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Found 508628 cases in entire database

Case Details (Sorted by Vaccination Date)

This is page 1346 out of 5087

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VAERS ID:104008 (history)  Vaccinated:1997-10-20
Age:0.6  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1997-10-21, Days after onset: 1
Location:New York  Entered:1997-10-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACTH
Current Illness:
Preexisting Conditions: infantile spasms responded to ACTH-ACTH d/c 14OCT97;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4380612IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2352A21IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM265RF2IMLL
Administered by: Private     Purchased by: Private
Symptoms: Gaze palsy, Hypotonia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: @ 130-2PM had an episode (w/babysitter) for about 2min-eyes rolled back, pt was limp;no tonic/clonic movements, no vomiting or fever;pt seen in office & eval;no tx necessary;

VAERS ID:104028 (history)  Vaccinated:1997-10-20
Age:0.0  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1997-10-23, Days after onset: 2
Location:Texas  Entered:1997-10-28, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 22OCT97 Naproysn;
Current Illness: NONE
Preexisting Conditions: very sensitive to all meds;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3337GB0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Ecchymosis, Injection site hypersensitivity, Injection site pain, Oedema, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: bruising, some edema, warm to touch;no nausea or vomiting, or pain;c/o itching in inj site only;reports area only uncomfortable;

VAERS ID:104302 (history)  Vaccinated:1997-10-20
Age:40.7  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1997-10-24, Days after onset: 4
Location:Vermont  Entered:1997-11-03, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 0SCRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: rt upper arm, deltoid area became hot to touch w/tenderness, along w/a hard raised rash of 3" inches in circumference around the inj site;reporter states flu vax provided by Wyeth tubex prepared w/ 5/8" for Im shot;

VAERS ID:104307 (history)  Vaccinated:1997-10-20
Age:55.4  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1997-10-21, Days after onset: 1
Location:Washington  Entered:1997-11-03, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Premarin; Day pro;Plaquil;
Current Illness: NONE
Preexisting Conditions: allergies: pollen (trees, grasses, plants);perfumes;dx auto immune synd;undifferentiated;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81868   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Face oedema, Pruritus, Rash, Rash maculo-papular, Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: eyes began itching approx 4hr p/vax;2PM 20OCT itching on face w/a few raised rash areas began evening 20OCT;eyes puffy w/facial itching 21OCTAM;pink macular pap rash areas on face & neck;raised area devel w/itching;

VAERS ID:104362 (history)  Vaccinated:1997-10-20
Age:77.1  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1997-10-28, Days after onset: 7
Location:New York  Entered:1997-11-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fosamax, amitiptiyline, focor, HCTZ
Current Illness: NONE
Preexisting Conditions: sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781441IMRA
Administered by: Private     Purchased by: Private
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: diffuse, 2-3cm circular patchy flat erythematous lesions scattered in extensor surfaces of arms;no blanching w/pressure;appeared 1 day p/flu shot;stiff present on 27OCT97;pt used hydrocortisone;

VAERS ID:104370 (history)  Vaccinated:1997-10-20
Age:42.1  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1997-10-30, Days after onset: 10
Location:Maryland  Entered:1997-11-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergies to grass, trees, weeds, molds, mites
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Unknown
Symptoms: Pruritus, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 20OCT97 & 6PM had red rash & itchy over upper torso (chest, back, arms, neck & face);rash cont till Thursday when it was replaced by discreet spots particularly on upper chest;rash & itching resolved by Saturday;

VAERS ID:104586 (history)  Vaccinated:1997-10-20
Age:36.2  Onset:1997-10-22, Days after vaccination: 2
Gender:Female  Submitted:1997-10-28, Days after onset: 6
Location:Mississippi  Entered:1997-11-10, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic to PCN
Diagnostic Lab Data: NONE
CDC Split Type: MS97041
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6K81354 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Lymphadenopathy, Pain, Pruritus, Skin discolouration, Skin nodule, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: pt came into clinic stating lt arm has been killing her;LDM-red area extends to about 8-10cm diameter w/grayish dark area in ctr about 1" diameter;hard nodule area felt hot to touch;high fever & lump under arm, sore to touch;itches;

VAERS ID:104962 (history)  Vaccinated:1997-10-20
Age:67.6  Onset:1997-10-23, Days after vaccination: 3
Gender:Female  Submitted:1997-10-23, Days after onset: 0
Location:Ohio  Entered:1997-11-19, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: pepcid, proventil,, anacin, humulin insulin, rezulin, estylenol, xanax
Current Illness: NONE
Preexisting Conditions: IDDM, obesity, osteorthritis knee, AAD, canddiasis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818850IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: fever, chills, myalgia, malaise, tx w/APAP & fluids, bed rest;get a thermometer & monitor temp

VAERS ID:105045 (history)  Vaccinated:1997-10-20
Age:1.4  Onset:1997-10-20, Days after vaccination: 0
Gender:Male  Submitted:1997-10-23, Days after onset: 3
Location:Michigan  Entered:1997-11-20, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: MI97131
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM833A23IMRL
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Crying, Skin nodule, Vasodilatation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: crabby, crank & then started screaming 20OCT lump in rt leg started;23OCT97 size of quarter w/redness greatest @ the edges;

VAERS ID:105325 (history)  Vaccinated:1997-10-20
Age:40.8  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1997-11-18, Days after onset: 29
Location:South Carolina  Entered:1997-12-02, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781820IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: local rxn of 6cm x 6cm redder area w/swelling occurred 20min p/vax & vax was given by employer as a yearly thing;

VAERS ID:105327 (history)  Vaccinated:1997-10-20
Age:42.1  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1997-11-24, Days after onset: 35
Location:Oklahoma  Entered:1997-12-02, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness:
Preexisting Conditions: systemic lupus erythematosis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818950IMA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Myalgia, Nausea, Personality disorder, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: diffuse myalgia, arthralgia, fever, chills, changes in mental status;nausea;onset of sx-12hr lasted 48hr;

VAERS ID:105643 (history)  Vaccinated:1997-10-20
Age:31.3  Onset:1997-11-12, Days after vaccination: 23
Gender:Female  Submitted:1997-12-08, Days after onset: 26
Location:Texas  Entered:1997-12-15, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: neurologist dx w/tests;
CDC Split Type: TX97165
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817230 RA
Administered by: Public     Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: sxs of ascending paralysis GBS dx by neuro MD;

VAERS ID:106257 (history)  Vaccinated:1997-10-20
Age:1.3  Onset:1997-10-28, Days after vaccination: 8
Gender:Female  Submitted:1997-12-18, Days after onset: 51
Location:Maryland  Entered:1998-01-08, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature-28wk GA, stills murmur
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM165RH  LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0734E0 RL
Administered by: Private     Purchased by: Other
Symptoms: Cough, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 20OCT97 & seen 29OCT pt devel T103.2 (rx APAP) +rash-bumps on front & back-4-5mm (x12-15inches in diameter) discrete, non confluent + cough;pt rx Ibuprofen, APAP;fever dec;pt d/c home;

VAERS ID:106741 (history)  Vaccinated:1997-10-20
Age:65.8  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1998-01-17, Days after onset: 88
Location:New Jersey  Entered:1998-01-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: sulfa, seasonal allergies;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81896  LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.4440670 RA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 20OCT pain in upper arm;21OCT cont pain in arm (p/a sleepless noc), swelling above & below area of shot;22OCt heat, redness, cont swelling spreading over larger area, visit to family MD, antihistamine & steroids prescribed;

VAERS ID:106934 (history)  Vaccinated:1997-10-20
Age:63.0  Onset:0000-00-00
Gender:Female  Submitted:1998-01-08
Location:New York  Entered:1998-01-26, Days after submission: 18
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898013003L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978144 IMA
Administered by: Public     Purchased by: Other
Symptoms: Dyspnoea, Hypoxia, Pharyngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax & devel a bad cold;w/in 2 days post vax pt had diff breathing was hosp & regular mechanical ventilation;pt was d/c from hosp p/2wk;

VAERS ID:106981 (history)  Vaccinated:1997-10-20
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:1998-01-16
Location:California  Entered:1998-01-26, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0767E0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0811E0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: low grade fever 10 days p/vax & 2 days p/fever, a morbilliform red rash of 3mm-6mm papules appeared;both the fever & rash subsided several days later & pt was back to usual state of good health

VAERS ID:107934 (history)  Vaccinated:1997-10-20
Age:0.5  Onset:1997-10-21, Days after vaccination: 1
Gender:Male  Submitted:1997-10-22, Days after onset: 1
Location:Kansas  Entered:1998-03-02, Days after submission: 131
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: KS97044
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6F814450IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1655D0IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0770B0PO 
Administered by: Public     Purchased by: Public
Symptoms: Gaze palsy, Hypotonia, Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: pt recv vax 20OCT97 & 21OCT97 3AM mom noted pt to be hot-temp 103 ax despite APAP being given since vax as directed;pt limp, lethargic, eyes rolled back & had projectile vomiting;mom gave pt tepid bath, drops of apple juice;

VAERS ID:108642 (history)  Vaccinated:1997-10-20
Age:36.0  Onset:1997-11-18, Days after vaccination: 29
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: NONE
Current Illness:
Preexisting Conditions: allergy PCN
Diagnostic Lab Data: serum hepatitis B surface-negative p/3 doses;
CDC Split Type: WAES97111302B
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2IM 
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Headache, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax 20OCT97 & 18NOV97 pt exp h/a, fatigue, nausea & noc sweats;

VAERS ID:109090 (history)  Vaccinated:1997-10-20
Age:0.3  Onset:1997-10-23, Days after vaccination: 3
Gender:Unknown  Submitted:1997-10-29, Days after onset: 6
Location:Florida  Entered:1998-03-17, Days after submission: 139
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897321006L
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4380841IMLL
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 3 days p/vax pt devel an inj site rxn characterized by 2cm area of induration & fine papulovesicular rash;pt was seen by MD & treated w/cool compresses & DPH;as of 29OCT the rash & induration were beginning to resolve;

VAERS ID:109188 (history)  Vaccinated:1997-10-20
Age:38.0  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1997-10-23, Days after onset: 3
Location:New Jersey  Entered:1998-03-26, Days after submission: 154
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897311009L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978207 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Ecchymosis, Haemorrhage, Injection site hypersensitivity, Injection site mass, Injection site pain, Vasodilatation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & immed p/vax there was a tremendous amount of bleeding @ the inj site;w/in 24hr a 15cm area of redness, warmth, induration, pain & mult purple & red ecchymotic splotches formed;pt was seen by MD who prescribed a steroid cream;

VAERS ID:109282 (history)  Vaccinated:1997-10-20
Age:44.2  Onset:1997-10-28, Days after vaccination: 8
Gender:Male  Submitted:1997-11-11, Days after onset: 14
Location:South Carolina  Entered:1998-03-26, Days after submission: 135
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic to Clinoril
Diagnostic Lab Data: ESR mildly elevated;Eosinophil count:nl;tests for parvovirus, rheumatoid arthritis, connective tissue disorder: negative;
CDC Split Type: 897344011L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49782058IMRA
Administered by: Private     Purchased by: Private
Symptoms: Arthritis, Pyrexia, Serum sickness, Tendon disorder
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (narrow)
Write-up: 8 to 9 days post vax pt devel serum sickness characterized by fever up to 101, migratory polyarthritis & tendonitis;joints primarily affected were both shoulders, both elbows, both knees, second lt metacarpal joint & epicondyles;

VAERS ID:109337 (history)  Vaccinated:1997-10-20
Age:50.1  Onset:1997-10-22, Days after vaccination: 2
Gender:Female  Submitted:1997-10-22, Days after onset: 0
Location:Pennsylvania  Entered:1998-03-26, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Verelan
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898007022L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978139 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 2 days after receiving vax on 10/20/97, patient developed inject site rxn of induration, swelling, itching, redness and warmth. This is 1 of 8 employees of the facility to develop and inject site using lot #4978139

VAERS ID:109338 (history)  Vaccinated:1997-10-20
Age:  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1997-10-22, Days after onset: 1
Location:Pennsylvania  Entered:1998-03-26, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898007023L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978139 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Oedema, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: One day following vax, patient developed inject site rxn of induration, swelling, itching, redness, and warmth. This is 1 of 8 employees of this facility to develop an injection site rxn. with lot# 4978139

VAERS ID:109339 (history)  Vaccinated:1997-10-20
Age:37.8  Onset:1997-10-21, Days after vaccination: 1
Gender:Male  Submitted:1997-10-22, Days after onset: 1
Location:Pennsylvania  Entered:1998-03-26, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Non-insulin dependent diabetes mellitus; allergic to penicillin, Bactrim, bee venom
Diagnostic Lab Data:
CDC Split Type: 898007024L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978139 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Patient developed inject site rxn of redness and swelling. This is 1 of 8 employees of this facility to develop and inject site rxn following vax with lot #4978139.

VAERS ID:109340 (history)  Vaccinated:1997-10-20
Age:25.0  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1997-10-22, Days after onset: 2
Location:Pennsylvania  Entered:1998-03-26, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898007025L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978139 IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt. devel inject site rxn w/redness & swelling. This is 1 of 8 employees of this facility to devel inject site rxn with lot# 4978139

VAERS ID:109341 (history)  Vaccinated:1997-10-20
Age:  Onset:0000-00-00
Gender:Female  Submitted:1997-10-22
Location:Pennsylvania  Entered:1998-03-26, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898007026L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978139 IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt devel inject site rxn with soreness at inject site, she is 1 of 8 employees at this facility to devel inject site rxn with lot #4978139

VAERS ID:109846 (history)  Vaccinated:1997-10-20
Age:1.2  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1998-04-06, Days after onset: 167
Location:Arizona  Entered:1998-04-20, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: AZ9816
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7A816353IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS6J813653IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0466E0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Otitis media, Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: pt recv vax 20OCT97 & 2AM pt felt had convulsion & given fever med;no further problems;seen by PMD 2-3 days later;had episode NOV97 time of fever w/OM;had sz;

VAERS ID:112545 (history)  Vaccinated:1997-10-20
Age:52.2  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1998-06-11, Days after onset: 233
Location:Georgia  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA;Vancenase;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: MPI97829C
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3277GA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest pain, Chills, Diarrhoea, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax 20OCT97 & exp inc temp 100, n/v, diarrhea, chills, chest pain & severe h/a x 2 days;

VAERS ID:112546 (history)  Vaccinated:1997-10-20
Age:41.0  Onset:1997-10-24, Days after vaccination: 4
Gender:Male  Submitted:1998-06-15, Days after onset: 234
Location:Georgia  Entered:1998-07-13, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Serentil;Zantac
Current Illness:
Preexisting Conditions: Mental retardation;Gastroesphegal reflux disease;
Diagnostic Lab Data: NONE
CDC Split Type: MPI97829D
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E277GA IM 
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Cough, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: pt recv vax 20OCT97 & devel wheezing, cough, vomiting & an inc temp to 99 4 days p/vax; tx w/med;

VAERS ID:113060 (history)  Vaccinated:1997-10-20
Age:37.0  Onset:1997-10-22, Days after vaccination: 2
Gender:Male  Submitted:1998-07-30, Days after onset: 281
Location:California  Entered:1998-08-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: allergenic extract
Current Illness:
Preexisting Conditions: resp condition
Diagnostic Lab Data:
CDC Split Type: WAES97101687
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 20OCT97 & 22OCT97 pt devel a local rxn @ the inj site which was described as redness approx 2inches in diameter w/some swelling & warmth;

VAERS ID:113463 (history)  Vaccinated:1997-10-20
Age:  Onset:1997-11-18, Days after vaccination: 29
Gender:Female  Submitted:1998-04-02, Days after onset: 135
Location:California  Entered:1998-08-11, Days after submission: 130
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898093021R
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978150  LA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Neck pain, Neuropathy, Pain
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: pt recv vax 20OCT97 & devel brachial plexus neuropathy;

VAERS ID:115757 (history)  Vaccinated:1997-10-20
Age:41.0  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 371
Location:North Carolina  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Klonopin
Current Illness:
Preexisting Conditions: fibromyalgia;pt was recently dx w/fibromyalgia;
Diagnostic Lab Data:
CDC Split Type: 19970249261
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2370A42IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diplopia, Eye disorder, Visual disturbance
SMQs:, Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad)
Write-up: pt recv vax 20OCT97 & that same day 20OCT97 20OCT97 pt exp double vision while driving home;pt f/u w/an eye MD & dx w/esotropia hyperopia;exp small angle esotropia w/double & distant vision;

VAERS ID:115761 (history)  Vaccinated:1997-10-20
Age:45.0  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1998-10-26, Days after onset: 370
Location:New York  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt recv #1 & #2 dose of Engerix B in 1994; pt exp unknown rx.
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: 19970253611
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2296A43 RA
Administered by: Other     Purchased by: Other
Symptoms: Ecchymosis, Muscle twitching, Neck pain, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Dyskinesia (broad), Dystonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt recv vax on 10/20/97; on 10/21/97 pt exp ecchymosis around vax site, Rt arm muscle twitching, vax site hives & itching, shooting pain in neck

VAERS ID:119593 (history)  Vaccinated:1997-10-20
Age:82.0  Onset:1997-10-23, Days after vaccination: 3
Gender:Female  Submitted:1998-11-18, Days after onset: 391
Location:Connecticut  Entered:1999-02-26, Days after submission: 100
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zocor, ASA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: 7712
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81854  LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0906F  RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: pt recv vax 20OCT97 & 3 days later, pt exp inj site rxn described as redness @ the site;

VAERS ID:125084 (history)  Vaccinated:1997-10-20
Age:72.0  Onset:1998-01-22, Days after vaccination: 94
Gender:Male  Submitted:1999-06-14, Days after onset: 507
Location:Montana  Entered:1999-06-22, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: influenza A swab positive on 1/23/98
CDC Split Type: U199900393
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81832 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Infection, Pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow)
Write-up: p/vax pt was hosp w/an upper resp infect;

VAERS ID:171176 (history)  Vaccinated:1997-10-20
Age:  Onset:2000-03-24, Days after vaccination: 886
Gender:Female  Submitted:2001-05-15, Days after onset: 416
Location:Indiana  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00040077
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0646E1IM 
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Varicella - information has been received from a health care profesisonal concerning a caucasian female patient who on 17 Sep 1997 and 20 Oct 1997 was vaccinated with the first and second doses respectively. of varicella virus vaccine live IM in the left arm. On 27 Mar 2000 the patient broke out in about 15 pox. No further information is available.

VAERS ID:186610 (history)  Vaccinated:1997-10-20
Age:3.8  Onset:2002-02-24, Days after vaccination: 1588
Gender:Male  Submitted:2002-05-15, Days after onset: 79
Location:Unknown  Entered:2002-06-17, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Suprax and sulfa allergy
Diagnostic Lab Data:
CDC Split Type: WAES0202USA02794
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a licensed practical nurse concerning an 8 year old male with allergies to Suprax and sulfa who on 10/20/1997 was vaccinated with varicella virus vaccine live. On 02/24/2002, "after exposure to wild VZV," the pt developed a fever for 24 hours and 5-6 vesicular lesions. Follow-up info indicated that the pt developed chickenpox on 02/24/2002 and subsequently recovered. The pt was not seen in the physician''s office for his experience. No further info is available.

VAERS ID:196242 (history)  Vaccinated:1997-10-20
Age:  Onset:2003-01-09, Days after vaccination: 1907
Gender:Female  Submitted:2003-01-10, Days after onset: 1
Location:Florida  Entered:2003-01-15, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0624E0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0547E0 LA
Administered by: Private     Purchased by: Private
Symptoms: Infection
SMQs:
Write-up: Broke out in chicken pox.

VAERS ID:229607 (history)  Vaccinated:1997-10-20
Age:1.0  Onset:2004-11-10, Days after vaccination: 2578
Gender:Female  Submitted:2004-11-15, Days after onset: 5
Location:Nebraska  Entered:2004-11-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.801E0 LL
Administered by: Private     Purchased by: Private
Symptoms: Skin ulcer, Viral infection
SMQs:
Write-up: Approximately 20 typical lesions with chicken pox no fever no complications to date.

VAERS ID:244490 (history)  Vaccinated:1997-10-20
Age:1.2  Onset:2005-09-20, Days after vaccination: 2892
Gender:Female  Submitted:2005-09-20, Days after onset: 0
Location:Florida  Entered:2005-09-23, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURERUNK  UN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURERUNK  UN
Administered by: Private     Purchased by: Private
Symptoms: Viral infection
SMQs:
Write-up: Pt had chickenpox after having vaccination

VAERS ID:447953 (history)  Vaccinated:1997-10-20
Age:  Onset:0000-00-00
Gender:Female  Submitted:2011-12-20
Location:Unknown  Entered:2012-01-23, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin; Birth control
Current Illness:
Preexisting Conditions: The subject has no relevant medical history.
Diagnostic Lab Data: Hepatitis B antibody, 9mIU/ml
CDC Split Type: A0933925A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Hepatitis B antibody negative, No therapeutic response
SMQs:, Lack of efficacy/effect (narrow)
Write-up: This case was reported by a healthcare professional and described the occurrence of not responding to therapy in an adult female subject who was vaccinated with ENGERIX B (GlaxoSmithKline). Concurrent medications included Multivitamins (Multi Vitamin) and Birth control. On 20 October 1997, 20 May 1997 and 18 April 1997 the subject received 3rd dose, 2nd dose and 1st dose of ENGERIX B to complete the three dose series. Recently (date not specified) hepatitis B titers were drawn and showed 9 mIU/ml. The subject did not have protective titers and was considered to be a non-responder. No additional information was known.

VAERS ID:105609 (history)  Vaccinated:1997-10-20
Age:66.4  Onset:1997-10-21, Days after vaccination: 1
Gender:Female  Submitted:1997-11-20, Days after onset: 30
Location:Foreign  Entered:1997-12-11, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: partial mixed (perception & conduction) hearing loss
Diagnostic Lab Data:
CDC Split Type: 897329014L
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Condition aggravated, Deafness permanent
SMQs:, Hearing impairment (narrow)
Write-up: pt recv vax 20OCT97 & 21OCT97 pt devel total bilateral deafness;pt hosp for diagnostic eval;as a result of this additional info, this report was reclassified as serious, unlabelled;

VAERS ID:105669 (history)  Vaccinated:1997-10-20
Age:0.2  Onset:1997-11-18, Days after vaccination: 29
Gender:Male  Submitted:1997-12-15, Days after onset: 27
Location:Foreign  Entered:1997-12-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO7789
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURERS3424 IML
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESM1201 IML
Administered by: Unknown     Purchased by: Unknown
Symptoms: Petechiae, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad)
Write-up: pt recv vax 20OCT97 & 18NOV97 pt presented w/petechia which were dx as ITP; pt hosp;platelet counts done on 18NOV97;36,000, platelets done 21NOV97 80,000;pt recovered in 3 days;

VAERS ID:112549 (history)  Vaccinated:1997-10-20
Age:82.7  Onset:1997-10-22, Days after vaccination: 2
Gender:Male  Submitted:1998-06-11, Days after onset: 232
Location:Foreign  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA;Co-Codamol;Coproxamol;Doralese;
Current Illness:
Preexisting Conditions: prostatitis;transurethral resection of prostate;pubicprostatectomy in 1975;laminectomy L3-5 in 1990;
Diagnostic Lab Data: NONE
CDC Split Type: EML97835A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.71009BD SC 
Administered by: Other     Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Arthralgia, Constipation, Influenza, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: pt recv vax & suffered severe flu like sx: arthralgia, myalgia, pyrexia w/in 48hr of vax;sx have persisted for 3-4 wk;dx polymylagia & arthralgia was given;pain in shoulder, spine, abd;abd was reported to be bloated poss d/t constipation

VAERS ID:112573 (history)  Vaccinated:1997-10-20
Age:91.3  Onset:1997-10-20, Days after vaccination: 0
Gender:Female  Submitted:1998-06-15, Days after onset: 238
Location:Foreign  Entered:1998-07-13, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ischaemic heart disease;CHR;unspecified arthritis;rosacea;problems w/hearing HH-hard of hearing?;
Diagnostic Lab Data: NONE
CDC Split Type: EML971025D
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E71009BD1 SC 
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Cough, Influenza, Malaise
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad)
Write-up: pt recv vax & devel prolonged flu like sx; pt exp malaise, weakness & chesty cough 5 days p/vax;

VAERS ID:168623 (history)  Vaccinated:1997-10-20
Age:  Onset:0000-00-00
Gender:Male  Submitted:2001-04-10
Location:Foreign  Entered:2001-04-12, Days after submission: 2
Life Threatening? No
Died? Yes
   Date died: 2001-01-24
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20010086621
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: 0     Purchased by: 0
Symptoms: Epilepsy, Speech disorder
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: On 10/29/97, the vaccinee received a dose of DTP-HIB. Nine days later, the vaccinee developed severe epilepsy and delayed speech. On 1/24/01, approx. 3 1/4 years later, the vaccinee died. No autopsy was performed. Probable cause of the unexplained death was reported to be epilepsy. The reporter considered the reaction to be serious as it was disabling and the vaccinee died. The most recent information was received on 4/5/01. No other details were given. No further information is expected.

VAERS ID:103945 (history)  Vaccinated:1997-10-21
Age:  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-10-22, Days after onset: 1
Location:Illinois  Entered:1997-10-27, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt devel swelling @ inj site last yr w/flu vax dose 1;
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Unknown
Symptoms: Glossitis, Injection site hypersensitivity, Laryngospasm, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 21OCT97 & devel redness around inj site w/itching followed by hives & sensation of thick tongue & diff swallowing;

VAERS ID:103953 (history)  Vaccinated:1997-10-21
Age:1.5  Onset:1997-10-21, Days after vaccination: 0
Gender:Male  Submitted:1997-10-22, Days after onset: 1
Location:West Virginia  Entered:1997-10-27, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4468362IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Screaming
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad)
Write-up: pain @ site;excessive screaming d/t pain $g5hr;

VAERS ID:104015 (history)  Vaccinated:1997-10-21
Age:38.0  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-10-22, Days after onset: 1
Location:Michigan  Entered:1997-10-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: sinus problems occasionals
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818550IMLA
Administered by: Other     Purchased by: Private
Symptoms: Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: 320PM pt recvd vax & waited 15min @ 415PM felt nauseated & vomited;drank coffee & took APAP;hives appeared on neck & arms, for about 2hr;felt fine later;

VAERS ID:104266 (history)  Vaccinated:1997-10-21
Age:48.2  Onset:1997-10-22, Days after vaccination: 1
Gender:Male  Submitted:1997-10-29, Days after onset: 7
Location:Massachusetts  Entered:1997-11-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Insulin, BP meds, Acupril
Current Illness: NONE
Preexisting Conditions: diabetic, inc BP-NKA;
Diagnostic Lab Data: NONE
CDC Split Type: MA9721
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817931IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0993E0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt became will on 22OCT97 w/ fever 102 & swelling RUA was seen in the ER on Wednesday & was started on IV ATB x 4 days & PO ATB x 5 days;dx cellulitis rt upper arm;

VAERS ID:104322 (history)  Vaccinated:1997-10-21
Age:68.5  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1997-10-23, Days after onset: 1
Location:New York  Entered:1997-11-03, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: BAB019
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E10017HC1 RA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0815D1 RA
Administered by: Other     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt felt hard lump @ the site where pt recv vax;also reported that the lump appeared red;

VAERS ID:104411 (history)  Vaccinated:1997-10-21
Age:19.4  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1997-10-23, Days after onset: 1
Location:Colorado  Entered:1997-11-05, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781761IM 
HEPA: HEP A (VAQTA)MERCK & CO. INC.0756E0IM 
Administered by: Military     Purchased by: Military
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: erythema, tenderness around vax site devel next day;dx cellulitis;rx warm compresses, course dicloxacillin;

VAERS ID:104523 (history)  Vaccinated:1997-10-21
Age:17.3  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-10-21, Days after onset: 0
Location:Illinois  Entered:1997-11-07, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: amoxicillin, APAP (rash)
Diagnostic Lab Data:
CDC Split Type: IL97099
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2250A21 LA
Administered by: Other     Purchased by: Public
Symptoms: Chills, Headache, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: mom states pt recv vax 10 or 11AM & shortly p/vax devel chills, h/a & vomiting;came home from school T98.6 according to mom;feel bad immed p/vax;

VAERS ID:104531 (history)  Vaccinated:1997-10-21
Age:35.8  Onset:1997-10-21, Days after vaccination: 0
Gender:Male  Submitted:1997-10-24, Days after onset: 3
Location:North Carolina  Entered:1997-11-07, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NC97108
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7L81412 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Dizziness, Injection site hypersensitivity, Malaise, Myalgia, Oedema, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: 21OCT felt bad that not p/shot but does not name anything specific;22OCt had fever, chills & stayed in bed all day;small sl raised red area @ inj site;area < size of dime;hurting in both shoulders & arms;23OCt dizziness & faint;

VAERS ID:104558 (history)  Vaccinated:1997-10-21
Age:61.6  Onset:1997-10-29, Days after vaccination: 8
Gender:Female  Submitted:1997-10-29, Days after onset: 0
Location:Florida  Entered:1997-11-10, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Maxide, Estrace, prozac
Current Illness: stepped on nail
Preexisting Conditions: H20 retention, depression
Diagnostic Lab Data: NA
CDC Split Type: FL97079
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7E916571IMRL
Administered by: Public     Purchased by: Public
Symptoms: Oedema, Pain, Pruritus, Pyrexia, Rash, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 21OCT97 p/nail injury;pt had redness, swelling, sore arm, sl temp for 3 days p/vax; on day 8 pt devel 5 1/2" x 4 1/2 area of erythema w/itching, burning & swelling;

VAERS ID:104663 (history)  Vaccinated:1997-10-21
Age:12.0  Onset:1997-10-21, Days after vaccination: 0
Gender:Male  Submitted:1997-11-06, Days after onset: 16
Location:Delaware  Entered:1997-11-12, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6L813925IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0709E0SC 
Administered by: Private     Purchased by: Public
Symptoms: Face oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt mom noticed swollen eyelids & hives on p/vax;pt taken to ER & given DPH by mouth;

VAERS ID:104668 (history)  Vaccinated:1997-10-21
Age:1.5  Onset:1997-10-26, Days after vaccination: 5
Gender:Male  Submitted:1997-11-09, Days after onset: 14
Location:California  Entered:1997-11-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7L816733 LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0686E0 RA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: urticaria;

VAERS ID:104670 (history)  Vaccinated:1997-10-21
Age:60.7  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1997-11-04, Days after onset: 13
Location:Illinois  Entered:1997-11-12, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pred;Premarin
Current Illness:
Preexisting Conditions: lupus
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, Injection site hypersensitivity, Injection site oedema, Laryngospasm, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (narrow), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: throat closing;hands & feet turning red & itchy;joints hurting;red & swelling where shot was given;

VAERS ID:104724 (history)  Vaccinated:1997-10-21
Age:20.1  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-10-23, Days after onset: 2
Location:Washington  Entered:1997-11-13, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818622IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Laryngospasm, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: arm red elbow to shoulder itching;DPH given c/o SOB;epi given;c/o throat discomfort;improved p/epi;

VAERS ID:104887 (history)  Vaccinated:1997-10-21
Age:54.0  Onset:1997-10-23, Days after vaccination: 2
Gender:Male  Submitted:1997-11-10, Days after onset: 18
Location:Massachusetts  Entered:1997-11-19, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MA9729
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817931 LA
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Anxiety, Asthenia, Dizziness, Headache, Hypertension, Nervousness, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Vestibular disorders (broad)
Write-up: about 23OCT97 to 29OCT97 apprehensive, nervous, impending doom no temp, did have h/a, bed very early, sl BP elevation, dizzy when working out, no energy-no appetite;

VAERS ID:104894 (history)  Vaccinated:1997-10-21
Age:1.3  Onset:1997-10-23, Days after vaccination: 2
Gender:Male  Submitted:1997-10-28, Days after onset: 5
Location:Utah  Entered:1997-11-19, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: UT971036
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4477183IMRL
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: 21OCT97 730PM t102 gave APAP every 4hr;22OCT97 temp ran 101 all day even w/APAP q 4 hr;23OCT97 T105 3AM sponged, gave APAP;T101 again w/APAP;1130PM T106;taken to ER T105 R;

VAERS ID:104961 (history)  Vaccinated:1997-10-21
Age:57.3  Onset:1997-10-22, Days after vaccination: 1
Gender:Male  Submitted:1997-11-11, Days after onset: 20
Location:Montana  Entered:1997-11-19, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Synthroid;Darvocet;Estrogen;
Current Illness: vertigo, ?
Preexisting Conditions: fibro myalgia, hypothyroidism,bronchiolitis;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978159 IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES444067 IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Cellulitis
SMQs:
Write-up: cellulitis following inj;

VAERS ID:105119 (history)  Vaccinated:1997-10-21
Age:65.7  Onset:1997-10-23, Days after vaccination: 2
Gender:Female  Submitted:1997-11-04, Days after onset: 12
Location:Florida  Entered:1997-11-25, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897310014L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES  IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES441213 IMRA
Administered by: Public     Purchased by: Other
Symptoms: Cellulitis, Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: 2 days p/vax pt devel cellulitis @ pnu imune23 site;pt was hosp treated w/IV ATB & d/c from the hosp on 28OCT;

VAERS ID:105292 (history)  Vaccinated:1997-10-21
Age:43.2  Onset:1997-10-22, Days after vaccination: 1
Gender:Male  Submitted:1997-11-25, Days after onset: 34
Location:Minnesota  Entered:1997-12-01, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MN97049
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781680IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypoaesthesia, Oedema peripheral, Pain, Skin disorder, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: swelling in upper arm between elbow & shoulder;hard to move arm;red, sore, warm to touch;swelled 2-3x nl size;skin taut, anything touching it hurt;saw MD 1-2wk later suggested Ibuprofen;said not to repeat;

VAERS ID:105296 (history)  Vaccinated:1997-10-21
Age:74.1  Onset:1997-11-01, Days after vaccination: 11
Gender:Male  Submitted:1997-11-24, Days after onset: 23
Location:Florida  Entered:1997-12-02, Days after submission: 8
Life Threatening? No
Died? Yes
   Date died: 1997-11-21
   Days after onset: 20
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81894 IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Asthenia, CSF test abnormal, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;

VAERS ID:105307 (history)  Vaccinated:1997-10-21
Age:54.3  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-10-30, Days after onset: 9
Location:Wyoming  Entered:1997-12-02, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: HTN
Diagnostic Lab Data:
CDC Split Type: WY9710
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978146 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Condition aggravated, Dizziness, Dry mouth, Dysphagia, Hypotension, Tachycardia, Tongue oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: shortly p/vax c/o diff swallowing, chest tightness, thickness of tongue, dry mouth;BP 80/60, P92 regular pt has hx HTN, DPH given & pt put in lying position;p/5min BP 130/82, feeling better, some light headedness;P88 regular;5min later BP 1

VAERS ID:105311 (history)  Vaccinated:1997-10-21
Age:1.0  Onset:1997-10-29, Days after vaccination: 8
Gender:Male  Submitted:1997-11-06, Days after onset: 8
Location:South Carolina  Entered:1997-12-02, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: SC97083
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1240D0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1541D0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 21OCT97 & it was reported that child had 20-25 vesicles on head, chin, trunk & legs;saw child 2NOV97;most vesicles cleared @ that time & pt OK

VAERS ID:105381 (history)  Vaccinated:1997-10-21
Age:65.2  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1997-11-05, Days after onset: 14
Location:California  Entered:1997-12-04, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Advil
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49782001IMA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Diarrhoea, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: w/in 24-36hr fatigue, nausea, diarrhea, 6-7 days temp 101.3, extreme fatigue;

VAERS ID:105395 (history)  Vaccinated:1997-10-21
Age:13.4  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-10-24, Days after onset: 3
Location:California  Entered:1997-12-04, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA970106
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1615D2 LA
Administered by: Public     Purchased by: Public
Symptoms: Oedema, Pain, Skin nodule, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: s/s edema, induration & heat-pain;tx advil, ice-sling-warm bath;

VAERS ID:105434 (history)  Vaccinated:1997-10-21
Age:69.9  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-10-22, Days after onset: 1
Location:Michigan  Entered:1997-12-05, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MI97148
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978196 IMRA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES431805 IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C91556 IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Asthenia, Hypertension, Pollakiuria, Thirst, Tremor, Vasodilatation
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow)
Write-up: c/o uncontrollable shivers for 1/2hr & cold forehead hot but did not take temp, weak, inc urination, inc thirst;called 911 but did not want to got to hosp;RP was up & had enough 02 in blood;

VAERS ID:105901 (history)  Vaccinated:1997-10-21
Age:1.3  Onset:1997-10-26, Days after vaccination: 5
Gender:Female  Submitted:1997-12-23, Days after onset: 58
Location:Pennsylvania  Entered:1997-12-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 29OCT97 WBC 14,660;85% lym;ESR 1;9NOV WBC 13,400;85% lym;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM235RA IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0625E0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Anaemia, Laboratory test abnormal, Leukocytosis, Lymphadenopathy, Salivary gland enlargement, Skin nodule, Thrombocythaemia, Vasodilatation
SMQs:, Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: pt recv vax 21OCT97 & exp swollen node rt submandibular 26OCT97 & lt groin lump 28OCt;keflex 10 days;rt gone 6NOV;lt groin same 6NOV;

VAERS ID:106554 (history)  Vaccinated:1997-10-21
Age:2.0  Onset:1997-10-21, Days after vaccination: 0
Gender:Male  Submitted:1998-01-12, Days after onset: 83
Location:Unknown  Entered:1998-01-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES97101555
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: pt recv vax 21OCT97 & pt exp large knot @ the inj site & was treated w/cold compresses;

VAERS ID:107064 (history)  Vaccinated:1997-10-21
Age:32.6  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1997-11-13, Days after onset: 22
Location:Texas  Entered:1998-01-29, Days after submission: 77
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type: TX98007
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817730IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: local redness, swelling & heat;no treatment given;resolved w/in 48hr of vax;

VAERS ID:107065 (history)  Vaccinated:1997-10-21
Age:25.5  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-11-13, Days after onset: 23
Location:Texas  Entered:1998-01-29, Days after submission: 77
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type: TX98006
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817730IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: localized swelling, heat & redness x 4-5days;resolved;

VAERS ID:107178 (history)  Vaccinated:1997-10-21
Age:12.4  Onset:1998-01-02, Days after vaccination: 73
Gender:Male  Submitted:1998-01-12, Days after onset: 10
Location:North Dakota  Entered:1998-02-02, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: pt exp VAX by MSD lot# 0652D & HBV by MSD lot# 0251D given 10SEP97
Current Illness: NONE
Preexisting Conditions: childhood asthma, no allergies
Diagnostic Lab Data:
CDC Split Type: ND9803
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1480D1 RA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C915561 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Dermatitis bullous, Productive cough, Pruritus, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 2JAN98 pt had elevated temp 102-103;also cough productive w/yellow sputum;elevated temp lasted for 4 days & PAPA was effective reducing temp;cough is less but cont as of this date;10JAN98 blister area n upper lip then cover body;itching;

VAERS ID:107817 (history)  Vaccinated:1997-10-21
Age:44.2  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1997-10-23, Days after onset: 1
Location:California  Entered:1998-02-24, Days after submission: 124
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: MVI, fibers
Current Illness: NONE
Preexisting Conditions: hayfever, allergy to papayas-fruit sprays
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781430IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Paraesthesia, Vasodilatation
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 21OCT97 & c/o tingling feeling @ site;c/o soreness to lt deltoid area; 22OCT97 noticed redness & heat to area; 7x8x4cm redness & sl elevation;

VAERS ID:107911 (history)  Vaccinated:1997-10-21
Age:1.0  Onset:1997-11-13, Days after vaccination: 23
Gender:Male  Submitted:1998-02-02, Days after onset: 81
Location:Texas  Entered:1998-03-03, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: platelet count 3,000 @ time of dx;
CDC Split Type: TX98023
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0009E0SCA
Administered by: Public     Purchased by: Public
Symptoms: Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad)
Write-up: hosp 13NOV & 14NOV w/dx idiopathic thrombocytopenia purpura-given IGIV;pt followed @ cancer & blood disorder clinic;recv IGIV again 1DEC97;

VAERS ID:109181 (history)  Vaccinated:1997-10-21
Age:33.8  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1997-10-23, Days after onset: 2
Location:Kentucky  Entered:1998-03-26, Days after submission: 154
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt has had similar inj site rxn p/flu vax;
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897310019L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 3  
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & immed devel an inj site rxn characterized by burning, redness & a 5inch welt;

VAERS ID:109184 (history)  Vaccinated:1997-10-21
Age:  Onset:1997-10-22, Days after vaccination: 1
Gender:Unknown  Submitted:1997-10-23, Days after onset: 1
Location:Wisconsin  Entered:1998-03-26, Days after submission: 154
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897310022L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49782060SCA
Administered by: Public     Purchased by: Military
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: w/in 24hr of vax several pt from this facility devel an inj site rxn characterized by redness, swelling & tenderness;

VAERS ID:109194 (history)  Vaccinated:1997-10-21
Age:  Onset:1997-10-28, Days after vaccination: 7
Gender:Unknown  Submitted:1997-10-30, Days after onset: 2
Location:Texas  Entered:1998-03-26, Days after submission: 147
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897311025L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt devel rash 7 days p/vax;

VAERS ID:111097 (history)  Vaccinated:1997-10-21
Age:34.0  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1998-04-05, Days after onset: 165
Location:Louisiana  Entered:1998-05-19, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO7682
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C91583  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Agitation, Injection site hypersensitivity, Injection site mass, Injection site pain, Vasodilatation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 21OCT97 & the next day pt exp a large local rxn in the lt deltoid that appeared as a lemon sized lump, red, warm & indurated;pt was described as crying in pain;greater than 10 yr since last Td;

VAERS ID:111156 (history)  Vaccinated:1997-10-21
Age:0.6  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1998-04-21, Days after onset: 182
Location:Arkansas  Entered:1998-05-26, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC on 22OCT97
CDC Split Type: AR9823
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES08618502IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0358E2IMLL
HIBV: HIB (PROHIBIT)CONNAUGHT LABORATORIES08618502IMRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0761K2PO 
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Hypersensitivity, Pyrexia, Screaming
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 21OCT97 between 8AM & 9AM;mom states pt was fussy all day;mom states gave APAP alternating w/motrin for fever control throughout day;evening began crying all noc w/o stopping & fever went to 102-104;called ER

VAERS ID:111239 (history)  Vaccinated:1997-10-21
Age:50.7  Onset:1997-12-01, Days after vaccination: 41
Gender:Male  Submitted:1998-02-04, Days after onset: 65
Location:Florida  Entered:1998-05-27, Days after submission: 111
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: 12/97: RPR - positive, 01/22/98: RPR - negative, FTA - negative
CDC Split Type: 898049002L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49782190IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.4456420IMLA
Administered by: Private     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Pt recvd vax 10/21/97. Approx Dec pt donated blood; RPR test was positive. Seen by MD 01/22/98; FTA test & RPR both negative.

VAERS ID:111256 (history)  Vaccinated:1997-10-21
Age:82.9  Onset:1997-10-22, Days after vaccination: 1
Gender:Female  Submitted:1998-02-24, Days after onset: 125
Location:Pennsylvania  Entered:1998-05-27, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898105019L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49782081IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4440700IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypersensitivity, Injection site hypersensitivity
SMQs:, Angioedema (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & next day devel redness @ inj site;this event was dx as an allerg rxn;pt recovered;this is 1 of 2 residents from this facility to have an adverse exp p/pnu immune 23 lot#444070;

VAERS ID:112544 (history)  Vaccinated:1997-10-21
Age:66.1  Onset:1997-10-24, Days after vaccination: 3
Gender:Female  Submitted:1998-06-12, Days after onset: 231
Location:Georgia  Entered:1998-07-13, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Caltrate/calcium carbonate;Celestone Betamethasone;Calritin;Premarin;
Current Illness:
Preexisting Conditions: thyroid dysfunction
Diagnostic Lab Data: NONE
CDC Split Type: MPI97829B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3277GA IM 
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax 21OCT97 & exp sx of n/v, raised temp 3 days p/vax;tx w/phenergan & sx resolved;

VAERS ID:114537 (history)  Vaccinated:1997-10-21
Age:90.0  Onset:1997-10-21, Days after vaccination: 0
Gender:Unknown  Submitted:1997-10-23, Days after onset: 2
Location:New York  Entered:1998-09-30, Days after submission: 342
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid;unspecified antihypertensive
Current Illness: NONE
Preexisting Conditions: hypertension, hypothyroidism, pacemaker insertion 8JUL94;
Diagnostic Lab Data:
CDC Split Type: 897321016L
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES 1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & devel redness & swelling @ inj site;pt declined to grant permission for f/u;

VAERS ID:119575 (history)  Vaccinated:1997-10-21
Age:38.0  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1998-11-17, Days after onset: 392
Location:Arizona  Entered:1999-02-26, Days after submission: 101
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: cannot state w/certainty that has vaccine from Connaught but has had vaccine every year for 5-6years w/o incident;
Diagnostic Lab Data:
CDC Split Type: 7678
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81750   
Administered by: Other     Purchased by: Private
Symptoms: Headache, Myalgia, Nuchal rigidity, Photophobia, Rash maculo-papular
SMQs:, Rhabdomyolysis/myopathy (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 21OCT97 4 to 5hr p/vax pt exp photophobia, h/a, stiff neck, generalized myalgia;also the pt has a rash on face that extends across nose, is palpable but does not itch;

VAERS ID:119586 (history)  Vaccinated:1997-10-21
Age:  Onset:1997-10-21, Days after vaccination: 0
Gender:Unknown  Submitted:1998-11-17, Days after onset: 392
Location:Idaho  Entered:1999-02-26, Days after submission: 101
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 7698
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81840   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 21OCT97 & that same day pt exp an inj site rxn described as red, swollen, hot to touch from elbow to shoulder;

VAERS ID:119649 (history)  Vaccinated:1997-10-21
Age:57.6  Onset:1997-11-01, Days after vaccination: 11
Gender:Female  Submitted:1998-06-09, Days after onset: 219
Location:Ohio  Entered:1999-02-26, Days after submission: 262
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Pt refered to specialist
CDC Split Type: U199800205
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81904   
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7E91657   
Administered by: Other     Purchased by: Other
Symptoms: Breast neoplasm
SMQs:, Tumours of unspecified malignancy (narrow), Breast tumours of unspecified malignancy (narrow)
Write-up: Pt recv vax on 10/21/97; 3-4 wk post vax pt exp lumps in her breast

VAERS ID:322301 (history)  Vaccinated:1997-10-21
Age:0.4  Onset:1997-10-22, Days after vaccination: 1
Gender:Male  Submitted:2008-08-15, Days after onset: 3950
Location:Texas  Entered:2008-08-15
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 30 days
    Extended hospital stay? Yes
Previous Vaccinations: encephalitis,blindness,epilepsy~DTaP (no brand name)~2~0~In Patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: BOM. gingival stomatitis.
Diagnostic Lab Data: he has all types of tests. Labs and Diagnostics: Brain CT and MRI initially WNL. F/u 1 wk later (+) for occipital lobe brain deterioration. CSF protein 86, glucose 187, WBCs 33 and RBCs 5,880. CSF viral studies (-). SGOT 460-1800. BUN 30.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1UNUN
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1  
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1  
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Aspartate aminotransferase increased, Blindness, Blood urea increased, CSF glucose increased, CSF protein increased, CSF virus no organisms observed, CSF white blood cell count increased, Convulsion, Cyanosis, Developmental delay, Disability, Encephalitis, Epilepsy, Haematochezia, Hypotonia, Immunisation reaction, Laboratory test, Liver function test abnormal, Microcephaly, Nuclear magnetic resonance imaging brain abnormal, Red blood cells CSF positive, Renal disorder, Resuscitation, Scan brain, Unresponsive to stimuli, Visual evoked potentials abnormal
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Glaucoma (broad), Optic nerve disorders (narrow), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad)
Write-up: on the next day of his vaccines,he has a seizure go to the hospital they use resusitation and he stay for 1 month, when he open his eyes after 2 weeks in the hospital,he was blind,with epilepsy,encephalitis,and comes home permantly disabled. 2/26/09 MR received for DOS 10/22-11/19/1997 with no specific D/C DX given. Seizure activity and Encephalitis type picture-likely viral noted. Pt presented to ER following an episode of cyanosis, limpness and unresponsiveness on 10/22/97. Initially brought to PCP where O2 was given and EMS called. Seizure activity noted in ER and during admission.. Pt had some bloody stool which resolved, as well as elevated LFTs and renal issues which also resolved. Pt noted to be blind by ophth consult. Later records 10/12-14/98 report dx of CNS reaction to Pertussis vaccine, now with blindness, microcephaly, significant developmental delay and seizure disorder. Seizures 1-2/day.

VAERS ID:105665 (history)  Vaccinated:1997-10-21
Age:2.0  Onset:1997-11-03, Days after vaccination: 13
Gender:Female  Submitted:1997-12-10, Days after onset: 37
Location:Foreign  Entered:1997-12-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: 5NOV97 platelet count 5,000;6NOV97 platelet count 37,000;
CDC Split Type: WAES97110720
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Ecchymosis, Epistaxis, Infection, Lymphocytosis, Skin disorder, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad)
Write-up: pt recv vax 21OCT97 & 3NOV97 pt exp thrombocytopenia purpura w/ecchymosis on legs & face, epistaxis;pt hosp;5NOV97 lab eval revealed platelet count of 5,000;tx w/IV immunoglobulins;6NOV97 platelet count were 37,000;

VAERS ID:105748 (history)  Vaccinated:1997-10-21
Age:38.0  Onset:1997-10-22, Days after vaccination: 1
Gender:Male  Submitted:1997-12-11, Days after onset: 50
Location:Foreign  Entered:1997-12-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: human insulin
Current Illness:
Preexisting Conditions: insulin-dependent diabetes mellitus
Diagnostic Lab Data: unk
CDC Split Type: WAES97115155
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia, Urinary retention
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: pt recv vax 21OCT97 & 22OCT97 pt exp fever & retention of urine & was hosp;pt fever & retention of urine persisted;

VAERS ID:112463 (history)  Vaccinated:1997-10-21
Age:58.5  Onset:1997-10-22, Days after vaccination: 1
Gender:Male  Submitted:1998-06-11, Days after onset: 232
Location:Foreign  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humulin/Insulin
Current Illness:
Preexisting Conditions: 1DEC97 insulin-depend;diabetes status
Diagnostic Lab Data: NONE
CDC Split Type: REG97970
Vaccination
Manufacturer
Lot
Dose
Route
Site
BCG: BCG (NO BRAND NAME)UNKNOWN MANUFACTURER    
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.    
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Urinary retention
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: pt recv vax & exp pyrexia & urine retention 1 day p/vax;sx led to a hosp admission;pt had not recovered @ the time the report was submitted;

VAERS ID:112499 (history)  Vaccinated:1997-10-21
Age:71.3  Onset:1997-10-21, Days after vaccination: 0
Gender:Male  Submitted:1998-06-11, Days after onset: 233
Location:Foreign  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA;Isosorbide;Tolbutamide
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: REG98026
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E71012BA1 IM 
Administered by: Other     Purchased by: Other
Symptoms: Anaphylactoid reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & had an anaphylactic rxn;pt recovered same day;time to onset & tx were not reported;

VAERS ID:112532 (history)  Vaccinated:1997-10-21
Age:57.3  Onset:1997-10-21, Days after vaccination: 0
Gender:Female  Submitted:1998-06-11, Days after onset: 233
Location:Foreign  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin;Atenolol;Glyceryl;Simvastatin
Current Illness:
Preexisting Conditions: 28OCT97 rxn to tetanus vax, nil else;not allergic to eggs;
Diagnostic Lab Data: NONE
CDC Split Type: EML97805
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.    
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt devel quite a severe local rxn w/in 6hr of vax;pt had an erythematous area of about 6cm diameter which was considerably painful;

VAERS ID:112571 (history)  Vaccinated:1997-10-21
Age:0.7  Onset:1997-10-23, Days after vaccination: 2
Gender:Male  Submitted:1998-06-11, Days after onset: 231
Location:Foreign  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline;ASA;Cardura;
Current Illness:
Preexisting Conditions: allergic ponstan; transurethral resection of prostate;hyperplasia of prostate;angina pectoris;inguinal hernia;
Diagnostic Lab Data: NONE
CDC Split Type: EML971025B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E71009BD1 SC 
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Cough, Influenza, Malaise
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad)
Write-up: pt recv vax & was described as having prolonged flu like sx w/onset 3 days p/vax;pt exp gen malaise, weakness & chest cough;

VAERS ID:151113 (history)  Vaccinated:1997-10-21
Age:59.0  Onset:1997-11-01, Days after vaccination: 11
Gender:Male  Submitted:2000-04-21, Days after onset: 901
Location:Foreign  Entered:2000-04-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Arcalase, Lasix, glipizide, Persantine, enalapril, aspirin
Current Illness:
Preexisting Conditions: DM and hypertension
Diagnostic Lab Data: Exam of circulatory system-arterial insufficiency (peripheral), eye-nml, heart rate-nml, neurology-left-sided hemiparesis, MRI-myelitic changes in spinal cord with thickened roots and arachnoiditis in lumbar region.
CDC Split Type: 20000207711
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  IM 
Administered by: Other     Purchased by: Other
Symptoms: Arachnoiditis, Cardiovascular disorder, Epistaxis, Hemiparesis, Hypoaesthesia, Muscle spasms, Myelitis, Nasopharyngitis, Oedema peripheral, Peripheral vascular disorder, Skin ulcer
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)
Write-up: On 10/21/1997, the dose of Fluorix was given. Still, approximately 1 week post vax, the pt developed a slight cold. During the first week of 11/1997, he developed a brief episode of feeling of numbness in fingertips of both hands. On 11/13/1997, he attended a clinical ward with increasing feeling of weakness in left arm and leg, showing a fluctuating picture. About 24 hours after admission, he developed paralysis of the left hemibody. Despite extensive investigation, no clear pathogenasia could be found, so he was transferred to a rehab clinic. On admission, he was speaking with a weak voice. He presented with a left-sided hemiparesis. He recovered some activity in the left leg. During this period of care, he developed pain in his left leg with a distal ulcer. Exam of circulation showed slight insufficiency with slight stenosis in abductor canal and close stenosis in the left popliteal artery. He was treated with Baclofen with good effect and was also given Botox injection in quadriceps and hamstring muscles of the left leg. On discharge, he was able to walk with frame and has received an electric wheelchair. On further exams, it appeared that the Botox injections had had no effects on spasms. A recurrance of the ulcer on the leg which tends to swell has been noted. The pt reported also a tendency to nose bleeding. He was found to have bulging conchae without polyps. During his period of medical care, the pt has been hospitalized several times. As of 4/12/2000, the events were ongoing and the events were mentioned to be incapacitating. The reporting physician considers the events to be probably related to the vaccine.

VAERS ID:162590 (history)  Vaccinated:1997-10-21
Age:46.0  Onset:1997-10-31, Days after vaccination: 10
Gender:Female  Submitted:2001-07-21, Days after onset: 1358
Location:Foreign  Entered:2000-11-27, Days after submission: 235
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Quincke''s edema, dysesthesia, unspecified reactin to wasp sting.
Diagnostic Lab Data: LP-nml, brain MRI-syringomyelic slit and cervico-occipital junction malformation, electromyelogram-nml,
CDC Split Type: 20000334621
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1993AC SC 
Administered by: 0     Purchased by: 0
Symptoms: Difficulty in walking, Dysphagia, Laboratory test abnormal, Pain, Paraesthesia, Respiratory disorder, Speech disorder, Vertigo, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow)
Write-up: Report describes the occurrence of neurological symptoms in a 49 year old female pt vaccianted with Engerix-B. The pt''s relevant medical history inlcuded Quincke''s Edema in childhood. The pt experienced also dysesthesia following ingestion of chocolate and other unspecified food recently, the pt experienced an unspecified reaction following wasp sting. Concurrent medical conditions included moderate depression. Ten days post vax, the pt experienced severe right foot pain for two hours. A few days later, she experienced severe vertigo for 45 minutes. A few days later, she had vertigo again, with blurred vision. A few days later, she developed paresthesia from lower limbs to the head. A few days later, she had back pain. She was hospitalized several times between 1997-1999. In August 2000, the pt developed sensitive disorder with swallowing disorder, respiratory disorder, and walking difficulty. In October 2000, the pt experienced cervico-cranial junction pain and speech difficulty. No dx was set for these neurological symptoms. Multiple sclerosis was evoked but psychogenic origin was not ruled out. Neurological check-up was planned. On 03/12/2001, allergic check-up was performed. Hepatic check-up, electrolytogram and blood cell count showed no abnormality.Erythrocytic magnesium and serum iron were within normal range. Erythrocyte sedimentation rate, thyroid-stimilating hormone and polymerase chain reaction were normal. According to the physician, the pt''s neurologic disorders could be due to candide albicane hyperreactivity and to digestive allergy. The most recent info was received on 07/13/2001, reports the outcome of the pt as not yet recovered.

VAERS ID:203569 (history)  Vaccinated:1997-10-21
Age:1.5  Onset:1998-04-21, Days after vaccination: 182
Gender:Male  Submitted:2003-05-16, Days after onset: 1851
Location:Foreign  Entered:2003-05-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Physical examination (08/24/1997): developmental test showed a global developmental delay
CDC Split Type: WAES0305USA01466
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Autism, Epilepsy, Gastrointestinal disorder, Neurodevelopmental disorder
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Initial information has been received from a foreign legal firm regarding a case in litigation concerning a 18 month old male who on 10/21/97 was vaccinated with MMR II. On approximately 4/21/98, six months post vaccination, the pt suffered from seizures and was diagnosed with epilepsy. In October 2000, the pt was diagnosed with global developmental delay. The pt also had not been able to communicate when he needed to go to the toilet and had suffered from bowel problems since receiving the vaccination. Upon internal review, epilepsy and global developmental delay were considered to be other important medical events (OMIC). It has also been alleged that the pt''s brother developed autism and global developmental delay post vaccination (WAES0302USA00270). No further info is available. Received on 06/03/2003: "Follow up information was received on 05/19/2003 via an assessment performed on 10/04/2000 regarding the patient''s older brother. This assessment indicated that the patient also ssimilarly showed global developmental delay and a small stature like his older brother. The patient was born by normal delivery after a normal pregnancy with a birth weight of 3460kg. He also had problems with feeding. He also failed to gain weight and suffered chest infections. A developemental test at the age of ten and quarter months showed a global developmental delay. He was obsessed now with switches and had breath-holding attacks when frustrated. He has had numerous febrile convulsions in the past and had recently had a generalized tonic clonic seizure lasting approximately fifteen minutes followed by subsequent seizure. He had been on sodium valproate in the past but this was stopped over a year ago. He also had a sister and a younger brother with no reported developmental difficulties. Upon internal review, epilepsy and global developmental delay were considered to be other important medical events. It has also been alleged that the patient''s brother developed Autism and Global developmental delay post MMRII (WAES

VAERS ID:454938 (history)  Vaccinated:1997-10-21
Age:  Onset:0000-00-00
Gender:Female  Submitted:2012-05-03
Location:Foreign  Entered:2012-05-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Hypercholesterolemia; Lumbar Disc Arthrosis; Osteopenia; Osteoporosis
Preexisting Conditions:
Diagnostic Lab Data: Antinuclear factor, 1998, positive; Electroencephalogram, 04Mar1999, not provided
CDC Split Type: B0799418A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Antinuclear antibody positive, Arthralgia, Asthenia, CSF oligoclonal band present, Change of bowel habit, Chronic fatigue syndrome, Coordination abnormal, Dyspepsia, Dysstasia, Electroencephalogram, Fatigue, Fibromyalgia, Gait disturbance, Gastric ulcer, Guillain-Barre syndrome, Hyperaesthesia, Hyperreflexia, Hypoaesthesia, Hypotonia, Impaired gastric emptying, Localised oedema, Malaise, Movement disorder, Muscle contractions involuntary, Muscle spasms, Myalgia, Nerve root lesion, Neurological examination abnormal, Pain in extremity, Paraesthesia, Poor quality sleep, Sleep disorder, Visual acuity reduced
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal obstruction (narrow), Gastrointestinal ulceration (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Demyelination (narrow), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (broad)
Write-up: This case was reported by a regulatory authority (DHH-N2012-058648) and described the occurrence of guillain-barre in a adult female subject whow as vaccinated with TEDIVAX ADULT (GlaxoSmithKline). Concurrent medical conditions included diabetes, hypercholesterolemia, lumbar disc arthrosis, osteopenia and osteoporosis. Concomitant medication included Simvastatine (EG Tab 84 x 20mg). On 21 October 1997, the subject received unspecified dose of TEDIVAX ADULT (unknown route of administration, unknown site of injection, batch number not provided). Report from 11 June 1998: The subject experienced fatigue, a feeling of not being able to continue without real cramps in upper legs. This feeling necessitated her to sit down. To stand did not help. These complaints have seriously increased in the last five months. Sometimes the subject got awakens at night by the pain. During the day there was sometimes a sleeping feeling in the upper legs. A similar complaint, but less important was present at level of the arms, hands and neck. Report from 1998: No real spinal pain was reported but clearly contracted back muscles. Clinical neurological examination showed hyperreflexia upper and lower. Muscle decline and very defective coordination was reported. Anti-nuclear factor positive was observed without clear clinical relevance. Report from February 1999: Before the vaccination, the subject did not complain. Since then she experienced Guillain-Barre syndrome. There were still complaints of fatigue and pain in the legs. The subject experienced pain with changing locations, intermittent local edema, decreased of strength in lower limbs. An increase of anti-nuclear factor and an oligoclonal band in gamma fraction were observed. Report from 4 March 1999: The subject came to consultation because she has had more and more problems for the last few days. She had pain over almost all muscles. She had more difficulties to stand up and walk. To move was also difficult. According to subject the complaints started after a tetanus injection in 1997. She would then have felt ill and afterwards there was an improvement. Since 1998 the subject experienced diffuse muscle and joint pain starting in the morning, going better after a few hours but always present. It prevents her from sleeping. It was not going better with analgesics. Since 1998, the subject also experienced fatigue with non invigorating sleep and vision decrease when extremely tired. She also experienced decreased capacity for efforts, sometimes paresthesia at level of fingers, feet and around the mouth, sometimes during a few days and changing stools pattern with abdominal cramps (going better after defecation), pyrosis and epigastric pain. She also experienced gastric ulcers and impression that food did not digest. Before October 1997, the subject was in good condition. She walked from workplace to workplace and could make the household without problems. Afterwards, she still went for a walk of 2 to 3 km with the dog and could spend the evening without extreme fatigue nor pain. Report from 2004: The subject slept badly. The subject described occasionally atypical blockades at level of both legs. She had problems because of vision disorders at left eye. Clinical neurological test showed hypoesthesia at level of left half face, symmetrical segmentary strength, symmetrical tendon reflexes, normal sensibility, no meningeal signs and a normal coordination. Diffuse contracted muscles with local pressure pain on tendon fixing places and muscle was also noted. An electroencephalogram was performed on 4 March 1999, no result was provided. Report from 16 June 2004: the subject declarer that the pain was extended to the whole body and that the maximal localisation could change quickly. She had a sleep feeling in the face. She also said that she was sometimes completely blocked and that she couldn''t dress. She received several treatments but without success. She also said that pain drastically increased whe

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