|
VAERS ID: |
73464 (history) |
Form: |
Version 1.0 |
Age: |
48.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1995-04-13 |
Onset: | 1995-04-13 |
Days after vaccination: | 0 |
Submitted: |
1995-04-18 |
Days after onset: | 5 |
Entered: |
1995-04-24 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
424A6 / UNK |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Diarrhoea,
Dizziness,
Dysgeusia,
Headache,
Hypertension,
Pallor SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (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? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: PCN & shellfish Allergies: Diagnostic Lab Data: NA CDC Split Type:
Write-up: pt recvd vax 13APR95 1115AM & 15-20mins later could taste it describing it as a bitter taste;asked if has any tightness in throat or SOB; stated felt lightheaded & looked pale; observed 10 mins; BP 174/90; exp diarrhea & h/a |
|
VAERS ID: |
73622 (history) |
Form: |
Version 1.0 |
Age: |
36.0 |
Sex: |
Female |
Location: |
D.C. |
Vaccinated: | 1995-04-18 |
Onset: | 1995-04-18 |
Days after vaccination: | 0 |
Submitted: |
1995-04-25 |
Days after onset: | 7 |
Entered: |
1995-05-01 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA425A6 / 1 |
- / IM |
JEV: JAPANESE ENCEPHALITIS (J-VAX) / CONNAUGHT LABORATORIES |
EJN095 / 1 |
- / SC L |
Administered by: Military Purchased by: Military Symptoms: Diarrhoea,
Injection site hypersensitivity,
Injection site oedema,
Nausea,
Pyrexia,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), 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: pt recvd Recombivax 2FEB95 & 4MAR95; Current Illness: NONE Preexisting Conditions: hayfever Allergies: Diagnostic Lab Data: NA CDC Split Type:
Write-up: pt recv vax 18APR95; sx started 12hr later-edema/redness @ inj of JE site; nausea & vomiting 12 hr later w/diarrhea & low grade temp, lasting 48-72hr; |
|
VAERS ID: |
73718 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 1995-04-17 |
Onset: | 1995-04-18 |
Days after vaccination: | 1 |
Submitted: |
1995-04-21 |
Days after onset: | 3 |
Entered: |
1995-05-03 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / IM A |
Administered by: Private Purchased by: Other Symptoms: Conjunctivitis SMQs:, Severe cutaneous adverse reactions (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (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: NONE Allergies: Diagnostic Lab Data: CDC Split Type: 950035171
Write-up: father reports that his child was accidentally given adult dose of Havrix; p/24 hr pt was reported to be asymptomatic x/for bloodshot eyes; No tx was given; outcome unk; referred to MD for f/u; |
|
VAERS ID: |
73884 (history) |
Form: |
Version 1.0 |
Age: |
26.0 |
Sex: |
Male |
Location: |
Oregon |
Vaccinated: | 1995-04-24 |
Onset: | 1995-04-24 |
Days after vaccination: | 0 |
Submitted: |
1995-04-26 |
Days after onset: | 2 |
Entered: |
1995-05-05 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA424A6 / 1 |
LA / IM |
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. |
J1155 / 3 |
RA / - |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Back pain,
Insomnia,
Lymphadenopathy,
Myalgia,
Pharyngitis,
Pyrexia,
Renal pain SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NA Allergies: Diagnostic Lab Data: UA WNL CDC Split Type:
Write-up: 1630 on 24APR95 pt c/o sore throat, swollen glands, feeling achy all over, esp in lower back, kidney area; c/o feeling feverish; sx gradually inc from 1630 & c/o restless noc; feeling tired; |
|
VAERS ID: |
73920 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Male |
Location: |
Utah |
Vaccinated: | 1995-04-27 |
Onset: | 1995-04-27 |
Days after vaccination: | 0 |
Submitted: |
1995-04-28 |
Days after onset: | 1 |
Entered: |
1995-05-08 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA424A6 / 1 |
RA / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0988A / 2 |
RA / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
380942 / 5 |
MO / PO |
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH |
4948176 / 1 |
- / A |
Administered by: Public Purchased by: Public Symptoms: Conjunctivitis,
Hypertension,
Hyperventilation,
Paraesthesia,
Pyrexia,
Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: CDC Split Type: UT950808
Write-up: 630PM numbness-tingling of extremities; t101, loss of consciousness; BP 142/98, R26, P82; blood shot eyes; no wheezing or rash; observed w/02 x 30 mins released instructed to inc fluid; APAP for temp; |
|
VAERS ID: |
74130 (history) |
Form: |
Version 1.0 |
Age: |
30.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 1995-03-31 |
Onset: | 1995-04-03 |
Days after vaccination: | 3 |
Submitted: |
1995-05-10 |
Days after onset: | 37 |
Entered: |
1995-05-17 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
420A6 / 1 |
LA / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
378959 / UNK |
MO / PO |
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH |
4948083 / UNK |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Osteoarthritis,
Pruritus,
Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Arthritis (narrow), 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? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: s/p lyme disease-summer 1994 Allergies: Diagnostic Lab Data: unk CDC Split Type:
Write-up: pt recv vax 31MAR95 & 3APR95 devel pruritis; 4APR95 devel hives on abd, lower back & legs; joints in toes on lt foot swelled; seen by MD given Pred; |
|
VAERS ID: |
74483 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Male |
Location: |
Pennsylvania |
Vaccinated: | 1995-05-15 |
Onset: | 1995-05-19 |
Days after vaccination: | 4 |
Submitted: |
1995-05-30 |
Days after onset: | 11 |
Entered: |
1995-06-02 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Private Symptoms: Chills,
Conjunctivitis,
Insomnia,
Myalgia,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (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? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: insulin, hytrin, prozac; Current Illness: none Preexisting Conditions: Insulin-dependent diabetes mellitus; Allergies: Diagnostic Lab Data: CBC, U/A, ESR, SMA-12 (incl CPK), CXR, EKG all nl; CDC Split Type:
Write-up: pt recv vax;lower limb girdle ache followed w/in 24 hr upper limb girdle aches;awakened fr sleep;ASA, codeine; no tenderness or weakness;fever to 102R; chills & mild conjunctivitis but disappeared on 28may95; |
|
VAERS ID: |
75247 (history) |
Form: |
Version 1.0 |
Age: |
31.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: | 1995-05-12 |
Onset: | 1995-05-15 |
Days after vaccination: | 3 |
Submitted: |
1995-06-10 |
Days after onset: | 26 |
Entered: |
1995-06-19 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
427A6 / 1 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Pruritus,
Rash maculo-papular SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), 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: Other Medications: Tri-levlin BCP''s; Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: none CDC Split Type:
Write-up: Nonerythematous papular rash, pruritic, generalized @ 10 days; began @ 3 d p/immunization; rx: DPH/chlortrimeton; |
|
VAERS ID: |
80480 (history) |
Form: |
Version 1.0 |
Age: |
11.0 |
Sex: |
Female |
Location: |
Connecticut |
Vaccinated: | 1995-03-31 |
Onset: | 1995-03-31 |
Days after vaccination: | 0 |
Submitted: |
1995-06-13 |
Days after onset: | 73 |
Entered: |
1995-06-23 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
- / 1 |
- / IM A |
Administered by: Other Purchased by: Other Symptoms: Vomiting SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: ulcer disease Allergies: Diagnostic Lab Data: CDC Split Type: 950030961
Write-up: pt recvd vax & w/in 6hrs exp one episode of vomiting; |
|
VAERS ID: |
80481 (history) |
Form: |
Version 1.0 |
Age: |
38.0 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1995-04-04 |
Onset: | 1995-04-04 |
Days after vaccination: | 0 |
Submitted: |
1995-06-13 |
Days after onset: | 70 |
Entered: |
1995-06-23 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
420A6 / 1 |
LA / - |
Administered by: Other Purchased by: Private Symptoms: Diarrhoea,
Myalgia,
Pyrexia SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), 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? Yes 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: CDC Split Type: 950031991
Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work |
|