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Found 554176 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:92554 (history)  Vaccinated:1996-11-10
Age:49.6  Onset:1996-11-10, Days after vaccination: 0
Gender:Female  Submitted:1996-11-22, Days after onset: 12
Location:Wisconsin  Entered:1996-12-02, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp nausea & gen malaise p/1995-1996 flu vax;
Other Medications: plain robitussin
Current Illness: dry, hacky cough gets every winter
Preexisting Conditions: amoxicillin allergy;hayfever, high cholesterol
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681561 A
Administered by: Other     Purchased by: Private
Symptoms: Face oedema, Hypertension, Hyperventilation, Oedema peripheral, Paraesthesia, Urticaria, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 30min p/vax pt very warm-very red face & neck w/hive like areas;no diff breathing or swallowing;BP 200/80-heart rate 84, resp 24;face appeared puffy;sent to ER tx w/med;exp sensitivity to cold w/hands swelling up;

VAERS ID:95781 (history)  Vaccinated:1996-11-10
Age:40.7  Onset:1996-11-10, Days after vaccination: 0
Gender:Female  Submitted:1996-12-17, Days after onset: 37
Location:California  Entered:1997-03-06, Days after submission: 79
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: 896355014L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968162 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: w/in 4hr p/vax pt devel an inj site rxn characterized by an area of erythema & induration measuring 50mm in diameter;pt had recovered @ the date of this report;this is 1 of 4 pt from this site to devel an inj site rxn p/flu vax;

VAERS ID:107578 (history)  Vaccinated:1996-11-10
Age:3.5  Onset:1996-11-13, Days after vaccination: 3
Gender:Male  Submitted:1997-11-28, Days after onset: 380
Location:Colorado  Entered:1998-01-15, Days after submission: 48
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: CO7079
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712380  
Administered by: Private     Purchased by: Private
Symptoms: Gait disturbance, Hypokinesia, Pain, Red blood cell sedimentation rate increased, Rheumatoid arthritis
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow), Hypoglycaemia (broad)
Write-up: pt recv vax 1NOV96 & 13NOV96 it was reported that pt could not bear weight on lt leg;x-ray results did not determine a dx;16DEC96 pt reportedly had a sed rate of 48;dx JRA;

VAERS ID:94844 (history)  Vaccinated:1996-11-10
Age:53.1  Onset:1996-11-11, Days after vaccination: 1
Gender:Female  Submitted:1996-11-23, Days after onset: 12
Location:Foreign  Entered:1997-02-06, Days after submission: 75
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: H&RT
Current Illness: NONE
Preexisting Conditions: allergy to septra
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERM08810 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: area of erythema 7cm diameter local heat & moderate itch;appeared w/in 24hr of inj & almost completely faded 10 days later;

VAERS ID:100475 (history)  Vaccinated:1996-11-10
Age:29.2  Onset:1996-11-10, Days after vaccination: 0
Gender:Male  Submitted:1997-07-17, Days after onset: 248
Location:Foreign  Entered:1997-07-28, Days after submission: 11
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:
Current Illness:
Preexisting Conditions: herniated disk;
Diagnostic Lab Data: NOV96 CT Scan nl; Electromyogram nl;Evoked potentials nl;
CDC Split Type: 970165781
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Chest pain, Dyspnoea, Hypoaesthesia, Muscle spasms, Neuropathy, Paraesthesia, Vasculitis
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vasculitis (narrow)
Write-up: 2hr p/vax pt exp severe asthenia & calfs cramp which regressed in a few hr;5 days later pt exp stabbing pain between lt calvicle & lt nipple;lt upper limb paresthesia, pain & hypoesthesia occured w/sometimes some flash pain;hosp;dx plexitis

VAERS ID:262541 (history)  Vaccinated:1996-11-10
Age:  Onset:1997-08-29, Days after vaccination: 292
Gender:Female  Submitted:2006-08-29, Days after onset: 3287
Location:Foreign  Entered:2006-09-05, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0608USA05488
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.   UN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Autism
SMQs:
Write-up: Information has been received from a health professional and a health professional and a health authority concerning a female of unknown age who on 11/10/1996 was vaccinated IM with a dose of MMR II (manufacturer unknown). On 8/29/1997, the pt became autistic. No further information was provided. At the time of this report the pt had not yet recovered. Upon internal review, the pts adverse experience was determined to be an other important medical event (OMIC). Other business partner numbers included E200604303. No further information is available.

VAERS ID:92126 (history)  Vaccinated:1996-11-11
Age:1.0  Onset:1996-11-12, Days after vaccination: 1
Gender:Male  Submitted:1996-11-13, Days after onset: 1
Location:California  Entered:1996-11-18, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn 29JAN96 @ 2mp w/DTP fever dose 1;
Other Medications: PPD by Connaught lot# 241712 given 11NOV96;
Current Illness: NONE
Preexisting Conditions: has sz disorder
Diagnostic Lab Data: CBC-nl;phenobarbital level 18;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0317D0 LL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: 10min gen convuls 24hr p/vax;

VAERS ID:92160 (history)  Vaccinated:1996-11-11
Age:0.2  Onset:1996-11-11, Days after vaccination: 0
Gender:Male  Submitted:1996-11-12, Days after onset: 1
Location:Massachusetts  Entered:1996-11-19, 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: APAP
Current Illness: URI
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)MASS. PUB HLTH BIOL LABDTP2960IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM240NB0IMRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0743A0PO 
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Crying
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)
Write-up: screaming, crying & fussy for 2hr;

VAERS ID:92178 (history)  Vaccinated:1996-11-11
Age:62.2  Onset:1996-11-12, Days after vaccination: 1
Gender:Female  Submitted:1996-11-13, Days after onset: 1
Location:Florida  Entered:1996-11-19, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec;Diazide, slow K
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00576P0 LA
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: red, feverish spot on lt deltoid the size of a quarter on onset inc in size to 3inches in diameter above & below inj area;sl puffy & swollen;

VAERS ID:92260 (history)  Vaccinated:1996-11-11
Age:0.5  Onset:1996-11-12, Days after vaccination: 1
Gender:Female  Submitted:1996-11-19, Days after onset: 7
Location:Michigan  Entered:1996-11-22, Days after submission: 3
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: plugged tear duck
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES6K711492 LL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0280D2 RL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES6J711042 LL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0745M2PO 
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Similar reaction on previous exposure to drug
SMQs:, Hypersensitivity (narrow)
Write-up: pt recv vax & exp macular pap rash both thighs;seen by MD 18NOV96;

VAERS ID:92332 (history)  Vaccinated:1996-11-11
Age:65.7  Onset:1996-11-13, Days after vaccination: 2
Gender:Female  Submitted:1996-11-13, Days after onset: 0
Location:North Dakota  Entered:1996-11-25, Days after submission: 12
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: allergy sulfa
Diagnostic Lab Data:
CDC Split Type: ND96022
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681785IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES3949360IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, 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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: inj site swollen hot & red;fever 100;

VAERS ID:92420 (history)  Vaccinated:1996-11-11
Age:15.6  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1996-11-12, Days after onset: 1
Location:California  Entered:1996-11-26, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: afeb, sore throat
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1613A10IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6H812690IMLA
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Headache, Injection site pain, Insomnia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fever of 104.0, aches & pains, h/a, dizziness, insomnia, localized muscle soreness in inj site;these sx lasted 2 days till pt recovered;

VAERS ID:92433 (history)  Vaccinated:1996-11-11
Age:1.3  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1996-11-18, Days after onset: 7
Location:Nebraska  Entered:1996-11-26, 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: amoxicillin chewable
Current Illness: NONE
Preexisting Conditions: suprax causes diarrhea) NKAM
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4367893IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0391D0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 10AM 5hr later 3PM t100;by 2AM fever inc to 104 (103 A);ran fever off & on the following day & part of next (101-102);

VAERS ID:92601 (history)  Vaccinated:1996-11-11
Age:67.7  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1996-11-18, Days after onset: 7
Location:New York  Entered:1996-12-05, Days after submission: 17
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Chills, Conjunctivitis, Cough, Dyspnoea, Lacrimal disorder
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular infections (broad), Hypersensitivity (broad)
Write-up: diff breathing, asthmatic coughing, tearing red eyes, chills;DPH, Pred had nof effect;

VAERS ID:92824 (history)  Vaccinated:1996-11-11
Age:1.2  Onset:1996-12-02, Days after vaccination: 21
Gender:Female  Submitted:1996-12-09, Days after onset: 7
Location:New Jersey  Entered:1996-12-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NA
Diagnostic Lab Data: platelet count 1,000;pt 12.4, ptt 2.5;WBC 11.8; (n/l diff);
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES5E710743IML
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4230NA3IML
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0469D0SCL
Administered by: Private     Purchased by: Private
Symptoms: Ecchymosis, Epistaxis, Gingival bleeding, Mouth ulceration, Petechiae, Thrombocytopenia
SMQs:, Severe cutaneous adverse reactions (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 11NOV96 & 2DEC96 h/o epistaxis, bruising, gum lesion;seen 3DEC96 noted to have hemmorragic bullae of gum;petechie, ecchymosis of extremities & back;3DEC96 platelet count 1,000;

VAERS ID:92841 (history)  Vaccinated:1996-11-11
Age:1.0  Onset:1996-11-12, Days after vaccination: 1
Gender:Male  Submitted:1996-11-13, Days after onset: 1
Location:Michigan  Entered:1996-12-13, Days after submission: 30
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: MI96172
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES6J710593IMRL
HIBV: HIB (PROHIBIT)CONNAUGHT LABORATORIES6C710743IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0476D0SCLL
Administered by: Public     Purchased by: Unknown
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 11NOV96 3PM had fever (not measured) x 48hr;had 2 vomiting episodes w/in 20hr of vax;MD was not called by parents;pt treated w/APAP;

VAERS ID:92909 (history)  Vaccinated:1996-11-11
Age:  Onset:1996-11-12, Days after vaccination: 1
Gender:Female  Submitted:1996-11-14, Days after onset: 2
Location:Pennsylvania  Entered:1996-12-16, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968206 IMA
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Dyspnoea, Personality disorder
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)
Write-up: 11012hr p/vax awoke in middle of noc w/difficult breathing;became panicked;sat up for 1hr-no sx;went to bed, difficult breathing lying down;sat up to sleep;awoke-no sx since;did not call MD;

VAERS ID:93251 (history)  Vaccinated:1996-11-11
Age:0.2  Onset:1996-11-11, Days after vaccination: 0
Gender:Male  Submitted:1996-11-18, Days after onset: 7
Location:California  Entered:1996-12-23, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: expmp by lederle lot # A600
Current Illness: chronic stuffy nose
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (TRI-IMMUNOL)LEDERLE LABORATORIES4367920 RL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0674D0 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0748H0PO 
Administered by: Unknown     Purchased by: Private
Symptoms: Anorexia, Pyrexia, Screaming, Somnolence, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt recv vax; fever of 101 p/ DTP; slept for 9 1/2 hr; would not eat; pt cried all day; 1 lb weight loss over 2 days;

VAERS ID:93451 (history)  Vaccinated:1996-11-11
Age:60.9  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1996-11-30, Days after onset: 19
Location:Unknown  Entered:1996-12-31, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: seen that day for asthma w/PF 300 - mild wheezing
Preexisting Conditions: asthma aug96
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthma, Condition aggravated
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: pt recv vax; had asthma exacerbation over next 24 hr - not relieved w/meds; er visit required; sx resolved;

VAERS ID:94275 (history)  Vaccinated:1996-11-11
Age:36.9  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Washington  Entered:1997-01-23
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: No relevant data;
CDC Split Type: WAES96111218
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1SC 
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: pt recv vax 11NOV96 & pt devel a rash around inj site about the size of a hand;

VAERS ID:94282 (history)  Vaccinated:1996-11-11
Age:3.3  Onset:1996-11-12, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Ohio  Entered:1997-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling exp chickenpos @ 5yr w/varivax dose 1;
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96111307
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0838D0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Malaise, Pruritus, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 11NOV96 & 12NOV96 pt devel a chickenpox rash consisting of multiple lesions on back, abd & in oral cavity;pt was covered w/lesions;pt also exp fever up to 102, severe itching, & discomfort;

VAERS ID:94283 (history)  Vaccinated:1996-11-11
Age:5.7  Onset:1996-11-12, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Ohio  Entered:1997-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling exp varicella @ 40M w/varivax dose 1
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96111309
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0838D0SCA
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Malaise, Pruritus, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 11NOV96 & 12NOV96 pt devel chickenpox rash consisting of multiple lesions on back, abd & in oral cavity;pt was covered w/lesions;pt also exp fever to 102, severe itching, & discomfort;pt sx improved 36hr p/vax; pt recovered;

VAERS ID:94337 (history)  Vaccinated:1996-11-11
Age:12.6  Onset:1996-11-27, Days after vaccination: 16
Gender:Female  Submitted:0000-00-00
Location:Pennsylvania  Entered:1997-01-23
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: No relevant data;
CDC Split Type: WAES96120075
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2129A20IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0781D0IM 
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 11NOV96 & 27NOV96 pt devel a rash consisting of about 15 lesions;pt was brought into MD office;

VAERS ID:94842 (history)  Vaccinated:1996-11-11
Age:60.9  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1996-11-30, Days after onset: 19
Location:Massachusetts  Entered:1997-02-06, Days after submission: 68
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: hx DM, asthma AUG96;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthma, Condition aggravated
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: pt w/hx of asthma, stable;pt recv flu shot-over next 24hr had asthma exacerbation not relieved w/meds;required ER visit;

VAERS ID:95367 (history)  Vaccinated:1996-11-11
Age:0.3  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1996-12-31, Days after onset: 50
Location:Iowa  Entered:1997-02-25, Days after submission: 56
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:
CDC Split Type: 897013012L
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4386230IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1156D1IMRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0747L0PO 
Administered by: Public     Purchased by: Private
Symptoms: Crying, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax & cried inconsolably for 4hr & devel a fever of unspecified degree;pt had recovered @ the date of this report;

VAERS ID:95778 (history)  Vaccinated:1996-11-11
Age:27.4  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1996-12-17, Days after onset: 36
Location:California  Entered:1997-03-06, Days after submission: 79
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft;Synthroid;Desyrel
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: 896355011L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968162 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: immed p/vax pt devel inj site rxn characterized by induration & erythema;pt recovered @ the date of this report;this is 1 of 4 pt from this site to devel an inj site rxn following vax;

VAERS ID:95779 (history)  Vaccinated:1996-11-11
Age:49.3  Onset:1996-11-13, Days after vaccination: 2
Gender:Female  Submitted:1996-12-17, Days after onset: 34
Location:California  Entered:1997-03-06, Days after submission: 79
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propulcid
Current Illness: NONE
Preexisting Conditions: fibromyalgia
Diagnostic Lab Data: NONE
CDC Split Type: 896355012L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968162 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 2 days p/vax pt devel an inj site rxn characterized by 45mm by 40mm area of erythema & induration;pt recovered @ the date of this report;this is 1 of 4 pt from this site to devel an inj site rxn following the vax;

VAERS ID:95443 (history)  Vaccinated:1996-11-11
Age:1.4  Onset:1996-11-20, Days after vaccination: 9
Gender:Female  Submitted:1997-03-04, Days after onset: 104
Location:New York  Entered:1997-03-07, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97011435
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0888D0SC 
Administered by: Private     Purchased by: Other
Symptoms: Cyanosis, Depressed level of consciousness, Diarrhoea, Gastrointestinal disorder, Miosis, Mydriasis, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 25NOV96 pt devel high fever of 104 to 106 & began turning blue several times a day;became dehydrated almost & hosp;while in hosp pt exp a dec fever of 93.4;hosp x 6 days;pt pupils constrict under light, then dilate & constrict;cyanosis

VAERS ID:97143 (history)  Vaccinated:1996-11-11
Age:3.2  Onset:1996-12-01, Days after vaccination: 20
Gender:Female  Submitted:1997-04-18, Days after onset: 137
Location:Illinois  Entered:1997-04-23, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt sibling exp febrile sz @ unk age w/DTP dose 3;
Other Medications:
Current Illness: NA
Preexisting Conditions: dizzy speels in summer 1996;
Diagnostic Lab Data: EEG, urine organic acids, lactate,amino acid nl;abn venous blood gas, PH 7.29, CO2 251;PO2 96; BE 2.8;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1080D   
Administered by: Private     Purchased by: Other
Symptoms: Acidosis, Coordination abnormal, Laboratory test abnormal
SMQs:, Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tumour lysis syndrome (broad), Hypoglycaemia (broad)
Write-up: ataxic episode 3wk following vax;

VAERS ID:99620 (history)  Vaccinated:1996-11-11
Age:32.0  Onset:1996-12-18, Days after vaccination: 37
Gender:Female  Submitted:1996-12-18, Days after onset: 0
Location:Connecticut  Entered:1997-05-29, Days after submission: 161
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Azmacort, Albuterol
Current Illness: UNK
Preexisting Conditions: hx of asthma & bronchitis;
Diagnostic Lab Data: UNK
CDC Split Type: 010150970021000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00176P0IMA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Influenza, Myalgia, Pharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax & exp flu sx on 18DEC96 described as myalgias, sore throat, fever & cough for 1wk p/vax;pt recovered;

VAERS ID:101425 (history)  Vaccinated:1996-11-11
Age:39.3  Onset:1996-11-11, Days after vaccination: 0
Gender:Male  Submitted:1997-04-11, Days after onset: 150
Location:Indiana  Entered:1997-07-22, Days after submission: 102
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: CO6966
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6H81269   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax 11NOV96 & immed exp severe pain @ inj site;pain persisted & was treated w/Flexeril;no inflammation present however area is still tender as of 14NOV96;

VAERS ID:101828 (history)  Vaccinated:1996-11-11
Age:45.3  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1997-08-06, Days after onset: 267
Location:Ohio  Entered:1997-08-25, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Estrace
Current Illness: no illness
Preexisting Conditions: NONE
Diagnostic Lab Data: no evidence of significant CNS demyelination;r/o MS had spinal tap;MRI of brain;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0 A
Administered by: Other     Purchased by: Public
Symptoms: Coordination abnormal, Gait disturbance, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: pt devel daily severe h/a (constant) 4 hr p/vax until present;pt was hosp for new onset of daily persistent h/a & put on preventative meds;pt has also exp gait difficulties since vax; (mild unsteadiness);

VAERS ID:102403 (history)  Vaccinated:1996-11-11
Age:39.0  Onset:0000-00-00
Gender:Female  Submitted:1996-11-18
Location:Unknown  Entered:1997-09-10, Days after submission: 295
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt had an inj site rxn & immobilization of shoulder 10yr ago p/tetanus toxoid
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 896338016L
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES  IM 
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Hypokinesia, Injection site hypersensitivity, Injection site oedema, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax & devel an inj site rxn characterized by redness & swelling;also exp myalgia & arthralgia w/immobilization of shoulder;tx w/topical corticosteroid cream & advil;

VAERS ID:103574 (history)  Vaccinated:1996-11-11
Age:3.0  Onset:1997-07-04, Days after vaccination: 235
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:1997-10-20
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: exposure, varicella;
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97070760
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0427B SC 
Administered by: Other     Purchased by: Private
Symptoms: Drug ineffective, Infection, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax & 4JUL97 pt broke out in spots 7 days p/immunized sibling came down w/chickenpox;

VAERS ID:107298 (history)  Vaccinated:1996-11-11
Age:0.2  Onset:1996-11-12, Days after vaccination: 1
Gender:Female  Submitted:1997-12-18, Days after onset: 401
Location:California  Entered:1997-12-23, Days after submission: 5
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: CO6967
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES5F71109 IMRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2127A2 IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES6M61032 IMRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES  PO 
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Crying, Injection site hypersensitivity, Injection site mass, Injection site oedema, 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), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: pt recv vax & devel screaming sometime p/vax;6DEC96 pt cried hard for 2hr;APAP did not help;cold compresses to legs;site was red, raised lump, warm to touch;

VAERS ID:107543 (history)  Vaccinated:1996-11-11
Age:69.5  Onset:1996-11-11, Days after vaccination: 0
Gender:Female  Submitted:1997-11-29, Days after onset: 383
Location:Ohio  Entered:1998-01-15, Days after submission: 47
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: CO6970
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71306   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Angioneurotic oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt devel angioedema w/in 8hr p/vax;pt reportedly PCN allergic;

VAERS ID:119257 (history)  Vaccinated:1996-11-11
Age:0.1  Onset:1996-11-24, Days after vaccination: 13
Gender:Male  Submitted:1999-02-15, Days after onset: 813
Location:New Jersey  Entered:1999-02-23, Days after submission: 8
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 25 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: ptrecv hep b vax by MSD 13OCT96 lot# 0515D
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2116A91SCLL
Administered by: Private     Purchased by: Public
Symptoms: Convulsion, Dehydration, Delirium, Diabetes mellitus, Hyperglycaemia, Ketosis, Mental retardation severity unspecified
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: pt had blood glucose of $g100 on 24NOV96 dx w/diabetic ketoacidosis (DKA) & as a result of no prev dx became dehydrated suffering brain injury & sz w/major developmental delays (3mo current development);stomach tube for 1/2-2/3 calarie

VAERS ID:123147 (history)  Vaccinated:1996-11-11
Age:4.0  Onset:1998-05-19, Days after vaccination: 554
Gender:Female  Submitted:1999-05-14, Days after onset: 360
Location:Ohio  Entered:1999-05-21, Days after submission: 7
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: WAES98051348
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: it was rpt pt recv 1st dose varivax 11/96 & in 5/98 pt devel chickenpox. had 3 lesions.

VAERS ID:166315 (history)  Vaccinated:1996-11-11
Age:  Onset:1997-01-01, Days after vaccination: 51
Gender:Male  Submitted:2001-02-17, Days after onset: 1508
Location:Virginia  Entered:2001-03-02, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mercury toxicity, autism.~Vaccine not specified~~1~In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Vit A and D, elemental hair analysis, DPT and MMR titers, Mercury challenge test, chelation, IgG allergy assessment, etc.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2128A91IMLL
Administered by: Private     Purchased by: Other
Symptoms: Aphasia, Autism, Drug level increased, Drug toxicity, Gastrointestinal disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: At 12 month, began losing 3 work vocabulary. At 12-24 months, increasing gastrointestinal problems. At 27 months, dx''d with Autism. At 33 months +; clinical trials; fat soluble, vitamin A, later, followed by bethanechol, supplements, chelation. The 60 day follow-up states that the pt has autism; multiple mental totoxicity especially mercury. The pt''s partent states that the pt was poisoned by thimerosal HB and was disabled by the pertusis vaccine.

VAERS ID:174450 (history)  Vaccinated:1996-11-11
Age:4.0  Onset:2000-10-11, Days after vaccination: 1430
Gender:Male  Submitted:2000-10-11, Days after onset: 0
Location:Georgia  Entered:2001-08-20, Days after submission: 313
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.088800 LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1080D0 RL
Administered by: Private     Purchased by: 0
Symptoms: Dermatitis bullous, Rash erythematous, Rash maculo-papular
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This child developed maculopapular erythematous rash with vesicles.

VAERS ID:217839 (history)  Vaccinated:1996-11-11
Age:1.3  Onset:2004-03-02, Days after vaccination: 2668
Gender:Male  Submitted:2004-03-08, Days after onset: 6
Location:Oklahoma  Entered:2004-03-16, Days after submission: 8
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES07838303IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES07838303IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0773D0SCLA
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Varicella lesions outbreak Tues 3/2/04.

VAERS ID:221302 (history)  Vaccinated:1996-11-11
Age:13.0  Onset:2003-11-03, Days after vaccination: 2548
Gender:Male  Submitted:2004-05-14, Days after onset: 192
Location:Connecticut  Entered:2004-05-21, 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: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0311USA00693
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6179080777D0SC 
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous, Pyrexia, Rhinorrhoea
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a licensed practical nurse concerning a 13 year old white male with no pertinent medical history and no known drug allergies who on 11Nov96 was vaccinated with a first dose of varicella virus vaccine live, SC in the left arm. On 04Nov2003 the pt presented to the Dr''s office with break through chickenpox, described as a 24 hour rash with red vesicular lesions over his trunk,arms, and body. The pt also had a mild fever and a runny nose. Medical attention was sought. The child was prescribed desloratadine (Clarinex) for treatment as needed. There was no product quality complaint. The pt recovered. No further information is expected.

VAERS ID:107716 (history)  Vaccinated:1996-11-11
Age:33.4  Onset:1997-01-01, Days after vaccination: 51
Gender:Female  Submitted:1998-02-13, Days after onset: 408
Location:Foreign  Entered:1998-02-18, Days after submission: 5
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: pt father died from chronic lymphatic leucemia;
Diagnostic Lab Data: 8JAN97 thrombocytes 1646;thrombocytes 7MAR97 1310;bone marrow exam chronic myeloproliferative disease;
CDC Split Type: 980039111
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Hypokinesia, Myeloproliferative disorder, Pyrexia, Thrombocythaemia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Blood premalignant disorders (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tumours of unspecified malignancy (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 11NOV96 & 1 day later pt exp fatigue assoc w/fever & restricted mobility of vaccinated arm;15NOV96 thrombocytosis occurred;bone marrow exam later showed chronic myeloproliferative systemic disease;

VAERS ID:92067 (history)  Vaccinated:1996-11-12
Age:0.3  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-11-13, Days after onset: 1
Location:California  Entered:1996-11-15, Days after submission: 2
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: NONE
Diagnostic Lab Data: CXR, CBC, chem panel @ hosp;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4386201 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4349931PO 
Administered by: Private     Purchased by: Private
Symptoms: Cyanosis, Dyspnoea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt was napping @ home 6-7PM woke mom picked pt up to nurse & pt started gasping for air & turned ash color then cyanotic face & upper extremities;father tried to clear airway & then started rescue breathing;parents called 911;taken to ER

VAERS ID:92169 (history)  Vaccinated:1996-11-12
Age:39.6  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-11-12, Days after onset: 0
Location:Washington  Entered:1996-11-19, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bentyl
Current Illness: NONE
Preexisting Conditions: Crohn''s disease
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00786P0 LA
Administered by: Other     Purchased by: Other
Symptoms: Dysphagia, Dyspnoea, Pruritus, Rash, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash & itching lt arm;lump in throat, SOB, tachycardia;

VAERS ID:92228 (history)  Vaccinated:1996-11-12
Age:4.8  Onset:1996-11-13, Days after vaccination: 1
Gender:Male  Submitted:1996-11-14, Days after onset: 1
Location:Arizona  Entered:1996-11-20, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6G71016 IMRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0744F PO 
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site inflammation, Injection site mass, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: local inflammation & swelling of thigh, erythema & induration noted for 2 days;possible cellulitis;given med started on ATB;returned next day w/much improvement;

VAERS ID:92439 (history)  Vaccinated:1996-11-12
Age:1.3  Onset:1996-11-13, Days after vaccination: 1
Gender:Male  Submitted:1996-11-18, Days after onset: 5
Location:Colorado  Entered:1996-11-26, Days after submission: 8
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 but croup when seen 14NOV
Preexisting Conditions: eczema
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6M711843 LL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Laryngitis, Pyrexia
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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: fever & 1min, tonic-clonic sz;croup dx by MD on f/u visit 14NOV96;

VAERS ID:92448 (history)  Vaccinated:1996-11-12
Age:32.4  Onset:1996-11-15, Days after vaccination: 3
Gender:Female  Submitted:1996-11-21, Days after onset: 6
Location:California  Entered:1996-11-27, 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: Naprosyn
Current Illness:
Preexisting Conditions: allergic PCN, Floxin
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)PFIZER/WYETH49680611IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: pt recv vax & 3 days later soreness @ site had ince to be very painful lasting another 3 days;tx local heat & Naprosyn;

VAERS ID:92486 (history)  Vaccinated:1996-11-12
Age:25.4  Onset:1996-11-13, Days after vaccination: 1
Gender:Female  Submitted:1996-11-19, Days after onset: 6
Location:Massachusetts  Entered:1996-11-29, Days after submission: 10
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 4 RA
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral, Osteoarthritis
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow)
Write-up: swollen joints-hands & all major joints per pt;no joint inflam detected on exam;

VAERS ID:92498 (history)  Vaccinated:1996-11-12
Age:0.3  Onset:1996-11-12, Days after vaccination: 0
Gender:Male  Submitted:1996-11-18, Days after onset: 6
Location:Pennsylvania  Entered:1996-12-02, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: aldactone;Diuril
Current Illness: mild nasal congestion
Preexisting Conditions: 27wk gestation;bronchopulmonary dysplasia on A-B monitor
Diagnostic Lab Data: RSV of nasal secretions negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES07813101IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2129A21IMRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4373611PO 
Administered by: Private     Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Hypotonia, Hypoventilation, Hypoxia, Pallor, Respiratory disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow)
Write-up: several hr p/vax pt became white, blue, limp while mom was changing monitor leads;needed CPR;pt was successfully revived, but needed ventilator assistance for a few days & supplemental 02 several more;

VAERS ID:92571 (history)  Vaccinated:1996-11-12
Age:5.5  Onset:1996-11-14, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Florida  Entered:1996-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: amocil-rash
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (TRI-IMMUNOL)LEDERLE LABORATORIES4388254IMRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2118A22 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.021601SCLL
Administered by: Military     Purchased by: Private
Symptoms: Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rt thigh w/6 1/2" inflammation erythema, warm to touch;onset 13NOV;immunizations given 12NOV96;

VAERS ID:92641 (history)  Vaccinated:1996-11-12
Age:58.1  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-11-15, Days after onset: 3
Location:Indiana  Entered:1996-12-06, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Dyazide, hormone replacement therapy
Current Illness:
Preexisting Conditions: ceclor & topical steroid cream;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71288 IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, 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 12NOV96 noticed redness that noc;14NOV96 w/ 2cm induration @ site of inj & surrounding redness & edema of 3x9cm;itching; tx w/med;

VAERS ID:92657 (history)  Vaccinated:1996-11-12
Age:0.6  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-11-29, Days after onset: 17
Location:West Virginia  Entered:1996-12-09, 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:
Current Illness: NONE
Preexisting Conditions: 30OCT96 had OM treated w/Amoxicillin
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES07760502IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0517D2IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES07760502IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES741H42PO 
Administered by: Private     Purchased by: Public
Symptoms: Personality disorder, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: crying for 4-5hr p/shot & acting different;t101-102;would lie still & cry instead of moving about but had no unusual movements & no inc tone;

VAERS ID:92665 (history)  Vaccinated:1996-11-12
Age:85.3  Onset:1996-11-18, Days after vaccination: 6
Gender:Female  Submitted:1996-11-21, Days after onset: 3
Location:Maryland  Entered:1996-12-09, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp swelling, itching @ 18yr w/tetanus
Other Medications: Lanoxin, Synthroid, Furosemide, Klor-Con, B-complex vitamins
Current Illness: NONE
Preexisting Conditions: hypothyroidism
Diagnostic Lab Data: CXR negative;blood work
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4368240 LA
Administered by: Other     Purchased by: Public
Symptoms: Cough, Headache, Myalgia, Productive cough, Pyrexia, Respiratory disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: awoke w/h/a;exp chills, fever, achiness, dry, hacky cough;seen by MD 19NOV96;t99, producing grayish sputum;upper resp congestion;

VAERS ID:92716 (history)  Vaccinated:1996-11-12
Age:0.1  Onset:1996-11-13, Days after vaccination: 1
Gender:Female  Submitted:1996-12-03, Days after onset: 20
Location:Arizona  Entered:1996-12-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE x/APAP
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: AZ9717
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES4299670 LL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1966A21 RL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES4299670 LL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4335130PO 
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Screaming
SMQs:, Hostility/aggression (broad)
Write-up: pt recv vax 12NOV96 & mom called 13NOV @ noc reporting persistent crying, anorexia for 36hr;no sz never went to hosp;resolved by next AM of 14NOV;

VAERS ID:92736 (history)  Vaccinated:1996-11-12
Age:45.4  Onset:1996-11-12, Days after vaccination: 0
Gender:Male  Submitted:1996-12-04, Days after onset: 22
Location:Illinois  Entered:1996-12-10, 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F713071IMRA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Headache, Hypokinesia, Myalgia, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt recv vax 12NOV96 & arm became extremely sore 7PM;could not lift arm above shoulder height;approx 9PM pt became chilled;shivered uncontrollably for 4hr till fever came @ approx 1AM;violent h/a also during 9PM-1AM;

VAERS ID:92838 (history)  Vaccinated:1996-11-12
Age:2.8  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-11-15, Days after onset: 3
Location:Michigan  Entered:1996-12-13, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MI96169
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4380902IMRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2139A21IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES745M12PO 
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)
Write-up: inj site rt anterior thigh red, warm to touch;inflammation approx 5x5cm;

VAERS ID:92842 (history)  Vaccinated:1996-11-12
Age:63.0  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-11-14, Days after onset: 2
Location:Michigan  Entered:1996-12-13, Days after submission: 29
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: hx, anaphlactic shock from cHYMAR 30 yr ago;dx by PP turned purple & could not breath, 45min;
Diagnostic Lab Data:
CDC Split Type: MI96173
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4318050SCLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Injection site hypersensitivity, Injection site oedema, Rash maculo-papular, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: approx 5" redness surrounded site from day of inj;chills started today for last 3hr;noted red fine rash on chest today;like when had strep infect in the past;lt arm swollen from site site to elbow all the way to outer side;warm to touch

VAERS ID:93138 (history)  Vaccinated:1996-11-12
Age:  Onset:1996-11-17, Days after vaccination: 5
Gender:Female  Submitted:0000-00-00
Location:Illinois  Entered:1996-12-13
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: very sick, arms hurt real bad, persisted for 3-4wk;

VAERS ID:92889 (history)  Vaccinated:1996-11-12
Age:50.8  Onset:0000-00-00
Gender:Male  Submitted:1996-12-05
Location:Colorado  Entered:1996-12-16, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: redness swelling @ site
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71320  RA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4404200 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, 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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 24hr p/vax fever 102, redness, swelling @ site of inj;tx Levloz, Ibuprofen;rxn resolved;

VAERS ID:92892 (history)  Vaccinated:1996-11-12
Age:2.1  Onset:1996-11-13, Days after vaccination: 1
Gender:Male  Submitted:1996-12-12, Days after onset: 29
Location:New York  Entered:1996-12-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unk
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6G710161IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0517D1IMRL
Administered by: Public     Purchased by: Public
Symptoms: Gaze palsy, Hypotonia, Muscle twitching
SMQs:, Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: pt recv vax 10AM;@ 3AM the following morning pt @ first became limp, eyes rolled back & all extremities began to jerk according to father;sx occurred intermittently for approx 1hr;father took child to PMD who prescribed APAP, robituss

VAERS ID:92923 (history)  Vaccinated:1996-11-12
Age:50.1  Onset:1996-11-16, Days after vaccination: 4
Gender:Female  Submitted:1996-11-25, Days after onset: 9
Location:Washington  Entered:1996-12-16, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Lopressor;Lanoxin, Synthroid, Entex LA, Nazalide, Estrogen
Current Illness: NONE
Preexisting Conditions: premature heart beats, TMJ sinus-allergies
Diagnostic Lab Data: Mammogram
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00786P0 LA
Administered by: Other     Purchased by: Other
Symptoms: Myalgia, Oedema peripheral
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt states had flu shot on 12NOV96 & on 16NOV96 pt devel swelling & soreness under lt arm & into lt breast;

VAERS ID:93941 (history)  Vaccinated:1996-11-12
Age:5.0  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-12-16, Days after onset: 34
Location:Kansas  Entered:1997-01-21, Days after submission: 36
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: constipation
Preexisting Conditions: up to age 3-4 was eval for pulmonary stenosis-grew out of this
Diagnostic Lab Data:
CDC Split Type: KS96045
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681570IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Rash, Urticaria, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt devel welts all over but not the face;feet were so swollen that could not wear shoes;had red rash between welts;no fever;no resp distress;rash around mouth;welts move to face;

VAERS ID:94454 (history)  Vaccinated:1996-11-12
Age:1.1  Onset:1996-11-26, Days after vaccination: 14
Gender:Female  Submitted:1997-01-21, Days after onset: 56
Location:Utah  Entered:1997-01-28, 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: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0396D SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0775D0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Influenza, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2wk p/vax had chicken pox, fever-low, flu sx-achy, several pox-all over body-not counted-not as many pox as usual-i.e.: other children @ other episodes;twin did not get chicken pox;

VAERS ID:94521 (history)  Vaccinated:1996-11-12
Age:10.3  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-11-13, Days after onset: 1
Location:Hawaii  Entered:1997-01-29, Days after submission: 77
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unk
Preexisting Conditions: hx of environmental allergies;
Diagnostic Lab Data:
CDC Split Type: HI9701
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1025D0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: pt recv vax 1245PM;during observation period pt wa asymptomatic;no rxn or signs of distress noted;approx 130PM pt c/o SOB;teacher called pt mom;pt taken to MD & given epi & DPH;

VAERS ID:94537 (history)  Vaccinated:1996-11-12
Age:58.2  Onset:1996-11-14, Days after vaccination: 2
Gender:Female  Submitted:1996-11-19, Days after onset: 5
Location:Maryland  Entered:1997-01-29, Days after submission: 71
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: albuterol;Theophyllin
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data: NONE
CDC Split Type: MD96050
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E386GD5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthma, Chills, Condition aggravated, Myalgia, Pharyngitis, Pruritus, Pyrexia, Rash maculo-papular
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 14NOV96 pt began sx of achiness, sore throat, fever, chills, red blotchy itchy rash;also had sx of asthma (pre-existing condition);seen by MD 15NOV96 who felt this was a rxn to flu vax;

VAERS ID:94593 (history)  Vaccinated:1996-11-12
Age:1.6  Onset:1996-11-18, Days after vaccination: 6
Gender:Male  Submitted:1996-11-27, Days after onset: 9
Location:Texas  Entered:1997-01-30, Days after submission: 64
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: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX96194
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES6K711273IMLA
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1324B3IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0113D0SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0743K2PO 
Administered by: Public     Purchased by: Public
Symptoms: Drug ineffective, Infection, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: mom stated pt broke out w/rash starting on back of neck @ hair line;pt was taken to MD & was told to wait it out had the measles;rash persisted for 6 days; no tx was given;

VAERS ID:94600 (history)  Vaccinated:1996-11-12
Age:68.2  Onset:1996-11-13, Days after vaccination: 1
Gender:Female  Submitted:1996-11-14, Days after onset: 1
Location:Texas  Entered:1997-01-30, Days after submission: 77
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: BP, heart, fld, muscle relaxant
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX96191
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712757IMLA
Administered by: Public     Purchased by: Public
Symptoms: Face oedema, Oedema, Oedema peripheral, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 14NOV96 230PM & approx 12-13 hr p/vax pt devel swelling of the face, neck & hands w/itchy rash;DPH was taken to relieve sx;approx 24hr later sx got worse & a visit to hosp ER was necessary;shot given for itching;

VAERS ID:94907 (history)  Vaccinated:1996-11-12
Age:34.0  Onset:1996-11-14, Days after vaccination: 2
Gender:Male  Submitted:1996-11-22, Days after onset: 8
Location:Washington  Entered:1997-02-10, Days after submission: 80
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI done, EMG w/nl results
CDC Split Type: WA971324
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM181A4A1 LA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Dry mouth, Hypertonia, Muscle twitching, Paraesthesia, Pharyngitis
SMQs:, Agranulocytosis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 days p/vax pt beginning w/leg twitching & spasms, arm tightness & heaviness;14NOV96 dry mouth, muscle tightness in hands & arms & arms feel heavy;legs feel tight & tingling;went to MD

VAERS ID:94912 (history)  Vaccinated:1996-11-12
Age:34.0  Onset:0000-00-00
Gender:Female  Submitted:1997-02-06
Location:Alabama  Entered:1997-02-10, Days after submission: 4
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: No relevant data;
CDC Split Type: WAES96120384
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: pt recv vax 12NOV96 & was 1.5 wk pregnant;pt exp a spontaneous abortion;

VAERS ID:95004 (history)  Vaccinated:1996-11-12
Age:72.2  Onset:1996-12-24, Days after vaccination: 42
Gender:Male  Submitted:1996-12-27, Days after onset: 3
Location:Colorado  Entered:1997-02-12, Days after submission: 47
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: hay fever in spring
Diagnostic Lab Data: did not see MD
CDC Split Type: CO96066
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS0576P10IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Chills, Myalgia, Pyrexia, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 24DEC96 fever, severe body aches, tight chest, head cold, chills;

VAERS ID:95018 (history)  Vaccinated:1996-11-12
Age:14.7  Onset:1996-11-14, Days after vaccination: 2
Gender:Male  Submitted:1997-01-22, Days after onset: 69
Location:Massachusetts  Entered:1997-02-12, Days after submission: 21
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: UNK
Diagnostic Lab Data: NONE
CDC Split Type: QC9646
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD594IMRA
Administered by: Private     Purchased by: Public
Symptoms: Influenza, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 days post vax pt devel fever to 101 & flu-like sx w/aches & muscle pain;sx resolved p/tx w/Advil & APAP;

VAERS ID:95146 (history)  Vaccinated:1996-11-12
Age:0.4  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1997-01-21, Days after onset: 70
Location:Ohio  Entered:1997-02-18, 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: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: OH97009
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4348111 LL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0746A1PO 
Administered by: Public     Purchased by: Public
Symptoms: Crying, Insomnia, Screaming
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: w/in 30min p/vax pt had high loud screech cry that was unconsolable for 3hr;short nap (10 min) & then resumed crying for rest of the evening approx 8-9hr;pt did not nurse until middle of noc;resumed nl behavior p/48hr

VAERS ID:95745 (history)  Vaccinated:1996-11-12
Age:46.6  Onset:1996-11-13, Days after vaccination: 1
Gender:Female  Submitted:1996-11-13, Days after onset: 0
Location:Massachusetts  Entered:1997-03-06, Days after submission: 113
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:
Diagnostic Lab Data:
CDC Split Type: 896338002L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968139 IMRA
Administered by: Private     Purchased by: Private
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: 1 day p/vax pt devel an inj site rxn characterized by a 6cm by 8cm area of redness & swelling;

VAERS ID:95780 (history)  Vaccinated:1996-11-12
Age:49.2  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-12-17, Days after onset: 35
Location:California  Entered:1997-03-06, Days after submission: 79
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin D
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: 896355013L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968162 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: w/in 30min of vax pt devel a 40mm by 30mm area of induration @ inj site;pt had recovered @ the date of this report;this is 1 of 4 pt from this site to devel an inj site rxn p/flu vax;

VAERS ID:96196 (history)  Vaccinated:1996-11-12
Age:0.1  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:1997-03-11
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: No relevant data;
CDC Split Type: WAES96111224
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0701A1  
Administered by: Private     Purchased by: Other
Symptoms: Agitation, Screaming
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)
Write-up: pt recv vax 12NOV96 & that same day pt exp prolonged irritability crankiness & crying for 8 to 10hr;sx slowly resolved over the next 12hr;

VAERS ID:96376 (history)  Vaccinated:1996-11-12
Age:1.2  Onset:1996-11-19, Days after vaccination: 7
Gender:Female  Submitted:0000-00-00
Location:North Carolina  Entered:1997-03-19
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0467D0IMLL
Administered by: Military     Purchased by: Military
Symptoms: Diarrhoea, Drug ineffective, Infection, Myalgia, Myasthenic syndrome, Pyrexia, Rash maculo-papular, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Malignancy related conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: t104 x 3-4 days measle-like rash x 3 dasy measles all over body head to toe, muscle weakness legs/soreness, lethargic, fatigue, somnolence x 2 days, diarrhea x 2 days @ end of illness rxn, loss of appetite;

VAERS ID:97049 (history)  Vaccinated:1996-11-12
Age:1.1  Onset:1996-11-14, Days after vaccination: 2
Gender:Female  Submitted:1997-01-21, Days after onset: 68
Location:Kansas  Entered:1997-04-18, Days after submission: 86
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: KS97004
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1963A22 RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1417B0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Pruritus, Skin disorder
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2-3 days p/vax pt devel redness & rash @ immun site, pruritis, no inc temp, no inc crying;no cough, no resp sx;today 21JAN97 scabbed areas seen @ site from pruritis;referred to MD;

VAERS ID:97515 (history)  Vaccinated:1996-11-12
Age:15.0  Onset:1996-12-09, Days after vaccination: 27
Gender:Female  Submitted:0000-00-00
Location:Virginia  Entered:1997-04-18
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: allergy, PCN
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97011303
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Infection, Pharyngitis
SMQs:, Severe cutaneous adverse reactions (narrow), Agranulocytosis (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 12NOV96 & 9DEC96 pt devel an upper resp infect & a couple of lesions on neck;the lesions spread to back & torso;A school nurse confirmed chickenpox w/approx 30 lesions;

VAERS ID:98352 (history)  Vaccinated:1996-11-12
Age:58.9  Onset:1996-11-19, Days after vaccination: 7
Gender:Male  Submitted:1997-05-15, Days after onset: 176
Location:Minnesota  Entered:1997-05-28, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 24 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: spinal tap & EMG;
CDC Split Type:
Vaccination
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Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH    
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Facial palsy, Guillain-Barre syndrome, Influenza, Myasthenic syndrome, Ophthalmoplegia, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Demyelination (narrow), Hearing impairment (broad), Ocular motility disorders (narrow)
Write-up: Got Guillain-Barre synd; 5-7 days pvax stomach flu; numb in boxer short area, then wst to toes, then upper body. Intens care 14d, on respirator; still problems-- eyes yes don''t close, tape eyes to sleep, mouth tired when eating; tiredness

VAERS ID:99473 (history)  Vaccinated:1996-11-12
Age:73.0  Onset:1996-11-14, Days after vaccination: 2
Gender:Female  Submitted:1996-11-26, Days after onset: 12
Location:Pennsylvania  Entered:1997-05-29, Days after submission: 183
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Procardia XL, cardura
Current Illness: UNK
Preexisting Conditions: HTN
Diagnostic Lab Data: NONE
CDC Split Type: 010150960136000
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS 0IMA
Administered by: Private     Purchased by: Private
Symptoms: Muscle spasms, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad)
Write-up: pt recv vax 12NOV96 & pt exp nocturnal lt leg cramping on 14NOV96;the next morning both legs felt sore;pt also reported that lt foot feels numb from time to time;sx were improving;pt past med hx is remarkable for HTN;

VAERS ID:100510 (history)  Vaccinated:1996-11-12
Age:44.0  Onset:1996-11-15, Days after vaccination: 3
Gender:Female  Submitted:1996-11-19, Days after onset: 4
Location:South Carolina  Entered:1997-07-18, Days after submission: 240
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp generalized arthralgias following flu vax 95/96;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 896330037L
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681381IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Similar reaction on previous exposure to drug
SMQs:, Arthritis (broad)
Write-up: 3 days p/vax pt exp arthralgia;f/u info was recv 6JAN97;pt exp arthralgia in all joints;it was worse in the small joints;@ the time of f/u arthralgia persisted but was not as severe;

VAERS ID:100373 (history)  Vaccinated:1996-11-12
Age:39.6  Onset:1996-11-13, Days after vaccination: 1
Gender:Male  Submitted:1997-07-03, Days after onset: 231
Location:California  Entered:1997-07-21, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Motrin, Melatonin
Current Illness: NONE
Preexisting Conditions: rheumatoid arthritis
Diagnostic Lab Data: NONE
CDC Split Type: CA970058
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712120 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1391B0 RA
Administered by: Public     Purchased by: Public
Symptoms: Lymphadenopathy, Pain
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 13NOV97 reduction in rheumatoid arthritis sx;17NOV96 lymph nodes (ax) swollen & painful both sides;27NOV96 MD notes hx of pain axillary area poss secondary to vax;

VAERS ID:100558 (history)  Vaccinated:1996-11-12
Age:2.0  Onset:1997-03-25, Days after vaccination: 133
Gender:Male  Submitted:0000-00-00
Location:North Carolina  Entered:1997-07-23
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: infect, ear, recurrent;allergy amoxicillin;
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97031957
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax 12NOV96 & 25MAR97 pt devel chickenpox;

VAERS ID:102704 (history)  Vaccinated:1996-11-12
Age:37.0  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1996-11-12, Days after onset: 0
Location:Massachusetts  Entered:1997-09-05, Days after submission: 296
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:
CDC Split Type: 896324022L
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49682060IMLA
Administered by: Public     Purchased by: Private
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: approx 10min p/vax pt exp the sensation of an electrical wave from lt deltoid down to foot;this was followed by numbness & tingling in lt leg;

VAERS ID:102865 (history)  Vaccinated:1996-11-12
Age:1.1  Onset:1996-11-17, Days after vaccination: 5
Gender:Female  Submitted:1996-11-21, Days after onset: 4
Location:Texas  Entered:1997-09-30, Days after submission: 312
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type: TX97076
Vaccination
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DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4348103IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0468D0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1080D0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: mom reports pt has 2 vesicles on 17NOV;by 19NOV rash of $g50 lesions progressed to abd, buttocks, back & neck;lesions began to crust on Wed but another crop of lesions started;fever 103.6 1AM;fever reached 101.6;advised treat like chickenpox

VAERS ID:104244 (history)  Vaccinated:1996-11-12
Age:4.0  Onset:1996-11-13, Days after vaccination: 1
Gender:Female  Submitted:1996-11-21, Days after onset: 8
Location:Illinois  Entered:1997-10-30, Days after submission: 343
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:
CDC Split Type: 960169751
Vaccination
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2140A20IMRL
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & 1 day later exp a 5x5 cm indurated, warm, & red patch @ inj site;2 days post vax the patch was 12x13cm;pt treated w/DPh elixir & cool compress;pt will be seen by MD;sx persisted as of 14NOV96;

VAERS ID:105293 (history)  Vaccinated:1996-11-12
Age:78.9  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1997-11-24, Days after onset: 377
Location:Oregon  Entered:1997-12-02, Days after submission: 8
Life Threatening? No
Died? Yes
   Date died: 1996-11-13
   Days after onset: 1
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:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712380 LA
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: death

VAERS ID:105543 (history)  Vaccinated:1996-11-12
Age:52.1  Onset:1996-11-18, Days after vaccination: 6
Gender:Male  Submitted:1997-12-02, Days after onset: 379
Location:Indiana  Entered:1997-12-09, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 35 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ASA;Valium, Vicodin, Procan, Daypro
Current Illness:
Preexisting Conditions: SDMA coumpound, nalfon;degenerative disc disease lumars
Diagnostic Lab Data: blood test, spinal tap, MRI, NCV, EMG, EKG
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F712770  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypotension, Hypoxia, Infection, Influenza, Neck pain, Paralysis, Pneumonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: flu like sx wk of 17NOV96 & again wk of 8DEC96;pain in neck & shoulders 23DEC96;weakness 24DEC96;collapsed in floor 26DEC96;hosp 27DEC97 transferred to rehab ctr 31JAN97;totally paralyzed staph pneumonia;T107.4;

VAERS ID:107520 (history)  Vaccinated:1996-11-12
Age:80.1  Onset:1996-11-26, Days after vaccination: 14
Gender:Female  Submitted:1997-11-28, Days after onset: 367
Location:Florida  Entered:1998-01-15, Days after submission: 48
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: CO7172
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Muscle atrophy, Myasthenic syndrome
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: pt recv vax 12NOV96 & it was reported that 2wk post vax pt exp soreness @ the gluteal site of inj;1mo post vax it was reported that the exp indentation @ the inj site;pt loosing muscle mass & is c/o muscle weakness in thigh;

VAERS ID:109421 (history)  Vaccinated:1996-11-12
Age:0.4  Onset:1996-11-12, Days after vaccination: 0
Gender:Female  Submitted:1997-10-20, Days after onset: 341
Location:Kansas  Entered:1998-03-09, Days after submission: 140
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: See comments
Other Medications: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898183029L
Vaccination
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DTP: DTP (TRI-IMMUNOL)LEDERLE LABORATORIESUNK1  
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURERUNK   
HIBV: HIB (HIBTITER)LEDERLE PRAXSISUNK1IML
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIESUNK1PO 
Administered by: Private     Purchased by: Other
Symptoms: Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother states 12 hours. post vax, child developed 102.5 fever, w/foul smelling diarrhea. Tylenol given, temp decreased to 96. (rectal). Temp returned to normal within 2 days. Diarrhea resolved after 10 days. Mother felt problems related to

VAERS ID:133630 (history)  Vaccinated:1996-11-12
Age:4.7  Onset:2000-01-27, Days after vaccination: 1171
Gender:Male  Submitted:0000-00-00
Location:Georgia  Entered:2000-02-01
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
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0733D0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0771D0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mild case, pox lesions on trunk spread out peripherally on arms & legs. No fever. Feeling well at this time. No treatment.

VAERS ID:179401 (history)  Vaccinated:1996-11-12
Age:6.0  Onset:2001-12-04, Days after vaccination: 1848
Gender:Male  Submitted:2001-12-04, Days after onset: 0
Location:Alabama  Entered:2001-12-26, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.088910IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1452B0IM 
Administered by: Private     Purchased by: Private
Symptoms: Bacterial infection, Drug ineffective, Infection, Proctitis, Pruritus
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Gastrointestinal nonspecific inflammation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt developed varicella lesions on 12/4/01. Treatment on 12/6/01 with Zovirax 2 1/2 tsp qid X 5 days. Also had strep proctitis on 12/6/01. Atarax prescribed for itching. He will recover.

VAERS ID:112042 (history)  Vaccinated:1996-11-12
Age:44.0  Onset:1997-03-15, Days after vaccination: 123
Gender:Female  Submitted:1998-06-16, Days after onset: 457
Location:Foreign  Entered:1998-06-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U199800295
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TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIES    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Myasthenic syndrome
SMQs:, Malignancy related conditions (narrow)
Write-up: pt recv vax 12NOV96 & 4mo later a Myasthenia-Gravis synd was dx;the check up for an immunological disorder was negative;pt did not recovered yet;

VAERS ID:182940 (history)  Vaccinated:1996-11-12
Age:56.0  Onset:1998-07-01, Days after vaccination: 596
Gender:Female  Submitted:2002-04-19, Days after onset: 1388
Location:Foreign  Entered:2002-03-28, 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:
Current Illness: UNK
Preexisting Conditions: Acquired hypothyroidism; Hypertension arterial; Vitiligo
Diagnostic Lab Data: Cerebral CT Scan-nml in 1993; Brain MRI-showed unspecified lesions probably related to arterial hypertension: multiple sclerosis was eliminated on 2/28/00; Brain MRI-showed unspecified lesions: the dx of possible acute demyelination contemp
CDC Split Type: B0263212A
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Akathisia, Balance disorder, Demyelination, Dysphagia, Eye pain, Hypoacusis, Muscular weakness, Nuclear magnetic resonance imaging brain abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Akathisia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Demyelination (narrow), Hearing impairment (narrow), Vestibular disorders (broad)
Write-up: At unspecified dates, the pt was vaccinated with Engerix-B at a dose of 20mcg and with GenHevac B. In 1985, the pt developed balance disorder for which multiple sclerosis was suspected. In 7/98, the pt consulted for acathisia, eye pain, deglutition trouble, muscular fatigue, hypoacousis and balance disorder, neurological exam was normal and walking perimeter was unlimited: multiple sclerosis benign form was suspected. The most recent information received on 3/14/02, reports the outcome of the pt as not yet recovered. Causality assessment was coded as dubious for Engerix-B and GenHevac B. The follow up states the pt''s medical history also included balance disorder in 1985 for which multiple sclerosis was suspected, the pt''s aunt had a multiple sclerosis. On 6/6/95, on 7/8/95 and on 8/11/95, the pt wsa vaccinated with GenHevac B (hep b vaccine). On 11/12/96, the pt was vaccinated with Engerix B at a dose of 20mcg. In July 1998, approximately two years after Engerix B vaccination, the pt consulted for the adverse events. The most recent info received on 4/5/02 reports the outcome of the pt as not yet recovered.

VAERS ID:92476 (history)  Vaccinated:1996-11-13
Age:11.5  Onset:1996-11-13, Days after vaccination: 0
Gender:Male  Submitted:1996-11-21, Days after onset: 8
Location:North Carolina  Entered:1996-11-29, 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: unk
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC;WBC-4.4;HCT 41;plt 255;
CDC Split Type:
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2137A21IMLA
Administered by: Public     Purchased by: Other
Symptoms: Pruritus, Purpura, Rash, Similar reaction on previous exposure to drug
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax & devel rash same day-+pruritus, purpuric lesions on both arms (equal distribution arms) progressed to legs-few lesions on chest;

VAERS ID:92573 (history)  Vaccinated:1996-11-13
Age:47.6  Onset:1996-11-13, Days after vaccination: 0
Gender:Female  Submitted:1996-11-14, Days after onset: 1
Location:California  Entered:1996-12-03, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: PCN
Diagnostic Lab Data:
CDC Split Type:
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2129A20IMLA
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: dizziness, nausea, vomiting, faintness, pale;epi & Solumedrol given;

VAERS ID:92692 (history)  Vaccinated:1996-11-13
Age:1.4  Onset:1996-11-14, Days after vaccination: 1
Gender:Female  Submitted:1996-12-05, Days after onset: 21
Location:Illinois  Entered:1996-12-09, Days after submission: 4
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:
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1176B0SCLL
Administered by: Public     Purchased by: Other
Symptoms: Ear disorder, Migraine, Personality disorder, Pharyngitis, Pyrexia, Rash, Screaming, Tachycardia
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal infections (narrow), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 14NOV96 pt devel fever & inc to 103;HR ince to 160 which then dec;15NOV96 pt devel h/a (which was migraine);pt screamed 3hr & would hit head w/hands;MD checked pt d/t redness in throat & ears gave ATB pt had drug rxn-broke out w/rash

VAERS ID:92862 (history)  Vaccinated:1996-11-13
Age:88.3  Onset:1996-11-13, Days after vaccination: 0
Gender:Male  Submitted:1996-11-18, Days after onset: 5
Location:Florida  Entered:1996-12-13, Days after submission: 25
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: daughter states none
Diagnostic Lab Data:
CDC Split Type: FL96087
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Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3106HD3IMLA
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Confusional state, Malaise, Myalgia, Personality disorder, Pyrexia, Somnolence, Urinary incontinence
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 6hr p/shot appetite dec, confused, to bed-lethargic;calling milk "orchard";next AM daughter wnt to pt room had snipped a linen into pieces;incontinent, t101;ached all over especially ribs;dec energy;slept a lot;advised to see MD;

VAERS ID:96918 (history)  Vaccinated:1996-11-13
Age:1.0  Onset:1996-11-13, Days after vaccination: 0
Gender:Male  Submitted:1996-11-14, Days after onset: 1
Location:Louisiana  Entered:1997-04-14, Days after submission: 150
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: NONE
Diagnostic Lab Data: mom reports white & red cell counts done in ER & was told both were nl
CDC Split Type: LA970402
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4348103IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0390D0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Cyanosis, Pyrexia, Somnolence, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: child mom reports left clinic about 1230PM;pt fell asleep on way home & mom put pt in bed upon arriving home;mom heard pt moving around went to check & found pt shaking all over, hands & feet were blue & couldn''t rouse pt;t101;to ER t102 R;

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