ID: 0025001
Sex: F
Age:
State: WI
Vax Date: 06/04/1990
Onset Date: 06/04/1990
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Loud intense cry with screaming for 1 1/2 hrs. Seen next day, child normal.
Other Meds:
Current Illness:
Date Died:
ID: 0025003
Sex: M
Age:
State: TX
Vax Date: 01/29/1990
Onset Date: 02/04/1990
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Other Meds:
Current Illness:
ID: 0025004
Sex: M
Age:
State: NY
Vax Date: 11/13/1989
Onset Date: 11/13/1989
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Pt developed chills for approx. 1 hr, felt achy all over, genital area turned red with some swelling, no pain 24 hrs later, now has pain in genital area. Genitals pain, swelling, redness for 8 days. Fever, dematitis contact, rigors
Other Meds:
Current Illness:
ID: 0025005
Sex: U
Age:
State: OK
Vax Date:
Onset Date:
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 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
Other Meds:
Current Illness:
ID: 0025006
Sex: F
Age: 16
State: OH
Vax Date: 11/17/1989
Onset Date: 11/17/1989
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 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
Other Meds:
Current Illness:
ID: 0025007
Sex: U
Age:
State: OR
Vax Date:
Onset Date:
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 2 or 3 patients who received immunization & developed swollen red arm.
Other Meds:
Current Illness:
ID: 0025008
Sex: F
Age: 75
State: KY
Vax Date: 07/05/1989
Onset Date:
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Pt developed an inject site rxn. Aea was erthematous, hard & warm to touch several days /p immunization, treated w/ Benadryl.
Other Meds:
Current Illness:
ID: 0025009
Sex: M
Age: 3
State: FL
Vax Date: 04/05/1990
Onset Date: 04/06/1990
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 15mon. male w/ hx of recurrent ear infections & measles in Feb. 89'. 5Apr89 was given MMR. Within 24 hrs /p vaccine, parents noted hearing deficit, confirmed by physician exam.
Other Meds:
Current Illness:
ID: 0025012
Sex: M
Age:
State: WI
Vax Date: 10/20/1989
Onset Date: 10/23/1989
Rec V Date: 07/02/1990
Hospital:
Lab Data: xrays of left shoulder, clavicle, humerus & forearm - WNL
Allergies:
Symptoms: 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.
Other Meds:
Current Illness:
ID: 0025013
Sex: U
Age:
State: ND
Vax Date:
Onset Date:
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 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.
Other Meds:
Current Illness:
ID: 0025014
Sex: U
Age:
State: SC
Vax Date:
Onset Date:
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 4 month old infant received 2nd immunization & became very irritable, fussy & refused to eat. w/ 1st imminization, infant was fussy for about 3 days.
Other Meds:
Current Illness:
ID: 0025015
Sex: U
Age:
State: GA
Vax Date: 11/01/1989
Onset Date: 11/01/1989
Rec V Date: 07/02/1990
Hospital:
Lab Data: n/a
Allergies:
Symptoms: 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
Other Meds:
Current Illness:
ID: 0025016
Sex: F
Age:
State: GA
Vax Date: 02/09/1986
Onset Date: 02/09/1986
Rec V Date: 07/02/1990
Hospital:
Lab Data: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
Allergies:
Symptoms: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.
Other Meds:
Current Illness:
ID: 0025017
Sex: F
Age:
State: CO
Vax Date: 07/19/1989
Onset Date: 07/21/1989
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: pt deveolped cellulitis at injection site within 48 hrs p/ immun., mass was not drained or cultured, however is was fluctuant, seen in ER treated w/ with Cirpo & warm compresses, returned to ER for pain, asymptomatic on 4th day.
Other Meds:
Current Illness:
ID: 0025018
Sex: F
Age:
State: KY
Vax Date: 07/07/1989
Onset Date: 07/10/1989
Rec V Date: 07/02/1990
Hospital:
Lab Data:
Allergies:
Symptoms: pt developed an injection site reaction resulting in a mass 4 cm in diameter, area was erythematous, warm to touch & firm, treated with Atarax, resolved
Other Meds:
Current Illness:
ID: 0025019
Sex: M
Age:
State: NC
Vax Date: 06/08/1990
Onset Date: 06/08/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Received DTP on 8JUN90 & had prolonged fever for a week's time
Other Meds:
Current Illness:
ID: 0025020
Sex: F
Age:
State: NY
Vax Date: 06/14/1990
Onset Date: 06/14/1990
Rec V Date: 07/09/1990
Hospital: Y
Lab Data:
Allergies:
Symptoms: Urticaria, wheezy, & periorbital edema which abated /p administration of subcut. epinephrine, Bendryl IV, Solumendrol IV
Other Meds: Subcut- Epinephrine, Bendryl & Solumedrol IV
Current Illness:
ID: 0025021
Sex: F
Age:
State: FL
Vax Date: 06/08/1990
Onset Date: 06/08/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: /p receiving vaccine developed headache, sorejoints, chills, sternal chest pain, low grade fever, low blood pressure & low heart rate, chills again, relief lasted about 2-2.5 hrs. I have not found the low B/P & HR documented.
Other Meds:
Current Illness:
ID: 0025022
Sex: F
Age:
State: MD
Vax Date: 04/26/1990
Onset Date: 04/26/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: fever 102 F. local adenopathy, screaming episode & local reaction
Other Meds:
Current Illness:
ID: 0025023
Sex: M
Age:
State: PA
Vax Date: 10/23/1989
Onset Date: 12/07/1989
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: pt has URI prior to onset of Guillian-Barre symptoms. He has rheumatoid arthritis & was receiving gold therapy concurrently. He was given the flu vaccine on 23Oct89
Other Meds: receiving gold therapy for rhematiod arthritis
Current Illness: URI
ID: 0025024
Sex: U
Age:
State: NH
Vax Date:
Onset Date:
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Sore edema on arms massive redness from top of shoulder to elbows. More than the usual expected reaction. Just started using the DT two weeks ago. All reactions during this period 6 out of 30 patients.
Other Meds:
Current Illness:
ID: 0025025
Sex: U
Age:
State: FL
Vax Date:
Onset Date: 01/10/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: rash, pruritus
Other Meds: treated with Hydroxazine
Current Illness:
Date Died: 01/14/1990
ID: 0025026
Sex: M
Age:
State: WA
Vax Date: 01/12/1990
Onset Date: 01/14/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Other Meds:
Current Illness:
ID: 0025027
Sex: F
Age:
State: NY
Vax Date: 05/29/1990
Onset Date: 05/31/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: fever 102.5 F, rash
Other Meds:
Current Illness:
Date Died: 06/25/1990
ID: 0025028
Sex: M
Age:
State: TN
Vax Date: 05/24/1989
Onset Date: 06/24/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Pt admitted with H-Flu meningitis on 24Jun90. Pt expired on 25Jun90. Pt received HIB vaccine at 18 months of age.
Other Meds:
Current Illness:
ID: 0025029
Sex: F
Age:
State: FL
Vax Date:
Onset Date: 04/02/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: p/ receiving DPT #2 infant developed fever 103.4 for 4 days and extreme lethargy
Other Meds:
Current Illness:
ID: 0025030
Sex: F
Age:
State: NY
Vax Date: 12/01/1989
Onset Date: 12/03/1989
Rec V Date: 07/09/1990
Hospital: Y
Lab Data:
Allergies:
Symptoms: Mylagias occurred within 3 days of immun. Seen on 4 additional occasions for continued pain & increasing eye/temporal pain. Considered poss. meningoencephalitis due to vaccine. Admit to hosp for Guillain-Barre Synd. on 15Feb90.
Other Meds: Lisinopril 20mg, Verapamil 120mg, HCTZ 25mg, Thyrolar
Current Illness:
ID: 0025031
Sex: U
Age:
State:
Vax Date:
Onset Date:
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: rash skin on legs
Other Meds:
Current Illness:
ID: 0025033
Sex: M
Age: 4
State: IL
Vax Date: 06/25/1990
Onset Date: 06/25/1990
Rec V Date: 07/09/1990
Hospital: Y
Lab Data:
Allergies:
Symptoms: Elevated temp (as high as 104.3), headache, vomiting, irritable 40 hours.
Other Meds: 16May90 Oral polio vaccine Lederle 265-927
Current Illness:
ID: 0025034
Sex: M
Age:
State: WI
Vax Date: 06/20/1990
Onset Date: 06/20/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Prolonged screaming
Other Meds:
Current Illness:
ID: 0025036
Sex: F
Age:
State: MD
Vax Date:
Onset Date: 06/29/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Within 5-10 of injection pt pased out/fainted temp 100.8
Other Meds:
Current Illness:
ID: 0025037
Sex: F
Age:
State: MI
Vax Date: 04/03/1990
Onset Date: 04/04/1990
Rec V Date: 07/09/1990
Hospital: Y
Lab Data:
Allergies:
Symptoms: 31yr old women admitted to Hosp with hives and tightness of her chest for the preceding 36 hours, at least. Approximately 36 hrs after vaccination had hives, prutitus, tightness of the chest, dyspnea, urticaria & wheezing.
Other Meds:
Current Illness:
ID: 0025038
Sex: F
Age:
State: CA
Vax Date: 03/05/1990
Onset Date: 03/05/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Elevated temp (103), some vomiting, lethargy
Other Meds:
Current Illness:
ID: 0025039
Sex: F
Age: 0
State: IN
Vax Date: 06/14/1990
Onset Date: 06/15/1990
Rec V Date: 07/09/1990
Hospital: Y
Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
Allergies:
Symptoms: Hypotonia, Hyporesponsive reaction.
Other Meds:
Current Illness:
ID: 0025040
Sex: M
Age:
State: AR
Vax Date: 06/14/1990
Onset Date: 06/15/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 15 min period of being limp and unresponsive. No breathing difficulties, no jerking, no fever.
Other Meds:
Current Illness:
ID: 0025042
Sex: M
Age:
State: MN
Vax Date: 06/14/1990
Onset Date: 06/14/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Fever of 106F rectally beginning 1 hr after immunizations and lasting <24 hrs. Seen at ER treated w/tylenol & cool baths.
Other Meds:
Current Illness:
ID: 0025043
Sex: F
Age:
State: WI
Vax Date: 06/14/1990
Onset Date: 06/14/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Unconsolable crying for > 4 hours immediately following 1st DTP vaccination.
Other Meds:
Current Illness:
ID: 0025044
Sex: M
Age:
State: CA
Vax Date: 05/24/1990
Onset Date: 05/30/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: Beginning 6 days after immunization had 3 days of fever followed by 3 days of slurred speech, wide-based gait, lethargy, and bizarre behavior, followed in turn by complete resolution.
Other Meds:
Current Illness:
ID: 0025045
Sex: F
Age:
State: TX
Vax Date: 06/18/1990
Onset Date: 06/18/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 4 hrs /p injection DPT .25 cc child woke up crying, parents noted child pale & blue around mouth, extremities were twitching, in route to MD ofc. childs head went limp.
Other Meds:
Current Illness:
ID: 0025046
Sex: M
Age:
State: CA
Vax Date: 06/18/1990
Onset Date: 06/18/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: fever > 102 F, pain & induration of thigh at inject site
Other Meds:
Current Illness:
ID: 0025047
Sex: M
Age:
State: MS
Vax Date: 03/27/1990
Onset Date: 03/27/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: continuous crying since vaccine. Pt seen in ER
Other Meds:
Current Illness:
ID: 0025048
Sex: M
Age:
State: CA
Vax Date: 05/17/1990
Onset Date: 05/17/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data: CBC 10.1, WBC 76.9 other labs illegible to read
Allergies:
Symptoms: pt screaming for hours, still crying much 21May90 & 19Jun90. Parents report still not sleeping well at night, pt appears otherwise healthy now
Other Meds: Tylenol
Current Illness:
ID: 0025049
Sex: M
Age:
State: PA
Vax Date: 06/12/1990
Onset Date: 06/12/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data: Labs drawn 12Jun90 WBC - 10,700, HgB - 9.8, Polys - 54, Mono - 5, Lymphs - 41
Allergies:
Symptoms: Hypotomic-Hyporesponsive, very pale, about 4 hrs after 1st DTP injection
Other Meds:
Current Illness:
ID: 0025050
Sex: F
Age: 3
State: CA
Vax Date: 05/07/1990
Onset Date: 05/07/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: fever. inject site reaction
Other Meds:
Current Illness:
ID: 0025051
Sex: M
Age: 5
State: SD
Vax Date: 05/04/1990
Onset Date: 05/05/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: fever, inject site reaction, swelling in right thigh
Other Meds:
Current Illness:
ID: 0025052
Sex: F
Age: 0
State: OR
Vax Date: 10/23/1989
Onset Date: 10/24/1989
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: temp 99.6, vomiting X 1
Other Meds:
Current Illness:
ID: 0025053
Sex: U
Age:
State: NY
Vax Date:
Onset Date:
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: several patients experienced raised red welts & skin irritation at the site of inject several days /p receiving Td. The only complaints came from clinic patients who generally receive injections frequently.
Other Meds:
Current Illness:
ID: 0025054
Sex: F
Age:
State: ME
Vax Date: 11/22/1989
Onset Date: 11/22/1989
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: pt developed erytema, edema & induration w/ warmth in a 13 X 11 cm area surrounding the injection site after receiving TTF vaccine
Other Meds: Augmentin 500mg TID
Current Illness:
ID: 0025059
Sex: F
Age:
State: PA
Vax Date: 06/15/1990
Onset Date: 06/15/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: screaming for 5-6 hrs /p DTP/OPV
Other Meds:
Current Illness:
ID: 0025062
Sex: F
Age: 1
State: CO
Vax Date: 06/26/1990
Onset Date: 06/26/1990
Rec V Date: 07/09/1990
Hospital:
Lab Data:
Allergies:
Symptoms: 18 mon. female w/ DPT 11:00am in lt thigh. 48 hrs /p T 101-103 w/ irritability refused to bear weight or sit up. Refusing solid food but drinking Pedolyte well. Peak T 103, Excessive sleepiness the past 48 hrs.
Other Meds:
Current Illness: