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Case Details (Sorted by Vaccination Date)

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VAERS ID:91500 (history)  Vaccinated:1996-10-24
Age:5.4  Onset:1996-10-25, Days after vaccination: 1
Gender:Male  Submitted:1996-10-25, Days after onset: 0
Location:Massachusetts  Entered:1996-10-30, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: thallasemo minor
Preexisting Conditions: thallasemo minor;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)MASS. PUB HLTH BIOL LABDTP2954 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1321B1 LA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0739D4PO 
Administered by: Private     Purchased by: Public
Symptoms: Drug ineffective, Infection, Sialoadenitis
SMQs:, Lack of efficacy/effect (narrow), Oropharyngeal infections (narrow)
Write-up: pt devel lt parotitis might or morning p/vax;

VAERS ID:91522 (history)  Vaccinated:1996-10-24
Age:41.4  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-25, Days after onset: 1
Location:New York  Entered:1996-10-30, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: SLE-lupus
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6H812691  
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71237  LA
Administered by: Other     Purchased by: Other
Symptoms: Hyperhidrosis, Hypotension, Laryngospasm, Pallor
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Dystonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: pale, diaphoretic, felt throat closure-911 called;transported to ER;BP prior to transport 110/78;given epi by RN;

VAERS ID:91455 (history)  Vaccinated:1996-10-24
Age:1.7  Onset:1996-10-24, Days after vaccination: 0
Gender:Male  Submitted:1996-10-25, Days after onset: 1
Location:Ohio  Entered:1996-11-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES 3IM 
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES  PO 
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Anorexia, Hypokinesia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: elevated temp 102, crying, wouldn''t stand up, dec appetite;Ibuprofen, DPH;

VAERS ID:91575 (history)  Vaccinated:1996-10-24
Age:42.8  Onset:1996-10-25, Days after vaccination: 1
Gender:Female  Submitted:1996-10-28, Days after onset: 3
Location:Wisconsin  Entered:1996-11-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp large local rxn @ 21yr w/BCG dose 1;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hayfever type allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2129A20IMLA
Administered by: Other     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: devel diffuse hives 24hr p/vax;hives still present 28OCT;saw MD tx w/DPH;

VAERS ID:91633 (history)  Vaccinated:1996-10-24
Age:30.4  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-25, Days after onset: 1
Location:Texas  Entered:1996-11-05, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX96176
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712750IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Headache, Malaise, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: began feeling bad about 6hr p/flu vax;muscles aching h/a, stomachache, bottom of feet ached;sx lasted almost 24hr then felt better & feeling only weakness;

VAERS ID:91641 (history)  Vaccinated:1996-10-24
Age:8.5  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-31, Days after onset: 7
Location:New York  Entered:1996-11-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: abd pain ? mild illness during day of vax;
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NYS96069
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2117A21 LA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Chest pain, Face oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: c/o ?chest pain w/swelling of lip & lt eye w/hives 3hr p/vax;c/o joint pain 2 days p/incident;c/o earlier in day a/shot abd pain but afeb & feeling well when shot was given;DPH given in ER;

VAERS ID:91657 (history)  Vaccinated:1996-10-24
Age:6.6  Onset:1996-10-24, Days after vaccination: 0
Gender:Male  Submitted:1996-10-24, Days after onset: 0
Location:Pennsylvania  Entered:1996-11-05, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Albuterol nebulization
Current Illness: wheezing noted @ this visit
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1622B0IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0112D1SC 
Administered by: Private     Purchased by: Private
Symptoms: Pallor
SMQs:, Hypotonic-hyporesponsive episode (broad)
Write-up: few min p/vax pt became pale, ashen looking on face-pt referred to ER-EPI given;

VAERS ID:91667 (history)  Vaccinated:1996-10-24
Age:76.1  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-11-01, Days after onset: 8
Location:New York  Entered:1996-11-05, 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: 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: Public     Purchased by: Other
Symptoms: Arrhythmia, Myalgia, Skin nodule
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tendinopathies and ligament disorders (broad)
Write-up: pt states exp arrhythmia @ home;it was not intense but lengthy (45-50 min);pt also stated arm was sore x 3 days;felt like a golf ball was in arm;tx pt prayed;

VAERS ID:91800 (history)  Vaccinated:1996-10-24
Age:57.9  Onset:1996-10-26, Days after vaccination: 2
Gender:Male  Submitted:1996-11-05, Days after onset: 10
Location:Iowa  Entered:1996-11-08, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type: IA96037
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00686P0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Myalgia, Pharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 days p/vax pt noted throat scratchy;2 days later fever 101 to 103 lasting for 5 days;also noted coughing & aching;stayed in for 7 days;

VAERS ID:91813 (history)  Vaccinated:1996-10-24
Age:48.5  Onset:1996-10-25, Days after vaccination: 1
Gender:Female  Submitted:1996-10-30, Days after onset: 5
Location:Illinois  Entered:1996-11-08, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: IL960104
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6E81148  LA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Hyperhidrosis, Hypokinesia, Myalgia, Oedema, Pain, Pollakiuria, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: awakened 25OCT96 w/severe pain lt arm could move hand, could not lift arm;no redness , sl swelling, & warmth;pain cont thru AM 28OCT96, no fever;25OCT96 gen muscle pain in hips, legs & jaw, frequent urination;noc sweats;

VAERS ID:91856 (history)  Vaccinated:1996-10-24
Age:27.2  Onset:1996-11-02, Days after vaccination: 9
Gender:Male  Submitted:1996-11-05, Days after onset: 3
Location:New York  Entered:1996-11-11, 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:
Preexisting Conditions: PCN & keflex allergy
Diagnostic Lab Data: 1991: pt had varicella zoster 199 elisa test: 4.3 (no immunity);2NOV96 direct fluresc antibody test:negative;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0769D0SCA
Administered by: Other     Purchased by: Other
Symptoms: Headache, Injection site hypersensitivity, Injection site mass, Nuchal rigidity, Oedema, Pruritus, Rash, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 24OCT pt recv vax & 2NOV96 redness, warmth, induration;pruritus & 4x3cm erythema @ inj site;also stiff neck, h/a, swollen arm (inj arm) & several lesions on abd which cultured negative;(no temp);

VAERS ID:91886 (history)  Vaccinated:1996-10-24
Age:29.5  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-28, Days after onset: 4
Location:Massachusetts  Entered:1996-11-12, Days after submission: 15
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 LABORATORIES6F712260 A
Administered by: Private     Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Injection site hypersensitivity, Injection site pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: 24OCT96 1hr p/vax sharp pain was exp across chest which lasted 1/2hr @ that time;breathing was also diff;24 hr later site of inj was red 7 sore, completely resolved w/in 48hr;

VAERS ID:91887 (history)  Vaccinated:1996-10-24
Age:38.4  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-11-01, Days after onset: 8
Location:Massachusetts  Entered:1996-11-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: father exp nausea, h/a @ 78yr w/flu vax dose 1
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCn allergy
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712260IM 
Administered by: Private     Purchased by: Public
Symptoms: Headache, Myalgia, Nausea, Pruritus, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: nausea, h/a, sore itchy arm since recv vax APAP & ice to arm w/full recovery aside from arm soreness on 27OCT96;

VAERS ID:91891 (history)  Vaccinated:1996-10-24
Age:47.4  Onset:1996-10-25, Days after vaccination: 1
Gender:Female  Submitted:1996-11-04, Days after onset: 10
Location:Utah  Entered:1996-11-12, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49581500 LA
Administered by: Private     Purchased by: Private
Symptoms: Face oedema, Personality disorder, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt stated started feeling weird the noc of 24OCT96;face swelled & got hives a day later;

VAERS ID:91896 (history)  Vaccinated:1996-10-24
Age:44.7  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-25, Days after onset: 1
Location:Michigan  Entered:1996-11-12, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other meds
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EKG 24OCT nl
CDC Split Type: MI96160
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681634IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthma, Dizziness, Dyspnoea, Hypersensitivity, Hypotension, Hypoxia, Injection site pain, Nausea
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt exp poss allerg rxn, flu shot hurt @ time of inj, burning sensation in arm when given;11/2hr later feeling dizzy & nauseated;BP lt 120/68;diff breathing, t99.6;wheezing, SOB, 02 started;dx as rxn to flu vax;

VAERS ID:92193 (history)  Vaccinated:1996-10-24
Age:23.4  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-30, Days after onset: 6
Location:Massachusetts  Entered:1996-11-12, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt father exp allerg rxn w/flu vax dose 1;
Other Medications: BCP Desogen
Current Illness: UTI Monday 28OCT96
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712260IM 
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Headache, Myalgia, Oedema, Pyrexia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fatigue, h/a, body aches, t100.9 po, swelling & hives on lt arm;31OCT96 7PM completely resolved by Sunday afternoon, APAP for relief;

VAERS ID:91971 (history)  Vaccinated:1996-10-24
Age:2.2  Onset:1996-11-02, Days after vaccination: 9
Gender:Female  Submitted:1996-11-04, Days after onset: 2
Location:New York  Entered:1996-11-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0242D0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: 9th day p/inj pt devel local varicella;

VAERS ID:91972 (history)  Vaccinated:1996-10-24
Age:27.7  Onset:1996-10-26, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:Washington  Entered:1996-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: probable viral synd
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS01066P0 RA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: myalgias & fatigue for 3wk prior to vax;pt exp little red spots on abd;also mildly pruritic salmon colored maculo papular rash on trunk & arm;size up to 1cm diameter impression:pityriasis rosea;

VAERS ID:91924 (history)  Vaccinated:1996-10-24
Age:0.4  Onset:1996-10-25, Days after vaccination: 1
Gender:Female  Submitted:1996-11-09, Days after onset: 15
Location:Pennsylvania  Entered:1996-11-14, 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: possibly APAP
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4386231IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0746K1PO 
Administered by: Private     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: gen urticaria w/in 24hr of vax;pt given med;

VAERS ID:92069 (history)  Vaccinated:1996-10-24
Age:0.3  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-11-04, Days after onset: 11
Location:Oklahoma  Entered:1996-11-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES0754101IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406B1IMLL
HIBV: HIB (PROHIBIT)CONNAUGHT LABORATORIES07954101IMRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0745E1PO 
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Screaming
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: crying for about 12hr;dec use of leg for 7 days;

VAERS ID:92223 (history)  Vaccinated:1996-10-24
Age:74.6  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-11-14, Days after onset: 21
Location:Missouri  Entered:1996-11-20, 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:
Current Illness: NONE
Preexisting Conditions: NONE-other than dust
Diagnostic Lab Data: urine test;blood test for cholesterol
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES5771239 IMRA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Chills, Dizziness, Ear disorder, Infection, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: c/o chills, weakness, light headedness in mid Pm p/inj;saw MD;dx w/kidney infect & fluid in ear;

VAERS ID:92381 (history)  Vaccinated:1996-10-24
Age:4.2  Onset:1996-10-25, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Georgia  Entered:1996-11-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: GA96147
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES5E710740IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1167B1SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0740A3PO 
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)
Write-up: only c/o is of local rxn-rt deltoid size 100mm x 75mm erythematous-warm to touch;

VAERS ID:92527 (history)  Vaccinated:1996-10-24
Age:40.2  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-11-12, Days after onset: 19
Location:Colorado  Entered:1996-12-02, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: CO96053
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681641IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypokinesia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt reported pain in lt shoulder, aching & dec movement on 8NOV96;stated the inj was given into the joint;advised to see PMD;13NOV6 950AM pt reports aching in arm immed p/vax;seen by MD for pain limited movement of lt arm;

VAERS ID:92564 (history)  Vaccinated:1996-10-24
Age:73.1  Onset:1996-10-27, Days after vaccination: 3
Gender:Female  Submitted:1996-11-25, Days after onset: 29
Location:Washington  Entered:1996-12-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Sinenet, Klonopin, Zantace, Feldane, Premarin, Provera, Thyroid
Current Illness: NA
Preexisting Conditions: restless leg synd, hypothyroidism;
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968177 SCLA
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: onset gen persistent myalgias 3 days p/vax 29OCT; pain inc w/activity;no weakness or numbness;no muscle tenderness;nl CPK;

VAERS ID:92681 (history)  Vaccinated:1996-10-24
Age:32.2  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Missouri  Entered:1996-12-09
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: Kimlinger;allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681680IMLA
Administered by: Other     Purchased by: Private
Symptoms: Condition aggravated, Dizziness, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 11AM on 24OCT96 vax given approx 12PM on 24OCT96 returned to staff givening vax c/o lightheadedness & feeling itchy;stated has allergies & can tell when skin is going to break out; no c/o SOB or diff breathing;BP 130/84;skin warm & dry;

VAERS ID:92696 (history)  Vaccinated:1996-10-24
Age:1.5  Onset:1996-10-31, Days after vaccination: 7
Gender:Female  Submitted:1996-11-13, Days after onset: 13
Location:Georgia  Entered:1996-12-09, Days after submission: 26
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:
CDC Split Type: GA96157
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4335670IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1405B1IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1167B0SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0741A0PO 
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: parent called & stated pt had rash, fever to 102 & diarrhea x 3 days;(started 7 days post vax);pt seen by MD 6NOV96 MD states rxn to MMR vax;

VAERS ID:92925 (history)  Vaccinated:1996-10-24
Age:60.7  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-30, Days after onset: 6
Location:Iowa  Entered:1996-12-17, Days after submission: 48
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE;NKA
Diagnostic Lab Data: Chem profile, Artirial Gases, Cardiac enzymes, multiple EKG;CXR 2 view''s over 24OCT96 & 25OCT96;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71316 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dysphagia, Dyspnoea, Hyperhidrosis, Hypertension, Malaise
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)
Write-up: recv vax 24OCT96 2PM & w/in 10min flet funny;BY 245PM unable to swallow, dysphoritic, diff breathing;BP 190/110;given med a/emergency transport to hosp;@ hosp recv more meds then adm to f/o rxn triggering a MI d/c 25OCT96;

VAERS ID:93507 (history)  Vaccinated:1996-10-24
Age:1.7  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-25, Days after onset: 1
Location:Idaho  Entered:1997-01-03, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP;
Current Illness: unk
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: ID96079
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES07839003IMLL
Administered by: Public     Purchased by: Public
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax; approx 3hrs later, started v; had been given apap;

VAERS ID:93646 (history)  Vaccinated:1996-10-24
Age:79.1  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-29, Days after onset: 5
Location:Oklahoma  Entered:1997-01-09, Days after submission: 72
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OK9652
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER01286P0IMLA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER1626B0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Osteoarthritis, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow)
Write-up: pt reports that on the noc of 24OCT96 when laid on rt side that shoulder hurt;then the next day rt elbow was red & swollen;went to MD who prescribed ATB & ice packs;by the next day arm did not hurt & red & swelling resolved;

VAERS ID:93691 (history)  Vaccinated:1996-10-24
Age:0.4  Onset:1996-10-26, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:Pennsylvania  Entered:1997-01-13
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: healthy infant;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER  PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oedema, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: reportedly gen reddness, puffiness w/in 24 hrs of vax;

VAERS ID:93968 (history)  Vaccinated:1996-10-24
Age:66.0  Onset:1996-10-25, Days after vaccination: 1
Gender:Male  Submitted:1996-11-01, Days after onset: 7
Location:Massachusetts  Entered:1997-01-23, Days after submission: 83
Life Threatening? No
Died? Yes
   Date died: 1996-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Diagnostic Lab Data:
CDC Split Type: MA9632
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71226 IMA
Administered by: Public     Purchased by: Public
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)
Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;

VAERS ID:94236 (history)  Vaccinated:1996-10-24
Age:1.0  Onset:1996-11-03, Days after vaccination: 10
Gender:Female  Submitted:0000-00-00
Location:North Carolina  Entered:1997-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96110275
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Lung disorder, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 24OCT96 & 3NOV96 pt exp a rash w/15 lesions on trunk & back, sl fever & mild resp involvement;

VAERS ID:94033 (history)  Vaccinated:1996-10-24
Age:67.9  Onset:1996-10-26, Days after vaccination: 2
Gender:Male  Submitted:1996-10-29, Days after onset: 3
Location:Massachusetts  Entered:1997-01-24, Days after submission: 87
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681360IMLA
Administered by: Public     Purchased by: Private
Symptoms: Cough, Malaise, Pharyngitis, Pneumonia, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 26OCT96 started w/cold sx;27OCT96 felt worse, fever, cough;25OCT96 went to own MD started on amoxicillin;almost had pneumonia;1NOV95 r/c wife states pt much better; improved 29OCT96;

VAERS ID:94411 (history)  Vaccinated:1996-10-24
Age:0.4  Onset:1996-10-24, Days after vaccination: 0
Gender:Male  Submitted:1997-01-20, Days after onset: 88
Location:Mississippi  Entered:1997-01-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4326571IM 
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.2130A21IM 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES 1PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Anaphylactoid reaction, Oedema, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: w/in 10min of vax pt devel anaphylactic like rxn (gen hives & palpebral edema);epi given, rxn ceased w/in 15 min;

VAERS ID:94437 (history)  Vaccinated:1996-10-24
Age:57.0  Onset:1996-11-26, Days after vaccination: 33
Gender:Male  Submitted:1997-01-16, Days after onset: 51
Location:Massachusetts  Entered:1997-01-28, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71226 IMA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Guillain-Barre syndrome, Influenza, Myasthenic syndrome, Pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Cardiomyopathy (broad), Demyelination (narrow)
Write-up: flu sx 16NOV-pain, legs following wk-progressed diff breathing-went to hosp dx w/ GBS 26NOV;

VAERS ID:94567 (history)  Vaccinated:1996-10-24
Age:56.1  Onset:1996-10-26, Days after vaccination: 2
Gender:Female  Submitted:1996-10-31, Days after onset: 5
Location:Texas  Entered:1997-01-30, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX96171
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES3910 LA
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Injection site reaction
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4-5 water filled blisters @ inj site;largest was 1cm in diameter;pt exp no discomfort;

VAERS ID:94571 (history)  Vaccinated:1996-10-24
Age:63.5  Onset:1996-10-25, Days after vaccination: 1
Gender:Female  Submitted:1996-11-01, Days after onset: 7
Location:Texas  Entered:1997-01-30, Days after submission: 90
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: Insulin;Zestril;APAP
Current Illness: HTN-diabetes-arthritis
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX96180
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712751 LA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6F81189  RA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 24OCT96 reddened area w/o rash to upper lt arm;warm & soft to palpation;c/o tenderness-no swelling;appt w/MD 20NOV96;

VAERS ID:94894 (history)  Vaccinated:1996-10-24
Age:1.5  Onset:1996-11-02, Days after vaccination: 9
Gender:Female  Submitted:0000-00-00
Location:North Dakota  Entered:1997-02-10
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: WBC count 18,300;hemoglobin 12.8, platelets 337,000;47% segs, 26% bands, 22% lymphocytes, 4% monos;blood cult was taken & is pending;
CDC Split Type: ND9706
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4380871 RL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0517D2 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0391D0SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0744M1PO 
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Condition aggravated, Convulsion, Dyspnoea, Febrile convulsion, Leukocytosis, Pyrexia, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: mom states pt had t101;APAP given temp came down;mom found pt coughing-jerking in crib called 911;pt gasping;tonic-clonic movements looked postictal;fussier;dx sz, febrile;

VAERS ID:94944 (history)  Vaccinated:1996-10-24
Age:4.1  Onset:1996-10-28, Days after vaccination: 4
Gender:Male  Submitted:1996-12-10, Days after onset: 43
Location:Georgia  Entered:1997-02-11, Days after submission: 63
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: PCN
Diagnostic Lab Data: CBC dx of thrombocytopenia, prob ITP
CDC Split Type: GA96160
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES5K610151IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1169B1SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0740A3PO 
Administered by: Public     Purchased by: Public
Symptoms: Ecchymosis, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax & pt in MD office 28OCT96 w/bruises on legs;dx thrombocytopenia problem ITP 1NOV96 CBC nl;

VAERS ID:95202 (history)  Vaccinated:1996-10-24
Age:55.8  Onset:1996-10-26, Days after vaccination: 2
Gender:Female  Submitted:1997-01-10, Days after onset: 76
Location:Idaho  Entered:1997-02-19, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Estrogen-mult vit & calcium
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT scan
CDC Split Type: ID97002
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681460IMRA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal distension, Cardiovascular disorder, Immune system disorder, Lymphadenopathy, Oedema peripheral, Pseudo lymphoma
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: pt reports 2 days p/vax devel swelling in rt leg;eval for DVT negative;saw MD several times & referred to circulatory specialist;CT scan indicated abd mass w/lymph node involvement;biopsy done dx lymphoma;pt felt vax triggered immune

VAERS ID:95683 (history)  Vaccinated:1996-10-24
Age:42.4  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-24, Days after onset: 0
Location:Minnesota  Entered:1997-03-06, Days after submission: 133
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ammonium lactate;cimetidine;beclommethasone;atenolol;loratadine;sertaline;nitrolgycerin;naproxen;albuterol inhaler
Current Illness: NONE
Preexisting Conditions: asthma, iodine allergy
Diagnostic Lab Data:
CDC Split Type: 896312013L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 1IMA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax & 15-20min later, devel an inj site rxn characterized by splotches & itching;

VAERS ID:95690 (history)  Vaccinated:1996-10-24
Age:35.2  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-24, Days after onset: 0
Location:Minnesota  Entered:1997-03-06, Days after submission: 133
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: 896313005L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968205 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: approx 2hr p/vax pt devel an area of numbness the size of a hand @ the inj site;

VAERS ID:95736 (history)  Vaccinated:1996-10-24
Age:40.2  Onset:1996-10-31, Days after vaccination: 7
Gender:Female  Submitted:1996-11-13, Days after onset: 13
Location:Indiana  Entered:1997-03-06, Days after submission: 113
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid;Prozac, oral contraceptive, vitamins
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 896337020L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968189 IM 
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 days p/vax pt devel an itchy, papular rash on the scalp;the rash spread to shoulders, back, chest, & arms;tx w/medrol dosepak;when the medrol was discontinued, the rash returned;

VAERS ID:95539 (history)  Vaccinated:1996-10-24
Age:36.5  Onset:1996-10-29, Days after vaccination: 5
Gender:Female  Submitted:1997-02-24, Days after onset: 118
Location:Kentucky  Entered:1997-03-10, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712880IMLA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Hypokinesia, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 29OCT96 devel aching, fatigue, malaise & required bed rest through 31OCT;immed p/that devel severe lt hip pain;tx w/ pred temp relief;saw MD on 29JAN96 recv cortisone inj w/immed relief recurrent hip pain;sl tightness;

VAERS ID:96192 (history)  Vaccinated:1996-10-24
Age:38.2  Onset:1996-10-26, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:Pennsylvania  Entered:1997-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96110671
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0355D1IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 24OCT96 & 26OCT96 pt devel a series of 3 to 4 arc-like pruritic lesions @ the inj site;w/in 2 days pt had recovered from exp;pt was vaccinated w/a rabies vax on an unspecified date & had the same rxn;

VAERS ID:99422 (history)  Vaccinated:1996-10-24
Age:  Onset:1996-10-28, Days after vaccination: 4
Gender:Unknown  Submitted:1996-12-11, Days after onset: 44
Location:New Jersey  Entered:1997-05-29, Days after submission: 168
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: 010150960067000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00586P IM 
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax 22OCT96 & 23OCT96;pt devel vomit & diarrhea w/o fever 48hr p/vax;pharmacist related there wee other pt that exp v, d who did not recv vax;this is one of 25 cases reported by a pharmacist;

VAERS ID:99425 (history)  Vaccinated:1996-10-24
Age:  Onset:1996-10-24, Days after vaccination: 0
Gender:Unknown  Submitted:1996-12-11, Days after onset: 48
Location:New Jersey  Entered:1997-05-29, Days after submission: 168
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: 010150960069000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00586P IM 
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax 24OCT96 & pt devel vomit & diarrhea w/o fever 48hr p/vax;pharmacist relater there were other pt that exp v,d who did not recv vax;this is one of 25 cases reported by pharmacist;

VAERS ID:99442 (history)  Vaccinated:1996-10-24
Age:  Onset:1996-10-25, Days after vaccination: 1
Gender:Male  Submitted:1996-11-11, Days after onset: 17
Location:Maryland  Entered:1997-05-29, Days after submission: 198
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: 010150960088000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00276P IMA
Administered by: Private     Purchased by: Other
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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax between 24OCT96 & 1NOV96;w/in 24hr p/vax pt devel an inj site rxn between 6-15cm in diameter w/redness, swelling & itching;this is 1 of 3 pt;

VAERS ID:99443 (history)  Vaccinated:1996-10-24
Age:  Onset:1996-10-25, Days after vaccination: 1
Gender:Female  Submitted:1996-11-11, Days after onset: 17
Location:Maryland  Entered:1997-05-29, Days after submission: 198
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: 010150960089000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00276P IMA
Administered by: Private     Purchased by: Other
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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax between 24OCT96 & 1NOV96 & w/in 24hr p/vax pt devel an inj site rxn between 6-15cm in diameter w/redness, swelling & itching;

VAERS ID:99444 (history)  Vaccinated:1996-10-24
Age:  Onset:1996-10-25, Days after vaccination: 1
Gender:Unknown  Submitted:1996-11-10, Days after onset: 16
Location:Maryland  Entered:1997-05-29, Days after submission: 199
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: 010150960092000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS00276[ IMA
Administered by: Private     Purchased by: Other
Symptoms: Nuchal rigidity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax between 24OCT96 & 1NOV96 & devel a fever & stiff neck 24hr p/vax;

VAERS ID:99652 (history)  Vaccinated:1996-10-24
Age:59.7  Onset:1996-12-24, Days after vaccination: 61
Gender:Male  Submitted:1996-12-27, Days after onset: 3
Location:Michigan  Entered:1997-05-29, Days after submission: 152
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple unspecififed med
Current Illness: UNK
Preexisting Conditions: diabetes Type II & heart condition
Diagnostic Lab Data: UNK
CDC Split Type: 010150970058000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKE-DAVIS  IMA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Chills, Pharyngitis, Rhinitis, Vasodilatation
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 24OCT96 & 24DEC96 pt devel hot & cold flashes, a sore throat, congestion & gen weakness;pt has not yet recovered;

VAERS ID:100432 (history)  Vaccinated:1996-10-24
Age:78.2  Onset:1996-11-03, Days after vaccination: 10
Gender:Male  Submitted:1997-01-27, Days after onset: 85
Location:Virginia  Entered:1997-07-18, Days after submission: 171
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol inhaler;Atrovent inhaler;Floxin, Theophylline, Vicodan, Ibuprofen, enulose, Bactrim;
Current Illness: unspecified infect
Preexisting Conditions: COPD, hx of sz, cataracts, hx of alcohol abuse, status post basal cell carcinoma, status post pneumonia, hx of fractures;
Diagnostic Lab Data: 26SEP Theophylline level 15.0;5NOV 25.4;11NOV 9.4;
CDC Split Type: 897107028L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Bone disorder, Chest pain, Injury, Laboratory test abnormal, Urinary tract infection
SMQs:, Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (broad)
Write-up: pt recv vax 25OCT96 & 29OCT fell & fractured hip, requiring surgery;p/surgery devel a urinary tract infect & treated w/floxin;d/c from hosp on 1NOV;3NOV exp chest pain & rehosp;

VAERS ID:100500 (history)  Vaccinated:1996-10-24
Age:78.7  Onset:1996-10-28, Days after vaccination: 4
Gender:Female  Submitted:1997-01-27, Days after onset: 91
Location:Virginia  Entered:1997-07-18, Days after submission: 171
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Captopril;Colace,digoxin, Furosemide, Insulin, Isosorbide, mevacor, proventil inhaler, senekot, serevent inhaler, synthroid, theophylline, trazadone, vanceril inhaler;
Current Illness: NONE
Preexisting Conditions: COPD,hypothyroidism, depression, insulin-dependent diabetes mellitus, CHF, CAD, hyperlipidemia, sulfa allergy;
Diagnostic Lab Data: Theophylline level 21OCT 5.5, 28OCT 17.3;
CDC Split Type: 897107025L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Laboratory test abnormal
SMQs:
Write-up: pt recv vax 24OCT96 & 28OCT theophylline level was 17.3;this is 1 of 2 pt from this sit to devel elevated theophylline levels p/vax;pt theophylline dose was inc on 22OCT96;

VAERS ID:100505 (history)  Vaccinated:1996-10-24
Age:42.1  Onset:0000-00-00
Gender:Female  Submitted:1997-01-30
Location:Maine  Entered:1997-07-18, Days after submission: 168
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: allergic to erythromycin, L5-S1 spondylolysis, spondylolisthesis;
Diagnostic Lab Data:
CDC Split Type: 897108008L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681733IMA
Administered by: Public     Purchased by: Private
Symptoms: Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax & devel a fever which persisted for 72hr, & swelling @ the inj site;pt recovered;this is 1 of 6 pt from this site to have an adverse exp following vax;

VAERS ID:101423 (history)  Vaccinated:1996-10-24
Age:72.8  Onset:1996-10-29, Days after vaccination: 5
Gender:Female  Submitted:1997-04-11, Days after onset: 163
Location:Colorado  Entered:1997-07-22, Days after submission: 102
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: pt reported allergic to sulfa, demerol & codeine;
Diagnostic Lab Data:
CDC Split Type: CO6932
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES    
Administered by: Private     Purchased by: Unknown
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt devel a band of severe redness @ the inj site & pain @ the inj site;rxn began 7-9 days p/vax given;pt devel cellulitis @ the site 5 days p/vax;

VAERS ID:102389 (history)  Vaccinated:1996-10-24
Age:36.0  Onset:1996-10-25, Days after vaccination: 1
Gender:Male  Submitted:1996-10-28, Days after onset: 3
Location:Ohio  Entered:1997-09-10, Days after submission: 316
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unspecified asthma medication;
Current Illness: NONE
Preexisting Conditions: asthma;
Diagnostic Lab Data:
CDC Split Type: 896311016L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES   RA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4386700IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Infection, Injection site hypersensitivity, Lymphadenopathy, Pyrexia, Skin striae
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax & the next evening pt devel chills, fever of 102.5, redness @ the Pnu-Imune 23 inj site w/red streaks radiating to the inner arm & axilla & lt axillary;lymphadenopathy;2 days p/vax MD dx secondary infect;

VAERS ID:104166 (history)  Vaccinated:1996-10-24
Age:43.0  Onset:0000-00-00
Gender:Female  Submitted:1996-12-04
Location:Florida  Entered:1997-10-30, Days after submission: 330
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp erythema @ inj site & swelling shoulder area, itching w/dose 1 Engerix-B;
Other Medications: Estrace;Entex LA;Humibid
Current Illness:
Preexisting Conditions: environmental allergies;food allergies;
Diagnostic Lab Data:
CDC Split Type: 960173951C
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 2IMA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Pruritus, Pyrexia, Similar reaction on previous exposure to drug
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 24OCT96 & exp erythema @ inj site & swelling in shoulder area, knot was present & itching;pt felt miserable;seen by allergist again;

VAERS ID:104226 (history)  Vaccinated:1996-10-24
Age:18.0  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-11-11, Days after onset: 18
Location:New Jersey  Entered:1997-10-30, Days after submission: 353
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: No allergies were provided
Diagnostic Lab Data:
CDC Split Type: 960164561
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1810A1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Face oedema, Migraine
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 24OCT96 & pt exp a migraine h/a & swelling around th eye rt on the noc of 24OCT96;pt recv shots in ER:d/c from ER w/steroids dose pack;

VAERS ID:107508 (history)  Vaccinated:1996-10-24
Age:79.0  Onset:1996-10-25, Days after vaccination: 1
Gender:Female  Submitted:1997-12-30, Days after onset: 431
Location:California  Entered:1998-01-15, Days after submission: 16
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: Renal dialysis pt shunt placed APR96 & pt rx w/dilaudid @ that time;pt reported to have same sx @ that time
Diagnostic Lab Data:
CDC Split Type: CO6916
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Ecchymosis, Oedema, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: pt recv vax 24OCT96 & w/in 24hr of vax pt arm had turned black & blue from shoulder to elbow, the inside of mouth became swollen & cracked & fingers became swollen & red @ tips;

VAERS ID:107566 (history)  Vaccinated:1996-10-24
Age:47.0  Onset:1996-10-25, Days after vaccination: 1
Gender:Female  Submitted:1997-11-28, Days after onset: 399
Location:Illinois  Entered:1998-01-15, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO7018
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71224  RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Lymphadenopathy, Pain
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 24OCT96 & the following day pt devel shoulder pain & an axillary lymphadenopathy (4cm) on the rt upper extremity;pt was seen in office on 28OCT96 & rxn was reported to have persisted @ time of report 29NOV96;

VAERS ID:185450 (history)  Vaccinated:1996-10-24
Age:2.6  Onset:2002-02-18, Days after vaccination: 1943
Gender:Male  Submitted:2002-02-20, Days after onset: 2
Location:Oklahoma  Entered:2002-05-28, Days after submission: 96
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: OK0214
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: The pt broke out with blister bumps on 02/18/2002 during night time. The pt visited a physician and was diagnosed with chicken pox. No treatment was given.

VAERS ID:239189 (history)  Vaccinated:1996-10-24
Age:  Onset:2004-12-15, Days after vaccination: 2974
Gender:Unknown  Submitted:2005-05-16, Days after onset: 151
Location:Unknown  Entered:2005-06-07, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0503USA02238
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a RN concerning a 3rd grade student who on 10/24/1996 was vaccinated with a dose of varicella virus vaccine live. In mid December 2004 the student developed Chickenpox in mid December of 2004. According to the school nurse 58 other elementary school students who developed chicken pox and 34 of them had previously been vaccinated with a dose of varicella virus vaccine live. Unspecified medical attention was sought. There was no information regarding the present status of the student. No product quality complaint was involved. Addition information has been requested.

VAERS ID:92461 (history)  Vaccinated:1996-10-24
Age:0.4  Onset:1996-10-24, Days after vaccination: 0
Gender:Female  Submitted:1996-10-28, Days after onset: 4
Location:Foreign  Entered:1996-11-29, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations: pt recv 1st dose of vax w/o rxn;
Other Medications: NONE
Current Illness: unk
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: 896311005L
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Drug ineffective, Encephalitis, Infection, Meningitis, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 1 few hr p/vax pt devel fever & sz;pt was hosp & meningitis/encephalitis dx;This report was recv from Pharmaserve-Lilly, w/the statement that there was not a causal relationship;

VAERS ID:288760 (history)  Vaccinated:1996-10-24
Age:10.0  Onset:2007-06-12, Days after vaccination: 3883
Gender:Male  Submitted:2007-08-22, Days after onset: 71
Location:Foreign  Entered:2007-08-23, Days after submission: 1
Life Threatening? No
Died? Yes
   Date died: 2007-06-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: None Provided.
CDC Split Type: GBWYE178915AUG07
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)PFIZER/WYETHL0305B10UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Death, Meningitis haemophilus, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow)
Write-up: This is a fatal case. Information regarding Hib-Titer Vaccine was received from a healthcare professional via a regulatory authority regarding a 10-year-old male patient who experienced vaccine failure and Hib meningitis. The patient received the first dose on 24-Oct-1995. The patient experienced Hib meningitis date and was attributed to vaccine failure. The cause of death was reported as vaccination failure and meningitis haemophilus. The reporter stated that Hib-Titer may be contributory to the patient''s death. The patient died on 12-Jun-2007. No additional information was available at the time of this report.

VAERS ID:91572 (history)  Vaccinated:1996-10-25
Age:1.2  Onset:1996-10-25, Days after vaccination: 0
Gender:Female  Submitted:1996-10-28, Days after onset: 3
Location:New Mexico  Entered:1996-11-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4326543IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES07431L4PO 
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Cellulitis, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)
Write-up: pt recv vax 25OCT96 in lt thigh & lt leg started swelling;pt very irritable;seen Saturday noc in ER for cellulitis;

VAERS ID:91600 (history)  Vaccinated:1996-10-25
Age:1.3  Onset:1996-10-25, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Minnesota  Entered:1996-11-04
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: Ceclor
Diagnostic Lab Data: throat cult negative for strep A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES6A710522IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES6A710522IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0467D0SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES3969291PO 
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: hives on stomach & chin, arms;DPh 1/4 tsp PRN;

VAERS ID:91814 (history)  Vaccinated:1996-10-25
Age:43.9  Onset:1996-10-26, Days after vaccination: 1
Gender:Female  Submitted:1996-10-28, Days after onset: 2
Location:Illinois  Entered:1996-11-08, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Capozid, Potassium, Synthroid, Lopressor, Trazadone, Serax
Current Illness: NONE
Preexisting Conditions: HTN, hypothyroid
Diagnostic Lab Data: CBC done 28OCT96
CDC Split Type: IL960103
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1955A60IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6B81036 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Lymphadenopathy, Lymphangitis, Oedema, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 26OCT96 devel fever 100;felt tired;27OCT96 fever to 102 & noted puffiness in clavicle area of lt side;took APAP & called MD who advised Ibuprofen & DPH;seen by MD 28OCT96;dx lymphangitis lymph node palpable under lt arm;given ATB;

VAERS ID:91900 (history)  Vaccinated:1996-10-25
Age:70.8  Onset:1996-10-25, Days after vaccination: 0
Gender:Male  Submitted:1996-10-28, Days after onset: 3
Location:Michigan  Entered:1996-11-12, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Trental TID;
Current Illness: NONE
Preexisting Conditions: triple bypass surgery JUL96;rt arm was used to inject dye for testing prior to surgery
Diagnostic Lab Data:
CDC Split Type: MI96153
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49682040IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4539590IMRA
Administered by: Public     Purchased by: Other
Symptoms: Myalgia, Oedema peripheral, Pain, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax 25OCT96 PM by that evening the rt arm was painful & tender by sat noon the rt arm was hot, tender & swollen from the shoulder to below the elbow;pt went to ER on 26OCT96 PM;given IV & then had steroid through the IV & sent

VAERS ID:91948 (history)  Vaccinated:1996-10-25
Age:64.2  Onset:1996-10-26, Days after vaccination: 1
Gender:Unknown  Submitted:1996-11-04, Days after onset: 9
Location:Georgia  Entered:1996-11-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn w/tetansu toxoid;
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968155 IMA
Administered by: Private     Purchased by: Other
Symptoms: Myalgia, Oedema, Pain, Skin discolouration, Skin nodule, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
Write-up: approx 18hr p/vax pt arm began to get red & swell;by next day severe redness, induration, & swelling w/soreness;dark spot 10 days p/vax;

VAERS ID:91949 (history)  Vaccinated:1996-10-25
Age:4.4  Onset:1996-10-29, Days after vaccination: 4
Gender:Female  Submitted:1996-11-06, Days after onset: 8
Location:Texas  Entered:1996-11-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES440763  LA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES745H5 PO 
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: approx 4 days p/vax pt devel redness, swelling, & warmth;area of 10cm x 8cm irregular margins, warmth, tenderness noted on 31OCT96;no swelling of elbow or shoulder;placed on Duricef;

VAERS ID:91955 (history)  Vaccinated:1996-10-25
Age:39.2  Onset:1996-10-25, Days after vaccination: 0
Gender:Female  Submitted:1996-10-25, Days after onset: 0
Location:New Jersey  Entered:1996-11-13, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: P92, R26 BP 120/50;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712770  
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Chest pain, Cyanosis, Dyspnoea, Hyperhidrosis, Hypotension, Lung disorder, Pruritus
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: approx 7min p/vax pt appeared ashen, BP 80/50, pulse 72, sl diff breathing but lungs clear, resp 24;911 called c/o feeling like was going to die;epig given;pt feeling itchy & weakness;inc tightness in chest, diaphoresis, dec breath so

VAERS ID:91957 (history)  Vaccinated:1996-10-25
Age:1.0  Onset:1996-11-03, Days after vaccination: 9
Gender:Female  Submitted:1996-11-05, Days after onset: 2
Location:Illinois  Entered:1996-11-13, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0386D0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0561D0 LA
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash & fever 3NOV96-7NOV96;

VAERS ID:91964 (history)  Vaccinated:1996-10-25
Age:52.9  Onset:1996-10-25, Days after vaccination: 0
Gender:Male  Submitted:1996-11-06, Days after onset: 12
Location:Alaska  Entered:1996-11-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: sulfur
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash-sx;DPH tx sx lasted 12 days;

VAERS ID:91973 (history)  Vaccinated:1996-10-25
Age:74.1  Onset:1996-10-26, Days after vaccination: 1
Gender:Male  Submitted:1996-11-05, Days after onset: 10
Location:Massachusetts  Entered:1996-11-13, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71226  RA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER0001D  LA
Administered by: Private     Purchased by: Public
Symptoms: Chills, Hypotonia, Stupor
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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: very lifeless, no pain, chills, appetite good;couldn''t get warm;no nausea;

VAERS ID:92117 (history)  Vaccinated:1996-10-25
Age:29.7  Onset:1996-10-26, Days after vaccination: 1
Gender:Female  Submitted:1996-11-06, Days after onset: 11
Location:California  Entered:1996-11-18, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Birth control pills
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES0221D  LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.   RA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Pain, Rash maculo-papular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: swelling @ site inj upper arm w/erythemic surrounding macules & plaques 1 to 2 cm tender afeb;

VAERS ID:92123 (history)  Vaccinated:1996-10-25
Age:40.0  Onset:1996-10-25, Days after vaccination: 0
Gender:Female  Submitted:1996-11-15, Days after onset: 21
Location:California  Entered:1996-11-18, 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: Premarin, Duril
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0 RA
Administered by: Other     Purchased by: Private
Symptoms: Oedema, Pain, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: w/in 3hr of vax red, inflamed rt arm, from elbow to shoulder;edema 4+ lasted 4 days, pruritis, pain;tx w/ice, DPH;

VAERS ID:92419 (history)  Vaccinated:1996-10-25
Age:0.2  Onset:1996-10-25, Days after vaccination: 0
Gender:Male  Submitted:1996-11-20, Days after onset: 26
Location:Wisconsin  Entered:1996-11-26, 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
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4386230 LL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2128A90 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0743P0PO 
Administered by: Private     Purchased by: Private
Symptoms: Crying, Injection site hypersensitivity, Injection site mass, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 3hr of high pitched, inconsolable crying (unusual cry-not baby''s usual);marked local rxn-10cm of induration;highest temp 1st 6hr 101.2;

VAERS ID:92427 (history)  Vaccinated:1996-10-25
Age:54.1  Onset:1996-10-25, Days after vaccination: 0
Gender:Female  Submitted:1996-11-18, Days after onset: 24
Location:California  Entered:1996-11-26, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp same rxn entire life w/tetanus all doses;
Other Medications: Normodyne, Premarin, Paxil
Current Illness: NONE
Preexisting Conditions: allergic to sulfur & all sulfur derivatives, thimerosol several antihypertension meds;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712140 RA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Injection site mass, Injection site oedema, Injection site pain, Oedema, Pain, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: minor constriction in chest (but definitely noticeable);10-20min p/vax;same evening required motrin & ice packs for soreness & onset of swelling;also very itchy;swelling hot, hard, sore , itchy moved from deltoid inj site to inner bicep;

VAERS ID:92528 (history)  Vaccinated:1996-10-25
Age:51.7  Onset:1996-10-25, Days after vaccination: 0
Gender:Female  Submitted:1996-10-25, Days after onset: 0
Location:Colorado  Entered:1996-12-02, Days after submission: 38
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: CO96054
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681651IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Oedema peripheral, Pruritus, Skin discolouration, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rt deltoid area very red, swollen w/pt c/o itchy feeling on observation several long raised white areas noted around inj site (? secondary to itching);

VAERS ID:92543 (history)  Vaccinated:1996-10-25
Age:1.3  Onset:1996-10-26, Days after vaccination: 1
Gender:Male  Submitted:1996-11-21, Days after onset: 26
Location:California  Entered:1996-12-02, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications: MMR by MSD lot# 0388P given 9AUG95 & hep B by SKB lot# 2095A2 given 9AUG95;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
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Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0835D0SC 
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax 25OCT & pt attended party 26OCT96-5 people from that exposure reportedly devel chicken pox;pt devel clinical chicken pox 11 days from vax;

VAERS ID:92715 (history)  Vaccinated:1996-10-25
Age:7.7  Onset:1996-10-26, Days after vaccination: 1
Gender:Male  Submitted:1996-10-31, Days after onset: 5
Location:Washington  Entered:1996-12-09, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WA961307
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F712460 RA
Administered by: Private     Purchased by: Private
Symptoms: Ear pain, Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: seen @ hosp onset earche 26OCT dx Bell''s palsy;28OCT to MD for confirmation dx- progressive rt side weakness droopy, rt lip, unable to close;

VAERS ID:92823 (history)  Vaccinated:1996-10-25
Age:0.2  Onset:1996-10-26, Days after vaccination: 1
Gender:Male  Submitted:1996-11-14, Days after onset: 19
Location:Louisiana  Entered:1996-12-12, Days after submission: 28
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: LA961201
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4380870 LL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1405B1 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0746H0PO 
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Dehydration, Diarrhoea, Hypoxia, Meningitis, Otitis media, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt recv vax 25OCT96 & on way home was involved in auto accident & taken to hosp & released;26OCT96 began w/diarrhea, vomiting & t101;seen by pvt MD sent home on ATB w/OM;adm to hosp w/sz;put on respirator & IV fluids;tx viral meningitis

VAERS ID:92867 (history)  Vaccinated:1996-10-25
Age:76.0  Onset:1996-10-30, Days after vaccination: 5
Gender:Male  Submitted:1996-12-11, Days after onset: 42
Location:Missouri  Entered:1996-12-16, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: CT scan was unremarkable;LP results- protein 30, glucose 60, WBC none or one;CSF cult negative;repeat LP 30nov96 protein 38,glucose 68,WBC 102, RBC 158
CDC Split Type: CO6976
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Agitation, Asthenia, CSF test abnormal, Confusional state, Hyperaesthesia, Pharyngitis, Pyrexia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: pt recv vax 25OCT96 & 30OCT96 pt began feeling weak;31OCT96 pt had hyperasthesias & was very agitated;pt hosp acting very confused tx w/meds;1NOV96 c/o sore throat & had a t103.3;

VAERS ID:92875 (history)  Vaccinated:1996-10-25
Age:58.4  Onset:1996-11-04, Days after vaccination: 10
Gender:Female  Submitted:1996-12-12, Days after onset: 38
Location:Arizona  Entered:1996-12-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Ziac
Current Illness: NONE
Preexisting Conditions: high blood pressure
Diagnostic Lab Data: spinal tap, blood tests, blood gas;also many tests done prior to dx of GBS that were unnecessary;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681640  
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Back pain, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Neuropathy, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: 4NOV pain in lower back;8NOV feet began to feel asleep & tingled all the time;10NOV hands/ginger tingled all the time MD sciatic nerve problem of dx; pt can walk but not welll;17NOV emergency ambulance to to hosp extreme pain & unable walk''

VAERS ID:92883 (history)  Vaccinated:1996-10-25
Age:1.0  Onset:1996-11-01, Days after vaccination: 7
Gender:Female  Submitted:1996-11-19, Days after onset: 18
Location:California  Entered:1996-12-16, Days after submission: 27
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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dermatitis bullous, Herpes zoster
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: herpes zoster-like eruption on trunk;

VAERS ID:92914 (history)  Vaccinated:1996-10-25
Age:13.0  Onset:1996-10-26, Days after vaccination: 1
Gender:Female  Submitted:1996-12-10, Days after onset: 45
Location:Iowa  Entered:1996-12-16, 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: NKA
Diagnostic Lab Data: NONE
CDC Split Type: IA96039
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0459D0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: broke out in rash all over the body;pt to have no more Hep B vax;

VAERS ID:94260 (history)  Vaccinated:1996-10-25
Age:33.4  Onset:1996-10-25, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Connecticut  Entered:1997-01-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES96110794
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0242D SC 
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 25OCT96 & pt exp pain @ inj site, a few papules @ inj site;fatigue, & a tender, red, raised area;

VAERS ID:94427 (history)  Vaccinated:1996-10-25
Age:37.1  Onset:1996-10-25, Days after vaccination: 0
Gender:Male  Submitted:1996-11-09, Days after onset: 15
Location:Minnesota  Entered:1997-01-27, Days after submission: 79
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71221 IMA
Administered by: Other     Purchased by: Unknown
Symptoms: Chest pain, Malaise, Myalgia, Nausea, Pyrexia, Similar reaction on previous exposure to drug
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: body aches, inc temp 103.0, nausea & tightness in chest;felt dreadful for approx 24hr;body aches cont for 48hr;have had rxn to flu shot in the past but, not as severe & not every year;

VAERS ID:94572 (history)  Vaccinated:1996-10-25
Age:48.3  Onset:1996-10-26, Days after vaccination: 1
Gender:Female  Submitted:1996-10-31, Days after onset: 5
Location:Texas  Entered:1997-01-30, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: ?allergies (inj);
Diagnostic Lab Data:
CDC Split Type: TX96181
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.6F71275  RA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES394961  LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: redness, tenderness, bump per site, fever @ site;seen in ER;

VAERS ID:94602 (history)  Vaccinated:1996-10-25
Age:1.5  Onset:1996-10-26, Days after vaccination: 1
Gender:Male  Submitted:1996-11-15, Days after onset: 20
Location:Texas  Entered:1997-01-30, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC & CT scan done when fever was high;no unusual results;
CDC Split Type: TX96185
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0397D0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0837D0 LA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: very high fever 105.6 went to ER had a rash that appeared to be spots;MD was not sure what is was;rash lasted 24hr;CBC & CT scan was done & nothing was wrong;not clear on dx;

VAERS ID:94636 (history)  Vaccinated:1996-10-25
Age:1.1  Onset:1996-11-03, Days after vaccination: 9
Gender:Male  Submitted:1996-11-04, Days after onset: 1
Location:Georgia  Entered:1997-01-31, Days after submission: 88
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: HGB 12.1;HCT 37.1;MCH 26;HPV 6.1;lymph 19.5;mono 24.8;EOS.0;BASO .0;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4348133 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1167B0 RL
Administered by: Public     Purchased by: Public
Symptoms: Febrile convulsion, Gaze palsy, Laboratory test abnormal, Otitis media, Salivary hypersecretion, Somnolence, Stupor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: pt recv vax 25OCT96 & febrile sz occurred 3NOV96 necessitated ER visit;rash occurred 5NOV96;onset of shaking, eyes rolled back in head;drooling non-responsive;felt warm;crying, lethargic;dx febrile sz & lt OM;

VAERS ID:95424 (history)  Vaccinated:1996-10-25
Age:37.4  Onset:1996-10-26, Days after vaccination: 1
Gender:Female  Submitted:1996-10-29, Days after onset: 3
Location:Virginia  Entered:1997-03-04, Days after submission: 126
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none
Other Medications: MS Contin;Pyridium;Ultram;Flexorel;Restoril;Birth Control pills
Current Illness: NONE
Preexisting Conditions: 1989 spinal cord injury (L4,5-F1);CSF leaks hx bladder/perpherial neuropathy 1989-1995
Diagnostic Lab Data: 26OCT96 WBC 19,000+
CDC Split Type: VA96071
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681362IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4359550SCLA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema, Injection site pain, Myalgia, Skin discolouration
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: 18hr pain/redness/swelling @ site (2-4diameter);24hr severe muscle aches, t104.8;dx cellulitis started Ceflex sx more severe (4"-6"_;48hr cellulitis @ site 8"+ diameter;sx cont;72hr t101.2 started pred;muscle aches severe, site-blacki

VAERS ID:95784 (history)  Vaccinated:1996-10-25
Age:34.1  Onset:1996-10-26, Days after vaccination: 1
Gender:Male  Submitted:1996-12-20, Days after onset: 55
Location:New York  Entered:1997-03-06, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: sl throat redness
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 896361005L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71246  LA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Injection site hypersensitivity, Injection site oedema, Myalgia, Neuropathy, Pain, Paraesthesia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: 1 day p/vax pt devel a rash & swelling @ inj site;2 days post vax the swelling inc & the area was hot to touch;pt also exp numbness & tingling in lt arm, pain ulnar nerve diff, & gen muscle & joint aches;tx w/meds;

VAERS ID:101998 (history)  Vaccinated:1996-10-25
Age:  Onset:1996-10-25, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Washington  Entered:1997-07-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96102608
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax 25OCT96 & 25OCT96 pt devel swelling, redness, & heat in arm;28OCT96 pt recovered from the swelling, redness & heat in arm;

VAERS ID:101999 (history)  Vaccinated:1996-10-25
Age:  Onset:1996-10-25, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Washington  Entered:1997-07-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96102609
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt recv vax 25OCT96 & same day pt devel splotched area that extended into underarm;pt was placed on ATB, & slowly began to get better;

VAERS ID:156548 (history)  Vaccinated:1996-10-25
Age:4.0  Onset:1999-09-30, Days after vaccination: 1070
Gender:Female  Submitted:2000-05-16, Days after onset: 229
Location:Ohio  Entered:2000-07-13, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99101115
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0838D0SC 
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Infection, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Subsequent to receiving one dose of varicella virus vaccine live, pt developed a rash consistent with shingles on the right chest.

VAERS ID:204685 (history)  Vaccinated:1996-10-25
Age:7.0  Onset:2003-05-04, Days after vaccination: 2382
Gender:Male  Submitted:2003-06-02, Days after onset: 29
Location:Michigan  Entered:2003-06-10, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: Mom reported about 163 chickenpox like spots. No fever noted. Was back to school 5/12/03.

VAERS ID:220874 (history)  Vaccinated:1996-10-25
Age:11.0  Onset:2003-06-20, Days after vaccination: 2429
Gender:Male  Submitted:2004-05-14, Days after onset: 329
Location:New York  Entered:2004-05-19, 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: UNK
Current Illness:
Preexisting Conditions: Varicella exposure
Diagnostic Lab Data: Serum varicella zoster positive for IgM
CDC Split Type: WAES0307USA00203
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Private     Purchased by: Private
Symptoms: Blister, Drug ineffective, Infection, Laboratory test abnormal, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning an 11 year old Caucasian male with no past medical history who on 10/25/95 was vaccinated with a first dose of varicella virus vaccine live (SC), in the left arm. There was no illness at the time of vaccination. On 6/20/03 the patient developed a fever and fluid filled vesicles, about 20 to 30. The patient was diagnosed with chicken pox. The patient sought medical attention. The patient was treated with acyclovir 800 mgm QID for 5 days, acetaminophen and colloidal oatmeal. The symptoms resolved in 5 to 7 days. it was reported that the patient had a positive titer for varicella IgM. It was noted that the patient had been exposed to varicella many times when he was younger but never developed varicella. No further information is expected.

VAERS ID:237770 (history)  Vaccinated:1996-10-25
Age:2.0  Onset:2004-04-02, Days after vaccination: 2716
Gender:Female  Submitted:2005-05-16, Days after onset: 408
Location:Minnesota  Entered:2005-05-23, 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: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0404USA00474
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Rash, Skin ulcer, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a consumer concerning her 9 year old daughter with no past medical history who on 10/25/96 was vaccinated with a 0.5ml dose of varicella virus vaccine live. There was no concomitant medication. On 4/2/04, the patient developed a full blown case of chickenpox. The patient had hundreds of lesions. Unspecified medical attention was sought, but treatment was not required and laboratory tests were not performed. The reporter also noted that therapy with varicella virus vaccine live was discontinued. At the time of the report, the patient was much improved. It was also noted that the adverse event abated and the patient is recovering with sequelae. A product quality complaint was not involved. Additional information is not expected.

VAERS ID:237844 (history)  Vaccinated:1996-10-25
Age:  Onset:2004-03-01, Days after vaccination: 2684
Gender:Female  Submitted:2005-05-16, Days after onset: 440
Location:Unknown  Entered:2005-05-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0404USA01265
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1656B   
Administered by: Other     Purchased by: Other
Symptoms: Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning a female patient at an elementary school of kindergarten to fourth grade, who on 10/25/96 was vaccinated with a dose of varicella virus vaccine live (lot #616997/1656B). Between 03/01/04 and 4/05/04, the patient developed breakthrough varicella. The patient had less than fifty pox and was afebrile. Unspecified medical attention was sought. A product quality complaint was not involved. The reporter also mentioned other cases of breakthrough varicella at the same elementary school (WAES040401117 and 0404USA01259 through 0404USA01264). Additional information is not available.

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