|
VAERS ID: |
25001 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1990-06-04 |
Onset: | 1990-06-04 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
9Q01042 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Agitation SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Loud intense cry with screaming for 1 1/2 hrs. Seen next day, child normal. |
|
VAERS ID: |
25003 (history) |
Form: |
Version 1.0 |
Age: |
0.8 |
Sex: |
Male |
Location: |
Texas |
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Days after vaccination: | 6 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259962 / 4 |
- / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
241950 / 4 |
MO / PO |
Administered by: Unknown Purchased by: Unknown Symptoms: Delirium,
Hypokinesia,
Hypotonia SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations. |
|
VAERS ID: |
25005 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Oklahoma |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
247955 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Arthritis,
Injection site oedema,
Injection site reaction SMQs:, Systemic lupus erythematosus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 890277901
Write-up: 7 patients within 2 weeks have reported joint pain & tenderness which radiated up to the shoulder, redness & slight swelling @ injection site, no treatment prescribed, 1 patient is due to visit a neurologist for shoulder. Vaccines routine |
|
VAERS ID: |
25006 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 1989-11-17 |
Onset: | 1989-11-17 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
247953 / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Convulsion,
Dizziness SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: no hx of local or systemic rxns Allergies: Diagnostic Lab Data: CDC Split Type: 890278001
Write-up: 16 yr old female feeling faint & then had seizure within a few min. /p Td/MMR immunization. MD is uncertain if seizure was due to hyperventilation episode. No treatment initiated. Pt asymptomatic. Vaccine given routine |
|
VAERS ID: |
25007 (history) |
Form: |
Version 1.0 |
Age: |
39.0 |
Sex: |
Unknown |
Location: |
Oregon |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
229968 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site inflammation,
Injection site reaction SMQs:, Extravasation events (injections, infusions and implants) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 900005902
Write-up: 2 or 3 patients who received immunization & developed swollen red arm. |
|
VAERS ID: |
25008 (history) |
Form: |
Version 1.0 |
Age: |
75.0 |
Sex: |
Female |
Location: |
Kentucky |
Vaccinated: | 1989-07-05 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES |
199602 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Injection site inflammation,
Injection site reaction SMQs:, Extravasation events (injections, infusions and implants) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 8901590.01
Write-up: Pt developed an inject site rxn. Aea was erthematous, hard & warm to touch several days /p immunization, treated w/ Benadryl. |
|
VAERS ID: |
25012 (history) |
Form: |
Version 1.0 |
Age: |
0.2 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 1989-10-20 |
Onset: | 1989-10-23 |
Days after vaccination: | 3 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
253963 / UNK |
RL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Hypotonia,
Monoplegia,
Neuropathy SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: xrays of left shoulder, clavicle, humerus & forearm - WNL CDC Split Type: 890255101
Write-up: 3 days /p immun. infant only able to move fingers of left arm, no tone in arm. Immun. given in Right thigh/buttocks. Mononeuropathy left upper extremity. |
|
VAERS ID: |
25013 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Unknown |
Location: |
North Dakota |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Erythema multiforme,
Rash SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 8902746.01
Write-up: Pt received DTP/OPV vaccine developed rash in groin area, became wide spread, DX rash, erythema multiforme (E.R. report indicates due to OPV vaccine) At 6 mon. child received DTP w/ no problems. |
|
VAERS ID: |
25014 (history) |
Form: |
Version 1.0 |
Age: |
0.4 |
Sex: |
Unknown |
Location: |
South Carolina |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
259965 / 2 |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Agitation,
Anorexia SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 8902804.01
Write-up: 4 month old infant received 2nd immunization & became very irritable, fussy & refused to eat. w/ 1st imminization, infant was fussy for about 3 days. |
|
VAERS ID: |
25015 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Georgia |
Vaccinated: | 1989-11-01 |
Onset: | 1989-11-01 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
1990-07-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES |
- / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site mass,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: n/a CDC Split Type: 8902805.01
Write-up: vaccine contained large amount of sediment which will not resuspend. Also, reporter states that he has not seen an increase in the number of reactions; however, he has noted more severity of local rxns, more than nl temp and knot under skn |
|