Days after vaccination:10
Submitted: 2001-06-16
   Days after onset:1
Entered: 2001-07-05
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 984A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1851K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T04852 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 479792 / 1 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-06-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The baby was found dead in the crib. Autopsy report states death due to myocarditis.


VAERS ID: 177306 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:1999-08-07
Onset:1999-10-14
   Days after vaccination:68
Submitted: 2001-10-24
   Days after onset:741
Entered: 2001-11-07
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV037 / 3 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Adrenocortical insufficiency chronic, Cardiac arrest, Chest pain, Coma, Hypothyroidism, Immune system disorder, Menopause, Obesity, Pericardial effusion, Pericarditis, Pneumonia, Renal failure
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydrocortisone; Florinef Acetate; Levothyroxine; Colchicine; vitamins; calcium; Prednisone; Vicodin
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Too many to list
CDC Split Type:

Write-up: On 10/14/99, I woke up feeling horrible with heaviness in my chest and pain when breathing. That afternoon I was taken by EMS to the ER and was examined and released with a dx of pneumonia and was given prescriptions for Biaxin and Vicodin. The next day, 10/15/99, I felt worse and again was taken by EMS to the ER and within hours of arrival at the hospital, my heart stopped. I had a pericardial effusion (tamponade). My heart stopped 3 X, once for 20 minutes. My kidneys failed and I went into a coma. My parents came to the hospital and they were told that I was most likely going to die. My family and friends prepared themselves for my death. I spent a total of 3 weeks in the hospital, much of it in ICU, experiencing a myriad of heart problems, kidney dialysis and miscellaneous invasive procedures. After release from the hospital, I did not get better. I was re-admitted to the same hospital on 11/18/99. After 4 days of testing, I was dx''d with Addison''s Disease and Hypothyroidism. When I received the medication for these conditions, I felt better and went home. I was off of work from mid 10/99 until 1/00. On 1/21/00, I again felt heaviness in my chest and went to ER. I was immediately admitted and surgery was later performed. I had a pericardial window and 600cc of fluid drained. I missed more work. On 3/13/00, I went to ER and was dx''d with pericarditis, although there was no fluid build up due to the pericardial window. From 3/00 to present, I have had recurrent pericarditis. It occurs regularly and is very painful. I now have 3 autoimmune conditions that I did not have prior to receipt of the anthrax vaccinations. My Rheumatologist is considering putting me on Methotrexate, as well, for Prednisone sparing purposes. I have gained 50 pounds and am quite obese as a result of the continuous steroid use. I am experiencing early onset menopause due to my endocrine problems. The annual follow up states that, "I will have autoimmune problems for the rest of my life as a result of these vaccinations: Addison''s disease, autoimmune hypothyroidism and recurrent pericarditis. I had none of these conditions prior to the anthrax shots. My life expectancy has been shortened."


VAERS ID: 177908 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2001-10-19
Onset:2001-11-13
   Days after vaccination:25
Submitted: 2001-11-13
   Days after onset:0
Entered: 2001-11-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0672AA / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Blood creatinine increased, Cardiac disorder, Cardiac failure, Cardiac failure congestive, Cardiomyopathy, Myocarditis, Viral infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Retroperitoneal fibrosis (broad), Cardiomyopathy (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (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:
Other Medications:
Current Illness:
Preexisting Conditions: Kidney stones, penicillin allergy, hypertension
Allergies:
Diagnostic Lab Data: ECHO: left ventricle markedly dilated with severe diffuse hypokinesia and an ejection fraction of less than 20%; blood cultures: neg; BUN/SCr: 19/2.0; left heart cath: left ventricular dysfunction with dilated cardiomyopathy
CDC Split Type:

Write-up: Pt was admitted to hospital with symptoms of congestive heart failure. Pt was normally in excellent health. Cardiologist''s diagnosis was active viral myocarditis.


VAERS ID: 182920 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Jersey  
Vaccinated:2002-03-04
Onset:2002-03-14
   Days after vaccination:10
Submitted: 2002-03-27
   Days after onset:13
Entered: 2002-03-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0542BA / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1510L / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA658AA / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR U0425 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484856 / 2 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bacterial infection, Coma, Myocarditis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-03-14
   Days after onset: 0
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: Cultures are submitted of blood and cerebrospinal fluid. Antigen test for respiratory syncytial virus was performed and was positive.
CDC Split Type:

Write-up: The pt received a 2nd dose of immunizations on 3/4/02 and passed away on 3/14/02. The infant was found unresponsive at his residence. The cause of death is still pending. Per F/U 4/24/02 autopsy; COD-myocarditis.


VAERS ID: 183217 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2001-10-16
Onset:0000-00-00
Submitted: 2002-04-05
Entered: 2002-04-08
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Bacterial infection, Cough, Endocarditis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: Mitral valve regurgitation; mitral valve prolapse; rheumatic fever
Allergies:
Diagnostic Lab Data: On 3/19/02 an ECG-showed similar results to the one done in February, which showed bacterial endocarditis of the mitral valve.
CDC Split Type: A0363652A

Write-up: This report refers to a 42 year old female with a medical history of mitral valve prolapse since she was ver young, possibly a result of rheumatic fever. Now she has a prolapse with regurgitation. The pt has yearly echocardiograms, which now show slight thickening on the mitral valve leaflets. There were no concomitant medications reported. The subject received the first doses of havrix and Engerix-B on 09/18/2001. She received the second dose of Engerix-B on 10/16/2001. The subject complained of increasing fever and cough that lasted "for months." On 02/04/2002, the subject had blood cultures drawn which, as reported by the pt, grew streptococcus viridans. She was admitted to the hospital on 02/07/2002 for treatment with intravenous gentamycin and vancomycin. She was discharged on 02/11/2002 on oral ceftriaxone sodium. The subject''s symptoms returned and she was readmitted on 02/21/2002 for treatment with vancomycin. She was diagnosed with bacterial endocarditis of the mitral valve. She was discharged on 02/25/2002. As of 03/14/2002, the event was reported as ongoing. An echocardiogram done on 03/19/2002 showed similar results to the one done in February, which showed bacterial endocarditis of the mitral valve. The investigator reported the vaccine possibly contributed. He clarified that there was no direct evidence for vaccine or vaccine administration as the cause of endocarditis, yet a possibility exists that the injection seeded the bloodstream in a person with preexisting mitral regurgitation. He could think of no way, short of contamination, to implicate the vaccine.


VAERS ID: 187034 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2000-03-18
Onset:2000-03-28
   Days after vaccination:10
Submitted: 2002-06-24
   Days after onset:817
Entered: 2002-06-28
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV031 / 4 RA / SC

Administered by: Military       Purchased by: Military
Symptoms: Antinuclear antibody positive, Anxiety, Arthralgia, Autoimmune disorder, Depression, Fatigue, Influenza like illness, Injection site nodule, Insomnia, Mouth ulceration, Myalgia, Pericarditis, Pharyngolaryngeal pain, Systemic lupus erythematosus
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to shellfish; seasona lenvironmental (grasses, dust)
Allergies:
Diagnostic Lab Data: ANA-positive 1:320 with speckled pattern
CDC Split Type:

Write-up: Flu-like sx and nodules at injection site post each of 4 anthrax shots. Extreme fatigue, joint pain, muscle pain, pericarditis (that progressed today) post #4 anthrax. Dx with lupus in 2001. In July 2001 pt sought treatment with rheumatologist. His ANA came back as positive with a speckled pattern and he was diagnosed with autoimmune and connective tissue disorder. he was prescribed Flexeril and Celebrex and a decrease in prednisone to 40mg. The Celebrex did not provide relief. Pt also was experiencing a sore throaat and palatal ulcers. He was treated with antibiotics but the symptoms did not resolved. Within few weeks the throat pain reduced but never subsided. The pail will increase on the left side when he has a flare up of symptoms. Shortly after discovering his inability to return to either job he began experiencing sleeplessness, depression and anxiety. Ambien was prescribed for his sleeplessness and he was able to sleep thee full hours per night and awaken feeling rested. Through October and November he was still depressed and the pain had progressed to the point where he could only walk a few days without being exhausted. He began taking Xanax and weaning off Prednisone and stopped taking Ambien. He was officially diagnosed wtih Systemic Lupus Erythematosus in November. He began taking Plaquenil and continued to wean off Prednisone.


VAERS ID: 189239 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2001-01-17
Onset:2002-03-07
   Days after vaccination:414
Submitted: 2002-08-21
   Days after onset:166
Entered: 2002-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER NOT REPORTED / 1 - / -

Administered by: Public       Purchased by: Unknown
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-03-15
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho-TriCyclen
Current Illness: none
Preexisting Conditions: Mitral Valve Prolapse
Allergies:
Diagnostic Lab Data: no etiology discovered
CDC Split Type:

Write-up: myocarditis


VAERS ID: 189877 (history)  
Form: Version 1.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2000-08-01
Onset:2001-02-01
   Days after vaccination:184
Submitted: 2002-09-06
   Days after onset:581
Entered: 2002-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Arthritis, Asthenia, Atrioventricular block, Cardiac valve disease, Carditis, Delirium, Fatigue, Oedema, Thyroid disorder, Thyroiditis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Conduction defects (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving LymeRix Vaccine, I first had flu like symptoms, then I was affected neurologically and hospitalized for a week. Then arthritis set in with extreme fatigue and weakness. Periodic swollen glands and always feeling ill, as though I never got over the flu. Then, my heart started to beat irregularly. I was diagnosed with heart block and eventually had to have a permanent pace maker. Every symptom I got was the same as though I had lymes disease, without having the disease it self. I feel the Lymerix vaccine caused all these symptoms. I still suffer with arthritis, especially in my knees, and the fact that my heart is now damaged has me very concerned. Per 60 day follow up: Pt has not recovered. Now have a permanent heart block, pace maker implant and has developed mytral vavle regurgatation. Pt may possibly need a vavle replacement in the future.


VAERS ID: 194506 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2002-11-06
Onset:2002-11-09
   Days after vaccination:3
Submitted: 2002-12-02
   Days after onset:23
Entered: 2002-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER F31202GA / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR N/A / 2 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Blood pressure decreased, Cardiomegaly, Cough, Heart rate increased, Hepatomegaly, Influenza like illness, Myocarditis, Pain, Pyrexia, Renal failure, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Flu Like, nausea, sinus, diahrea, coughing up flem.
Preexisting Conditions: n/a
Allergies:
Diagnostic Lab Data: heart biopsy 11/15. various blood and labs done throughout hospital stay.
CDC Split Type:

Write-up: Given Td/Influenza (same syringe)on 11/6, already had flu like symptoms at time of vacination. 11/9 showed increased signs of flu like symptoms, pain in neck and chest. 11/10 began vomiting, complained of chest pain rapid heart beat, had fever. 11/11 was given antibiotics at job corp center and sent home w/complaints of chest pain and coughing up green and black "stuff". Continued to vomit thru 11/12, had appointment to go to private doctor on 11/13. 11/13 0500 am collapsed. Taken to emergency room. BP low and continued to decrease. Showed enlarged heart and liver, kidneys shutting down. Dignosed with myocarditus, inflamation of heart muscle. Placed on ventilator for three days. Survived illness at this point heart functioning at 30%. Continued treatment indefinite at this point in time.


VAERS ID: 197378 (history)  
Form: Version 1.0  
Age: 26.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2003-01-25
Onset:2003-02-05
   Days after vaccination:11
Submitted: 2003-02-06
   Days after onset:1
Entered: 2003-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 RA / SC

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Headache, Lymphadenopathy, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 25 JAN 03 patient RECEIVED A DIRECTED SMALLPOX IMMUNIZATION. ON 2 FEB 03 HE EXPERIENCED SWOLLEN GLANDS IN HIS NECK AND SEVERE HEADACHE. ON 5 fEB 03 AT 5:30 A.M. patient TRANSPORTED HIMSELF TO THE EMERGENCY ROOM WITH A COMPLAINT OF CHEST PAIN. HOSPITALIZATION THRU 7 FEB 03 FOLLOWED. INDIVIDUAL WAS Dx WITH PRESUMPTIVE VACCINIA MYOCARDITIS.


VAERS ID: 198189 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: Georgia  
Vaccinated:2003-02-05
Onset:2003-02-13
   Days after vaccination:8
Submitted: 2003-02-23
   Days after onset:10
Entered: 2003-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 - / -

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Laboratory test abnormal, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cardiac enzymes elevated
CDC Split Type:

Write-up: Developed chest pain, found to have elevated cardiac enzymes, ECG-myocarditis, echocardiogram-normal, pain relieved by NSAIDs. Discharge diagnosis: Myo-pericarditis. Returned to duty


VAERS ID: 198190 (history)  
Form: Version 1.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2003-02-01
Onset:2003-02-08
   Days after vaccination:7
Submitted: 2003-02-23
   Days after onset:15
Entered: 2003-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 - / -

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Dyspnoea, Laboratory test abnormal, Myalgia, Myocarditis, Pleuritic pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Cardiac enzymes elevated
CDC Split Type:

Write-up: Fever 101, myalgia, chest pain. Next day pleuritic chest pain, shortness of breath; cardiac enzymes elevated, ECG normal. Diagnosis: myocarditis. MUGA normal ejection fraction. Returned to duty with followup ECG scheduled.


VAERS ID: 198312 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2003-02-13
Onset:2003-02-20
   Days after vaccination:7
Submitted: 2003-02-24
   Days after onset:4
Entered: 2003-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 - / -

Administered by: Military       Purchased by: Unknown
Symptoms: Arthralgia, Chest pain, Dyspnoea, Myalgia, Myocarditis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No formal reports available
CDC Split Type:

Write-up: Vaccine given 13 feb per pt. one week later developed severe joint and muscle aches as well as pleuritic chest pains and fever. By 23 Feb - sx''s intolerable and pt presented for evaluation at local emergency room. Per pt, eval consisted of blood work and CXR. Treated for systemic rxn to vaccine with vicodin. The 60 day follow up states dyspnea on exertion and chest painf rom slowly resolving peri/myocarditis.


VAERS ID: 198576 (history)  
Form: Version 1.0  
Age: 20.0  
Sex: Male  
Location: Georgia  
Vaccinated:2003-02-05
Onset:2003-02-13
   Days after vaccination:8
Submitted: 2003-02-20
   Days after onset:7
Entered: 2003-02-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0957AA / 4 - / IM
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 - / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR U1203 / 2 - / IM

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Motrin
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Echocardiogram, Cardiac enzymes, EKG''s
CDC Split Type:

Write-up: Patient presented to emergency room with chief complaint of chest pain. MI ruled out diagnosis of myocarditis associated with smallpox vaccination 2/5/03. Patient was initially admitted to cardiac ICU, but then discharged to home in stable condition on 2/16/03. Echo normal. Patient will be followed up in 2 weeks by doctor.


VAERS ID: 198764 (history)  
Form: Version 1.0  
Age: 28.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1999-05-13
Onset:1999-06-02
   Days after vaccination:20
Submitted: 2005-01-25
   Days after onset:2064
Entered: 2003-03-04
   Days after submission:693
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / GLAXOSMITHKLINE BIOLOGICALS 120D2 / 2 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Alanine aminotransferase increased, Arthralgia, Aspartate aminotransferase increased, Back pain, Bacterial infection, Blood bilirubin increased, Cardiac disorder, Chest pain, Fatigue, Herpes simplex, Lymphadenopathy, Lymphopenia, Malaise, Myalgia, Odynophagia, Pericarditis, Pharyngolaryngeal pain, Postnasal drip, Pruritus, Pyrexia, Rash morbilliform, Red blood cell sedimentation rate increased, Sepsis, Tachycardia, Tonsillitis, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Loratadine; Fosinopril sodium; Tretinoin; Ranitidine hydrochloride; Simvastatin
Current Illness: UNK
Preexisting Conditions: Acne; allergic rhinitis, asthma; bursitis; cubital tunnel syndrome; hypercholesterolemia; URI; Family history was significant for unspecified arthritis, hypertension and breast cancer in the patient''s mother; stroke with no residual symptoms in patient''s father.
Allergies:
Diagnostic Lab Data: ESR-71mm/hr increased 7/99; Endo-myocardial biopsy-no evidence of myocarditis, just changes consistent with ischemia; ALT on 7/19/99-68 IU/L (high); AST on 7/19/99-103 IU/L (high); Bilirubin total-2.30mg/dL (high); Blood lymphcytes-818 cells/cu mm (low); WBC-14,100 cells/cu mm (high) 7/18/99 Alanina aminotransferase 19Jul1999 68IU/L 10 low normal, 40 high normal;Antinuclear antibody 16Jul1999 negative;Antistreptolymin antibodies 18Jul1999 1:100;Antistreptolysin antibodies 06Aug1999 218IU/ml <200;Aspartate aminotransferase 19Jul1999 103U/L 10 low normal, 42 high normal;Bilirubin direct 19Jul1999 1.10mg/dl 0.0 low normal, 1.0 high normal;Bilirubin total 19Jul1999 2.10mg/dl 0.2 low normal, 1.0 high normal;C-reactive protein 20Jul1999 325.0mg/dl 0.08 low normal, 0.8 high normal;CK-MB 19Jul1999 49.9U/L low normal 0, high normal 6;CK-MB 20Jul1999 40.3U/L o low normal, 6 high normal;DNA Antibody (DS) 06Aug1999 <10 low normal <10;Erythrocye Sedimentation Rate 06Aug1999 8.00mm/hr;Erythrocyte Sedimentation rate Jul1999 71mm/hr;HLA-DR4 25May2001 negative;Lymphocytes, Blood 16Jul1999 818cells/cu mm 1050 low normal, 1500 high normal;Rheumatoid factor 16Jul1999 < 20IU/mL o low normal, 20 high normal;White Blood Cell Coutn 16Jul1999 14100cells/cu cm 4500 low normal, 11500 high normal;White Blood Cell count 16Jul1999 9200 cells/cu mm 3900 low normal, 10600 high normal. Lyme total antibodies, 16 July 1999: 1.60 L.I.V. (Reference range 0.00-0.90). Lyme IgG Western blot, 16 Julu 1999: Negative, 30 kD band present. Lyme IgM Western blot, 16 July 1999: Negative, 41 kD band present. Infectious mononeucleosis, 19 July 1999: Negative. Mycoplasma pneumoniae IgG, 19 July 1999: 1.40 (Reference range, < 1.10). Mycoplasma pneumoniae IgM, 19 July 1999: < 1.10 (Reference range < 1.10). 19 July 1999: portable chest x-ray revealed slightly enlarged heart. Mild elevation of right hemidiaphragm noted. The impression was that the patient had mild congestive heart failure. CKMB index was 5.6% (normal less than 2.5%). 19 July 1999: Echocardiogram showed moderate to severe global left ventricular syatolic dysfunction with mild left ventricular dilatation; mild left ventricular hypertrophy; trace mitral regurgitation; 1+ tricuspid regurgitation suggesting at bent mild pulmoonary hypertension, small pericardial effusion. 20 July 1999: CKMB index was elevated at 5.2%. 21 July 1999: Nuclear MUGA study of heart revealed moderate left ventricular dysfunction with diffuse hypokinesis (Ejection fraciton 40%). Mild right ventricular dysfunction with diffuse hypokinesis note (ejection fraction 35%). Gated wall motion study showed bilateral ventricular englargement. Biopsy of endomyocardium revealed mild edema, focal hemorrhage and some ischemic changes in myofibers. Rare histiocytes and lymphocytes noted aound vessls. Pathogenesis was unclear. Slides sent for consult,. No other information provided. 06 August 1999: Echocardiogram showed that left atrium and left ventricle were at upper limits of normal. Ejection fraction of 40%. Septal hypokinesis noted. No pericardial effusion noted. Doppler study showed no aortic insufficiency, mitral or tricuspid regurgitation. 27 August 1999: Gated wall motion study was within normal limits. It revealed left ventricular ejection fraction of 63% and right ventricular ejection fraction of 47%. This showed considerable improvement since the 21 January 1999 gate wall motion study. Lyme total antibodies, 06 August 1999: 1.65 L.I.V. (Reference range 0.00-0.99). Lyme IgG Western blot, 06 August 1999: Negative, 30 kD band present. Lyme IgM Western blot, 06 August 1999: Negative, 41 kD band present. Echocardiogram, 05 October 1999: Mild to moderate global left ventricular systolic dysfunction. Ejection fraction was 40.45%, improved from the 25-35% ejection fraction of the 19 Julu 1999 echocardiogram. Echocardiogram, 05 Apil 2000: Mild left ventricular dilatation with moderate global left ventricular systolic dysfunction. The ejection fractin (35-45%) was "essentially unchanged" from the 05 October 1999 echocardiogram, "Trace mitral and 1+ tricuspid regurgitation were unchanged from 05 October 1999 echocardiogram. Echocardiogram, 16 October 2000: Mild global left ventricular systolic dysfunction. The ejection fraction appears subjectively improved (value 40-50%) since 05 April 2000 echocardiogram at which time the estimated ejection fraction ws 35-45%. Trace mitral regurgitation into a normally sized left atrium. 1+ tricuspid and trace pulmonic insufficiency but no evidence of advanced pulmory hypertension noted. Echocardiogram, 18 April 2001: Mild global left ventricular systolic dsyfunction. No substantial change since echocardiogram performed 14 October 2001. Trace mitral and tricuspid regurgitation of doubtful clinical significance. Lyme total antibodies 17 October 2001: 0.92 L.I.V. (Reference range 0.00-0.99) Echocardiogram, 17 October 2001: Normal to mild global left ventricular systolic dysfunction. Minor subjective improvement since echocardiogram performed 18 April 2001. Trace mitral and tricuspid regurgitation of doubtful clinical or hemodynamic signifiance. Lyme total antibodies, 17 May 2003: 0.56 L.I.V. (Reference range, 0.00-0.99). Echnocardiogram, May 2003: "Final Impression" 1. Normal to mild left ventricular systolic dysfunction. The septum appears mildly hypokinetic. 2. Mild left ventricular dilatation. 3. Trace mitral regurgitation into a normally sized left atrium. 4. Trace tricuspid regurgitation which is of doubtful clinical significance." Gated cardiac SPECT, 03 June 2003: "Normal. EF (ejectin fraction) 47%."
CDC Split Type: A0381929A

Write-up: Report A0381929A describes joint pain in a 27 year old male who received Lyme disease vaccine recombinant OapA (Lymerix). This report was received as part of litigation proceedings, with forwarding of medical records. The patient''s medical history included hypercholesterolemia, childhood asthma, allergic rhinitis, upper respiratory tract infection, right shoulder bursitis, right cubital tunnel syndrome, and acne. The subject had no known drug allergies. Family history was significant for unspecified arthritis, hypertension, and breast cancer in the patient''s mother, stroke in the patient''s father. Concurrent medications included loratadine (Claritin), Fosinopril (Monopril), simvastatin (Zocor), and topical tretinoin (Retin-A). The subject received injections of Lymerix on 4/6/99 (LY120D9) and 5/13/99 (LY120D2). In a Statement of Injuries, his attorney alleged that the subject "suffers from joint pain, loss of breath and fatigue. These symptoms required hospitalization. He also experienced a rash". The following information was obtained from medical records. The subject presented to the vaccine provider on 6/3/99. He reported a 2 day history of sore throat, head congestion, feeling "hot/cold", odynophagia, cough productive of white sputum and post-nasal drip. The subject reported that he had experienced fatigue, malaise, fever and chills the previous night. "Pt reports the same set of symptoms occurred in 12/98 when he had a viral URI. Pt denies chest pain, SOB, nausea/vomiting/diarrhea." The subject self-medicated with Advil Cold & Sinus. On exam, the physician noted bilateral nasal erythema and "mild" pharyngitis without exudate. His impression was "Pharyngitis/URI". An in-office test for streptococcus was negative. The physician prescribed Tylenol and Entex LA. The subject returned to the vaccine provider on 6/5/99 with worsening sore throat and fevers. On exam, the physician noted injected oropharynx, tonsillar exudate and bilateral swollen anterior cervical lymph nodes. An in-office test for streptococcus yielded a "weak positive" result. The physician''s impression was "Acute follicular/streptococcal tonsillitis" and he prescribed Pen VK and Tylenol. The subject returned on 7/14/99 with a 1 day history of "pink spots" on his legs and face that were itchy and burning. He also reported sore throat, lower backache, myalgias and arthralgias. He had self-medicated with Benadryl. On exam, the physician noted "slight" erythema of the pharynx with no exudate. He observed "clustered vesicles on erythematous base" on the pt''s nose, cheeks and legs "with crusting". His impression was "HSV" initial outbreak. He prescribed Valtrex. The pt returned on 7/15/99 with bilateral wrist and knee pain, stiff neck, continued sore throat and extension of the rash. The pt was "concerned about Lyme disease". On exam, the physician noted erythema of the throat and a red rash on the face and neck. An in-office test for streptococcus yielded a "weak positive" result. The physician''s impression was "Strep pharyngitis". He continued Valtrex therapy and added Vantin. Lab analyses performed on 7/16/99 revealed a decreased lymphocyte count. Lyme total antibody screen was positive; IgG and IgM Western blots were negative. The pt presented to the local ER on 7/18/99 with complaints of "moderate and progressive general malaise, myalgias, arthritis and pleuritic chest pain for 2 days prior to arrival. Symptoms began while at rest; they have been increasing. The pt reported no improvement after beginning Vantin. He also reported that he had taken Relafen. On exam, the pt''s temperature was 100.7F. The physician noted "initially tachycardia..The pt is in much distress initially with myalgias. It is difficult for pt to walk without assistance". The throat was "erythematous without abscess". The physician also noted "diffuse joint pains. The pt was hydrated with IV normal saline solution "with moderate objective improvement". The ER physician prescribed IV Toradol, Percocet, IV doxycycline and IV Rocephin. The pt was hospitalized with dx of "acute sepsis rule out acute Lyme disease". The pt was evaluated by an infectious disease specialist "for an acute febrile illness with rash". The pt told this physician that he had a rash on his palms and soles. On exam the specialist noted "an early confluent, morbilliform type of rash on the face which seem to be resolving. There are some papules present in the palms and the soles, more on the palms than the soles but in both places the papules are fairly sparse, particularly compared to the face. Pharynx shows enlarged tonsils, lymph nodes are palpable but small in the anterior cervical region." His impression was "Acute febrile illness with rash that involves face, palms and soles with what is exudative pharyngitis/tonsillitis". He stated that "Lyme disease is unlikely cause of this acute illness". He ordered labs and continuation of doxycycline and ceftriaxone therapy. The pt was also evaluated by a cardiologist. Results of an ECG were consistent with acute pericarditis. His impressions were "Acute pericarditis in the setting of acute febrile illness likely related to acute strep infection, ? rheumatic fever, ? Lyme disease, ? viral, ? mononucleosis". The cardiologist discontinued ketorolac therapy and prescribed Indocin. On 7/19/99, the cardiologist noted myopericarditis and transferred the pt to a tertiary care center for further investigation. The cardiologist prescribed high-dose aspirin, Levaquin, Lasix, Capoten and digoxin. An infectious disease specialist Rx''d doxycycline. His symptoms improved and he was discharged from the hospital on 7/27/99. He remained under the care of the cardiologist at the tertiary care center until at least 8/14/01. On 8/6/99, the cardiologist wrote a letter to the pt''s local cardiologist stating his was much better. He wrote, "I remain uncertain as to the exact etiology of the pt''s ''syndrome''". On 8/27/99, he discontinued furosemide and captopril therapy and prescribed fosinopril (Monopril). On 8/14/01, the pt reported that he "fatigues easily...occasional SOB with extreme activity i.e. shoveling." The pt remained under the care of his local cardiologist until at least 10/17/01 when the pt reported that he feels fine and was asymptomatic. Following the reported onset of joint pain, the pt experienced idiopathic cardiomyopathy, sinus bradycardia, PVC''s, right rotator cuff strain, ulnar impingement syndrome of the right wrist, cellulitis of the right foot, acute sinusitis, right otitis media, tinea cruris, gastroenteritis, and exudative tonsillitis. These events were not reported as adverse due to vaccine administration but were found during the course of review of the pt''s medical records. Therefore, they are not listed as adverse events. The most recent info, received on 9/24/02, did not provide the outcome of the reported events. Info received on 2/27/02 indicated that all events had resolved by 10/17/01. Follow up on 02/27/04: "Information, received on 07/31/03, indicated that the subject continued to experience fatigue as of 05/12/03; otherwise, he had "no symptoms". Information received on 02/27/02 indicated that all events had resolved by 10/17/01." Information received on 27 July 2004 indicated that as of 08 July 2003, the patient was working full time. He complained of being easily fatigued, and of pain and dypsnea with excessive physical activity. The most recent information received on 30 September 2004 did not clarify outcome of the reported events.


VAERS ID: 198985 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Female  
Location: California  
Vaccinated:2002-01-04
Onset:2002-01-07
   Days after vaccination:3
Submitted: 2003-03-06
   Days after onset:423
Entered: 2003-03-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC Split Type:

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


VAERS ID: 199031 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2003-02-13
Onset:2003-02-23
   Days after vaccination:10
Submitted: 2003-03-07
   Days after onset:12
Entered: 2003-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 LA / ID

Administered by: Military       Purchased by: Other
Symptoms: Chest pain, Laboratory test abnormal, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Chronic subluxation L shoulder
Allergies:
Diagnostic Lab Data: Abnl EKG c ST segment elevations, 26 Mar: CPK 393 (55-170), CPK-MB 33 (1-10), CPK/MB/CPK 8.4% (0-4), troponin 1.3 (< 0.05), sed rate 5. Echocardiogram: no LV wall motion abnormalities, LVEF 65-70%, no effusion. Cardiac cath: coronary arteries wnl (26 Feb). Oropharyngeal and anal swabs-PCRs for enteroviruses, vaccinia-negative. 2 Mar: CPK 34, CPK MB 14, troponin 0.11
CDC Split Type:

Write-up: Acute myopericarditis c pleuritic chest pain, abnl EKG 24 Feb; transferred to hospital 26 Feb; elevated cardiac enzymes, Normal echocardiogram and cardiac catheterization; oropharyngeal and anal swab for PCRs-enteroviruses and vaccinia-negative. Rx''d methylprednisolone, indomethacin, made uneventful recovery, discharged 1 Mar.


VAERS ID: 199111 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Male  
Location: Virginia  
Vaccinated:2003-01-23
Onset:2003-02-09
   Days after vaccination:17
Submitted: 2003-03-06
   Days after onset:25
Entered: 2003-03-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 2 LA / -

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Chills, Laboratory test abnormal, Malaise, Pericarditis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atacand 32mg/day. Zyrtec 10mg per day; Flonase
Current Illness: NONE
Preexisting Conditions: Migraine; HTN
Allergies:
Diagnostic Lab Data: NL echo, NL thalamus, CPK-223 elevated, EKG(cardiologist impression: consistent with Pericarditis, nl- EKG, prior to onset of symptoms.
CDC Split Type:

Write-up: Pericarditis (fever, chills, malaise, atypical chest pain and EKG changes) (Global J pint elevation & ST segment Changes). These symptoms developed 17 days post vaccination. Admitted to Hosp. NSAIA''s and Prednisone.


VAERS ID: 199412 (history)  
Form: Version 1.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2003-02-27
Onset:2003-03-08
   Days after vaccination:9
Submitted: 2003-03-11
   Days after onset:3
Entered: 2003-03-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 RA / ID

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CK MB 46.4 (0-25), EKG global PR depression and ST elevation, echo showed good cardiac function and no effusion.
CDC Split Type:

Write-up: 23 YOM 9 days s/p primary SPV pt started to feel substernal CP. He presented to a local ER 36 hrs later and was d/w myopericarditis. He was admitted to CCU for observation and was treated with prednisone. The sxs quickly resolved. 60-day follow up on 02/11/04: "It is unknown if the pt recovered from adverse events. We cannot state whether he has recovered until after his 2 year follow up."


VAERS ID: 199606 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2003-02-27
Onset:2003-03-07
   Days after vaccination:8
Submitted: 2003-03-14
   Days after onset:7
Entered: 2003-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV065 / UNK RA / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 LA / ID

Administered by: Military       Purchased by: Military
Symptoms: Asthenia, Cardiovascular disorder, Chest pain, Dyspnoea, Erythema, Myocarditis, Pericarditis
SMQs:, Anaphylactic reaction (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: See above. Oropharyngeal swab and stool for enteroviruses by PCR neg; culture pending. Oropharyngeal swab for vaccinia by PCR neg, culture pending.
CDC Split Type:

Write-up: Acute myopericarditis c pleuritic chest pain occurring 8 days p vaccination; On exam, afebrile, VSS; Heart and lungs wnl; no pericardial friction rub. + 8 mm Jennerian scab c ~ 7 cm rim of erythema, CPK elevated to 512, Troponin I level 36.40 ng/mL (nl 0.3-2.0) ESR 6, CBC, chemistries otherwise wnl. CXR wnl; EKG: diffuse 1mm ST elevations. Echocardiogram c sl global hypokinesis, LVEF 50-55%. Complete clinical recovery, resolution of echocardiographic abnormalities c rest, ibuprofen. Nurse follow up on 07/27/04 states: "Short of breath, epicarditis, pericarditis, decreased stamina, decreased strength."


VAERS ID: 199619 (history)  
Form: Version 1.0  
Age: 37.0  
Sex: Male  
Location: Missouri  
Vaccinated:2003-01-17
Onset:2003-01-24
   Days after vaccination:7
Submitted: 2003-03-10
   Days after onset:45
Entered: 2003-03-14
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH - / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Chest discomfort, Headache, Injection site erythema, Injection site hypersensitivity, Injection site rash, Injection site vesicles, Myalgia, Oedema, Pain, Pericarditis, Pruritus, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Medical record not available
Allergies:
Diagnostic Lab Data: EKG (-),
CDC Split Type:

Write-up: Local redness, bump, reddish blister, local itching, headache, itchy all over, fever 101F, muscle aches, swollen lymph nodes, severe chest discomfort across entire chest and into arm and both sides of neck and lower jaws, decreased with Motrin, benadryl and tylenol. Became worse with movement, even worse next night, could not lie down had to sleep sitting up. Pt went to ER that AM. Tx with Vicodin for pain, motrin. Pt was told had Pericarditis, Vicodin helped, decreased sleep. Much better this AM. No short of breath.


VAERS ID: 199816 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Male  
Location: Alaska  
Vaccinated:2003-03-05
Onset:2003-03-14
   Days after vaccination:9
Submitted: 2003-03-18
   Days after onset:4
Entered: 2003-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 40020071 / 1 LA / ID

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain x 3 days, dx''d as pericarditis secondary to vaccine administration.


VAERS ID: 200187 (history)  
Form: Version 1.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2003-02-22
Onset:2003-02-22
   Days after vaccination:0
Submitted: 2003-02-24
   Days after onset:2
Entered: 2003-03-25
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 LA / -

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Cow pox, Insomnia, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: X-ray, labs
CDC Split Type:

Write-up: Woke up Saturday afternoon and noticed 6 red dots on chest. Went to work that night and started to feel pain in chest at approx. 05:00. Relieved of duty at 06:00. Went home and couldn''t sleep. Went to ER about 09:00 Sunday. Seen for chest pain 1-10 scale "7". Admitted to ward for generalized vaccinia with possible pericarditis vs costochondritis. Treated with 1 overnight stay at hospital. Motrin and Toradol given. Discharged with Motrin. Follow-up with cardiology for echo.


VAERS ID: 200188 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2003-02-11
Onset:2003-02-19
   Days after vaccination:8
Submitted: 2003-02-24
   Days after onset:5
Entered: 2003-03-25
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 RA / -

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Chest pain, Electrocardiogram abnormal, Enzyme abnormality, Headache, Influenza like illness, Myocarditis, Neck pain, Pain, Pharyngolaryngeal pain, Pyrexia, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG-2-3mm ST segment elevation in the inferior leads and 1mm elevation in the lateral leads (myocardial damage); Initial CPK-340; MB-37 Second CPK-over 1000 and MB-100; Troponin-11; ECG X 2-nml; Cardiac catheterization-rule out obstructive CAD and was nml.
CDC Split Type:

Write-up: Severe headaches, body aches and flu-like symptoms, 5 days after, on 2/19/03 AM. Woke up with a really bad sore throat at 06:00. Also had fever/chills and arthralgias. 24 hours in quarters with Motrin and Tylenol. Dx''d with viral syndrome. Later that night, started feeling chest pain radiating to neck. Went back to ER and was admitted on 2/19/03. Treated with GI Cocktail with no results. Treated with 3 nitroglycerin tablets and with IV Morphine. Discharged on 2/24/03. Convalescent leave for 7 days and take Motrin and Aspirin. Viral myocarditis can also be caused by enteroviruses and adenoviruses to name a few; however, if he has myocarditis, it is almost certainly related to Smallpox vaccination given the temporal relation. We also considered coronary vasospasm, especially given the cardiologist''s subjective assessment of decreased myocardial perfusion on the catheterization which can be associated with coronary vasospasm. However, it is my understanding that vasospasm causing this degree of damage in the absence of concomitant CAD is a very, very rare occurrence. Furthermore, the pt never had any other symptoms consistent with angina and I would have expected nitroglycerin to give him prompt relief in the setting of vasospasm. Therefore, given the concomitant viral symptoms due to Smallpox vaccination and the normal catheterization results, I feel this pt most likely has acute viral myocarditis presumedly due to vaccinia. Yet, myocarditis is a clinical dx and there is no way to definitively test this hypothesis (except by myocardial biopsy). We will be re-evaluating this pt today and tomorrow in our ICU to get more info, however, I doubt my assessment will change.


VAERS ID: 200498 (history)  
Form: Version 1.0  
Age: 33.0  
Sex: Male  
Location: Missouri  
Vaccinated:2003-02-28
Onset:2003-03-12
   Days after vaccination:12
Submitted: 2003-03-21
   Days after onset:9
Entered: 2003-03-31
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV072 / UNK - / -
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4020040 / UNK - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 5305A6 / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 746A2 / UNK - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0620 / UNK - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB273AA / UNK - / -
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH - / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Laboratory test abnormal, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Troponia up to 20; Cardiac cath negative; Positive EKG''s; PPD
CDC Split Type:

Write-up: Smallpox related myocarditis, chest pain, Troponin up to 20 day 12 of smallpox. See executive summary 3/13/03.


VAERS ID: 200652 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2003-01-30
Onset:2003-02-07
   Days after vaccination:8
Submitted: 2003-02-21
   Days after onset:14
Entered: 2003-04-01
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS - / UNK - / -
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH - / 1 LA / -

Administered by: Military       Purchased by: Military
Symptoms: Chest pain, Enzyme abnormality, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Cardiac cath negative; CKMB 7 normal; TROPONIN 30 normal; Viral studies pending
CDC Split Type:

Write-up: Admitted to hospital 2/12 with chest pain and elevated cardiac enzymes. ECG changed; Cardiac Cath negative. Diagnosis: myocarditis secondary to smallpox vaccination. Other viral studies pending.


VAERS ID: 200855 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: Washington  
Vaccinated:2003-03-21
Onset:2003-03-29
   Days after vaccination:8
Submitted: 2003-04-02
   Days after onset:4
Entered: 2003-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020077 / UNK LA / ID

Administered by: Public       Purchased by: Public
Symptoms: Discomfort, Fatigue, Lethargy, Pain, Pericarditis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: EKG: Normal sinus rhythm, within normal limits. Echocardiogram: no pericardial effusion and no myocardial decreased contactility, either globally or segmentally. Labs: WBC: 3.7 hematocrit: 40.8% platelet count: normal eosinophils: elevated 5.8% electrolytes: normal glucose: 84 BUN: 19 creatinine: 1.0 LFTs: normal CK: 47 troponin: Normal (<.04) Labs: CPK, Troponin
CDC Split Type:

Write-up: c/o left sided discomfort, fatigue, lethargy, fever. Pain was worse upon lying back and improved upon sitting forward. Diagnosed with pericarditis, post vaccinia syndrome


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