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: 25002 (history) Form: Version 1.0 Age: 82.0 Sex: Male Location: Foreign Vaccinated: 1989-11-20 Onset: 1989-11-20 Days after vaccination: 0 Submitted: 0000-00-00 Entered: 1990-07-02 Vaccin­ation / Manu­facturer Lot / Dose Site / Route PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. M0870 / UNK - / IM Administered by: Unknown Purchased by: Unknown

Symptoms: Chills, Convulsion

SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad) Life Threatening? No

Birth Defect? No

Died? No

Permanent Disability? Yes

Recovered? No

Office Visit? No

ER Visit? No

ER or Doctor Visit? No

Hospitalized? No

Previous Vaccinations: ~ ()~~~In patient

Other Medications: Thioridazine, Triazolam,

Current Illness:

Preexisting Conditions: Senile dementia, Diabetes mellitus, seizures

Allergies:

Diagnostic Lab Data:

CDC Split Type: WAES90040535 Write-up: 23 hrs post vaccination, developed seizures followed by rigor. Vaccine was given as a prophylaxis.

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: 25004 (history) Form: Version 1.0 Age: 0.9 Sex: Male Location: New York Vaccinated: 1989-11-13 Onset: 1989-11-13 Days after vaccination: 0 Submitted: 0000-00-00 Entered: 1990-07-02 Vaccin­ation / Manu­facturer Lot / Dose Site / Route OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 232961 / UNK - / - Administered by: Unknown Purchased by: Unknown

Symptoms: Chills, Dermatitis contact, Oedema genital, Pelvic pain

SMQs:, Angioedema (broad), Hypersensitivity (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? No

Previous Vaccinations: ~ ()~~~In patient

Other Medications:

Current Illness:

Preexisting Conditions:

Allergies:

Diagnostic Lab Data:

CDC Split Type: 890269201 Write-up: 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

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: Unknown 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: 25009 (history) Form: Version 1.0 Age: 3.0 Sex: Male Location: Florida Vaccinated: 1990-04-05 Onset: 1990-04-06 Days after vaccination: 1 Submitted: 0000-00-00 Entered: 1990-07-02 Vaccin­ation / Manu­facturer Lot / Dose Site / Route MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0333P / UNK - / - Administered by: Unknown Purchased by: Unknown

Symptoms: Deafness

SMQs:, Hearing impairment (narrow) Life Threatening? No

Birth Defect? No

Died? No

Permanent Disability? Yes

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: recurrent otitis media, measles

Allergies:

Diagnostic Lab Data:

CDC Split Type: WAES90030661 Write-up: 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.