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Found 511680 cases in entire database

Case Details (Sorted by Vaccination Date)

This is page 1346 out of 5117

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VAERS ID:103095 (history)  Vaccinated:1997-10-08
Age:71.0  Onset:1997-10-10, Days after vaccination: 2
Gender:Female  Submitted:1997-10-10, Days after onset: 0
Location:California  Entered:1997-10-14, Days after submission: 4
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: CA970091
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818410IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Diarrhoea, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: vomit, diarrhea, cont through day-feels completely out of it;

VAERS ID:103214 (history)  Vaccinated:1997-10-08
Age:42.7  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-10-11, Days after onset: 3
Location:California  Entered:1997-10-17, 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: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818841IMA
Administered by: Public     Purchased by: Other
Symptoms: Asthma, Face oedema, Paraesthesia oral
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: pt states that approx 6-7hr p/vax pt was noted to devel a wheeze;lips swollen & numb & puffy eyes;cleared spontaneously;

VAERS ID:103217 (history)  Vaccinated:1997-10-08
Age:38.6  Onset:1997-10-08, Days after vaccination: 0
Gender:Male  Submitted:1997-10-09, Days after onset: 1
Location:New Hampshire  Entered:1997-10-17, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817711 LA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Chills, Malaise, Myalgia, Nuchal rigidity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: sudden onset neck stiffness, abd pain, aching, low grade fever 103, chills;still felt ill late afternoon;seen by MD early PM 9OCT feels better this AM;

VAERS ID:103220 (history)  Vaccinated:1997-10-08
Age:43.3  Onset:1997-10-13, Days after vaccination: 5
Gender:Female  Submitted:1997-10-14, Days after onset: 1
Location:Nevada  Entered:1997-10-17, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: ESR;chem panal CBC;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F61799 IMRA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Back pain, Myalgia, Myositis, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: low back pain, thoracic myositis & pain;myalgia & arthralgia;

VAERS ID:103236 (history)  Vaccinated:1997-10-08
Age:63.3  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-10-08, Days after onset: 0
Location:North Carolina  Entered:1997-10-20, 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: Centrum;Diabeta;Premarin;Oridis
Current Illness: NONE
Preexisting Conditions: mild diabetes;
Diagnostic Lab Data:
CDC Split Type: NC97099
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781450IMLA
Administered by: Public     Purchased by: Public
Symptoms: Amblyopia, Dry mouth, Tongue oedema, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Optic nerve disorders (broad), Hypersensitivity (narrow)
Write-up: blurred vision @ 1110: mouth dry, tongue swollen, face flushed;

VAERS ID:103252 (history)  Vaccinated:1997-10-08
Age:47.2  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-10-09, Days after onset: 1
Location:Idaho  Entered:1997-10-20, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn w/typhoid;
Other Medications: Aldacone;
Current Illness: NONE
Preexisting Conditions: inc BP;pt had problems w/general anesthesia extreme nausea, dizziness, hot & cold flashes;pt children have allergies & sensitivity to vax;
Diagnostic Lab Data: NONE
CDC Split Type: ID97043
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2296A40 LA
Administered by: Public     Purchased by: Public
Symptoms: Ecchymosis, Myalgia, Pain, Skin nodule
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad)
Write-up: 7 1/2hr p/vax given noted pain, black & blue bruise;muscle ache stinging, burning sensation;9OCT97 bruise measures 2 3/4 x 1 1/2 & client went to work today;hard knot is felt when area pressed;

VAERS ID:103285 (history)  Vaccinated:1997-10-08
Age:50.8  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-10-14, Days after onset: 6
Location:New Jersey  Entered:1997-10-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Estrogen;Prilosec
Current Illness: NONE
Preexisting Conditions: No allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7J81850 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dry mouth, Dysgeusia
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: dry mouth & metallic taste in mouth starting 1/2hr post vax;reported back to med dept @ 4PM;exam no abnormal findings;

VAERS ID:103314 (history)  Vaccinated:1997-10-08
Age:0.2  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-10-15, Days after onset: 6
Location:Indiana  Entered:1997-10-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon drops
Current Illness: colic
Preexisting Conditions: colic
Diagnostic Lab Data: CBC, electrolytes, liver function, blood cult, CXR;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7B916210IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES7B916180IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N00390SCLL
Administered by: Private     Purchased by: Private
Symptoms: Dehydration, Insomnia, Screaming
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Hostility/aggression (broad)
Write-up: screaming inconsolably for 24hr;2hr of sleep in 36hr;dehydration;

VAERS ID:103330 (history)  Vaccinated:1997-10-08
Age:1.2  Onset:1997-10-17, Days after vaccination: 9
Gender:Male  Submitted:1997-10-20, Days after onset: 3
Location:South Dakota  Entered:1997-10-21, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DPH drops
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: bloodwork, low WBC;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Private     Purchased by: Private
Symptoms: Rash, White blood cell disorder
SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Hypersensitivity (narrow)
Write-up: broke out in a complete rash-all over entire body;dx rxn to MMR vax;

VAERS ID:103874 (history)  Vaccinated:1997-10-08
Age:48.0  Onset:1997-10-13, Days after vaccination: 5
Gender:Unknown  Submitted:1997-10-15, Days after onset: 2
Location:Kansas  Entered:1997-10-28, Days after submission: 13
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: cult positive for streptococcus pneumoniae
CDC Split Type: 897294002L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978184   
Administered by: Other     Purchased by: Other
Symptoms: Hypoxia, Infection, Influenza, Lung disorder, Pneumonia, Pneumothorax
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 8OCT97 & exp flu sx;11OCT (3 days post vax) pt was seen in ER & was found to have a pneumothorax & infiltrates in 5 lung lobes;pt was hosp & required mechanical ventilation;cult was positive for streptococcus pneumoniae;

VAERS ID:103995 (history)  Vaccinated:1997-10-08
Age:60.3  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-10-24, Days after onset: 16
Location:Massachusetts  Entered:1997-10-28, 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: Zestril;Vitamins;Dilantin;st John wort;
Current Illness: NONE
Preexisting Conditions: legally blind, h/o sz;
Diagnostic Lab Data: NONE
CDC Split Type: MA9720
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817931IMA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Hyperhidrosis, Pharyngitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow)
Write-up: chills, perspiration on neck, S.T. early noc since administration of the flu shot;

VAERS ID:104060 (history)  Vaccinated:1997-10-08
Age:4.7  Onset:1997-10-09, Days after vaccination: 1
Gender:Male  Submitted:1997-10-22, Days after onset: 13
Location:Florida  Entered:1997-10-30, 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: PPD by Connaught lot# 244411 given 8OCT97
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: FL97074
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7J815351IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0478E1SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0765L6PO 
Administered by: Public     Purchased by: Unknown
Symptoms: Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: paramedics called to child school 255Pm d/t sz;hx fever 102-104;pt transported to ER T101;pt given APAP & child motrin;d/c w/family from ER 5PM;seen @ clinic 13OCT97 w/fever 102 sent home w/APAP;

VAERS ID:104066 (history)  Vaccinated:1997-10-08
Age:0.2  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-10-10, Days after onset: 1
Location:Tennessee  Entered:1997-10-30, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: infant APAP pediacare
Current Illness: stuffy nose
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: TN97049
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6F814450IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2292A20IMRL
HIBV: HIB (PROHIBIT)CONNAUGHT LABORATORIES7B916180IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.M084410SCRL
Administered by: Public     Purchased by: Public
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: pt crying from 6AM-4PM 9OCT97 if only a few crying cessation during that time;mom states had been giving pt infant APAP 2-3hr since had vax the AM of 8OCT97;

VAERS ID:104383 (history)  Vaccinated:1997-10-08
Age:80.0  Onset:1997-10-11, Days after vaccination: 3
Gender:Female  Submitted:1997-11-04, Days after onset: 24
Location:New York  Entered:1997-11-05, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Colace/docusate sodium;sizc/ziac
Current Illness: HTN
Preexisting Conditions: hx of hypothyrodism, breast cancer, mild valvular heart disease;HTN
Diagnostic Lab Data: investigation included thyroid function, B12 & folate & lyme disease latter was negative;
CDC Split Type: MPI97759
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3317GH IM 
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Facial palsy, Hypotonia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: pt recv vax & exp Bell''s palsy 3 days p/vax;f/u info indicated that pt had lt facial droop 2 days p/vax & sx persist about 2wk;MD indicated that doubted but was not sure that sx caused by flu vax;

VAERS ID:104412 (history)  Vaccinated:1997-10-08
Age:41.1  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-10-17, Days after onset: 8
Location:North Carolina  Entered:1997-11-05, Days after submission: 19
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: arthritis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER7F818570IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Face oedema, Oedema, Pruritus, Somnolence, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: 5-6hr p/vax pt exp itching, hives, whelps on trunk & buttocks, thighs;eyes, ears, & head swollen;DPH taken @ time;slept all the next day;

VAERS ID:104433 (history)  Vaccinated:1997-10-08
Age:36.9  Onset:1997-10-10, Days after vaccination: 2
Gender:Female  Submitted:1997-10-20, Days after onset: 10
Location:Wisconsin  Entered:1997-11-05, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0547E0SCLA
Administered by: Public     Purchased by: Private
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: 40-50mm circular swelling hardness & redness @ site of inj;

VAERS ID:104526 (history)  Vaccinated:1997-10-08
Age:35.9  Onset:1997-10-12, Days after vaccination: 4
Gender:Female  Submitted:1997-10-28, Days after onset: 16
Location:Missouri  Entered:1997-11-07, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Tricyclen;Excedrin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MO97046
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781940IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: 4-5 days post vax devel rt upper arm muscle soreness which has persisted for about 2 1/2 wk;no localized redness, no fever, chills, numbness or tingling;had nl achiness fro the shot pain;no bruising;

VAERS ID:104543 (history)  Vaccinated:1997-10-08
Age:51.6  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-11-01, Days after onset: 23
Location:California  Entered:1997-11-07, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt devel severe flu & T106 w/flu vax;
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    
Administered by: Other     Purchased by: Other
Symptoms: Influenza, Laryngitis, Myalgia, Pharyngitis, Pyrexia, Similar reaction on previous exposure to drug, Sinusitis
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad)
Write-up: p/30 hr pt got the flu started w/ scratchy throat, then aches, fever, sore throat, sinus infect, laryngitis;

VAERS ID:104488 (history)  Vaccinated:1997-10-08
Age:77.3  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-10-09, Days after onset: 1
Location:Georgia  Entered:1997-11-10, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin-4 other meds
Current Illness:
Preexisting Conditions: states on 5 different med for various problems;
Diagnostic Lab Data:
CDC Split Type: GA97129
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81832 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: states recv immun 1130AM & felt fine until about 7PM when started having lt side abd pain cont through noc & still w/ complaints this AM;states no inc temp or any other sx;referred to MD;23OCT97 MD felt episode d/t Coumadin not vax-pt OK no

VAERS ID:104561 (history)  Vaccinated:1997-10-08
Age:73.4  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-11-03, Days after onset: 25
Location:Massachusetts  Entered:1997-11-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Metrogel & Nizaoral;QOD;
Current Illness: NONE
Preexisting Conditions: rosacea;allergy to sulfa drugs, phenothelane & eprinephrine;
Diagnostic Lab Data:
CDC Split Type: MA9723
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81793 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: red patch on lower back sized 3" x 5" - hot & itchy & raised (waffled);saw NP who prescribed med;a second small area devel later & is still evident;

VAERS ID:104592 (history)  Vaccinated:1997-10-08
Age:10.7  Onset:1997-10-14, Days after vaccination: 6
Gender:Male  Submitted:1997-10-14, Days after onset: 0
Location:Georgia  Entered:1997-11-10, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: unk
Current Illness: no illness;
Preexisting Conditions: unk
Diagnostic Lab Data: NONE
CDC Split Type: GA97130
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2210420IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C915740IMRA
Administered by: Public     Purchased by: Public
Symptoms: Infection, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: mom states started vomiting 5AM has vomited x5 12noon 14OCT97;advised mom to call MD & advise him of being sick;23OCT97 had a virus;

VAERS ID:105771 (history)  Vaccinated:1997-10-08
Age:0.2  Onset:1997-10-08, Days after vaccination: 0
Gender:Male  Submitted:1997-12-11, Days after onset: 64
Location:Ohio  Entered:1997-12-17, 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: premature 34wk
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7L816730IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM195RL0IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES769L60PO 
Administered by: Private     Purchased by: Other
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: inconsolable crying no treatment;

VAERS ID:105879 (history)  Vaccinated:1997-10-08
Age:70.1  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-10-22, Days after onset: 14
Location:Georgia  Entered:1997-12-24, Days after submission: 63
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: coumadine
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: no lab work done
CDC Split Type: GA97140
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81747 IMRA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4362761IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site mass, Injection site oedema, Injection site pain, Oedema peripheral, Pain, Pyrexia, Skin nodule
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: lt arm was swollen from site of inj down to wrist;about size of an eggplant;accompanied by extreme pain;T101;

VAERS ID:106312 (history)  Vaccinated:1997-10-08
Age:15.4  Onset:1997-12-05, Days after vaccination: 58
Gender:Female  Submitted:1998-01-09, Days after onset: 35
Location:Connecticut  Entered:1998-01-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
    Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: WBC 6.9;RBC 4.49;HGB 13.4;HCt 40.2;MCV 89.3;MCH 29.9;MCHC 33.4;RDW 11.8;PLT 244;MPV 8.0;neutro 60.5;lymph 28.9;mono 8.5;EOS 1.1;BASO 1.0;neutro 4.1;lymph2.0;mono 0.6;EOS 0.1;BASO 0.1;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Constipation, Dysuria, Hyperreflexia, Infection, Myelitis, Nuchal rigidity, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: stiff neck, muscle flaccid, unable to void or defecate;dx transverse myelitis (CMV virus in spinal fluid);MD reports fever, muscles aches, back pain, hyperactive reflexes;

VAERS ID:106531 (history)  Vaccinated:1997-10-08
Age:29.2  Onset:1997-10-10, Days after vaccination: 2
Gender:Female  Submitted:1998-01-12, Days after onset: 94
Location:New York  Entered:1998-01-15, 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: sulfa, nox
Current Illness:
Preexisting Conditions: septra allergy
Diagnostic Lab Data:
CDC Split Type: WAES97101022
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0351E0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Pharyngitis, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 8OCT97 & pr reported severe sx of chickenpox described as a rash from head to toe, fever, upper resp sx & pox on face, trunk, back & mouth;

VAERS ID:106755 (history)  Vaccinated:1997-10-08
Age:15.9  Onset:1997-10-24, Days after vaccination: 16
Gender:Female  Submitted:1998-01-12, Days after onset: 80
Location:D.C.  Entered:1998-01-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
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: WAES97110840
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Pruritus
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 8OCT97 & on 24OCT97 pt devel bumps similar to chickenpox on back, thigh, & chest;the rash lasted for 24hr then disappeared;it was reported that the rash was very itchy;LMP 5MAY97;pregnancy was confirmed via sonogram 5NO97;

VAERS ID:106716 (history)  Vaccinated:1997-10-08
Age:13.5  Onset:0000-00-00
Gender:Female  Submitted:1998-01-08
Location:New York  Entered:1998-01-21, Days after submission: 13
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: unk
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0336D0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Face oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax in AM & sometime that noc exp edema of face & was reported that child was eval @ ER that noc;

VAERS ID:107016 (history)  Vaccinated:1997-10-08
Age:60.7  Onset:1997-10-08, Days after vaccination: 0
Gender:Male  Submitted:1998-01-20, Days after onset: 104
Location:Pennsylvania  Entered:1998-01-27, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F818540 LA
Administered by: Other     Purchased by: Unknown
Symptoms: Asthenia, Bradycardia, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad)
Write-up: c/o weakness, sweating reported to school nurse w/ BP 98/60, P32?;pt normally hypertensive-MD ?BP med 2 days prior;sent to ER via amb;seen & released by hosp;

VAERS ID:107134 (history)  Vaccinated:1997-10-08
Age:67.3  Onset:1997-10-21, Days after vaccination: 13
Gender:Male  Submitted:1997-12-31, Days after onset: 71
Location:Montana  Entered:1998-02-02, Days after submission: 33
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zolodex, Casodex
Current Illness: NONE
Preexisting Conditions: Prostate cancer
Diagnostic Lab Data: PE, labwork
CDC Split Type: MT98002
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81734 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Coagulopathy, Headache, Hypertension, Malaise, Nausea, Overdose, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Drug abuse and dependence (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad)
Write-up: 17OCT97 had physical-no problems;PSA down to 48;21OCT97 h/a, felt funny;22OCT97 felt worse to MD for lab work;23OCT97 to hosp in kidney failure;blood not coagulating;kidney dialysis 3x wk x 1wk;7NOV97 w/hypertens & n;MD states toxic rxn

VAERS ID:107392 (history)  Vaccinated:1997-10-08
Age:62.9  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-19, Days after onset: 42
Location:Michigan  Entered:1998-02-09, Days after submission: 82
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: MI98007
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978296  LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site haemorrhage, Injection site oedema, Injection site reaction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: severe local rxn;saw MD 9OCT97;blood & fluid were removed by MD on 20CT97;cont med care;

VAERS ID:107397 (history)  Vaccinated:1997-10-08
Age:0.3  Onset:1997-10-10, Days after vaccination: 2
Gender:Male  Submitted:1997-10-11, Days after onset: 1
Location:California  Entered:1998-02-09, Days after submission: 121
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA98009
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6F814451IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1385D1IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.L12211SCRL
Administered by: Other     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: hives all over body;dx urticaria;

VAERS ID:107873 (history)  Vaccinated:1997-10-08
Age:39.7  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1998-02-19, Days after onset: 133
Location:Illinois  Entered:1998-02-27, 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: NONE
Current Illness: NONE
Preexisting Conditions: chronic cystitis
Diagnostic Lab Data: x-rays-both ankles NOV97 vascular flow study 3NOV97 & blood work CBC bone scan JAN98;MRI 11FEB98;
CDC Split Type: IL98009
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E20017HH5IM 
Administered by: Other     Purchased by: Public
Symptoms: Face oedema, Gait disturbance, Pain, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: facial swelling 9OCT97 persisted for several days;limping, inflammation, tenderness, pain in lt foot, ankle, leg & knee 15OCT97 pred started NOV97;to be dec p/2wk;started on Naprosyn NOV97;ibuprofen;seen by DR 3NOV97;

VAERS ID:108899 (history)  Vaccinated:1997-10-08
Age:80.9  Onset:1997-10-09, Days after vaccination: 1
Gender:Male  Submitted:1997-10-29, Days after onset: 20
Location:Ohio  Entered:1998-03-26, Days after submission: 148
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: has had hx colon cancer & being eval d/t inc RFL pain
Preexisting Conditions: hx colon cancer, liver
Diagnostic Lab Data: NONE
CDC Split Type: OH98020
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81754 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0845D0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: devel lumps under skin under side of upper rt arm around elbow;the following day the lumps were on lower arm near wrist;area did not appear red, but seemed like a pliable, fluid filled area about 3x3 area;

VAERS ID:109111 (history)  Vaccinated:1997-10-08
Age:21.0  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-10-08, Days after onset: 0
Location:California  Entered:1998-03-26, Days after submission: 169
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Pt T 103 X 3 days. Flu vax 96-97 MFR unk. MCN 8-97289-010L.
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897289009L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781561IMA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Hypertension, Palpitations, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: 1 hr p/vax pt devel palpitations & dizziness; 4 hr after vax, was seen by MD. Heart rate 116 beats/min. BP 130/90 mmHg. Given oral Benadryl. As of 10/10/97 heart rate is still greater than 100.

VAERS ID:109112 (history)  Vaccinated:1997-10-08
Age:  Onset:1997-10-09, Days after vaccination: 1
Gender:Male  Submitted:1997-10-10, Days after onset: 1
Location:Pennsylvania  Entered:1998-03-26, Days after submission: 167
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide
Current Illness: None
Preexisting Conditions: Hypertension
Diagnostic Lab Data:
CDC Split Type: 897289011L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978182 IMA
Administered by: Other     Purchased by: Other
Symptoms: Face oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt devel swelling upper lip 1 day following vax. Seen by MD and treated with Benadryl. Swelling began to resolve on 10/09/1997

VAERS ID:109306 (history)  Vaccinated:1997-10-08
Age:  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-12-05, Days after onset: 57
Location:Wisconsin  Entered:1998-03-26, Days after submission: 111
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897344048L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49782064IMLA
Administered by: Private     Purchased by: Other
Symptoms: Oedema peripheral, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: w/in 24hr of vax pt devel a pin-point, itchy rash on the trunk of body, legs & arms;treated self w/DPH & sx resolved w/in 1wk;this is 1 of 2 pt from this facility to devel a rash p/vax lot#4978206

VAERS ID:108912 (history)  Vaccinated:1997-10-08
Age:39.5  Onset:1997-12-01, Days after vaccination: 54
Gender:Female  Submitted:1998-03-25, Days after onset: 114
Location:Ohio  Entered:1998-03-27, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
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
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2300B61IMRA
Administered by: Public     Purchased by: Private
Symptoms: Face oedema, Oedema, Rhinitis, Sinusitis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: approx 2mo p/8OCT97 vax pt had cold/sinus infect which resulted in swelling of eyes, face & body;went to ER & was given a cortisone shot & a 10 day dose pack;pt had splotches that resemble mosquito bites;

VAERS ID:111095 (history)  Vaccinated:1997-10-08
Age:49.3  Onset:1997-10-10, Days after vaccination: 2
Gender:Male  Submitted:1998-04-05, Days after onset: 177
Location:New York  Entered:1998-05-19, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO7662
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7E91672   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 8OCT97 & 2 days later pt exp an inj site rxn consisting of redness, warmth & tenderness;

VAERS ID:111259 (history)  Vaccinated:1997-10-08
Age:47.2  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 49
Location:New York  Entered:1998-05-27, Days after submission: 181
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: 898117008L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781390IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & 6hr p/vax pt devel an inj site rxn characterized by erythema, edema & pruritus;pt recovered;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax lot# 4978139

VAERS ID:111260 (history)  Vaccinated:1997-10-08
Age:54.3  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-11-26, Days after onset: 48
Location:New York  Entered:1998-05-27, Days after submission: 181
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plendil
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898117009L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978139 IM 
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 1 day p/vax pt devel an inj site rxn characterized by erythema, induration & pruritus;pt recovered p/5 days;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax lot# 4978139;

VAERS ID:111261 (history)  Vaccinated:1997-10-08
Age:51.8  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 49
Location:New York  Entered:1998-05-27, Days after submission: 181
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: hypothroidsim
Diagnostic Lab Data:
CDC Split Type: 898117010L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781390IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & 5hr p/vax pt devel an inj site rxn characterized by erythema & pruritus;pt recovered p/5 days;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax w/lot# 4978139;

VAERS ID:111262 (history)  Vaccinated:1997-10-08
Age:59.6  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 49
Location:New York  Entered:1998-05-27, Days after submission: 181
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: dust & springtime allergies
Diagnostic Lab Data:
CDC Split Type: 898117011L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781390IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & 5hr p/vax pt devel an inj site rxn characterized by erythema & pruritus;pt recovered p/5 days;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax w/lot# 4978139;

VAERS ID:111263 (history)  Vaccinated:1997-10-08
Age:32.7  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 49
Location:New York  Entered:1998-05-27, Days after submission: 181
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic to PNC, gentamicin, Novacaine;
Diagnostic Lab Data:
CDC Split Type: 898117012L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781390IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: approx 5 hr p/vax pt devel an inj site rxn characterized by erythema, induration & pruritus;pt recovered p/ 5 days;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax w/lot# 4978139;

VAERS ID:111264 (history)  Vaccinated:1997-10-08
Age:56.2  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 49
Location:New York  Entered:1998-05-27, Days after submission: 181
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYnthroid;Estrogen,Claritin D;
Current Illness: NONE
Preexisting Conditions: hypothyroidism, airbone allergies
Diagnostic Lab Data:
CDC Split Type: 898117014L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781391IMA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 3hr p/vax pt devel an inj site rxn characterized by 80mm by 90mm area of erythema, induration & pruritus;applied ice to the area & recovered p/5 days;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax w/lot# 4978139;

VAERS ID:111265 (history)  Vaccinated:1997-10-08
Age:45.3  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 49
Location:New York  Entered:1998-05-27, Days after submission: 181
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase, Decongestants
Current Illness: NONE
Preexisting Conditions: hayfever, sinus arrythmia, allerg to PCN & fluoroquinolones;
Diagnostic Lab Data:
CDC Split Type: 898117015L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781391IMA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: approx 5hr p/vax pt devel an inj site rxn characterized by an 80mm by 90mm area of erythema, induration & pruritus;pt applied ice to the area & recovered p/5 days;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax;

VAERS ID:111266 (history)  Vaccinated:1997-10-08
Age:33.5  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 49
Location:New York  Entered:1998-05-27, Days after submission: 181
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid;
Current Illness: NONE
Preexisting Conditions: hypothyroidism
Diagnostic Lab Data:
CDC Split Type: 898117016L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781390IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 6hr p/vax pt devel an inj site rxn characterized by an 80mm by 90mm area of erythema, induration & pruritus;pt applied ice to the area & recovered p/5 days;this is 1 of 9 pt from this facility to devel an inj site rxn p/flu vax;

VAERS ID:112121 (history)  Vaccinated:1997-10-08
Age:71.1  Onset:1997-10-11, Days after vaccination: 3
Gender:Female  Submitted:1997-10-13, Days after onset: 2
Location:Indiana  Entered:1998-06-23, Days after submission: 253
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax
Current Illness: wound
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 897321032L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4484551IMRA
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: 3 days p/vax pt devel an inj site rxn characterized by redness,swelling & warmth;pt recovered;

VAERS ID:112518 (history)  Vaccinated:1997-10-08
Age:53.6  Onset:1997-10-11, Days after vaccination: 3
Gender:Female  Submitted:1998-06-12, Days after onset: 244
Location:Florida  Entered:1998-07-13, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: premarin/conjugated
Current Illness:
Preexisting Conditions: allery PCN;13OCT97 hysterectomy;
Diagnostic Lab Data: NONE
CDC Split Type: MPI97783B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E267GB IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & exp an inj site rxn consisting of redness & swelling extending down arm to elbow regions w/in 2 days of vax;it was reported that pt has an allergy to PCN;sx resolved w/in 3 days;pt reported sx 24hr post vax w/duration of 72hr;

VAERS ID:115691 (history)  Vaccinated:1997-10-08
Age:41.7  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 383
Location:New Hampshire  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt has local rx to injections in the past.
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: 19970246411
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2214A40IM 
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Pt recv vax on 10/8/97; 10-12 hr later pt exp vomiting & dizziness.

VAERS ID:119534 (history)  Vaccinated:1997-10-08
Age:55.4  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1998-10-29, Days after onset: 386
Location:Illinois  Entered:1999-02-26, Days after submission: 120
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: 7573
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81723   
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Dyspnoea, Eye disorder, Face oedema, Laryngospasm, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 8OCT97 & approx 5hr p/vax pt exp chest tightness, facial vasodilation ("felt real hot") & eyes became irritated, itchy & swollen;tx w/dimetapp & felt better p/1.5hr; Indicated that she had difficulty breathing, throat tight.

VAERS ID:119542 (history)  Vaccinated:1997-10-08
Age:76.7  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1998-07-23, Days after onset: 287
Location:Kansas  Entered:1999-02-26, Days after submission: 218
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diabetic medicine
Current Illness: NONE
Preexisting Conditions: Several allergies; Heart & liver problems
Diagnostic Lab Data: NONE
CDC Split Type: 7623
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81752  LA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt recv vax on 10/8/97; on 10/9/97 pt exp itchy vax site

VAERS ID:120549 (history)  Vaccinated:1997-10-08
Age:35.0  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-10-17, Days after onset: 8
Location:Nevada  Entered:1999-03-23, Days after submission: 522
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: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMA
Administered by: Other     Purchased by: Other
Symptoms: Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/8/97; on 10/9/97 pt exp erythema on arm w/ warmth x 1 wk

VAERS ID:122949 (history)  Vaccinated:1997-10-08
Age:1.0  Onset:1998-04-14, Days after vaccination: 188
Gender:Male  Submitted:1999-05-14, Days after onset: 395
Location:Nebraska  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: none
Current Illness:
Preexisting Conditions: herpes zoster exposure
Diagnostic Lab Data:
CDC Split Type: WAES98041456
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0345E0SC 
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: pt exposed to sibling w/herpes zoster who in 10/97 recv 1st dose varivax & in 4/98 pt devel ``a few vesicles'' addl info recv mom rpt to ofc pt had broken out w/chickenpox

VAERS ID:124099 (history)  Vaccinated:1997-10-08
Age:4.5  Onset:1998-10-15, Days after vaccination: 372
Gender:Male  Submitted:1999-05-14, Days after onset: 211
Location:Pennsylvania  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications:
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98101551
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1 RL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SCLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: approx 15 mos p/vax pt devel 2 itchy varicella-like lesions a inject site

VAERS ID:122509 (history)  Vaccinated:1997-10-08
Age:  Onset:1998-05-19, Days after vaccination: 223
Gender:Female  Submitted:1999-05-21, Days after onset: 367
Location:Colorado  Entered:1999-05-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: 5/19/98 diagnostic lab test negative rubela antibody titer;
CDC Split Type: WAES98070303
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0657E   
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax & sought unspecified medical treatment;5/19/98 a lab test indicated a negative titer for rubella;

VAERS ID:156658 (history)  Vaccinated:1997-10-08
Age:18.0  Onset:1999-03-17, Days after vaccination: 525
Gender:Female  Submitted:2000-05-16, Days after onset: 425
Location:Minnesota  Entered:2000-07-14, Days after submission: 59
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: UNK
Diagnostic Lab Data: serum varicella zoster (08/11/1997) not immune to VZV
CDC Split Type: WAES99031743
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1542D1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Subsequent to receiving first and second doses of varicella virus vaccine live on 8/14/97 and 10/8/98, the pt developed skin lesions consistent with varicella with diffuse lesions over the entire body, on 3/17/99. The pt was treated with Benadryl. The condition lasted for 6 days, then dried, scabbed, and cleared away.

VAERS ID:388568 (history)  Vaccinated:1997-10-08
Age:5.0  Onset:2009-12-15, Days after vaccination: 4451
Gender:Male  Submitted:2010-05-14, Days after onset: 149
Location:Unknown  Entered:2010-05-18, Days after submission: 4
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: Unknown
Diagnostic Lab Data: serum immunoglobulin G 12/08/09 - 2.14; serum immunoglobulin M 12/08/09 - <1:10; serum amylase test 12/08/09 - 39; body temp 100 degree -
CDC Split Type: WAES1001USA02251
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood amylase normal, Body temperature increased, Cough, Mumps, Parotitis, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow)
Write-up: Information has been received from a physician concerning an 18 year old male who on 22-APR-1993 and 08-OCT-1997 was vaccinated with the first and second doses of MMR II. On 09-NOV-2009 the patient experienced mumps. On 16-NOV-2009 the patient was diagnosed with mumps. On 16-NOV-2009 the patient had the first blood work, serum immunoglobulin G is 2.05, serum immunoglobulin M<1:10, serum amylase is 63. The patient did not have a fever. The patient did experience symptoms of cough and congestion. At the time of this report the patient status was unknown. Follow up information has been received from a physician reported that on 15-DEC-2009 the patient experienced mumps. On 18-DEC-2009 the patient was diagnosed with mumps. The patient developed right parotitis and a temperature of 100 degrees F. On 08-DEC-2009 the patient had the first blood work, serum immunoglobulin G is 2.14, serum immunoglobulin M<1:10, serum amylase is 39. Additional information has been requested.

VAERS ID:103598 (history)  Vaccinated:1997-10-08
Age:30.0  Onset:1997-10-09, Days after vaccination: 1
Gender:Male  Submitted:1997-10-23, Days after onset: 14
Location:Foreign  Entered:1997-10-24, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: immun against flu;
Preexisting Conditions: 9OCT97 encephalitis status resolved adm to hosp 2nd to 9th SEPT d/t spontaneous encephalitis;insulin-depend diabetes status;asthma status unk;pt suffers from asthma but not details are provided about med;
Diagnostic Lab Data: NONE
CDC Split Type: EML97754
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.    
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Confusional state, Convulsion, Hypoglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: approx 18hr p/vax pt became confused & agitated;also reported to have had a fit;taken to hosp given tx;reported to have recovered & been discharged approx 5 days p/admission;it was now thought poss that may have had hypoglycemic fit;

VAERS ID:104880 (history)  Vaccinated:1997-10-08
Age:53.4  Onset:1997-10-11, Days after vaccination: 3
Gender:Male  Submitted:1997-11-19, Days after onset: 39
Location:Foreign  Entered:1997-11-20, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: prophylaxis
Preexisting Conditions: allergies nickel, potassium dichromaic;astham (bronchiticasthma) bekhterev''s disease (anklosing spondilitis);
Diagnostic Lab Data: histology revealed hyperergic vasculitis;gastroscopy bulbitus;coloscopy inflamm changes of the appendix root;heliobacter test positive;CRP 9.2, proteinuria 0.99;
CDC Split Type: REG97848
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E710015AB1  
Administered by: Other     Purchased by: Other
Symptoms: Albuminuria, Gastrointestinal disorder, Haematuria, Infection, Melaena, Renal impairment, Urethritis, Vasculitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Vasculitis (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad)
Write-up: pt recv vax & it was reported that pt was suffering from vasculitis allergic suspected to be Schonlein_Henoch purpura;kidneys & intestinal mucosa affected;inc proteinuria & hematuria;helicobacter infect;blood in feces;

VAERS ID:106687 (history)  Vaccinated:1997-10-08
Age:45.0  Onset:1997-10-08, Days after vaccination: 0
Gender:Female  Submitted:1998-01-16, Days after onset: 100
Location:Foreign  Entered:1998-01-21, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: asthma inhaler;dyazide;estrogen;
Current Illness:
Preexisting Conditions: resp infect;asthma;
Diagnostic Lab Data: NOV97 liver function tests severely deranged
CDC Split Type: WAES97125036
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0176D IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Depression, Hepatic function abnormal, Injection site hypersensitivity, Injection site oedema, Injection site pain, Injection site reaction, Myalgia, Pain, Tendon disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & OCT97 exp local rxn markedly in both upper arms around inj site;13OCT97 had 2 day hx of rt wrist pain;19NOV97 dx extensor policis tendonitis;lt thumb was reported to be affected more than rt;pain @ inj site;redness & swelling

VAERS ID:107078 (history)  Vaccinated:1997-10-08
Age:49.9  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1998-01-27, Days after onset: 110
Location:Foreign  Entered:1998-01-30, 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:
Current Illness:
Preexisting Conditions: allergic to mercury
Diagnostic Lab Data: DEC97 allergy test, NOS-allergic to mercury
CDC Split Type: 980023651
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2084A1   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Face oedema, Hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 8OCT97 & next day pt devel swollen upper lip & 13OCT97 pt exp rash on face;events described as mild but were considered to have been a significant hazard, contraindication, side effect or precaution;allergy to mercury;

VAERS ID:107893 (history)  Vaccinated:1997-10-08
Age:11.0  Onset:1997-10-09, Days after vaccination: 1
Gender:Male  Submitted:1998-02-24, Days after onset: 138
Location:Foreign  Entered:1998-03-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Calcort;
Current Illness:
Preexisting Conditions: musculat dystrophy;
Diagnostic Lab Data: serum C-reactive protein;
CDC Split Type: WAES98021002
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site reaction, Laboratory test abnormal, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: pt recv vax 8OCT97 & the next day pt devel a local rxn (entire front of the lt thigh) @ the site of inj, a fever & c-reactive protein (CRP) inc to 100;pt hosp;pt recovered completely w/in next couple of days;

VAERS ID:112513 (history)  Vaccinated:1997-10-08
Age:63.5  Onset:1997-10-11, Days after vaccination: 3
Gender:Female  Submitted:1998-06-11, Days after onset: 243
Location:Foreign  Entered:1998-07-12, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diclomax SR/diclfenac sodium
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: EML97775A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E7010CB2 IM 
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: pt recv vax & exp pain radiating down the rt leg 4 days p/vax;the pain resolved in 48hr;

VAERS ID:112514 (history)  Vaccinated:1997-10-08
Age:66.5  Onset:1997-10-12, Days after vaccination: 4
Gender:Male  Submitted:1998-06-11, Days after onset: 242
Location:Foreign  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bendrofluazide;Epilim;Propine;timoptol
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: EML97775B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E7010CB2 IM 
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: pt recv vax & later exp pain radiating down the rt leg 5 days p/vax;the pain resolved in 48hr;the reporting nurse stated on f/u the events were not r/t vax;

VAERS ID:113378 (history)  Vaccinated:1997-10-08
Age:36.0  Onset:1997-10-11, Days after vaccination: 3
Gender:Female  Submitted:1998-08-03, Days after onset: 296
Location:Foreign  Entered:1998-08-12, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 33 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Rheumatic fever without cardiac sequelae, lombo-sciatica
Diagnostic Lab Data: Brucellosis serology-negative; CBC-normal; Chlamydiae-neg; D vit level-normal; Globular magnesium-normal; lyme disease-neg; parovirus-neg; phosphocalcic-normal
CDC Split Type: 19980193431
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  SC 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: On 10/8/97 pt recv vax and exp arthralgia and myalgia.Pt was hosp on 10/17/97.Pt disch on 10/25/97.Pt hosp again 11/2-8/97 in rheumatology and 5/4-12/97 in neurology.Pt dx DIPS. Pt tx = Deroxat & non-steroid anti-inflammatory drugs;Laroxyl.

VAERS ID:119592 (history)  Vaccinated:1997-10-08
Age:  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:1997-11-03, Days after onset: 25
Location:Foreign  Entered:1999-02-26, Days after submission: 480
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 7711
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Malaise, Nausea, Pain, Personality disorder
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Vestibular disorders (broad)
Write-up: pt recv vax 8OCT97 & the next day pt felt weak & unwell;5 days p/vax pt exp being dizzy, as if head on fire, spacey, nauseous;the episode required a MD visit or ER visit;

VAERS ID:176321 (history)  Vaccinated:1997-10-08
Age:45.0  Onset:1997-10-09, Days after vaccination: 1
Gender:Female  Submitted:2001-10-09, Days after onset: 1461
Location:Foreign  Entered:2001-10-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asthma inhaler; Dyazide; Estrogen
Current Illness: Respiratory infection
Preexisting Conditions: Asthma
Diagnostic Lab Data: Liver function tests in 11/97: Severely deranged. Liver function tests in 11/98-nml.
CDC Split Type: U1998002560
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81810 IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.HE29830 IM 
Administered by: 0     Purchased by: 0
Symptoms: Depression, Fibromyalgia, Injection site erythema, Injection site pain, Injection site reaction, Injection site swelling, Liver function test abnormal, Pain, Tendonitis
SMQs:, Liver related investigations, signs and symptoms (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (narrow)
Write-up: Information has been received concerning a 45 year old Caucasian female who on 10/8/97 was vaccinated with pneumococcal vaccine 23 (batch HE 29830 176D). The pt was vaccinated with inactivated influenza (Fluzone) at the same time. Subsequently, in 10/97, the pt experienced local reactions markedly in both upper arms around the administration sites of moderate severity. On 10/13/97, the pt attended a minor injuries unit with a 2 day history of right wrist pain. Subsequently, the pt developed pain in the left wrist. On 11/19/97, the pt was reviewed by a consultant physician and extensor policies tendonitis was dx''d. The reporting physician felt that the tendonitis was severely disabling. The left thumb was reported to be affected more than the right. At this time, the pt was found to have severely deranged liver function tests. Subsequently, the pt recovered from the pain at the injection sites. The tendonitis persisted. The reporting physician stated that the local redness and swelling were definitely related to vaccination with pneumococcal vaccine and the extensor policies tendonitis were probably related to vaccination with pneumococcal vaccine. Subsequently, the pt was referred to a Rheumatologist for rheumatic disease. A definitive dx of fibromyalgia was made. A connection with the pt''s mental state was made and subsequently, the pt needed psychotherapy (not specified). In 2/98, the pt''s liver function tests were normal. The reporting physician stated that the cause of the fibromyalgia and the depression has not resolved and can be linked to preceding medical complaints (not specified). Acute nature at the time of the report and the pt reported no previous relevant medical history. Additional information is not expected."

VAERS ID:103090 (history)  Vaccinated:1997-10-09
Age:49.0  Onset:1997-10-10, Days after vaccination: 1
Gender:Female  Submitted:1997-10-13, Days after onset: 3
Location:Maryland  Entered:1997-10-14, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Other     Purchased by: Public
Symptoms: Injection site hypersensitivity, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: arm, red 2" circle around site;hurt, hot, itchy x 3 days;

VAERS ID:103923 (history)  Vaccinated:1997-10-09
Age:6.9  Onset:1997-10-09, Days after vaccination: 0
Gender:Male  Submitted:1997-10-15, Days after onset: 6
Location:Illinois  Entered:1997-10-24, Days after submission: 9
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: club feet
Diagnostic Lab Data: NONE
CDC Split Type: IL97091
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6E81441 IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0286E SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0770A PO 
Administered by: Public     Purchased by: Public
Symptoms: Confusional state, Gaze palsy, Hypertonia, Salivary hypersecretion, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow)
Write-up: p/vax walked out of room & over to payment table & fell against table & onto the floor-mom picked pt up eyes rolled back, ridged, foaming @ mouth, unconscious;laid on floor for approx 5min then picked up & put on cough;disoriented;

VAERS ID:104130 (history)  Vaccinated:1997-10-09
Age:45.1  Onset:1997-10-09, Days after vaccination: 0
Gender:Female  Submitted:1997-10-10, Days after onset: 1
Location:Maryland  Entered:1997-10-31, 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:
Current Illness: NONE
Preexisting Conditions: sinus-not active @ this time
Diagnostic Lab Data: according to pt liver enzymes were elevated 13OCT97 & bilirubin was blood;
CDC Split Type: MD97012
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817490 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Back pain, Chills, Hepatic function abnormal, Hyperbilirubinaemia, Myalgia, Nuchal rigidity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Eosinophilic pneumonia (broad)
Write-up: stiff neck, chills, lower backache, aches in back of legs & thighs, temp 102 per pt;

VAERS ID:104324 (history)  Vaccinated:1997-10-09
Age:12.0  Onset:1997-10-09, Days after vaccination: 0
Gender:Female  Submitted:1997-10-14, Days after onset: 5
Location:North Carolina  Entered:1997-11-03, Days after submission: 20
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:
CDC Split Type: NC97104
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1627D0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0471E1SCLA
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain, Chills, Face oedema, Headache, Rash, Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: red face, puffy eyes, h/a, welts on chest more rash, stomach pain, skin hot, pt felt chilled;

VAERS ID:104533 (history)  Vaccinated:1997-10-09
Age:36.2  Onset:1997-10-19, Days after vaccination: 10
Gender:Female  Submitted:1997-10-29, Days after onset: 10
Location:North Carolina  Entered:1997-11-07, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications: pt recv PPD by Connaught lot# 246011 given 22SEP97
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0214D0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Arthropathy, Dermatitis bullous, Ear pain, Myalgia, Nuchal rigidity, Pharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (narrow), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt recv vax 9OCT97 & 19OCT97 T101.4, aching in arm where MMR given 22OCT97 sore throat, stiffness in elbow 24OCt97 stiff neck, ear pain still somewhat w/vesicular rash on side of nose;seen to ER seen by MD;

VAERS ID:104546 (history)  Vaccinated:1997-10-09
Age:46.6  Onset:1997-10-11, Days after vaccination: 2
Gender:Male  Submitted:1997-11-04, Days after onset: 24
Location:D.C.  Entered:1997-11-07, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: ragweed, grass, cat & dogs hair/dander
Diagnostic Lab Data: IgG/IgM
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0474E SCLA
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection, Lymphadenopathy, Pharyngitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow)
Write-up: devel confirmed case of measles 2 days post vax;sx rash, fever, sore throat, lymphadenopathy;

VAERS ID:105157 (history)  Vaccinated:1997-10-09
Age:46.5  Onset:1997-10-09, Days after vaccination: 0
Gender:Male  Submitted:1997-10-23, Days after onset: 14
Location:New Hampshire  Entered:1997-11-25, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: CBC done WNL; sed rate WNL
CDC Split Type: NH97025
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81854 IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Facial palsy, Nuchal rigidity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: pt recv vax p/noon of 9OCT97 later that PM pt noticed stiff neck-progressed over weekend to lt side of face, head, neck and lt arm numbness;no paralysis, no vision change;seen in office 14OCT97;

VAERS ID:105396 (history)  Vaccinated:1997-10-09
Age:79.5  Onset:1997-10-10, Days after vaccination: 1
Gender:Male  Submitted:1997-10-27, Days after onset: 17
Location:Idaho  Entered:1997-12-04, Days after submission: 38
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: ASA for arthritis;timoptic for glaucoma
Current Illness: NONE
Preexisting Conditions: to sulfa drugs;
Diagnostic Lab Data: NONE
CDC Split Type: ID97047
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978146 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Hyperhidrosis, Hypokinesia, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: chills, fever, shaking did not take temp;fever cause sweating so profuse that change pajama top, covered bed w/heavy bath towel;was sick in bed 10-13OCt;fever, severe chills, shaking so bad required assistance to walk;

VAERS ID:109360 (history)  Vaccinated:1997-10-09
Age:43.4  Onset:1997-10-09, Days after vaccination: 0
Gender:Female  Submitted:1997-10-14, Days after onset: 5
Location:Louisiana  Entered:1998-03-26, Days after submission: 163
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: 898035004L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781850IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 2hr p/vax pt devel an inj site rxn characterized by a 40mm by 45mm area of redness, warmth, itching & tenderness;pt recovered 3 days;this is 1 of 3 pt from this site to devel an inj site rxn p/vax w/lot# 4978185

VAERS ID:109361 (history)  Vaccinated:1997-10-09
Age:51.4  Onset:1997-10-10, Days after vaccination: 1
Gender:Female  Submitted:1997-10-14, Days after onset: 4
Location:Louisiana  Entered:1998-03-26, Days after submission: 163
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:
Diagnostic Lab Data:
CDC Split Type: 898035005L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781850IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 1 day p/vax pt exp pain @ the inj site;pt was seen by a MD on 25OCT & treated w/anti-inflammatory med;pain persisted as of 20NOV;this is 1 of 3 pt from this site to devel an inj site rxn p/vax w/lot# 4978185;

VAERS ID:110920 (history)  Vaccinated:1997-10-09
Age:4.7  Onset:1998-05-13, Days after vaccination: 216
Gender:Male  Submitted:1998-05-14, Days after onset: 1
Location:Kentucky  Entered:1998-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0688E0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax & exp vaccine failure;pt has chickenpox 7mo p/vax;

VAERS ID:112593 (history)  Vaccinated:1997-10-09
Age:67.5  Onset:1997-10-11, Days after vaccination: 2
Gender:Female  Submitted:1998-06-11, Days after onset: 243
Location:Georgia  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: sinusitis;Diabetes unspecified;other diseases of lung-pulmonary disease;cardiac arrhythmia bradycardia;
Diagnostic Lab Data: NONE
CDC Split Type: MPI971121
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E32779A   
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Bronchitis, Cough, Myalgia, Nausea, Pharyngitis, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: pt recv vax & exp coughing, nausea, aching joints, congestion & aching all over w/inset 2 days p/vax;

VAERS ID:115683 (history)  Vaccinated:1997-10-09
Age:7.0  Onset:1997-10-09, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 382
Location:California  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: 19970242391
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM235A21IMLA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Hypokinesia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: Pt recv vax on10/9/97; 1 hr later pt exp achiness, leg pain; 10/10/97 unable to walk; dx=bilateral hip pain, decreased mobility, arthralgia, myalgia; tx=Motrin.

VAERS ID:119539 (history)  Vaccinated:1997-10-09
Age:53.9  Onset:1997-10-09, Days after vaccination: 0
Gender:Male  Submitted:1998-01-22, Days after onset: 105
Location:California  Entered:1999-02-26, Days after submission: 400
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: 7620
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817530IM 
Administered by: Other     Purchased by: Private
Symptoms: Cough
SMQs:, Anaphylactic reaction (broad)
Write-up: Pt recv vax on 10/9/97; on same day pt exp dry cough

VAERS ID:119540 (history)  Vaccinated:1997-10-09
Age:49.2  Onset:1997-10-09, Days after vaccination: 0
Gender:Female  Submitted:1997-10-20, Days after onset: 11
Location:Pennsylvania  Entered:1999-02-26, Days after submission: 494
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: BP 60/40
CDC Split Type: 7621
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81883   
Administered by: Other     Purchased by: Other
Symptoms: Chills, Hyperhidrosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt recv vax on 10/9/97; 6 min post vax pt exp hypotension, coldness, clammy sweat, almost passing out

VAERS ID:119541 (history)  Vaccinated:1997-10-09
Age:21.9  Onset:1997-10-10, Days after vaccination: 1
Gender:Female  Submitted:1998-07-23, Days after onset: 286
Location:Virginia  Entered:1999-02-26, Days after submission: 218
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: 7622
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F817760  
Administered by: Private     Purchased by: Private
Symptoms: Chills, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Pt recv vax on 10/9/97; 12 hr post vax pt exp fever (102F), chills, headache & body aches

VAERS ID:119543 (history)  Vaccinated:1997-10-09
Age:57.4  Onset:1997-10-11, Days after vaccination: 2
Gender:Female  Submitted:1997-10-14, Days after onset: 3
Location:Minnesota  Entered:1999-02-26, Days after submission: 500
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: 7625
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES    
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt recv vax on 10/9/97; on 10/11/97 pt exp red rash over body

VAERS ID:123616 (history)  Vaccinated:1997-10-09
Age:  Onset:1997-10-28, Days after vaccination: 19
Gender:Female  Submitted:1999-05-14, Days after onset: 562
Location:Vermont  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: lab tests: 10/?/98, pos varicella titers
CDC Split Type: WAES98070547
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Public     Purchased by: Other
Symptoms: Dermatitis bullous, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: p/ pt recv vax approx 17 days later pt devel a ``varicella rash w/approx 50 lesions''''. in 7/98 pt devel a 2nd case of varicella w/40-50 ``varicella-like lesions'''' rpt MD felt both cases were not related to therapy w/varivax. tests done.

VAERS ID:159075 (history)  Vaccinated:1997-10-09
Age:2.0  Onset:1997-10-21, Days after vaccination: 12
Gender:Female  Submitted:2000-08-15, Days after onset: 1029
Location:Georgia  Entered:2000-08-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: lab test - diabetes
CDC Split Type: WAES00081007
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1353D0SC 
Administered by: Other     Purchased by: Other
Symptoms: Diabetes mellitus, Infection, Pharyngitis, Pyrexia, Vomiting, Weight decreased
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Twelve days post vax, the pt developed a fever and vomiting. The following day, the pt developed a throat infection. It was indicated that the pt lost four pounds in several days and was hospitalized. While hospitalized, the pt''s blood tests indicated that she was diabetic. The pt was discharged after 7 days. Additional information has been requested. 15-Day follow-up dated 9/7/00 states that there is a family hx of diabetes and that the pt was probably hospitalized due to the high blood glucose. The pt was diagnosed in the hospital and has recovered from her symptoms. As of 8/28/00 the pt was well maintained and on daily insulin.

VAERS ID:166698 (history)  Vaccinated:1997-10-09
Age:4.0  Onset:0000-00-00
Gender:Female  Submitted:2001-02-15
Location:Mississippi  Entered:2001-03-07, Days after submission: 20
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Public     Purchased by: Public
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: This patient broke out with mild case of chicken pox- unverified by the doctor 01/01. Received varicella 10/09/97.

VAERS ID:185498 (history)  Vaccinated:1997-10-09
Age:1.1  Onset:2001-09-25, Days after vaccination: 1447
Gender:Male  Submitted:2002-05-15, Days after onset: 232
Location:Unknown  Entered:2002-05-28, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Deoxyribonucleic acid-PCR analysis:Oka strain VZV
CDC Split Type: WAES01092948
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0544E SCLA
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster
SMQs:
Write-up: Information has been received from a registered nurse concerning a 5 year old male pt with no significant past medical history and no known allergies who on 10/09/1997 was vaccinated SC in the upper left deltoid with a 0.5 mL dose of varicella vaccine. There were no concomitant medications or concurrent diseases. On 10/13/1997, at the age of 13 months, the pt presented to a local ER for treatment of sinusitis. He was prescribed amoxicillin. On 10/14/1997, the pt''s mother called the physician''s office to report that the pt had been seen in the ER for sinusitis and a fever. No post vaccination rash was noted. On 09/25/2001, at the age of five year, the pt developed shingles on his left arm. There was no recent exposure to chickenpox and it was reported that the pt was not treated with acyclovir. He was see by two pediatricians and had a dermatology "consult." Vesicular fluid was collected for VZV analysis. On 10/19/2001, information was received that the specimen submitted for analysis on 10/04/2001 was found to be VZV positive. The presence of Oka vaccine strain was identified. The registered nurse reported that the pt was "much better." It was reported that photos were taken. Follow-up information has been received from a completed questionnaire which indicated that the pt''s lesions were vesicles and that there had been recent exposure to shingles. The lesions were located on the pt''s left arm and upper back. There was no history of chickenpox. A physician noted that the pt had been treated with acyclovir from 09/27/2001 to 10/01/2001. It was reported that no photos were taken. Follow-up info received from a physician indicated that the pt''s shingles had resolved. The physician felt that the sinusitis was not an adverse event. Upon internal review, sinusitis was determined to be an incidental finding. No further info is available.

VAERS ID:186928 (history)  Vaccinated:1997-10-09
Age:2.0  Onset:2002-06-16, Days after vaccination: 1711
Gender:Male  Submitted:2002-06-18, Days after onset: 2
Location:Iowa  Entered:2002-06-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Varicella (Varivax);;1;0;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0691E   
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Broke out in chicken pox 06/16/02 per mom hx of varivax vaccine 10/09/1997.

VAERS ID:198000 (history)  Vaccinated:1997-10-09
Age:2.0  Onset:1997-10-23, Days after vaccination: 14
Gender:Female  Submitted:2003-02-13, Days after onset: 1939
Location:Georgia  Entered:2003-02-20, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Child''s blood sugarwas 900 on 10/23/97
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1353D0  
Administered by: Private     Purchased by: Unknown
Symptoms: Blood glucose increased, Candidiasis, Diabetes mellitus, Infection, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Child became a diabetic 12 days after having the varivax vaccine. Child first had a throat infection the following week. then about 3 days later started throwing up; got shot of Pherghan; then changed antibiotic and got thrash. The about 3 days later, diagnosed with Diabetes. Pt was dignosed with Type I diabetes, she will not recover from this takes 2-3 shots per day. Sticks finger at least 4 times a day. If you find any connection between the shot and her having diabetes- would you please let me know. Annual follow up on 04/14/04: "Pt has not recovered from adverse events. She has diabetes and takes 3 shots every day and sticks her finger 4 times a day. We have to buy 7 medications every month. In small children a virus can attack the pancreas and it will no longer produce insulin. The varicella shot is a live virus. Yes, where do we get help from for this child. No one in our family has diabetes on either side-so what happened? I just want help. My medical insurance is $500.00 a month. There is no cure for this side effect. We still got the chickenpox also.

VAERS ID:221521 (history)  Vaccinated:1997-10-09
Age:10.0  Onset:2003-12-15, Days after vaccination: 2258
Gender:Female  Submitted:2004-05-14, Days after onset: 150
Location:Massachusetts  Entered:2004-05-24, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: WAES0312USA02094
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.623510/0694E0  
Administered by: Private     Purchased by: Public
Symptoms: Drug ineffective, Infection, Rash pustular
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning a 10 year-old female patient with no known allergies who on 09-Oct-1997 was vaccinated in the left deltoid with a first dose of varicella virus vaccine live (Lot #623510/0694E). The registered nurse indicated the patient''s mother reported that the patient has chicken pox with classic pustules on her trunk, which have been spreading for several days. It was noted the patient was not seen by the physician and there were not tests performed. The reporter noted, the patient is getting better at this point. Follow-up information received from the registered nurse reported the patient recovered with no problem. No other information is expected.

VAERS ID:228307 (history)  Vaccinated:1997-10-09
Age:1.0  Onset:2004-10-12, Days after vaccination: 2560
Gender:Male  Submitted:2004-10-18, Days after onset: 6
Location:Virginia  Entered:2004-10-27, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Herpes zoster
SMQs:
Write-up: Shingles after vaccination.

VAERS ID:236600 (history)  Vaccinated:1997-10-09
Age:0.6  Onset:2001-10-26, Days after vaccination: 1478
Gender:Female  Submitted:2005-04-21, Days after onset: 1273
Location:Michigan  Entered:2005-04-26, Days after submission: 5
Life Threatening? Yes
Died? Yes
   Date died: 2003-09-19
   Days after onset: 693
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Wilms tumor/Kidney Cancer; Lung bases demonstrated multiple pulmonary masses. 3 pound tumor encompassed left kidney.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4468352  
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0457E2  
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)LEDERLE LABORATORIES4552052  
Administered by: Public     Purchased by: Public
Symptoms: Anaemia, Impaired healing, Malaise, Neoplasm, Nephroblastoma, Pulmonary fibrosis, Pyrexia, Skin disorder, Viral infection, Weight decreased
SMQs:, Haematopoietic erythropenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignant tumours (narrow), Tumours of unspecified malignancy (narrow)
Write-up: 2 surgeries, Chemo, Radiation. Extensive 2 5 day (in hospital) Chemo stays and Stem cell transplant. Prior 2 oral polio 06/05/97 (lot # 0756D) and 8/7/97 (lot # 444062). Died 9/19/2003. 1/5/98: Office visit - sick. 4/9/98: Office visit - leg patches between knee and ankle. 8/14/01: Preschool physical 40.5 lbs, temp 100.6, BP 76/51, tired; Hemoglobin 9.2. Within week, sick. Dropped to 36lbs. by 9/4/01. Weight increased to 38lbs. Ear cut not healing. 10/02: Extensive blood work taken in preparation for stem cell transplant revealed 3 antibodies (Varicella, CMV, and Herpes Simplex). No further information received from medical record rec''d 06/13/2005. Hospital medical records received which revealed patient had dx of Stage IV Wilm''s tumor w/+ pulmonary nodules & liver mets & had relapses.

VAERS ID:239748 (history)  Vaccinated:1997-10-09
Age:1.1  Onset:2005-06-06, Days after vaccination: 2797
Gender:Male  Submitted:2005-06-07, Days after onset: 1
Location:Pennsylvania  Entered:2005-06-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.07125  RA
Administered by: Private     Purchased by: Private
Symptoms: Nonspecific reaction
SMQs:
Write-up: None indicated.

VAERS ID:103990 (history)  Vaccinated:1997-10-09
Age:2.8  Onset:1997-10-16, Days after vaccination: 7
Gender:Male  Submitted:1997-10-17, Days after onset: 1
Location:Foreign  Entered:1997-10-31, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: hemoglobin;platelets 10000;WBC count;
CDC Split Type: 970248081
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 1IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Haemorrhage, Infection, Petechiae, Purpura, Stomatitis, Subdural haematoma, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Severe cutaneous adverse reactions (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic cerebrovascular conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (broad), Hypersensitivity (broad)
Write-up: pt recv vax 9OCT97 & 17OCT97 9 days post vax pt exp diffuse hematoma & buccal purpura for which was hosp in emergency unit;severe thrombopenia was discovered & thrombocytopenic purpura dx;veinoglobulins were started;

VAERS ID:107673 (history)  Vaccinated:1997-10-09
Age:0.2  Onset:1997-10-13, Days after vaccination: 4
Gender:Male  Submitted:1998-01-28, Days after onset: 107
Location:Foreign  Entered:1998-02-17, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898036014L
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURERE73009A   
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS    
Administered by: Other     Purchased by: Other
Symptoms: Abscess
SMQs:
Write-up: 4 days p/vax pt devel a sterile abscess @ the head of the rt humerus;site of vax administration were not specified;pt was hosp;

VAERS ID:108040 (history)  Vaccinated:1997-10-09
Age:2.0  Onset:1997-10-30, Days after vaccination: 21
Gender:Male  Submitted:1998-03-03, Days after onset: 124
Location:Foreign  Entered:1998-03-06, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: WAES98022104
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.103011A SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Leukocytosis, Neuropathy, Paralysis, Pharyngitis, Red blood cell sedimentation rate increased, Sinusitis, Strabismus
SMQs:, Agranulocytosis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (narrow)
Write-up: pt recv vax 9OCT97 & 30OCT97 pt exp isolated abducens nerve palsy on lt side & was hosp;

VAERS ID:112595 (history)  Vaccinated:1997-10-09
Age:63.2  Onset:1997-10-10, Days after vaccination: 1
Gender:Female  Submitted:1998-06-12, Days after onset: 245
Location:Foreign  Entered:1998-07-13, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: DIS98010B
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & had a vax rxn rt upper arm, (size like 51DM coin) pruritus the day p/vax which lasted for 4 days;

VAERS ID:118332 (history)  Vaccinated:1997-10-09
Age:25.5  Onset:0000-00-00
Gender:Female  Submitted:1999-01-22
Location:Foreign  Entered:1999-01-26, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: pregnancy
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19980004621
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: pt pregnant, recv vax 9OCT97 & exp bleeding all the way through the pregnancy which became heavy at 38 wk gestation;pt exp a post partum hemorrhage;

VAERS ID:121281 (history)  Vaccinated:1997-10-09
Age:27.0  Onset:1998-03-12, Days after vaccination: 154
Gender:Female  Submitted:1999-04-15, Days after onset: 398
Location:Foreign  Entered:1999-04-19, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Brain CT scan nl;Cardiac doppler echography nl;ECG nl;Supra-aortic trunks doppler echography nl;anti-thyroid antibodies pos;LP protein=0.59, glucose & chlore cells nl,gammaglobulins inc;MRI small demyelinating lesions
CDC Split Type: 19990082141
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 4IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diplopia, Eye disorder, Headache, Multiple sclerosis, Paraesthesia, Stupor, Thyroiditis
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Corneal disorders (broad), Retinal disorders (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Ocular motility disorders (broad)
Write-up: pt recv vax 9OCT97 & approx 5mo later 12MAR98 pt devel cephalagia;14MAR98 diplopia occurred;pt hosp;neuro exam nl while brain scanner, electrocardiogram, cardiac doppler echography & supra-aortic trunk doppler echography nl;

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