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Found 551189 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:93127 (history)  Vaccinated:1996-12-09
Age:21.3  Onset:1996-12-09, Days after vaccination: 0
Gender:Female  Submitted:1996-12-13, Days after onset: 4
Location:Nebraska  Entered:1996-12-17, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: end of sinus infect-last dose of ATB
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX ID)PASTEUR MERIEUX INST.L12482 LA
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: pt recv vax & had local rxn 10-12 hr p/vax x 2 days;11DEC96 woke up w/itching all over;denies, SOB, dyspnea or hives;took DPH every 4hr;

VAERS ID:93147 (history)  Vaccinated:1996-12-09
Age:0.2  Onset:1996-12-09, Days after vaccination: 0
Gender:Female  Submitted:1996-12-16, Days after onset: 7
Location:Virginia  Entered:1996-12-19, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES 0IMLL
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRL
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0PO 
Administered by: Private     Purchased by: Private
Symptoms: Anorexia, Screaming
SMQs:, Hostility/aggression (broad)
Write-up: constant crying $g6hr-refusing to eat since immun;

VAERS ID:93149 (history)  Vaccinated:1996-12-09
Age:0.5  Onset:1996-12-09, Days after vaccination: 0
Gender:Male  Submitted:1996-12-17, Days after onset: 8
Location:Maryland  Entered:1996-12-19, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Acetaminophen
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, CHEM 23, magnesium level all nl;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4407462IML
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: high fever w/in hr of inj, leg pain, brief generalized sz on 10DEC96;

VAERS ID:93441 (history)  Vaccinated:1996-12-09
Age:29.9  Onset:1996-12-09, Days after vaccination: 0
Gender:Female  Submitted:1996-12-17, Days after onset: 8
Location:Minnesota  Entered:1996-12-31, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: in pt, n,fever,chy for 2-3 days after 1st dose of vax;
Other Medications:
Current Illness: none
Preexisting Conditions: lt shoulder injured in ski accident dec95;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1951A41IMLA
Administered by: Public     Purchased by: Private
Symptoms: Influenza, Myalgia, Nausea, Pharyngitis, Pyrexia, Rhinitis, Similar reaction on previous exposure to drug
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax; felt n and devel fever;was quite achy;apap given;devel sore throat w/ cold sx;referred to md who said it was the flu;gave med to pt;still has fever

VAERS ID:93548 (history)  Vaccinated:1996-12-09
Age:0.2  Onset:1996-12-09, Days after vaccination: 0
Gender:Male  Submitted:1996-12-27, Days after onset: 18
Location:New Jersey  Entered:1997-01-03, 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: caffeine, vitamin E, ferrinsol, polyvisol
Current Illness: none
Preexisting Conditions: prematurity ex 29 week; apnea
Diagnostic Lab Data:
CDC Split Type: NJ9712
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER6L711740IMLL
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURERM305NP0IMRL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERL11120SCRL
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Personality disorder, Vasodilatation
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: pt had tonic clonic movement of upper limbs lasting less than 5 minutes. no apnea, cyanosis. Pt turned red @ that time Pt not himself after episode.

VAERS ID:93680 (history)  Vaccinated:1996-12-09
Age:0.2  Onset:1996-12-26, Days after vaccination: 17
Gender:Female  Submitted:1997-01-09, Days after onset: 14
Location:Nevada  Entered:1997-01-13, Days after submission: 4
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillan
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: x-ray chest-neg w/poss prog congest
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Private     Purchased by: Private
Symptoms: Cough, Dyspnoea, Laryngitis, Rhinitis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: sever congestion, w/croupy cough-rx amox;

VAERS ID:93768 (history)  Vaccinated:1996-12-09
Age:0.7  Onset:1996-12-09, Days after vaccination: 0
Gender:Female  Submitted:1996-12-12, Days after onset: 3
Location:Arkansas  Entered:1997-01-13, Days after submission: 32
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: AR9691
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0516D2IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES6L711621IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0749B1PO 
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 9DEC96 3-4PM aorund 8-9PM started w/t013 ax sponge bath & APAP given;10DEC96 rash & temp inc to 102 ax;mon cont to treat w/APAP;11DEC96 temp around 99-100 & rash begining to fade;rash still present 12DEC96;red raised bumps;

VAERS ID:93870 (history)  Vaccinated:1996-12-09
Age:51.2  Onset:1996-12-13, Days after vaccination: 4
Gender:Female  Submitted:1997-01-09, Days after onset: 27
Location:Pennsylvania  Entered:1997-01-17, 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: Atrovent, Lopid, Uniphyl
Current Illness: NONE
Preexisting Conditions: COPD, S/P renal cancer, CAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71194   
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: swelling/tenderness lt shoulder & lt hand-redness @ site of inj lt shoulder;

VAERS ID:93925 (history)  Vaccinated:1996-12-09
Age:13.5  Onset:1996-12-10, Days after vaccination: 1
Gender:Male  Submitted:1997-01-09, Days after onset: 30
Location:Missouri  Entered:1997-01-21, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications: Depakote, Cyclert, Antidepressants
Current Illness:
Preexisting Conditions: hx of sz since birth
Diagnostic Lab Data: unk
CDC Split Type: MO97002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM1819A10IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES5L710950IMLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: t105 oral on 10DEC96;mom sought tx @ ER several sz in ER given Motrin, temp down to 102 & discharged home;no APAP given as instructed until p/temp got to 105;

VAERS ID:93956 (history)  Vaccinated:1996-12-09
Age:1.2  Onset:1996-12-17, Days after vaccination: 8
Gender:Female  Submitted:1997-01-15, Days after onset: 29
Location:New York  Entered:1997-01-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Diagnostic Lab Data: CBC-blood cult-UA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0888D0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0777D0 LA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Eye disorder, Pyrexia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: temp to 106-sz (eyes deviated to left) unresponsive 2 episodes-ER visit x 2-finally stayed overnoc;blood UA done-no source identified;

VAERS ID:94395 (history)  Vaccinated:1996-12-09
Age:33.0  Onset:1996-12-11, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:California  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: Albuterol;Azmacort
Current Illness:
Preexisting Conditions: asthma
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96121155
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 9DEC96 & 11DEC96 pt devel a rash w/over 1000 lesions all over body & a fever;

VAERS ID:94846 (history)  Vaccinated:1996-12-09
Age:2.6  Onset:1996-12-19, Days after vaccination: 10
Gender:Male  Submitted:1997-02-02, Days after onset: 45
Location:Massachusetts  Entered:1997-02-06, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp fever t103.5 @9mo w/pertussis dose 1;
Other Medications: NONE
Current Illness: had had one flu this fall
Preexisting Conditions: saome dry skin-one small spot in summer;stopped breast milk
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 3  
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Eczema, Personality disorder, Pruritus, Rash, Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: severe poison ivy like rash dx as topical eczema p/ typical fever on day 10 p/vax;rash first looked like measles, then welts then pustules all over arms & legs lasting 6wk-8wk;skin splotchy;change in attitude, cries easily, grumpy, t1

VAERS ID:95055 (history)  Vaccinated:1996-12-09
Age:1.4  Onset:1996-12-09, Days after vaccination: 0
Gender:Male  Submitted:1997-02-04, Days after onset: 57
Location:Illinois  Entered:1997-02-14, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type: IL97007
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4348083IMLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0748M3PO 
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Chills, Dermatitis bullous, Injection site hypersensitivity, Injection site oedema, Muscle twitching, Somnolence, Tremor
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 2hr post vax pt started shaking all over & chilling;stomach muscles were contracting;went to ER sx subsided in 30-40min;next day pt w/red splotches w/white raised pimples;poor appetite & sleeping more;3rd day post vax site was red & swollen

VAERS ID:95128 (history)  Vaccinated:1996-12-09
Age:36.7  Onset:1996-12-18, Days after vaccination: 9
Gender:Male  Submitted:1997-02-06, Days after onset: 50
Location:Wisconsin  Entered:1997-02-18, Days after submission: 12
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: hx allergies (multiple environmental) desenitization rx $g10yr ago;distant hx prostatitis;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968178   
Administered by: Private     Purchased by: Private
Symptoms: Headache, Neuritis, Optic neuritis, Visual disturbance
SMQs:, Peripheral neuropathy (narrow), Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Ocular infections (broad)
Write-up: pt devel visual problems & h/a;dx as optic neuritis lt eye;responded completely to pulse solumedrol;w/in 1wk of stopping neuritis recurred;

VAERS ID:96223 (history)  Vaccinated:1996-12-09
Age:9.0  Onset:1996-12-09, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Illinois  Entered:1997-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96120804
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0279D0IM 
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: pt recv vax 9DEC96 & that day pt exp terrible tiredness & a mild fever;pt sx persisted @ the time of the report;

VAERS ID:96786 (history)  Vaccinated:1996-12-09
Age:9.3  Onset:1997-03-31, Days after vaccination: 112
Gender:Female  Submitted:1997-04-01, Days after onset: 1
Location:Virginia  Entered:1997-04-07, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1105D0SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 9DEC96 & exposed to varicella 2wk ago-rash started 31MAR several erythematous papules face, back buttocks;

VAERS ID:96896 (history)  Vaccinated:1996-12-09
Age:61.0  Onset:1996-12-23, Days after vaccination: 14
Gender:Male  Submitted:1997-01-20, Days after onset: 28
Location:Ohio  Entered:1997-04-15, Days after submission: 84
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Allopurinol;Cipro;Fat Emulsion;Lasix;Lisinopril;Mefoxitin:midazolam;Morphine PCa;Mucomist aerosol;Nitroglycerin;Pepcid;Potassium chloride
Current Illness: unk
Preexisting Conditions: COPD, anemia, surgery for colon DEC96;
Diagnostic Lab Data:
CDC Split Type: 897093026L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4968154  A
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES    
Administered by: Private     Purchased by: Other
Symptoms: Guillain-Barre syndrome, Respiratory disorder
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Respiratory failure (broad)
Write-up: pt recv vax 9DEC96 & 3 days later to ER w/GBS in the lower extremities which progressed to resp musculature;hosp is presumed, although not documented;

VAERS ID:97231 (history)  Vaccinated:1996-12-09
Age:51.0  Onset:0000-00-00
Gender:Female  Submitted:1997-04-21
Location:California  Entered:1997-04-28, 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: Thyroid Hormone;Vitamin C;ASA;
Current Illness:
Preexisting Conditions: HGN, hypothyroid, lumbar laminectomy;neuro reports that pt had veen in gen good health;had back surgery 8 yr ago & had no back problems since;2-3 yr ago had a tremor & was found to be hyperthyroid & tx w/radioactive iodine;pt on thyroid med
Diagnostic Lab Data: 2JAN97 Inorganic phos 2.2;Albumin 47;Triglycerides 128;Total cholesterol 185;Red blood cell count 5.3;neuro exam WNL s/postive Romberg''s sign;neurologists immpression strongly suspect post vax encephalomyelopathy;MRI spur on vertebra;
CDC Split Type: 970060301
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM676A60IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthma, Bone disorder, Coordination abnormal, Depersonalisation, Encephalopathy, Laboratory test abnormal, Myasthenic syndrome, Speech disorder
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related conditions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad)
Write-up: pt exp weakness & (a depersonalization rxn), diff w/inspiration airway constriction;devel bacterial bronchitis;spur on a vertebra found on MRI & swelling in spinal column noted;loss of balance, vertigo;suspect post vax encephalopathy

VAERS ID:101749 (history)  Vaccinated:1996-12-09
Age:51.7  Onset:1996-12-12, Days after vaccination: 3
Gender:Female  Submitted:1996-12-19, Days after onset: 7
Location:Alaska  Entered:1997-08-19, Days after submission: 242
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: AK97004
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES433354 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Dyspnoea, Hypertonia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax 9DEC96 & c/o sore deltoid that PM;10DEC96 lt deltoid hard;12DEC96 c/o muscle spasm lt side of back intermittent spasms;13DEC966 cont spasms w/pain producing tears;tx w/heating pad & Ibuprofen;diff exhaling;

VAERS ID:102422 (history)  Vaccinated:1996-12-09
Age:65.8  Onset:1996-12-10, Days after vaccination: 1
Gender:Male  Submitted:1996-12-19, Days after onset: 9
Location:North Carolina  Entered:1997-09-10, Days after submission: 264
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Capoten;Nitroglycerin;Paxil;Restoril;Xanax;Inderal;ASA;Lasix;Persantine;Quinidex;Niacin:Vicodin;Trazadone;Lanoxicaps;
Current Illness: unk
Preexisting Conditions: CAD,hyperlipidemia, congestive heart failure, cardiac arrhythmias, anxiety, insomnia, major depression, COPD, degenerative dis disease, poss eye cancer;s/p aortic aneurysm repair JUL94, eye surgery FEB94, lt inguinal hernia repair 1995;
Diagnostic Lab Data: CT scan of brain evidence of deep white matter, small vessel disease, & chronic rt maxillary sinusitis;24-hr Holter monitor lt bundle block w/premature ventricular contractions;carotid ultrasound:plaque but no stenosis;
CDC Split Type: 896355015L
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES441214 SC 
Administered by: Other     Purchased by: Other
Symptoms: Bundle branch block, Hypokinesia, Hypotonia, Laboratory test abnormal, Neuropathy, Paraesthesia, Sinusitis, Ventricular extrasystoles
SMQs:, Peripheral neuropathy (narrow), Conduction defects (narrow), Ventricular tachyarrhythmias (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: 1 day p/vax pt devel numbness of the rt wrist & wrist drop;pt dx w/saturday night synd w/resultant neuropathy unrelated to vax;

VAERS ID:103761 (history)  Vaccinated:1996-12-09
Age:1.0  Onset:1997-08-24, Days after vaccination: 258
Gender:Male  Submitted:0000-00-00
Location:New Hampshire  Entered:1997-10-20
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: No relevant data;
CDC Split Type: WAES97081722
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1336D0  
Administered by: Private     Purchased by: Public
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax 9DEC96 & 24AUG97 pt devel full blown chickenpox;pt presented to MD office;

VAERS ID:133952 (history)  Vaccinated:1996-12-09
Age:4.0  Onset:2000-01-30, Days after vaccination: 1147
Gender:Male  Submitted:2000-02-02, Days after onset: 3
Location:Pennsylvania  Entered:2000-02-15, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Resolved Otitis Media
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1448B0SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1216D0SC 
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Pt had varicella vaccine in 1996. Presented with vesicular, itcy rash of body on 1/31/00. Dx: varicella & treated with Atarax. Afebrile & no other symptoms.

VAERS ID:156793 (history)  Vaccinated:1996-12-09
Age:1.9  Onset:1999-04-08, Days after vaccination: 850
Gender:Male  Submitted:2000-05-16, Days after onset: 404
Location:California  Entered:2000-07-14, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: therapy unspecified, steroid therapy
Current Illness:
Preexisting Conditions: varicella exposure; asthma; steroid therapy
Diagnostic Lab Data:
CDC Split Type: WAES99040573
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Subsequent to receiving one dose of varicella virus vaccine live on 12/9/96, the pt developed a mild case of chickenpox with approximately 30 lesions. The pt sought unspecified medical attention. The reporting physician felt the pt''s condition was unrelated to therapy with varicella virus vaccine live, and may have been influenced by the steroid therapy.

VAERS ID:157636 (history)  Vaccinated:1996-12-09
Age:3.0  Onset:1996-12-09, Days after vaccination: 0
Gender:Male  Submitted:2000-07-13, Days after onset: 1311
Location:Virginia  Entered:2000-07-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EEG-July, 1999-Positive for Absence seizure activity
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4391931IM 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0748D1PO 
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Autism, Convulsion, Crying, Injection site hypersensitivity, Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Post vax, the pt developed redness and swelling at injection site. The child cried most of the day after injection. He had a fever of 102.9; by that evening-after multiple doses of Tylenol; he was weak and not as responsive as his norm. Pt recovered from acute reaction but has seizure disorder and autism.

VAERS ID:184378 (history)  Vaccinated:1996-12-09
Age:6.6  Onset:2002-05-01, Days after vaccination: 1969
Gender:Male  Submitted:2002-05-02, Days after onset: 1
Location:Missouri  Entered:2002-05-09, 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:
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Herpes zoster
SMQs:
Write-up: The pt presented an early atypical varicella. It began on the evening of 05/01/2002 and no fever noted. Treated with Zovirax, and Benadryl.

VAERS ID:200618 (history)  Vaccinated:1996-12-09
Age:  Onset:2003-03-25, Days after vaccination: 2297
Gender:Male  Submitted:2003-03-27, Days after onset: 2
Location:Massachusetts  Entered:2003-04-01, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1106D0SC 
Administered by: Private     Purchased by: Public
Symptoms: Drug ineffective, Rash vesicular
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Patient developed clinical varicella.

VAERS ID:229126 (history)  Vaccinated:1996-12-09
Age:1.0  Onset:2004-09-27, Days after vaccination: 2849
Gender:Female  Submitted:2004-09-28, Days after onset: 1
Location:Georgia  Entered:2004-11-11, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0385P0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1663D0 RA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Chickenpox 100 pox

VAERS ID:238418 (history)  Vaccinated:1996-12-09
Age:  Onset:1997-10-30, Days after vaccination: 325
Gender:Unknown  Submitted:2005-05-16, Days after onset: 2754
Location:Unknown  Entered:2005-05-27, 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:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0407USA01453
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.617265/0566D   
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection, Skin ulcer
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a physician concerning a patient who on 12/09/1996 was vaccinated with a dose of varicella virus vaccine live. The physician reported that on 10/30/1997, the patient presented to the office with chickenpox characterized by less than 50 lesions. Treatment was not required. At the time of this report, the outcome was unknown. The physician also reported that three other patients developed chickenpox after being vaccinated with varicella virus vaccine live. Additional information is not expected.

VAERS ID:238544 (history)  Vaccinated:1996-12-09
Age:1.0  Onset:2003-10-30, Days after vaccination: 2516
Gender:Unknown  Submitted:2005-05-16, Days after onset: 563
Location:Ohio  Entered:2005-05-31, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0409USA01872
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 physician concerning a 7 year old pt who on 12/09/1996 was vaccinated with a dose of varicella virus vaccine live. On 10/30/2003 the pt experienced a case of breakthrough varicella. There were less than 50 lesions. Unspecified medical attention was sought, but there were was no Tx and no hospitalization. The pt recovered. No product quality complaint was involved. This is one pt out of 40 reported. Thirty nine other cases (WAES 0407USA01446 and 0409USA01855 through 0409USA01871 and 0409USA01873 through 0409USA01893) experienced breakthrough varicella after vaccination with varicella virus vaccine live. Additioal inoformation is not expected.

VAERS ID:250685 (history)  Vaccinated:1996-12-09
Age:0.7  Onset:1998-10-09, Days after vaccination: 669
Gender:Male  Submitted:2006-01-06, Days after onset: 2646
Location:New Jersey  Entered:2006-01-20, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: The subject''s medical history, concurrent conditions, and concurrent medications were not reported.
Diagnostic Lab Data: UNK
CDC Split Type: A0565834A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSENG2132A22 LA
Administered by: Private     Purchased by: Private
Symptoms: Mental retardation severity unspecified
SMQs:
Write-up: This case was reported by a nurse and described the occurrence of pervasive developmental disorder in a 2 year old male subject who was vaccinated with hepatitis B vaccine recombinant Engerix B for prophylaxis. This report was initially received via manufacturer research. On 3/29/1996, the subject received the first dose of hepatitis B vaccine unknown manufacturer. On 5/10/1996, the subject received the second dose of hepatitis B vaccine recombinant Engerix B (lot ENG2004A2). Approximately nine months after the first dose of hepatitis B vaccine, on 12/9/1996 the subject received the third dose of Engerix B (lot ENG2132A2). The recommended interval between the first and third dose of Engerix B is six months. On 10/9/1998, 22 months after the third dose of Engerix B, the subject was diagnosed with pervasive developmental disorder. The outcome of the event was not reported. The nurse considered the pervasive developmental disorder to not be related to vaccination with Engerix B.

VAERS ID:96630 (history)  Vaccinated:1996-12-09
Age:11.0  Onset:1996-12-10, Days after vaccination: 1
Gender:Female  Submitted:1997-03-24, Days after onset: 104
Location:Foreign  Entered:1997-04-01, Days after submission: 8
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: lead problem;the pt suffers from inc presence of lead in the blood;
Diagnostic Lab Data: all lab work was reported as normal
CDC Split Type: 970004001
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Encephalitis, Nystagmus, Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Ocular motility disorders (narrow)
Write-up: 1 day p/vax pt was hosp w/quadri-paresis & nystagmus;dx of encephalomyelitis was made (the initial dx of GBS was not retained);

VAERS ID:104831 (history)  Vaccinated:1996-12-09
Age:53.0  Onset:1996-12-17, Days after vaccination: 8
Gender:Female  Submitted:1997-11-07, Days after onset: 325
Location:Foreign  Entered:1997-11-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: skin biopsy lichenoid rxn w/epidermic hyperplasia;
CDC Split Type: 970255111
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  SC 
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Lichenoid keratosis, Neoplasm
SMQs:, Tumours of unspecified malignancy (narrow)
Write-up: pt recv vax 9DEC96 & 17DEC96 pt exp lichen planus;local corticotherapy was started but w/no efficacy;skin biopsy was in favor of lichenoid rxn w/epidermic hyperplasia;as lichen planus aggravation kept on occurring by small flare up;

VAERS ID:105667 (history)  Vaccinated:1996-12-09
Age:73.0  Onset:1997-11-18, Days after vaccination: 344
Gender:Female  Submitted:1997-12-09, Days after onset: 21
Location:Foreign  Entered:1997-12-16, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ASA;Cefadroxil;
Current Illness:
Preexisting Conditions: bladder disorder;depression;h/a, hiatal hernia;hip prosthesis placement;HTN;sialadenitis;spondylosis;hip osteoarthritis;
Diagnostic Lab Data: 17NOV97 CXR shadowing;Liver func test nl;Serum electrolytes nl;WBC count nl;serum C-reactive protein 17NOV97 positive;serum rheumatoid factor nl;blood urea test nl;red blood cell count nl;
CDC Split Type: WAES97115129
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.4443371  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bronchiectasis, Cerebrovascular accident, Emphysema, Hypokinesia, Laboratory test abnormal, Lung disorder, Myasthenic syndrome, Pain
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related conditions (narrow), Parkinson-like events (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax 31OCT97 & 14NOV97 C reactive protein was 165, rheumatoid factor was positive, urea & electrolytes, liver function tests & full blood count were all nl & plasma viscosity was 1.99;CXR same day showed shadowing;18NOV97 exp stroke;

VAERS ID:92887 (history)  Vaccinated:1996-12-10
Age:1.5  Onset:1996-12-11, Days after vaccination: 1
Gender:Female  Submitted:1996-12-13, Days after onset: 2
Location:New York  Entered:1996-12-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: persistent lt OM
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4410993IMLA
Administered by: Private     Purchased by: Public
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: pt recv vax in PM 10DEC96-had OM & low T;had simple sz x 1 & T104.4 in ER:

VAERS ID:93143 (history)  Vaccinated:1996-12-10
Age:11.9  Onset:1996-12-11, Days after vaccination: 1
Gender:Male  Submitted:1996-12-13, Days after onset: 2
Location:Michigan  Entered:1996-12-19, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Beconase, Vanceril, Proventil, Claritin, allergy inj
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM139A20IMLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 11x7cm area of induration;cellulitis lt upper arm;pt put on Duricef;

VAERS ID:93241 (history)  Vaccinated:1996-12-10
Age:1.0  Onset:1996-12-10, Days after vaccination: 0
Gender:Male  Submitted:1996-12-11, Days after onset: 1
Location:Arkansas  Entered:1996-12-23, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: AR9688
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4348083IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0891D0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: pt recv vax & was checked by RNP, pt was trembling but no temp; pt was taken home, slept & @ 6pm was taken to ER w/ temp of 105 degrees, temp treated w/ advil; 1am T102 degrees, advil was repeated. MD in ER said rxn was d/t vax

VAERS ID:93242 (history)  Vaccinated:1996-12-10
Age:0.2  Onset:1996-12-10, Days after vaccination: 0
Gender:Male  Submitted:1996-12-13, Days after onset: 3
Location:Missouri  Entered:1996-12-23, Days after submission: 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: allergic to codeine
Diagnostic Lab Data: none
CDC Split Type: MO96071
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4367890 LL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1408B1  
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4358710PO 
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Diarrhoea, Face oedema, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax; frequent d, eyes swollen and puffy; fussiness and T of 104; took acetaminophen and tepid bath; to see MD;

VAERS ID:93247 (history)  Vaccinated:1996-12-10
Age:7.8  Onset:1996-12-13, Days after vaccination: 3
Gender:Female  Submitted:1996-12-14, Days after onset: 1
Location:Ohio  Entered:1996-12-23, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: cefzil
Current Illness: none
Preexisting Conditions: chronic sinusitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4326880IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow)
Write-up: pt mtr reports next day pt congested but normal temp; second day mtr reports fever(99 to 103), sore throat, cough;

VAERS ID:93265 (history)  Vaccinated:1996-12-10
Age:0.2  Onset:1996-12-10, Days after vaccination: 0
Gender:Male  Submitted:1996-12-12, Days after onset: 2
Location:Arizona  Entered:1996-12-24, Days after submission: 12
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4386220 LL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0742B1 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4335130PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: Unconsolable crying, screaming, for four hours - began approx. one hour after shots given

VAERS ID:93275 (history)  Vaccinated:1996-12-10
Age:0.6  Onset:1996-12-10, Days after vaccination: 0
Gender:Female  Submitted:1996-12-16, Days after onset: 6
Location:Indiana  Entered:1996-12-24, Days after submission: 8
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
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4407462 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0749M2PO 
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Temp 103-105 x 4 days

VAERS ID:93514 (history)  Vaccinated:1996-12-10
Age:16.1  Onset:1996-12-18, Days after vaccination: 8
Gender:Male  Submitted:1996-12-29, Days after onset: 11
Location:Pennsylvania  Entered:1997-01-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1216D0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax; had varicella disease w/ hundreds of lesions; started 7 days p/ vax;

VAERS ID:93564 (history)  Vaccinated:1996-12-10
Age:41.2  Onset:1996-12-25, Days after vaccination: 15
Gender:Male  Submitted:1996-12-26, Days after onset: 1
Location:Unknown  Entered:1997-01-06, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1180B1SCLA
Administered by: Other     Purchased by: Unknown
Symptoms: Osteoarthritis, Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Arthritis (narrow)
Write-up: pt exp swelling in all joints, diffuse rash, maculopapular;spoke to child''s pediatrician re: rxn;vax given @ hosp (pvt);

VAERS ID:93570 (history)  Vaccinated:1996-12-10
Age:1.3  Onset:1996-12-18, Days after vaccination: 8
Gender:Female  Submitted:1996-12-18, Days after onset: 0
Location:Unknown  Entered:1997-01-06, Days after submission: 19
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: NA
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0890D SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: fever rxn to 1st MMR symtomatic tx only;

VAERS ID:93617 (history)  Vaccinated:1996-12-10
Age:2.3  Onset:1996-12-10, Days after vaccination: 0
Gender:Female  Submitted:1996-12-13, Days after onset: 3
Location:Tennessee  Entered:1997-01-07, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy to sulfa drugs
Diagnostic Lab Data: NONE
CDC Split Type: TN96107
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0519D2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Infection, Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 10DEC96 inc HR, fever of 102-104, vomiting a lot;no appetite;called MD advised to try tepid bath;@ time of report t102, eyes look weak;been giving chewable APAP;advised to see PCP or clinic acute care;MD felt probably virus;

VAERS ID:93685 (history)  Vaccinated:1996-12-10
Age:0.2  Onset:1996-12-10, Days after vaccination: 0
Gender:Male  Submitted:1996-12-31, Days after onset: 21
Location:North Carolina  Entered:1997-01-13, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: undscended testicles bilat/heart murmur
Diagnostic Lab Data:
CDC Split Type: NC97001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4386220IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2137A21IMRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0747C0PO 
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Crying, Hyperhidrosis, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: pt recv vax 10DEC96 & pt father reported pt exp tremors of arms/legs & sweating alot;denied inc temp;reported high pitch cry x several mins-quietens then begins again;sent to ER-hosp 24hr for observation;

VAERS ID:93766 (history)  Vaccinated:1996-12-10
Age:4.0  Onset:1996-12-11, Days after vaccination: 1
Gender:Female  Submitted:1996-12-12, Days after onset: 1
Location:Arkansas  Entered:1997-01-13, Days after submission: 32
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: AR9689
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES6L711744IMRA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0516D2IMLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0749B3PO 
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 10 1/2 x 13cm edematous, red & warm to touch area rt upper arm noted @ site of DTP inj;mom states pt c/o soreness & pain of rt arm 11DEC96;advised to take child to MD;

VAERS ID:93991 (history)  Vaccinated:1996-12-10
Age:0.5  Onset:1996-12-13, Days after vaccination: 3
Gender:Female  Submitted:1997-01-14, Days after onset: 32
Location:Nevada  Entered:1997-01-22, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EEG-negative;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4348122IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2072A22IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0741D2PO 
Administered by: Private     Purchased by: Public
Symptoms: Convulsion, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: 12OCT96 & 13DEC96 & generalized sz reported by parents;post ictal period;both events reported on 13DEC96;both w/o fever;

VAERS ID:94447 (history)  Vaccinated:1996-12-10
Age:42.2  Onset:1996-12-11, Days after vaccination: 1
Gender:Female  Submitted:1996-12-11, Days after onset: 0
Location:Tennessee  Entered:1997-01-28, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data: Varicella titre drawn x 2-negative ab;
CDC Split Type: TN97001
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1339D1SCLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Dry mouth, Headache, Myalgia, Neck pain, Nuchal rigidity, Somnolence, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: h/a, dry throat, body aches, hot flushed & sore stiff neck, shoulder pain, lethargy;

VAERS ID:94910 (history)  Vaccinated:1996-12-10
Age:11.2  Onset:1996-12-10, Days after vaccination: 0
Gender:Female  Submitted:1996-12-17, Days after onset: 7
Location:Washington  Entered:1997-02-10, Days after submission: 55
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: WA971327
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0359D0 LA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Hypokinesia, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: w/in 1hr of vax pt had fever of 99.2, abd cramping, aching in joints & unable to walk;sx lasted approx 2hr & abated;

VAERS ID:94911 (history)  Vaccinated:1996-12-10
Age:4.8  Onset:1996-12-14, Days after vaccination: 4
Gender:Female  Submitted:1996-12-16, Days after onset: 2
Location:Washington  Entered:1997-02-10, Days after submission: 56
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: not known appeares NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WA971328
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES6H710414 LA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0745F3PO 
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: c/o redness, swelling, itching @ inj site;began approx 4 days p/inj;inc sx 5th & 6th day (itching etc);nurse inspected site 6th day & dec swelling & redness

VAERS ID:95182 (history)  Vaccinated:1996-12-10
Age:18.9  Onset:1996-12-12, Days after vaccination: 2
Gender:Male  Submitted:1997-02-12, Days after onset: 62
Location:West Virginia  Entered:1997-02-19, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin, Zantac
Current Illness: bronchitis
Preexisting Conditions: Cerebral Palsy
Diagnostic Lab Data: NONE
CDC Split Type: WV9715
Vaccination
Manufacturer
Lot
Dose
Route
Site
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES754D PO 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES6F81204 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: c/o local rxn redness, swelling & pain @ lt shoulder where vaccine was given;

VAERS ID:95426 (history)  Vaccinated:1996-12-10
Age:41.1  Onset:1996-12-12, Days after vaccination: 2
Gender:Male  Submitted:1996-12-12, Days after onset: 0
Location:Virginia  Entered:1997-03-04, Days after submission: 82
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hismanal, Zestril
Current Illness: NONE
Preexisting Conditions: PCN
Diagnostic Lab Data:
CDC Split Type: VA96088
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49681361IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4359551IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Oedema peripheral, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: swelling, redness, pain rt arm approx 1" from inj site-first noticed this AM-extends to axilla;pt nl takes Hismanual, Zestril;pt returned to clinic 12DEC96 to report sx & was seeing CNP;

VAERS ID:95450 (history)  Vaccinated:1996-12-10
Age:0.5  Onset:1996-12-11, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Washington  Entered:1997-03-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES6M71210 IM 
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM330PD IM 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES749C PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: fever, vomiting;

VAERS ID:95551 (history)  Vaccinated:1996-12-10
Age:1.3  Onset:1996-12-18, Days after vaccination: 8
Gender:Female  Submitted:1996-12-18, Days after onset: 0
Location:Unknown  Entered:1997-03-10, Days after submission: 82
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406B SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: fever rxn to 1st MMR symptomatic tx only;

VAERS ID:96687 (history)  Vaccinated:1996-12-10
Age:0.2  Onset:1996-12-10, Days after vaccination: 0
Gender:Female  Submitted:1997-03-10, Days after onset: 90
Location:Ohio  Entered:1997-04-03, Days after submission: 24
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: OH97016
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4380870IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1406B1IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0746A0PO 
Administered by: Public     Purchased by: Public
Symptoms: Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: mom states pt had a fever developing in the evening of 103;states pt became listless & stayed that way for 2-3 days;mom states called the MD who decided no further tx was needed''

VAERS ID:97475 (history)  Vaccinated:1996-12-10
Age:1.5  Onset:1996-12-10, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Delaware  Entered:1997-04-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mycostatin
Current Illness: thrush
Preexisting Conditions: defect, ventricular septum, PDA;
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97010415
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER4380643  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0141D0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Injection site hypersensitivity
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 10DEC96 & same day pt exp varicella-like rash on buttocks, inj site, & abd which resoled w/in 24hr;

VAERS ID:97505 (history)  Vaccinated:1996-12-10
Age:  Onset:1997-01-13, Days after vaccination: 34
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:1997-04-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Suprax;Augmentin
Current Illness: infect, ear
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97011046
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 10DEC96 & 13JAN97 pt exp rash on the backs of hands & thighs & a fever 102.6;

VAERS ID:97666 (history)  Vaccinated:1996-12-10
Age:  Onset:1996-12-17, Days after vaccination: 7
Gender:Female  Submitted:0000-00-00
Location:Colorado  Entered:1997-04-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97010070
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Coordination abnormal, Gait disturbance, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: pt recv vax 10DEC96 & 17DEC96 pt exp a fever of 102-103 & clumsiness;pt also noted walk had been affected;

VAERS ID:97789 (history)  Vaccinated:1996-12-10
Age:33.0  Onset:1997-01-01, Days after vaccination: 22
Gender:Female  Submitted:0000-00-00
Location:Florida  Entered:1997-04-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD, depo-provera, rhinocort, zantac, soma, vicodin, Bentyl, Zyrtec
Current Illness:
Preexisting Conditions: allergy to sulfa,cipro, aspirin,morphine,NSAIDS
Diagnostic Lab Data: elisa 10jan97 0.74 var-negative;elisa 21feb97 0.56 var negative; rubella antibody positive;elisa 01nov96 negative to natural varicella
CDC Split Type: WAES97022188
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2118A20  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1103D SC 
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Infection, Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: pt recv vax 10dec96;concomitant vax included hep B vax, recombinant; concomitant therapy included meds; pt was recv the PPD skin test 13dec96 & 30dec96; 01jan97 the pt devel shingles on the left interior buttocks; looked like small papules

VAERS ID:102030 (history)  Vaccinated:1996-12-10
Age:42.0  Onset:1996-12-10, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Colorado  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: diabetes
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96121145
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0221D IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 10DEC96 & 10DEC96 pt exp swelling & redness in the area of the deltoid muscle @ inj site;

VAERS ID:103461 (history)  Vaccinated:1996-12-10
Age:7.0  Onset:1997-06-13, Days after vaccination: 185
Gender:Male  Submitted:0000-00-00
Location:New York  Entered:1997-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling devel varicella w/varivax dose 1;
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97061814
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1107D0SC 
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 10DEC96 & 13JUN97 pt devel a mild case of chickenpox;

VAERS ID:103513 (history)  Vaccinated:1996-12-10
Age:4.0  Onset:1997-06-23, Days after vaccination: 195
Gender:Female  Submitted:0000-00-00
Location:New Hampshire  Entered:1997-10-20
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: NO relevant data;
CDC Split Type: WAES97062356
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1662B0SCRA
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous, Herpes zoster, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 10DEC96 & 23JUN97 pt exp a red, blister-like, fluid-filled area on rt thigh which hurt;presented to MD who was dx w/shingles on rt upper thigh on 25JUN97;pt recovered;

VAERS ID:103709 (history)  Vaccinated:1996-12-10
Age:2.6  Onset:1997-06-27, Days after vaccination: 199
Gender:Male  Submitted:0000-00-00
Location:New York  Entered:1997-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling devel chickenpox w/varivax;
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97080621
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax 10DEC96 & 27JUN97 pt devel chickenpox 2wk p/sibling devel chickenpox (WAES 97061814);it was noted that both children were vaccinated @ the same time;

VAERS ID:104231 (history)  Vaccinated:1996-12-10
Age:17.0  Onset:1996-12-11, Days after vaccination: 1
Gender:Female  Submitted:1997-01-10, Days after onset: 30
Location:Massachusetts  Entered:1997-10-30, Days after submission: 293
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: NKDA
Diagnostic Lab Data:
CDC Split Type: 960167071
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2118A20IMLA
Administered by: Private     Purchased by: Other
Symptoms: Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: pt recv vax 10DEC96 & 11DEC96 pt woke up exp a steady pinch & tingling on pinky & ring finger on lt hadn & numbness;sx started in the wrist;when the wrist was pressed pt exp a lot of pain;pt had full use of hand & arm & total function;

VAERS ID:104906 (history)  Vaccinated:1996-12-10
Age:0.2  Onset:1996-12-10, Days after vaccination: 0
Gender:Male  Submitted:1997-06-03, Days after onset: 174
Location:Wisconsin  Entered:1997-11-19, Days after submission: 169
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: WI97032
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4386220 LL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0279D1 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0754C0PO 
Administered by: Public     Purchased by: Public
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: 6hr inconsolable crying;tx APAP & Ibuprofen;

VAERS ID:108333 (history)  Vaccinated:1996-12-10
Age:43.7  Onset:1996-12-10, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NO Relevant data;
Other Medications: NONE
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES97040836
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0650D1  
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site pain, Myalgia, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax 10DEC96 & same day pt exp pain inj site, a cold sensation & numbness in rt middle finger, rt lateral epicondylitis & muscle ache in the deltoid;

VAERS ID:108379 (history)  Vaccinated:1996-12-10
Age:51.0  Onset:1996-12-10, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp malaise, arthralgia, h/a, somnolence @ 50yr old w/Engerix-b dose 1;
Other Medications: engerix-b;
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES97051956
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0338B1IM 
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Headache, Malaise, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: pt recv vax 10DEC96 & beginning 10DEC96 pt slept for 2 days & exp a h/a, gen malaise & aching in joints;

VAERS ID:110171 (history)  Vaccinated:1996-12-10
Age:7.5  Onset:1998-01-21, Days after vaccination: 407
Gender:Female  Submitted:1998-04-15, Days after onset: 83
Location:Pennsylvania  Entered:1998-04-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES98020629
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Pruritus, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 10Dec96 pt recv 1 dose vax. 21Jan98 pt exp lesions on thorax,back & abdomen. Pruritus & low grade fever. Seen by MD 30Jan98 & pt had numerous healed & crusted lesions. Another pt reported w/similar exp WAES98020563

VAERS ID:118652 (history)  Vaccinated:1996-12-10
Age:22.4  Onset:1997-02-28, Days after vaccination: 80
Gender:Male  Submitted:1999-02-03, Days after onset: 705
Location:Michigan  Entered:1999-02-09, Days after submission: 6
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 19Aug97 kidney bx-FSGS nephrotic synd
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0557D2  
Administered by: Other     Purchased by: Other
Symptoms: Adverse drug reaction, Albuminuria, Glomerulonephritis, Nephrotic syndrome, Oedema, Similar reaction on previous exposure to drug
SMQs:, Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad)
Write-up: severe edema-nephrotic synd-lasted 2 months;dx FSGS form of glomerulonephritis;had 2 more episodes of nephrotic synd MAR98 & AUG98;controlled w/meds;Annual follow-up received on 9/29/00 states that the pt still is losing 2 grams of protein through kidneys per day. Will likely need dialysis or kidney transplant in future.

VAERS ID:119499 (history)  Vaccinated:1996-12-10
Age:62.9  Onset:0000-00-00
Gender:Male  Submitted:1998-10-29
Location:Indiana  Entered:1999-02-26, Days after submission: 120
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: glucotrol, neurontin
Current Illness: Back & leg pain
Preexisting Conditions: diabetes mellitus, sciatica
Diagnostic Lab Data: Pt saw neurologist, dx=immune mediated multifocal motor neuropathy w/ conductive blockage
CDC Split Type: 7485
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES6F71246 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Myasthenic syndrome, Neuropathy
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad)
Write-up: Pt recv vax on 12/10/96; on 10/29/98 pt exp post vax neuropathy-polyperipheral type w/ multi-limp weakness; f/u info reports pt exp first sx 10/29/96

VAERS ID:122771 (history)  Vaccinated:1996-12-10
Age:1.0  Onset:0000-00-00
Gender:Female  Submitted:1999-05-14
Location:Illinois  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98031911
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1339D0SC 
Administered by: Private     Purchased by: Private
Symptoms: Infection
SMQs:
Write-up: pt recv vax 12/10/96 & pt exp chickenpox;

VAERS ID:123136 (history)  Vaccinated:1996-12-10
Age:3.4  Onset:0000-00-00
Gender:Female  Submitted:1999-05-14
Location:Ohio  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness: cough; rhinorrhea
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: WAES98051196
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0568D0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Cough, Dermatitis bullous, Pain, Pharyngitis, Rash, Rhinitis
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow)
Write-up: it was rpt pt recv 1st dose of varivax & subsequently pt presented w/``approx 60 lesions'''' rpt noted rash atypical to varicella. painful, not pruritic, MD rpt cough, congestion & runny nose w/o fever. subsequently devel rash.

VAERS ID:157451 (history)  Vaccinated:1996-12-10
Age:3.0  Onset:1999-03-22, Days after vaccination: 832
Gender:Male  Submitted:2000-05-16, Days after onset: 420
Location:Pennsylvania  Entered:2000-07-19, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99080802
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Private     Purchased by: Private
Symptoms: Ear pain, Infection
SMQs:
Write-up: Subsequent to receiving one dose of varicella virus vaccine live the pt experienced an earache for 3 days and mild symptoms for 8 days. A physician reported that the mild symptoms were a mild breakthrough case of chickenpox.

VAERS ID:220089 (history)  Vaccinated:1996-12-10
Age:1.0  Onset:2004-05-02, Days after vaccination: 2700
Gender:Female  Submitted:2004-05-04, Days after onset: 2
Location:Virginia  Entered:2004-05-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Started Cefzil PO same date 12/10/96
Current Illness: Right Otitis Media
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0734D0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1105D0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Rash, Rash papular
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash x 2 days (48 hours) around 100 small papular, vesicles, come crusting.

VAERS ID:237953 (history)  Vaccinated:1996-12-10
Age:1.0  Onset:2004-05-07, Days after vaccination: 2705
Gender:Male  Submitted:2005-05-16, Days after onset: 374
Location:Massachusetts  Entered:2005-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0405USA00608
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0769D   
Administered by: Other     Purchased by: Other
Symptoms: Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning an 8 year old male on 12/10/96 was vaccinated with a dose of varicella virus vaccine live (lot # 617313/0769D). The RN reported that on 5/7/04, the patient developed a chicken pox rash of abut 40 lesions mostly on his torso. No other symptoms were noted. Unspecified medical attention was sought, but treatment was not required. At the time of this report, the outcome was unknown. No further information is available.

VAERS ID:256198 (history)  Vaccinated:1996-12-10
Age:1.3  Onset:2005-04-19, Days after vaccination: 3052
Gender:Male  Submitted:2006-05-12, Days after onset: 388
Location:Virginia  Entered:2006-05-17, 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: Sinusitis
Diagnostic Lab Data: Body temp 4/19/05-100.2
CDC Split Type: WAES0506USA01927
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1107D0  
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection, Infection transmission via personal contact, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Info has been received from a health professional concerning a 9 year old white male, with pre-existing sinusitis, who on 12/10/96 was vaccinated with a 1st dose of varicella virus vaccine live. There was no illness at the time of vaccination and no adverse events following prior vaccination. It was reported that on 4/19/05, the pt experienced chickenpox breakthrough, during a middle school outbreak, described as a generalized rash with moderate to severe lesions and fever of 100.2 for 2 days. There were no complications. It was reported that the pt recovered without hospitalization. Unspecified medical attention was sought. No product quality complaint was involved. No other info was provided. Additional info is not expected.

VAERS ID:162559 (history)  Vaccinated:1996-12-10
Age:40.0  Onset:1996-12-30, Days after vaccination: 20
Gender:Female  Submitted:2002-05-31, Days after onset: 1977
Location:Foreign  Entered:2000-11-24, Days after submission: 552
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: thyroxine sodium
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: C-reactive protein, serum-<5; c-reactive phosphokinase, serum-normal; erythrocyte sedimentation rate 2mm; follicle stimulating hormone 32.5U/l; follicle stimulating hormone 61mUI/ml; haemotocrit 37%; haemoglobin 12g/100ml; hepatitis b surfa
CDC Split Type: 20000332411
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS1925060IM 
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea, Fasciitis, Fatigue, Headache, Injection site inflammation, Injection site reaction, Laboratory test abnormal, Memory impairment, Musculoskeletal stiffness, Myalgia, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: On 12/10/96, the pt received her 1st Engerix-B injection and (at a time as yet unknown), developed an injection site inflammation (injection site reaction). On 12/30/96, the pt experienced myalgia and severe fatigue. On 1/16/97 and 7/10/97, the pt was again vaccinated with Engerix-B. A dx of disabling macrophages myofasciitis was made on 4/8/99. The most recent information received on 11/13/00, reports the outcome of the pt as not yet recovered. Causality assessment was not specified. The follow-up report received on 04/19/02 indicates that on 12/30/1996, the pt experienced muscular fatigue, and asthenia. Thyroid dose was increased from 75mcg/day to 100mcg/day without asthenia improvement. From January 1997, the pt reported tingling, stiffness, memory deficit, headache, breathing difficulty, elocution troubles, gynecological disorders and decreased auditive and visual acuity. In April 1998, hepatic check-up showed abnormal transaminases, normal abdominal echography. In doubt, the pt was appendectomised (non event) and hepatic enzymes normalized A digestive endoscopy showed hiatal hernia and peptic cosophagitis (non events) (stade I). In May 1998, hormonal dosage revealed perimenopause oyarian insufficiency (non event), osteodensimetry showed osteoporosis (non event) for which a treatment with Duphaston was started from September 1998. In January - February 1999, capillaroscopy for extremity cooling revealed aspecific microangiopathy probably secondary to neuro-hormono-thyroid dysfunction, x-ray shoulders and salivary gland biopsy were normal. On 03/30/99, inflammatory syndrome, CPK and LDH were normal, hepatitis b,c, HIV serologies were negative. Thorax x-ray, bone scintigraphy, pelvis echography were normal. On 04/08/99, the diagnosis of macrophagic myofascitis was made. Biological exam confirmed an early menopause. On 10/10/00, myalgia became more and more disabling leading to a morphine treatment (Skenan). The most recent info received on 04/09/02 reports the outcome of the pt as not yet recovered. Causality a

VAERS ID:93250 (history)  Vaccinated:1996-12-11
Age:1.5  Onset:1996-12-11, Days after vaccination: 0
Gender:Female  Submitted:1996-12-12, Days after onset: 1
Location:Wisconsin  Entered:1996-12-23, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cefaclor, Premarin;
Current Illness: Otitis media;
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4407463IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4372423PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Agitation, Anorexia, Coordination abnormal, Dizziness
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Vestibular disorders (broad)
Write-up: pt recv vax; fussiness, dec oral intake and apparent dizziness or incoordination starting 4-5 hr p/ vax; better 24 hr later;

VAERS ID:93227 (history)  Vaccinated:1996-12-11
Age:0.3  Onset:1996-12-11, Days after vaccination: 0
Gender:Male  Submitted:1996-12-16, Days after onset: 5
Location:Florida  Entered:1996-12-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (TRI-IMMUNOL)LEDERLE LABORATORIES4388250 LL
Administered by: Private     Purchased by: Private
Symptoms: Anorexia, Dysphagia, Hypotonia, Pallor, Pyrexia, 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: approx 2.5 hr post vax pt refused feeding, became limp & pale & hyporesponsive.Had some difficulty swallowing; was responsive to stimulation. Had temp of 100.8 degrees F (rectally) and then over 102 degrees. sx subsided approx 6 hr

VAERS ID:93263 (history)  Vaccinated:1996-12-11
Age:0.2  Onset:1996-12-11, Days after vaccination: 0
Gender:Male  Submitted:1996-12-11, Days after onset: 0
Location:West Virginia  Entered:1996-12-24, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WV9629
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES6H710410IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES5B711250IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0746K0PO 
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Hyperhidrosis, Stupor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: perfuse sweating, shaking of upper extremities, non-focusing eyes, crying

VAERS ID:93272 (history)  Vaccinated:1996-12-11
Age:0.3  Onset:1996-12-11, Days after vaccination: 0
Gender:Male  Submitted:1996-12-16, Days after onset: 5
Location:Ohio  Entered:1996-12-24, 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: grans 47%, lympho 53%, pletelet 260, Hyp 10.9, Hct 34.9, CBC, WBC 6.8
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4367911IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES743C41PO 
Administered by: Private     Purchased by: Private
Symptoms: Anorexia, Hypochromic anaemia, Pyrexia, Screaming, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad)
Write-up: High pitched screaming x 48 hr post immunization. Wakes with tremor. Temp 102. Appetite down.

VAERS ID:93298 (history)  Vaccinated:1996-12-11
Age:0.4  Onset:1996-12-11, Days after vaccination: 0
Gender:Male  Submitted:1996-12-21, Days after onset: 10
Location:Pennsylvania  Entered:1996-12-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv inj of PPT(tryndin);lot 6m71184 on 12/06/1996
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBPV: HIB POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER6E711131IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: local dermatitis right upper leg

VAERS ID:93574 (history)  Vaccinated:1996-12-11
Age:5.0  Onset:1996-12-12, Days after vaccination: 1
Gender:Male  Submitted:1996-12-13, Days after onset: 1
Location:Georgia  Entered:1997-01-06, Days after submission: 24
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: GA96174
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES5B711721IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1167B1SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0740A3PO 
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & exp swollen bigger than fifty cents peice & warm to touch;no reddness noted;

VAERS ID:93755 (history)  Vaccinated:1996-12-11
Age:0.5  Onset:1996-12-11, Days after vaccination: 0
Gender:Male  Submitted:1996-12-18, Days after onset: 7
Location:Nebraska  Entered:1997-01-13, 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: teething
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: NE971
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES08042502 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0747K2PO 
Administered by: Public     Purchased by: Private
Symptoms: Agitation, Diarrhoea, Injection site oedema, Pyrexia, Screaming, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)
Write-up: pt recv vax 10AM & was fine up til 4AM started cranky w/low fever (99-100) crying constantly from 7AM-12PM all day & applied cool wash cloth to leg;diarrhea & vomiting throughout day;

VAERS ID:93880 (history)  Vaccinated:1996-12-11
Age:0.2  Onset:1996-12-12, Days after vaccination: 1
Gender:Male  Submitted:1997-01-10, Days after onset: 29
Location:Indiana  Entered:1997-01-17, 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: NONE
CDC Split Type: IN97001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4348130 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4373620PO 
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Anorexia, Insomnia, Muscle twitching
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: 12DEC pt fussy & afeb;did not sleep well & would wake up p/body jerked;pt had jerky motion;pt did not eat well;did not sleep well;seen by MD;

VAERS ID:93926 (history)  Vaccinated:1996-12-11
Age:0.2  Onset:1996-12-11, Days after vaccination: 0
Gender:Female  Submitted:1996-12-18, Days after onset: 7
Location:Nebraska  Entered:1997-01-21, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: NE972
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES08042500 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0747K0PO 
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Anorexia, Crying, Rash maculo-papular, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 11DEC96 & was given APAP again 9PM;10-1030PM pt started crying;pt shrieking in pain;refused to nurse (didn''t eat from 530PM to 3AM) & was inconsolable;t97.8;slept almost constantly;not as alert, groggy;puffy bumps, rash;

VAERS ID:93932 (history)  Vaccinated:1996-12-11
Age:1.0  Onset:1996-12-31, Days after vaccination: 20
Gender:Female  Submitted:1997-01-13, Days after onset: 13
Location:Michigan  Entered:1997-01-21, 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: Amoxicillin
Current Illness: OM
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.0476D0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0176D0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Herpes zoster
SMQs:
Write-up: zoster like rash 2wk following vax administration;

VAERS ID:94036 (history)  Vaccinated:1996-12-11
Age:65.2  Onset:1996-12-11, Days after vaccination: 0
Gender:Female  Submitted:1996-12-12, Days after onset: 1
Location:Oklahoma  Entered:1997-01-24, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Premarin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OK973
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1626B0IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt rt arm is red & swollen from above elbow to deltoid region;clinic made arrangements for pt to see pvt MD;

VAERS ID:94413 (history)  Vaccinated:1996-12-11
Age:4.8  Onset:1996-12-14, Days after vaccination: 3
Gender:Female  Submitted:1997-01-17, Days after onset: 34
Location:Illinois  Entered:1997-01-27, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Amoxicillin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: IL97055
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (TRI-IMMUNOL)LEDERLE LABORATORIES4386034IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0279D0IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0754M3PO 
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash maculo-papular, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 2 1/2 days p/vax, neck turned bright red, blotches on arms & back;did not see MD;c/o itching;

VAERS ID:94536 (history)  Vaccinated:1996-12-11
Age:38.0  Onset:1996-12-11, Days after vaccination: 0
Gender:Female  Submitted:1996-12-11, Days after onset: 0
Location:Maryland  Entered:1997-01-29, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: spiralactinate
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MD96051
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E3106GB0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Back pain, Cough, Nausea, Pharyngitis, Respiratory disorder, Rhinitis, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad)
Write-up: pt began exp shaky feeling, nausea, abd pain, lower back pain;pt seen by MD the next day & had upper resp sx: e.g. runny nose, sneezing, cough, congestion;back pain dx as pulled muscle;17DEC96 pt has lingering cold sx;

VAERS ID:97570 (history)  Vaccinated:1996-12-11
Age:24.3  Onset:1996-12-11, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:1997-04-18
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: allergy, ASA;Von Willebrand''s disease
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97012310
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1105D0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: pt recv vax 11DEC96 & later on the same day pt exp a low grade fever, fatigue/lack of energy, gen achiness & malaise;

VAERS ID:98869 (history)  Vaccinated:1996-12-11
Age:19.0  Onset:1996-12-28, Days after vaccination: 17
Gender:Male  Submitted:0000-00-00
Location:Florida  Entered:1997-05-13
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:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96121967
Vaccination
Manufacturer
Lot
Dose
Route
Site
MER: MEASLES + RUBELLA (MR-VAX II)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 11DEC96 & 28DEC96 devel an red rash on trunk, face & neck;

VAERS ID:100710 (history)  Vaccinated:1996-12-11
Age:2.9  Onset:1997-04-14, Days after vaccination: 124
Gender:Unknown  Submitted:0000-00-00
Location:Georgia  Entered:1997-07-23
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: No relevant data;
CDC Split Type: WAES97041718
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1107D0  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax 11DEC96 & 14APR97 pt devel a mild case of chickenpox;dx of varicella was made on 15APR97;

VAERS ID:108251 (history)  Vaccinated:1996-12-11
Age:17.4  Onset:1996-12-12, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: NONE
Current Illness:
Preexisting Conditions: varicella;
Diagnostic Lab Data:
CDC Split Type: WAES97010645
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0516D0IM 
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 11DEC96 & next morning pt woke up w/red bumps all over body that itched;sx persisted for approx 5 days;pt recovered from sx;

VAERS ID:184318 (history)  Vaccinated:1996-12-11
Age:1.6  Onset:2002-04-20, Days after vaccination: 1956
Gender:Female  Submitted:2002-04-29, Days after onset: 9
Location:California  Entered:2002-05-08, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Public
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Pt received varicella injection on 12/11/1996. Pt seen on 04/20/2002 at a urgent care and diagnosed with chickenpox. Treated with Acyclovir and Benadryl. Called family on 04/29/2002 and was informed that the child will be returning to school the next day.

VAERS ID:202432 (history)  Vaccinated:1996-12-11
Age:1.1  Onset:2003-04-24, Days after vaccination: 2325
Gender:Male  Submitted:2003-04-25, Days after onset: 1
Location:Texas  Entered:2003-05-01, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: No
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster, Infection
SMQs:
Write-up: Zoster outbreak right C4-C5 dermatome. Clinical diagnosis 4/24/03.

VAERS ID:240761 (history)  Vaccinated:1996-12-11
Age:1.0  Onset:2005-06-21, Days after vaccination: 3114
Gender:Female  Submitted:2005-06-22, Days after onset: 1
Location:Pennsylvania  Entered:2005-06-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: GERD, Esophagitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0567O SCLA
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Onset of red bumps that evolved into vesicles 06/21/05. Fever. Vesicles itchy.

VAERS ID:97356 (history)  Vaccinated:1996-12-11
Age:12.9  Onset:1997-02-04, Days after vaccination: 55
Gender:Female  Submitted:1997-04-30, Days after onset: 84
Location:Foreign  Entered:1997-05-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 970097401
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM513A2A IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Encephalitis, Neuropathy
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow)
Write-up: 11DEC96 pt recv vax & pt was hosp w/dx of meningoencephalitis & suspected demyelinisation;24FEB97 pt was transferred to a neuro clinic;

VAERS ID:105535 (history)  Vaccinated:1996-12-11
Age:54.9  Onset:1997-01-01, Days after vaccination: 21
Gender:Male  Submitted:1997-12-03, Days after onset: 336
Location:Foreign  Entered:1997-12-09, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: 1997 anti HBS antibodies negative;Toxoplasmosis serology toxoplasmosis seroconversion;
CDC Split Type: 970278651
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Aspartate aminotransferase increased, Condition aggravated, Deafness, Immune system disorder, Infection
SMQs:, Liver related investigations, signs and symptoms (narrow), Hearing impairment (narrow)
Write-up: pt recv vax 11DEC96 & 1mo later JAN97 pt devel bilat deafness;lab eval result include toxoplasmosis seroconversion & negative anti-HBs antibodies;pt was not hosp;

VAERS ID:105538 (history)  Vaccinated:1996-12-11
Age:40.0  Onset:1997-02-01, Days after vaccination: 52
Gender:Female  Submitted:1997-12-05, Days after onset: 307
Location:Foreign  Entered:1997-12-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: herpes zoster
Diagnostic Lab Data: unk
CDC Split Type: WAES97080346
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Back pain, Headache, Infection, Influenza, Meningitis, Nausea, Nuchal rigidity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: pt recv vax 11DEC96 & FEB97 pt c/o influenza-like infect;pt was hosp in MAR & JUN97 d/t a viral meningitis;15APR97 pt exp meningitis, h/a, back pain, neck stiffness & nausea;pt recovered;

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