|
VAERS ID: |
26024 (history) |
Form: |
Version 1.0 |
Age: |
1.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: |
1962-02-16 |
Onset: |
1962-02-20 |
Days after vaccination: |
4 |
Submitted: |
1990-09-18 |
Days after onset: |
10436 |
Entered: |
1990-09-21 |
Days after submission: |
3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH |
- / UNK |
- / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Encephalitis SMQs:, Noninfectious encephalitis (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? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, 30 days Extended hospital stay? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: post vaccinal encephalitis |
|
VAERS ID: |
44597 (history) |
Form: |
Version 1.0 |
Age: |
23.0 |
Sex: |
Female |
Location: |
Rhode Island |
Vaccinated: |
1992-06-11 |
Onset: |
1992-06-19 |
Days after vaccination: |
8 |
Submitted: |
1992-08-26 |
Days after onset: |
68 |
Entered: |
1992-08-28 |
Days after submission: |
2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH |
4918223 / 2 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Arthralgia, Cellulitis, Dermatitis bullous, Injection site hypersensitivity, Injection site pain, Myalgia, Rash maculo-papular, Urticaria SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), 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? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: pt exp minor rash around vax site, syncope; w/HBV, Vaccina;~ ()~~~In patient Other Medications: Dimetapp, sudafed plus, Seldane; Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CBC: WBX 6.9; H/H 13.8/40.8; CDC Split Type: Write-up: 17JUN92 classic vesicle formation, little erythema; 19JUN92 malaise, myalgias, lt shoulder arthralgias; very tender, red lump on underside of lt upper arm w/surrounding area of erythema; pain not relieved by APAP; erythema; cellulitis, warm |
|
VAERS ID: |
73800 (history) |
Form: |
Version 1.0 |
Age: |
38.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: |
1994-06-09 |
Onset: |
1994-06-15 |
Days after vaccination: |
6 |
Submitted: |
0000-00-00 |
Entered: |
1995-03-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1232W / 1 |
- / - |
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Injection site reaction, Skin discolouration SMQs:, Hypotonic-hyporesponsive episode (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: No relevant data; CDC Split Type: WAES94070294 Write-up: pt recv vax 9JUN94 & 15JUN94 devel a black & blue area above the smallpox inj site; f/u indicated that the pt was seen by pharmacy house physician; |
|
VAERS ID: |
120975 (history) |
Form: |
Version 1.0 |
Age: |
1.42 |
Sex: |
Male |
Location: |
Louisiana |
Vaccinated: |
1971-04-14 |
Onset: |
1997-07-15 |
Days after vaccination: |
9589 |
Submitted: |
1999-03-29 |
Days after onset: |
622 |
Entered: |
1999-04-06 |
Days after submission: |
7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / UN |
MEA: MEASLES (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / UN |
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / - |
Administered by: Public Purchased by: Public Symptoms: Blood test, Surgery SMQs: 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, 11 days Extended hospital stay? No Previous Vaccinations: Other Medications: yes; DEPAKOTE Current Illness: surgery on genitals; (Mentally disabled) Preexisting Conditions: born a well child; (Mentally retarded) Allergies: Diagnostic Lab Data: Blood levels done @ 10 days CDC Split Type: Write-up: pt reports vaccine was put in lt side of heart & had surgery on genitals;MD witnessed this on 25JAN99;Annual follow-up received on 11/14/00 provides no additional data. Follow-up: 4/2/99 admitted t Hosp. by coroner. Just awarded disability. Vaccine injected into heart near breast. Hx of sz. Pt seems to think that his mother and doctors were conspiring together to kill him. He thinks that his mother took the insurance money from his injuries and spent it on herself. He said he almost died several times and that he only received $3,000.00 and that he needs to be compensated for his injuries. He said when the good Lord takes him that he wants this to stop, because parents conspire to kill their kids for insurance money and the children either come out retarded or die from being vaccinated. (1) I''m requesting for new information such as copies of reports. (2) And do I O a hospital bills. |
|
VAERS ID: |
123038 (history) |
Form: |
Version 1.0 |
Age: |
6.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: |
1998-04-29 |
Onset: |
0000-00-00 |
Submitted: |
1999-05-14 |
Entered: |
1999-05-21 |
Days after submission: |
7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
- / 3 |
- / - |
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
- / - |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
- / 1 |
- / - |
Administered by: Public Purchased by: Other Symptoms: Neck pain, Pruritus, Rash SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (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: No Relevant Data~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: unk Allergies: Diagnostic Lab Data: CDC Split Type: WAES98050044 Write-up: pt recv vax & exp burning & itching of neck & also a rash on neck; |
|
VAERS ID: |
131646 (history) |
Form: |
Version 1.0 |
Age: |
56.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: |
0000-00-00 |
Onset: |
0000-00-00 |
Submitted: |
1999-11-24 |
Entered: |
1999-12-02 |
Days after submission: |
8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Other Purchased by: Public Symptoms: Asthenia, Immune system disorder, Pain SMQs:, Guillain-Barre syndrome (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: ? Preexisting Conditions: Allergies: Diagnostic Lab Data: although extensive, invasive & debilitating tests were performed, unable to get the data; CDC Split Type: Write-up: severe, chronic autoimmune problems throughout life;tx w/steroids, ATB & surgery;ASA now;60 day follow-up states the pt still has severe pain and weakness resemblin flu-like symptoms. |
|
VAERS ID: |
160635 (history) |
Form: |
Version 1.0 |
Age: |
24.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: |
2000-06-16 |
Onset: |
2000-06-17 |
Days after vaccination: |
1 |
Submitted: |
2000-10-13 |
Days after onset: |
118 |
Entered: |
2000-10-18 |
Days after submission: |
5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. |
R01783 / 2 |
RA / IM |
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH |
4998391 / 1 |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Lymphadenitis, Myalgia, Pyrexia, Rash maculo-papular, Serum sickness SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), 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: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: bilateral culture of lesions-neg, SMA-18, CBC, ESR-neg CDC Split Type: Write-up: Same day post 2nd dose of vax, the pt developed a fever and a maculopapular rash. Myalgia and lymphadenitis also developed the following day. Symptoms consistent with serum sickness due to rabies vax. |
|
VAERS ID: |
176774 (history) |
Form: |
Version 1.0 |
Age: |
42.0 |
Sex: |
Female |
Location: |
Georgia |
Vaccinated: |
2001-10-12 |
Onset: |
2001-10-13 |
Days after vaccination: |
1 |
Submitted: |
2001-10-15 |
Days after onset: |
2 |
Entered: |
2001-10-26 |
Days after submission: |
11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH |
4008257 / 2 |
LA / IM |
Administered by: Other Purchased by: Public Symptoms: Heart rate irregular, Palpitations SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: Other Medications: Levoxyl, Serafen, Lo-Estrin Current Illness: NONE Preexisting Conditions: multinodular goiter, PMS Allergies: Diagnostic Lab Data: electrolytes - nml, TSH - pending CDC Split Type: Write-up: The pt experienced palpitations, irregular heartbeat on 10/13 and 10/14. Seen in ER on 10/13 but symptoms subsided during that time and reoccurred approximately 2 hours later. |
|
VAERS ID: |
179376 (history) |
Form: |
Version 1.0 |
Age: |
24.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: |
2001-09-07 |
Onset: |
2001-09-17 |
Days after vaccination: |
10 |
Submitted: |
2001-12-12 |
Days after onset: |
86 |
Entered: |
2001-12-26 |
Days after submission: |
14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH |
4008257 / 1 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Injection site erythema, Injection site pain, Lymphangitis SMQs:, Extravasation events (injections, infusions and implants) (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: Atrovent; Albuterol; Claritin Current Illness: NONE Preexisting Conditions: Asthma (stable); sulfa allergy Allergies: Diagnostic Lab Data: NONE CDC Split Type: Write-up: The pt developed redness and tenderness surrounding the vaccinia (primary rxn) vaccination site with lymphangitis spread to the axilla. Treated with 5 days of Levaquin 500mg/day. |
|
VAERS ID: |
179377 (history) |
Form: |
Version 1.0 |
Age: |
20.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: |
2001-10-15 |
Onset: |
2001-10-23 |
Days after vaccination: |
8 |
Submitted: |
2001-12-12 |
Days after onset: |
50 |
Entered: |
2001-12-26 |
Days after submission: |
14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH |
4008257 / 1 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Allergy to Ceclor Allergies: Diagnostic Lab Data: NONE CDC Split Type: Write-up: The pt developed a tender, red, swollen and warm area around the site of the vaccinia vaccination; treated with Levaquin 500mg day X 5 days. |
|