VAERS ID: 198974

AGE: 20| SEX: M|STATE: TX (United States)

Description

SMALLPOX LESIONS ON BACK. ADVERSE REACTION TO SMALLPOX VACCINE. PATIENT REFERRED TO DERMATOLOGY. NO TREATMETN GIVEN. PT DEVELOPED TWO DISCRETE VISICLES WITH 1MM RIM OF ERYTHEMA ON BACK MEASURING 5MM IN DIAMETER WITH DIFFUSE BODYWIDE ERYTHEMA, MALAISE, DIZZINESS AND HA.

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Symptoms

Blister, Dermatitis bullous, Dizziness, Erythema, Headache, Malaise, Necrosis

Vaccines

VAX DATE: 02-15-2003| ONSET DATE: 02-22-2003| DAYS TO ONSET: 7
NameDose #TypeManufacturerLotRouteSite
SMALLPOX (DRYVAX) 1 SMALL PFIZER\WYETH 4020071 ID Unknown

RECVDATE:03-06-2003
RPT_DATE:03-06-2003
CAGE_YR:20
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:Y
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:TISSUE BIOPSY: EPIDERMAL NECROSIS WITH KERATINOCYTE BALLOONING DEGENERATION. FINDINGS CONSISTENT WITH VACCINIA VIRUS INFECTION.
V_ADMINBY:MIL
OTHER_MEDS:UNKNOWN
CUR_ILL:UNKNOWN
HISTORY:UNKNOWN
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:1
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:MIL

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