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Case Details (Sorted by Vaccination Date)

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VAERS ID: 76357 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Michigan  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-01
   Days after onset:1
Entered: 1995-08-02
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 3hr p/vax pt devel fever of 103, med w/APAP; MD prescribed Advil liquid gave bath, temp dec to 101.9; temp inc 103.6 to ER; OK 24 hr later;


VAERS ID: 76414 (history)  
Form: Version 1.0  
Age: 53.0  
Gender: Female  
Location: California  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-02
   Days after onset:2
Entered: 1995-08-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Oedema peripheral, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: prozac, "grizantin", precardia
Current Illness: splinter in finger
Preexisting Conditions: allergy to grass & sulfer
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recv vax; 31jul started itching, swelling,blotchy rashes that spread up to legs, to the arms,neck & shoulders;1aug spread from neck to face;


VAERS ID: 76436 (history)  
Form: Version 1.0  
Age: 61.0  
Gender: Female  
Location: North Carolina  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1995-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 390934 / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: local rxn


VAERS ID: 76438 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: Virginia  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-01
   Days after onset:1
Entered: 1995-08-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386989 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0364A / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 394927 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Crying
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: persistent screaming episode


VAERS ID: 76439 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: New York  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-01
   Days after onset:1
Entered: 1995-08-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426150 / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Crying
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9PM 31JUL95 states pt had a high pitched cry for 1 1/2 hr; has no fever stopped crying ate & is sleeping now;


VAERS ID: 76493 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-02
   Days after onset:2
Entered: 1995-08-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378909 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Hypokinesia, Oedema, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: na~ ()~~~In patient
Other Medications:
Current Illness: na
Preexisting Conditions: na
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; swelling, warmth, tenderness; tx w/ periactin, warm compresses; now resolved;


VAERS ID: 76522 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Female  
Location: Texas  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 1995-08-02
   Days after onset:1
Entered: 1995-08-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958003 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Chills, Hypertonia, Injection site hypersensitivity, Injection site mass, Nausea, Neck pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: tb test by lederle
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt recv vax; approx 24 hr later, feeling of "chills" & n for few hr then pain in neck w/ mild spasms, gone next day 24-48 hr p/ shot; 1 1/2" induration/redness at site;


VAERS ID: 76542 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Male  
Location: West Virginia  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 1995-08-04
   Days after onset:3
Entered: 1995-08-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426117 / UNK RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Hypotonia, Pyrexia, Somnolence
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: vomited noc before "teething";
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WN9512

Write-up: pt recv vax; exp T 104; apap & tepid bath given;v x 1;low grade fever & dec appetite;


VAERS ID: 76716 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 1995-08-14
   Days after onset:13
Entered: 1995-08-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1816A2 / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema multiforme, Rash, Urticaria
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: nl 14.4/40.9/10.8; PMN 68; lymphs 30; EOS 2; ESR 5;
CDC Split Type:

Write-up: started w/hives in elbow 1AUG95 about 9PM; mom gave DPH & Calamine 2AUG95 hives worsened-still having DPH & calamine;went to lake w/family 5AUG worsened again; seen in ER 8AUG95-rash had worsened; erythema multiforme;


VAERS ID: 76864 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Illinois  
Vaccinated:1995-07-31
Onset:1995-08-18
   Days after vaccination:18
Submitted: 1995-08-23
   Days after onset:5
Entered: 1995-08-25
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Public
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: IL950098

Write-up: itching, broken out in little bumps all over;


VAERS ID: 77189 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: South Carolina  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-07
   Days after onset:7
Entered: 1995-09-05
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427839 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 396923 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: SC95067

Write-up: fever of 104 began 1 1/2hrs p/vax fever lasted x2 days; pt was taken to ER tx w/APAP & children''s motrin


VAERS ID: 77292 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: North Carolina  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-21
   Days after onset:21
Entered: 1995-09-11
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Gingivitis, Headache, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal infections (narrow), Gingival disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 31JUL95 45mins p/vax devel urticaria on both wrists, inner aspect of lt breast, both temples & back of neck, c/o itching in all these areas & palms of hands; 2AUG95 c/o h/a & swollen gums; Seldane given on 31JUL95 w/prescription x 3 days;


VAERS ID: 77364 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Texas  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 1995-08-02
   Days after onset:1
Entered: 1995-09-13
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5E61004 / 3 LA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5E61004 / 3 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1375A / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Rash maculo-papular, Rhinitis
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX95150

Write-up: red blotchy rash on lower extremities back & buttocks, runny nose, afeb


VAERS ID: 77372 (history)  
Form: Version 1.0  
Age: 66.0  
Gender: Female  
Location: Texas  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-09
   Days after onset:9
Entered: 1995-09-13
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4948026 / 1 RA / SC

Administered by: Private       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NA
Current Illness: stepped on mesquite thorn
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: TX95158

Write-up: c/o firm, red, swollen site rt deltoid; soreness


VAERS ID: 77374 (history)  
Form: Version 1.0  
Age: 48.0  
Gender: Male  
Location: Texas  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 1995-08-02
   Days after onset:1
Entered: 1995-09-13
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61119 / 2 RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Headache, Injection site hypersensitivity, Injection site oedema, Malaise, Pain, Pyrexia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX95160

Write-up: t102.4, bones aching, et h/a, malaise, 2AUG95 cont w/temp, h/a malaise has taken APAP & ASA w/no relief; rt arm w/swelling warmth et erythema 3AUG95;


VAERS ID: 77525 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Tennessee  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 1995-08-02
   Days after onset:1
Entered: 1995-09-19
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0212B / UNK RA / -
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5C71114 / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Hypertonia, Hypokinesia, Hypotonia, Injection site hypersensitivity, Injection site oedema, Migraine, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN95085

Write-up: awakened 1AUG95 w/"real bad migraine on leg & side of head", says lt side of body numb, arm, hand numb to fingers, drags foot, limps & c/o muscle spasms;denies hx hi BP; inj site red, swollen (size of quarter) urged see MD immed


VAERS ID: 77547 (history)  
Form: Version 1.0  
Age: 56.0  
Gender: Female  
Location: Oregon  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 1995-08-01
   Days after onset:0
Entered: 1995-09-20
   Days after submission:50
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1593A4 / 2 RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Chest pain, Influenza, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 31JUL95 & AM 1AUG95 pt awoke w/flu-like sx; chest pain; gen body aches; dry heaving; drank only sips of h20 until noon; @ noon ate toast/tea slept all day; by 1600 1AUG feel a little better; went to ER; took antihistamine


VAERS ID: 77809 (history)  
Form: Version 1.0  
Age: 36.0  
Gender: Female  
Location: Utah  
Vaccinated:1995-07-31
Onset:1995-08-01
   Days after vaccination:1
Submitted: 1995-08-03
   Days after onset:2
Entered: 1995-09-29
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1377A / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Dyspepsia, Headache, Injection site hypersensitivity, Injection site oedema, Myalgia, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: UT951817

Write-up: pt reports rash redness, swelling @ site beginning the evening of the inj; next day had h/a, upset stomach, sore muscles & joints, fever; called clinic 3 days p/inj stating all these side effects are quite severe; pt told to contact MD;


VAERS ID: 77846 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Maryland  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-09-25
   Days after onset:56
Entered: 1995-10-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4A61078 / 2 - / IM L
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1722A2 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4A61078 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 384948 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MD95036

Write-up: 6hrs p/vax pt temp went to 103+ came down w/APAP but then would go back;


VAERS ID: 78275 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Female  
Location: Kansas  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-02
   Days after onset:2
Entered: 1995-10-23
   Days after submission:82
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 386987 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 1 RL / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: KS95036

Write-up: pt rt thigh devel raised area approx 10mmx 10mm; area was below inj site;area around welt warm & red;pt kept in clinic for 20mins for observation;grandma encouraged to give DPH


VAERS ID: 78673 (history)  
Form: Version 1.0  
Age: 0.8  
Gender: Female  
Location: Colorado  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-08-07
   Days after onset:7
Entered: 1995-11-06
   Days after submission:91
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426117 / 3 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0723D / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Diarrhoea, Pyrexia
SMQs:, 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), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CO95050

Write-up: 5-6hrs p/vax pt ran temp of 102.6 w/APAP;fussy but no other sxs;devel diarrhea 1 wk p/shot;had diarrhea stools;tolerating fluids well;afeb;referred to PMD for further f/u


VAERS ID: 83402 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Delaware  
Vaccinated:1995-07-31
Onset:1995-07-31
   Days after vaccination:0
Submitted: 1995-09-29
   Days after onset:60
Entered: 1996-03-04
   Days after submission:157
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 394935 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis, Hypokinesia, Injection site mass, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tavist, Vancenase
Current Illness: unk
Preexisting Conditions: pt has hx of recurrent sinopulmonary infect-OM
Allergies:
Diagnostic Lab Data: All cultures negative (blood, urine)
CDC Split Type: 895355018L

Write-up: pt recv vax & 5hrs later devel a fever 104-105 & an inj site rxn,characterized by local induration & an inability to bear weight on lt thigh;tx IV ATB for suspected cellulitis;addtl info recv 13FEB96 resulted in reclass rpt as serious


VAERS ID: 85203 (history)  
Form: Version 1.0  
Age: 30.0  
Gender: Female  
Location: Unknown  
Vaccinated:1995-07-31
Onset:1995-08-02
   Days after vaccination:2
Submitted: 1996-01-16
   Days after onset:167
Entered: 1996-03-25
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Photophobia
SMQs:, Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 960004341

Write-up: pt recv vax;48 hrs later,exp photophobia&aching joints;sx lasted approx 1 wk;


VAERS ID: 86775 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Florida  
Vaccinated:1995-07-31
Onset:1995-08-10
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1996-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Chills, Myalgia, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES95080902

Write-up: pt recv vax 31JUL95 & 10AUG95 pt devel a rash, fever to 101 & mild chills, moderate to severe myalgias, & arthralgias, especially in both hands & neck/back;fever resolved p/2 days & the arthralgias lasted up to 2wk;


VAERS ID: 89463 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: North Carolina  
Vaccinated:1995-07-31
Onset:1995-08-02
   Days after vaccination:2
Submitted: 1996-06-20
   Days after onset:323
Entered: 1996-08-23
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1293A / 2 RA / -
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61118 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Lymphadenopathy, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6050

Write-up: swollen lt ax lymph node the size of egg;feeling tired & has some nausea;


VAERS ID: 91052 (history)  
Form: Version 1.0  
Age: 23.0  
Gender: Female  
Location: New York  
Vaccinated:1995-07-31
Onset:1995-08-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1996-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0387B / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Drug ineffective, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96082236

Write-up: pt recv 2nd dose of vax 31JUL95 & 4AUG95 pt devel a fever of 102 & diarrhea;By 6AUG95 pt recovered;lab eval revealed that pt failed to seroconvert;


VAERS ID: 97522 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Female  
Location: New York  
Vaccinated:1995-07-31
Onset:1996-07-30
   Days after vaccination:365
Submitted: 0000-00-00
Entered: 1997-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 608589 / 2 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: varicella antibody-value .02, negative
CDC Split Type: WAES97011307

Write-up: pt recv vax on 31may95 & 31jul95; lab evaluation revealed the pt had failed to seroconvert;


VAERS ID: 97530 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-07-31
Onset:1997-01-16
   Days after vaccination:535
Submitted: 0000-00-00
Entered: 1997-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0426B / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97011591

Write-up: pt recv vax 31JUL95 & 16JAN97 pt devel full-blown chickenpox consisting of many more than 50; at least 1000 lesions;it was reported that the pt was on no other med & is otherwise healthy;


VAERS ID: 101023 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Florida  
Vaccinated:1995-07-31
Onset:1997-05-11
   Days after vaccination:650
Submitted: 0000-00-00
Entered: 1997-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97052612

Write-up: pt recv vax 31JUL95 & 11MAY97 pt exp chicken pox w/50 to 60 lesions;


VAERS ID: 101075 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: New York  
Vaccinated:1995-07-31
Onset:1997-06-04
   Days after vaccination:674
Submitted: 0000-00-00
Entered: 1997-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0426B / 1 - / -

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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allergy, septra
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97060547

Write-up: pt recv vax 31JUL95 & on 4JUN97 pt exp a full-blown rash all over w/well over 200 lesions;


VAERS ID: 103583 (history)  
Form: Version 1.0  
Age: 1.9  
Gender: Male  
Location: New York  
Vaccinated:1995-07-31
Onset:1997-07-14
   Days after vaccination:714
Submitted: 0000-00-00
Entered: 1997-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0419B / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Herpes zoster, Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: bladder reflux;suurgery;allergy, bactirm;reactive airway disease;
Allergies:
Diagnostic Lab Data: JUL97 PCR vaccine strain VZV;IgG normal;IgM nl;
CDC Split Type: WAES97070924

Write-up: pt recv vax 31JUL95 & 14JUL97 pt to MD w/herpes zoster consisting of a rash on rt hip & around rt thigh & buttock;also exp a fever;lab eval by PCR revealed vax strain of VZV;


VAERS ID: 171903 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Illinois  
Vaccinated:1995-07-31
Onset:2000-11-18
   Days after vaccination:1937
Submitted: 2001-05-15
   Days after onset:177
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 6189971658B / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Skin ulcer, Viral infection
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00111765

Write-up: On 11/18/2000 the child presented with 19-20 chicken pox lesions. Unspecified medical attention was sought. The nurse reported that the patient recovered from the chicken pox. No further information is available.


VAERS ID: 182260 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Female  
Location: Georgia  
Vaccinated:1995-07-31
Onset:2002-03-07
   Days after vaccination:2411
Submitted: 2002-03-08
   Days after onset:1
Entered: 2002-03-12
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0403B / 1 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presents with 50 plus chicken pox lesions all over face and body on 03/08/2002


VAERS ID: 199315 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-07-31
Onset:2003-03-09
   Days after vaccination:2778
Submitted: 2003-03-11
   Days after onset:2
Entered: 2003-03-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt came into clinic and diagnosed with chicken pox.


VAERS ID: 216878 (history)  
Form: Version 1.0  
Age: 9.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-07-31
Onset:2004-02-16
   Days after vaccination:3122
Submitted: 2004-02-20
   Days after onset:4
Entered: 2004-02-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Drug ineffective, Erythema, Infection, Pyrexia, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 02/19/04: Office visit, rash started 3 days ago, itchy, fever 100.7 02/18/04, scattered red, papular rash 1-2 crusted. (+) mom with Zoster. Diagnosis: Varicella.


VAERS ID: 76433 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: New Jersey  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-08-01
   Days after onset:0
Entered: 1995-08-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 387910 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005LK996 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0723L12 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: fever 103, chills;


VAERS ID: 76475 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Illinois  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-08-04
   Days after onset:3
Entered: 1995-08-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1326A4 / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61119 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Back pain, Oedema peripheral, Pain, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: seasonal allergies, Ceclor
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL950090

Write-up: mom said pt ran fever of 98.6; rt arm red, swollen very sore up into shoulder & back; @ times breathing makes back ache more; seen by MD 3 days later arm, shoulder & back becoming more sore; fever lasted only 1st day;


VAERS ID: 76504 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: California  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-08-02
   Days after onset:1
Entered: 1995-08-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427838 / UNK LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1616B2 / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718M / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Hypotonia, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; a few mins p/ vax, pt asleep & noted to be flaccid & unable to awaken; pt had similar episode in past associated vax;


VAERS ID: 76706 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Female  
Location: Arizona  
Vaccinated:1995-08-01
Onset:1995-08-02
   Days after vaccination:1
Submitted: 1995-08-08
   Days after onset:6
Entered: 1995-08-18
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hypokinesia, Malaise, Neck pain, Oedema, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP to relieve pain
Current Illness: had cold several days a/
Preexisting Conditions: hayfever-gets shot annually, gastritis-no med presently
Allergies:
Diagnostic Lab Data:
CDC Split Type: AZ9520

Write-up: 2AUG95 notice soreness to touch x 1-2 days;4AUG95 soreness gone;7AUG95 woke w/sore arm feeling sl feverish & malaise;early PM noticing redness & swelling & some swelling & discomfort going up arm into neck;area of redness-cant raise arm;


VAERS ID: 76926 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Washington  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-08-01
   Days after onset:0
Entered: 1995-08-28
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51169 / 5 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 718H6 / 4 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Hypertonia, Hypokinesia, Injection site hypersensitivity, Injection site mass
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: anaphalactic reaction to PCN
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: WA951148

Write-up: rt leg became stiff, area of hard redness around inj site size of a coffee cup; pt does not want to bear weight; daycare called mom to pick up child;


VAERS ID: 77150 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Tennessee  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-08-18
   Days after onset:17
Entered: 1995-09-01
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 426121 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0716M / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anorexia, Crying, Eczema, Pyrexia, Rash, Weight decreased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: light rash both elbows,back,legs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN95076

Write-up: pt recv vax;PC to mom; mom states pt cried "screamed" p/ vax;T 101 & lost appetite;saw er MD who gave dph; pt lost 1 lb;sx lasted 2 days;had a rash; saw PMD 14aug95, pt has eczema;


VAERS ID: 77290 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1995-08-01
Onset:1995-08-14
   Days after vaccination:13
Submitted: 1995-09-01
   Days after onset:18
Entered: 1995-09-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0698A / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Furuncle, Oedema peripheral, Pyrexia, Skin disorder, Skin hypertrophy
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: severely swollen rt arm fr elbow to hand w/a boil-like sore near elbow, same large sore on rt side @ waistline, small sore on rt arm & leg;tx w/Bactroban by MD;allerg rxn to ointment, then given Augmentin x 5 days;pt now has scars;low fever


VAERS ID: 77363 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Texas  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-08-01
   Days after onset:0
Entered: 1995-09-13
   Days after submission:43
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1241A / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0120C / 4 MO / PO
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L61153 / 4 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Hypotonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX95149

Write-up: pt felt limp & fainted; father caught pt by the arm-no apparent injury


VAERS ID: 77454 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Male  
Location: Oklahoma  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-08-02
   Days after onset:1
Entered: 1995-09-18
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G61080 / 4 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Arrhythmia, Bradycardia, Convulsion, Hyperhidrosis, Hypotension, Pallor, Skin discolouration, Vasospasm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: OK9535

Write-up: pt appeared to have a sz approx 3mins following vax; placed on the floor & found to have an irregular pulse of 40 w/BP of 70/50; pt was cool & sweaty, pale w/blue lips; pt was transported to hosp; dx vasospasm


VAERS ID: 77565 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Male  
Location: Puerto Rico  
Vaccinated:1995-08-01
Onset:1995-08-02
   Days after vaccination:1
Submitted: 1995-08-07
   Days after onset:5
Entered: 1995-09-18
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1225B5 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M675KN / 4 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. A720A / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Convulsion, Gaze palsy, Pyrexia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: premature, bronchopulmonia,hyperbiliruminemia,PDA
Allergies:
Diagnostic Lab Data: spinal fluid, no growth; EEG neg;
CDC Split Type: PR95009

Write-up: pt recv vax; mom noticed inc T several hrs later; pt cried & mom found him unresponsive w/ upward turning of eyes & brought him to er; gen sz; lasted for approx 40 mins;


VAERS ID: 77912 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Alabama  
Vaccinated:1995-08-01
Onset:1995-08-08
   Days after vaccination:7
Submitted: 1995-09-06
   Days after onset:29
Entered: 1995-10-05
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51055 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0702A / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51055 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0721L / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Muscle spasms
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL9530

Write-up: hospitalized 7AUG95 w/szs; dx''d w/infantile spasms & remains under care of neurologist


VAERS ID: 78075 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Georgia  
Vaccinated:1995-08-01
Onset:1995-08-02
   Days after vaccination:1
Submitted: 1995-10-03
   Days after onset:62
Entered: 1995-10-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428033 / 2 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Crying, Screaming
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt recvd Hep B lot# 0516B on 6JUN95
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: had high pitch scream x 4hrs


VAERS ID: 78291 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: Florida  
Vaccinated:1995-08-01
Onset:1995-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1995-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4E61142 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Condition aggravated, Convulsion, Febrile convulsion, Otitis media, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: questionable otitis
Preexisting Conditions: hx of seizures-febrile
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: FL95062

Write-up: fever approx 103 followed by sz 18 hrs following vax;taken to ER dx''d febrile convuls pt has hx of febrile convuls; had repeat sx on 18AUG95 w/fever; spoke w/MD 1SEP95 dx''d OM & febrile convulsions


VAERS ID: 79223 (history)  
Form: Version 1.0  
Age: 1.6  
Gender: Female  
Location: Indiana  
Vaccinated:1995-08-01
Onset:1995-08-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1995-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95080768

Write-up: pt recvd vax; broke put in approx 12 chicken pox lesions;


VAERS ID: 79230 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Male  
Location: Florida  
Vaccinated:1995-08-01
Onset:1995-08-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 1995-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0387B / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95080891

Write-up: pt recvd vax; 10aug95 devel fever of 101.2 & approx 30 lesions on body;


VAERS ID: 78414 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Michigan  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-09-12
   Days after onset:42
Entered: 1995-10-27
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1224A / 5 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0723A / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Agitation, Injection site hypersensitivity, Injection site mass, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PE
CDC Split Type: MI95114

Write-up: 2-3d of crabby behavior & t100 & c/o abd pain, 6cm hard red local rxn


VAERS ID: 79042 (history)  
Form: Version 1.0  
Age: 35.0  
Gender: Female  
Location: Ohio  
Vaccinated:1995-08-01
Onset:1995-08-30
   Days after vaccination:29
Submitted: 1995-11-08
   Days after onset:70
Entered: 1995-11-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Condition aggravated, Myelitis, Pain, Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: mom states whenever child had vax she had a relapse of transverse myelitis (C6-T6); mom being followed by MD, 8/30 devel pain,weakness, 9/9 T6 paralysis.


VAERS ID: 79029 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-10-04
   Days after onset:64
Entered: 1995-11-16
   Days after submission:43
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1405A / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61145 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 388926 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Hypotonia, Injection site pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: had URI @ 6wks of age
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA95203

Write-up: pt had fever 103 2hrs p/vax given lasted for 3 days; mom gave APAP q 4-6 hrs for the fever;lt leg was sore & limp for 2 1/2 days; father has hx of febrile szs as a youth


VAERS ID: 79944 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Male  
Location: Virginia  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-11-27
   Days after onset:118
Entered: 1995-12-11
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Buccoglossal syndrome, Convulsion, Dizziness, Hypertonia, Nystagmus, Paraesthesia, Speech disorder, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (narrow), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt recvd RIG on AUG95
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: all laboratory results nl including head CT, EEG, pulse ox 100%, dextrostix 137;
CDC Split Type:

Write-up: pt exp dizziness, light-headedness & tingly sensation in the legs p/receiving vax;pt also became verbally unresponsive w/staring eyes, hypertonic extremities, smacking lips w/o clinic activity or loss of continence


VAERS ID: 81058 (history)  
Form: Version 1.0  
Age: 35.0  
Gender: Male  
Location: D.C.  
Vaccinated:1995-08-01
Onset:1995-09-09
   Days after vaccination:39
Submitted: 1995-12-06
   Days after onset:88
Entered: 1996-01-03
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Hepatic function abnormal, Hyperbilirubinaemia
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: hiv pos
Allergies:
Diagnostic Lab Data: SGPT 862 9sep95, SGPT 86 11oct95;SGOT 448 9sep95; SGOT 45 on 11oct95; ALKPH 263 9sep95;ALKPH 118 on 11oct95; Bilirubin .6mg/dl on 9sep95; bil .8 mg/dl on 11oct95
CDC Split Type: 950113911

Write-up: pt recvd vax; exp elev liver enzymes w/in 1 mon of vax;


VAERS ID: 82821 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: North Dakota  
Vaccinated:1995-08-01
Onset:1995-08-08
   Days after vaccination:7
Submitted: 1995-08-11
   Days after onset:3
Entered: 1996-01-11
   Days after submission:153
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 426373 / 4 MO / PO
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 923900 / 6 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Asthenia, Ear pain, Headache, Hypertonia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pediapred, Ventolin
Current Illness: ear infect
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895258010L

Write-up: pt recvd vax 1AUG95 & 8AUG95 presented w/h/a, fever (100.2), dec appetite, fatigue, rt sided ear pain;pt was started on Ceclor for ear infect;11AUG95 father reported pt devel leg stiffness & fever;


VAERS ID: 82933 (history)  
Form: Version 1.0  
Age: 39.0  
Gender: Male  
Location: Washington  
Vaccinated:1995-08-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0405B / 2 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: IGG .69 pre vax; IGG .91 post vax
CDC Split Type: WAES95100028

Write-up: pt recvd vax;six wks later,tested neg for antibody;IGG was .91 & pre dose was .69;


VAERS ID: 83149 (history)  
Form: Version 1.0  
Age: 75.0  
Gender: Female  
Location: Illinois  
Vaccinated:1995-08-01
Onset:1995-08-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1996-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Amblyopia, Herpes zoster
SMQs:, Optic nerve disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95110465

Write-up: pt recv vax AUG95 & devel a severe case of shingles on half of face & head;also exp blurred vision;pt was seen in an ER 13AUG95;adm to hosp


VAERS ID: 83806 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-08-01
Onset:1995-10-01
   Days after vaccination:61
Submitted: 1996-03-19
   Days after onset:170
Entered: 1996-03-22
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Aplastic anaemia
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Myelodysplastic syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96022223

Write-up: pt recv vax 1AUG95 & 1OCT95 pt presented w/aplastic anemia;MD reported he planned to have pt undergo a bone marrow transplant;f/u from pt''s MD indicated he saw no assoc between the use of vax & developing aplastic anemia;


VAERS ID: 85359 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Virginia  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1996-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0428B / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Dermatitis exfoliative, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness:
Preexisting Conditions: plaque, skin
Allergies:
Diagnostic Lab Data: 1995 Lyme titer negative; Biopsy perivascular lympho, dermatitis;Culture KOH neg, no fungus; 3AUG95 Lyme titer neg;29AUG95 Biopsy non-specific (gryate erythema)
CDC Split Type: WAES96010061

Write-up: pt recv vax 1AUG95 & w/in days of vax devel a gradual onset of multiple annular, sl scaly, predominantly dermal plaque;AUG95 pt was seen in MD office in late AUG95;biopsy showed lymphocytic dermatitis & poss gyrate erythema;


VAERS ID: 85731 (history)  
Form: Version 1.0  
Age: 38.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-08-01
Onset:1996-02-01
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 1996-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES96030569

Write-up: pt recv vax AUG95&FEB96 a test showed that the pt had not seroconverted;no further details were provided;


VAERS ID: 85732 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1995-08-01
Onset:1996-02-29
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 1996-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96030571

Write-up: pt recv vax 1AUG95 & 29FEB96 pt was found to have not seroconverted;no further details were provided;


VAERS ID: 85935 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Female  
Location: Illinois  
Vaccinated:1995-08-01
Onset:1996-01-25
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 1996-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Nausea, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96020140

Write-up: pt recv vax 1AUG95 & 25JAN96 pt presented w/chicken pox;had gen lesions, fever, & nausea;


VAERS ID: 85937 (history)  
Form: Version 1.0  
Age: 9.0  
Gender: Unknown  
Location: Illinois  
Vaccinated:1995-08-01
Onset:1996-01-15
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 1996-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96020143

Write-up: pt recv vax 1AUG95 & 15JAN96 pt devel chicken pox which was confirmed by a MD;


VAERS ID: 85959 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:1995-08-01
Onset:1996-01-28
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 1996-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES96020489

Write-up: pt recv vax;devel chicken pox which was confirmed by MD;


VAERS ID: 88381 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Virginia  
Vaccinated:1995-08-01
Onset:1996-04-01
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 1996-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES96042404

Write-up: pt recv vax 1AUG95 & APR96 pt exp full-blown chicken pox;


VAERS ID: 88419 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1995-08-01
Onset:1995-09-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 1996-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES96040251

Write-up: pt recv vax AUG95 & SEP95 pt devel a chicken-pox like rash on leg, thigh & chest;pt also had impetigo in the nose area;


VAERS ID: 88576 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: Iowa  
Vaccinated:1995-08-01
Onset:1996-05-10
   Days after vaccination:283
Submitted: 0000-00-00
Entered: 1996-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES96051200

Write-up: pt recv vax AUG95 & 10MAY96 pt devel a breakthrough case of chickenpox w/vesicular lesions & a fever of 102 x 3 days;


VAERS ID: 88638 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Virginia  
Vaccinated:1995-08-01
Onset:1996-05-20
   Days after vaccination:293
Submitted: 0000-00-00
Entered: 1996-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0412B / 1 RL / SC

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES96052253

Write-up: pt recv vax AUG95 & 20MAY96 pt exp a rash w/100-150 lesions which was dx as chicken pox;


VAERS ID: 88655 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1995-08-01
Onset:1996-05-03
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 1996-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: varicella antibody
CDC Split Type: WAES96052656

Write-up: pt recv vax AUG95 & 3MAY96 lab eval revealed varicella antibody less than 0.86, pt failed to seroconvert;


VAERS ID: 88660 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Female  
Location: Virginia  
Vaccinated:1995-08-01
Onset:1996-05-01
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 1996-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES96052662

Write-up: pt recv vax AUG95 & in MAY96 pt devel a rash w/over 100 lesions;


VAERS ID: 88669 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Male  
Location: Virginia  
Vaccinated:1995-08-01
Onset:1995-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1996-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Herpes simplex
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zovirax
Current Illness:
Preexisting Conditions: herpex simples, allergy to pcn, freq cold sores;
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES96052693

Write-up: pt recv vax 1AUG95 & 2AUG95 pt devel a fever blister on lip;pt recv 2nd dose of vax APR96;


VAERS ID: 90355 (history)  
Form: Version 1.0  
Age: 58.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-08-01
Onset:1995-09-01
   Days after vaccination:31
Submitted: 1995-09-15
   Days after onset:14
Entered: 1996-09-11
   Days after submission:362
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Headache, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895285011L

Write-up: pt recv vax & devel h/a, malaise, & gen body aches approx 1k p/vax;pt is being treated w/Toradol PO & sx persist;


VAERS ID: 92010 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1996-06-17
   Days after onset:321
Entered: 1996-10-30
   Days after submission:135
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1737A2 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Skin atrophy, Skin disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling 9yr old exp atrophoderma p/Engerix-B~ ()~~~In Sibling
Other Medications: NONE
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data: Lyme titer negative;VDRL negative;
CDC Split Type: 960019471

Write-up: pt recv vax AUG95 & w/in 1 wk post vax pt exp lesions scattered over arm & trunk;pt was found to have atrophoderma;lesions cont to devel as of 14MAR96;


VAERS ID: 92968 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Male  
Location: Kentucky  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-09-19
   Days after onset:49
Entered: 1996-10-30
   Days after submission:407
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: allergic to PCN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950003241

Write-up: pt recv vax JUL or AUG 1995 post vax whole arm swelled;sx resolved w/in 24hr;


VAERS ID: 92985 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Female  
Location: South Carolina  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1995-09-27
   Days after onset:57
Entered: 1996-10-30
   Days after submission:399
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1436A4 / 3 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950097731

Write-up: pt recv vax & w/in 48hr p/vax exp blistering around the inj site;ER or MD visit was required;pt was treated w/Neosporin & an antihistamine;sx resolved w/in a few days;


VAERS ID: 94336 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Iowa  
Vaccinated:1995-08-01
Onset:1996-11-20
   Days after vaccination:477
Submitted: 0000-00-00
Entered: 1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96120074

Write-up: pt recv vax 1AUG95 & 20NOV96 pt devel a rash on head & neck which spread to front & back, light fever;reporter described the rash as not severe;


VAERS ID: 96013 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Male  
Location: New York  
Vaccinated:1995-08-01
Onset:1996-03-15
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 1997-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96052075

Write-up: pt recv vax AUG95 & on approx 15MAR96 pt devel a full body rash;sx were exacerbated by cold, heat, pressure & exercise;which resulted in hives;


VAERS ID: 97495 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-08-01
Onset:1997-01-01
   Days after vaccination:519
Submitted: 0000-00-00
Entered: 1997-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 3JAN97 Varicella antibody 0.64 (<0.79=negative)
CDC Split Type: WAES97010815

Write-up: pt recv vax AUG95 & lab eval in JAN97 revealed that the pt failed to seroconvert (varicella antibody titer 0.64 negative);


VAERS ID: 97740 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1995-08-01
Onset:1997-02-04
   Days after vaccination:553
Submitted: 0000-00-00
Entered: 1997-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97021134

Write-up: pt recv vax 1AUG95 & on 4FEB97 pt devel chickenpox;It was noted that pt entire body had lesions-including head, face, & ears;


VAERS ID: 101385 (history)  
Form: Version 1.0  
Age: 33.0  
Gender: Female  
Location: Maine  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 1997-03-31
   Days after onset:608
Entered: 1997-07-22
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. - / 1 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Dizziness, Headache, Malaise, Sinusitis, Urinary tract infection
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt devel dizziness p/each dose in series;~ ()~~~In patient
Other Medications: Oral diabetes med for sugar over 300
Current Illness: NONE
Preexisting Conditions: diabetic;takes oral med only if sugar over 300;occasional pylenephritis;allergy to codeine;
Allergies:
Diagnostic Lab Data: blood sugar 123
CDC Split Type: CO6180

Write-up: dizziness 15min p/vax;completed series & had same sx each time;since 7OCT95 has non-specific sx of h/a, tired, dizzy;just does not feel right;seen on 7OCT95 blood sugar 123;poss sinus &/or UTI;tx w/Bactrim & Pyridium;


VAERS ID: 101032 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Female  
Location: Connecticut  
Vaccinated:1995-08-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1997-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0409B / 2 - / SC

Administered by: Public       Purchased by: Private
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: titer not immune;
CDC Split Type: WAES97052708

Write-up: pt recv vax 1AUG95 & pt exp titer is three p/2 doses (not immune);


VAERS ID: 108277 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: California  
Vaccinated:1995-08-01
Onset:1995-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1523W / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Asthma, Dyspnoea, Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES97020543B

Write-up: pt recv vax & w/in 24hr pt devel tongue swelling, SOB & bronchospasm;


VAERS ID: 109676 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: North Carolina  
Vaccinated:1995-08-01
Onset:1998-04-02
   Days after vaccination:975
Submitted: 1998-04-03
   Days after onset:1
Entered: 1998-04-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 414B / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Dermatitis bullous, Pruritus, Rash maculo-papular
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: started 2APR98 w/3 red areas today covered w/50 or more red raised spot some water filled w/itching;


VAERS ID: 110166 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Florida  
Vaccinated:1995-08-01
Onset:1998-02-02
   Days after vaccination:916
Submitted: 1998-04-15
   Days after onset:71
Entered: 1998-04-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data~ ()~~~In patient
Other Medications: None
Current Illness:
Preexisting Conditions: cerebral palsy
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98020568

Write-up: 01Aug95 pt recv 1 dose vax. 02Feb98 pt devel chickenpox. Additional info has been requested


VAERS ID: 110299 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Ohio  
Vaccinated:1995-08-01
Onset:1998-02-10
   Days after vaccination:924
Submitted: 1998-04-15
   Days after onset:63
Entered: 1998-04-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0398B / 1 - / SC

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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES98022285

Write-up: pt recv vax 1AUG95 & on 10FEB98 pt broke out w/chicken;had a total of 14 lesions which were not really pruritic;no fever was noted & was acting okay & was not ill @ all;13FEB98 lesions had crusted over & pt recovered;


VAERS ID: 122925 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Ohio  
Vaccinated:1995-08-01
Onset:1998-04-16
   Days after vaccination:989
Submitted: 1999-05-14
   Days after onset:393
Entered: 1999-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0416B / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Drug ineffective, Infection, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data~ ()~~~In patient
Other Medications: unknown
Current Illness:
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98041226

Write-up: m.d. rpt pt vax w/varicella in 8/95 & in 4/98 pt exp chickenpox over the entire body & fever of 100


VAERS ID: 124519 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Unknown  
Location: Kansas  
Vaccinated:1995-08-01
Onset:1999-02-08
   Days after vaccination:1287
Submitted: 1999-05-14
   Days after onset:94
Entered: 1999-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418B / 1 - / SC

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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No Relevant Data~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99020670

Write-up: p/vax pt exp chickenpox & was noted as having over 100 lesions;pt sought unspecified medical treatment;


VAERS ID: 123260 (history)  
Form: Version 1.0  
Age: 8.0  
Gender: Female  
Location: Nebraska  
Vaccinated:1995-08-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0426B / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt contracted disease


VAERS ID: 156437 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Wisconsin  
Vaccinated:1995-08-01
Onset:0000-00-00
Submitted: 2000-05-16
Entered: 2000-07-13
   Days after submission:58
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: serum varicella zoster - titer after first 2 doses indicated no conversion
CDC Split Type: WAES99111100

Write-up: Pt who in June and August of 1995 was vaccinated with a first and second dose of varicella virus vaccine live was tested and found to have a negative titer. On 09/08/1999 and 10/20/1999 the pt was vaccinated with a third and fourth dose of varicella virus vaccine live. The pt has not been re-titered as of yet.


VAERS ID: 156910 (history)  
Form: Version 1.0  
Age: 30.0  
Gender: Female  
Location: Virginia  
Vaccinated:1995-08-01
Onset:1998-10-29
   Days after vaccination:1185
Submitted: 2000-05-16
   Days after onset:564
Entered: 2000-07-17
   Days after submission:62
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0429B / 2 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: negative varicella antibody titer
CDC Split Type: WAES99041986

Write-up: Subsequent to receiving the second dose of varicella virus vaccine live the pt experienced a lack of response.


VAERS ID: 183156 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Unknown  
Vaccinated:1995-08-01
Onset:0000-00-00
Submitted: 2002-03-28
Entered: 2002-04-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Akathisia, Drug toxicity, Hyperacusis, Hypertonia, Nervous system disorder, Neurodevelopmental disorder, Oedema peripheral, Speech disorder, Staring, Strabismus
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (narrow), Parkinson-like events (narrow), Drug abuse and dependence (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0203USA02482

Write-up: Information has been received regarding a case in litigation concerning a female child who resides with her father that was injected with vaccinations containing the mercury-based preservative thimerosal. The pt received "at least 3 shots" of Heptavax, Engerix and Recombivax vaccinations from 8/95 to 2/96. The pt displayed symptoms of neurological damage soon after the 1st vaccination. It was reported that the pt''s eyes became crossed, started flapping her hands, stared into space, hearing became hypersensitive, had tightness in her feet and experienced loss of muscle tone. It was noted that the pt never developed language skills. The pt was receiving Chelation Therapy and had received approx. 300 Hyperbaric Oxygen therapy treatments. It was also noted that the pt was taking sulphur pills 3 days a week to "pull the mercury out of her system". The alleged result of these vaccinations is that the pt suffers from and in the future will continue to suffer from diminution in earning capacity, ability to enjoy life and to live independently, establishment and maintenance of personal relationships and in the usual and normal activities of daily living due to the toxic neurological effects of mercury poisoning. Upon internal review, mercury poisoning, neurological disorder, eyes became crossed, started flapping her hands, stared into space, hearing became hypersensitive, had tightness in her feet, experienced loss of muscle tone and never developed language skills were considered to be "Other Important Medical Events". No further information is available.


VAERS ID: 184700 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-08-01
Onset:2001-03-01
   Days after vaccination:2039
Submitted: 2002-05-15
   Days after onset:439
Entered: 2002-05-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01034370

Write-up: Information has been received from a health professional concerning a 6 year old male consumer who in August 1995, was vaccinated with varicella virus vaccine live. In March 2001, the pt developed chicken pox. Additional info has been requested.


VAERS ID: 186650 (history)  
Form: Version 1.0  
Age: 8.0  
Gender: Female  
Location: Unknown  
Vaccinated:1995-08-01
Onset:2002-03-15
   Days after vaccination:2418
Submitted: 2002-05-15
   Days after onset:60
Entered: 2002-06-17
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0203USA01755

Write-up: Information has been received from a physician concerning a 8 year old female who on 08/01/1995 was vaccinated with Varivax. On approximately 03/15/02, the patient developed chickenpox. The patient sought unspecified medical attention. Additional information has been requested.


VAERS ID: 197764 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: Unknown  
Vaccinated:1995-08-01
Onset:0000-00-00
Submitted: 2003-02-11
Entered: 2003-02-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Autism
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0302USA00291

Write-up: Information has been received from a consumer concerning her cousin''s currently 9.5 year old male child with no known allergies or medical history who at age 2, in approximately August 1995, was vaccinated with a dose of MMR (second generation) (lot # not reported). There were no concomitant medications. Subsequently, the child developed autism. Unspecified medical attention was sought. Upon internal review, autism was determined to be an other important medical event. The consumer also reported that the cousin''s other child, who is currently 12 years old, received a dose of MMR (second generation)(lot # not reported) at age 2 and now also has autism (WAES0302USA00343). Additional information has been requested.


VAERS ID: 239203 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: Unknown  
Vaccinated:1995-08-01
Onset:2004-12-15
   Days after vaccination:3424
Submitted: 2005-05-16
   Days after onset:151
Entered: 2005-06-07
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0503USA02252

Write-up: Information has been received from a registered nurse concerning a 5th grade elementary school student who on 08/01/1995 was vaccinated with a dose of varicella virus vaccine live. In mid December 2004 the student developed chickenpox. According to the school nurse, 58 other students in the school developed chickenpox in mid December 2004 and 34 of them had previously been vaccinated with a dose of varicella virus vaccine live. Unspecified medical attention was sought. There was no information regarding the present status of the 5th grade student. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 289221 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Male  
Location: Florida  
Vaccinated:1995-08-01
Onset:1995-08-01
   Days after vaccination:0
Submitted: 2007-08-28
   Days after onset:4410
Entered: 2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Dyspnoea, Headache, Hyperhidrosis, Pallor, Photophobia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: No records available
CDC Split Type:

Write-up: In 1995 got Typhoid - injection and soon after starting not feeling well- headache and feeling short of breath, with progressive worsening of headache, photophobia, and noted to be pale and diaphoretic, very short of breath, possible LOC (about 6 hours later). Called 911 and woke up in ED, got shots of 7 and also got full resus including cardioversion. Patient denies any unusual activity, travel, exposures at that time. Reports he was in school, not out in field. Patient was hospitalized overnite, and told that 2 others had similar reactions to his. Patient has since received oral version of typhoid 1995, and tolerated with no symptoms that he can recall. Symptoms: Dyspnea (shortness of breath), diaphoresis, Pallor, Headache (onset within hour of vaccine receipt and worsened over period of about 6-8 hours), and Syncope. 9/18/07 Received medical records which reveal patient experienced HA & SOB which worsened & developed photophobia, pallor & diaphoresis after receiveing injectable typhoid vax. Possible LOC & taken to ER, resuscitation & cardioversion. Admitted overnight in 1995. Received oral typhoid vax in 1995 w/o any noted problems. Seen in Allergy clinic 8/2007 when told had to have typhoid vax prior to deployment for Oct/2007. Tx w/oral typhoid vax while in clinic & then monitored for 2 hours w/o any AE. Sent home w/epi pen. Returned to clinic for 2nd & 3rd dose at clinic & to be monitored. Developed a HA after 2nd dose otherwise well tolerated.


VAERS ID: 314174 (history)  
Form: Version 1.0  
Age: 0.9  
Gender: Female  
Location: Florida  
Vaccinated:1995-08-01
Onset:2004-02-27
   Days after vaccination:3132
Submitted: 2008-05-16
   Days after onset:1539
Entered: 2008-05-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Varicella
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA04724

Write-up: Information has been received from a registered nurse (RN) concerning a 9-year-old Caucasian female with no known allergies who in August 1995, was vaccinated with a dose of varicella virus vaccine live (Oka/Merck) in another office. On 27-FEB-2004 the patient broke out with a mild case of chickenpox. No medical attention was sought. It was reported that the patient''s mother treated her with oat (AVEENO BATHS) and diphenhydramine hydrochloride (BENADRYL). Subsequently, the patient recovered from mild case of chickenpox on an unknown date. Additional information is requested.


VAERS ID: 315687 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1995-08-01
Onset:0000-00-00
Submitted: 2008-05-16
Entered: 2008-05-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Herpes zoster
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA06272

Write-up: Information has been received from a physician concerning an approximately 11 or 12 year old male who in August 1995, was vaccinated with a dose of varicella virus vaccine live (Oka/Merck). Concomitant therapy included montelukast sodium (MSD). In 2006 the patient developed shingles under arm and lasted for approximately 2 weeks. At the time of report, the patient had full recovery from shingles. Unspecified medical attention was sought. a product quality complaint was not involved. Additional information has been requested.


VAERS ID: 564667 (history)  
Form: Version 1.0  
Age: 1.25  
Gender: Female  
Location: Unknown  
Vaccinated:1995-08-01
Onset:2014-06-01
   Days after vaccination:6879
Submitted: 2015-01-07
   Days after onset:220
Entered: 2015-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 4 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Hepatitis B antibody negative, Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Titer was drawn for hepatitis B in June 2014 but result was low titer.
CDC Split Type: WAES1501USA001306

Write-up: This spontaneous report as received from a nurse refers to an approximately 1 month old female patient with no pertinent medical history, drug reactions or allergies. The nurse reported that the original hepatitis b vaccine (manufacturer unknown) (therapy type, dose, route, lot# and expiration date were not reported) series patient received total of 4 doses, in May 1994, July 1994, November 1994 and August 1995. The nurse could not provide why the patient received 4 doses of hepatitis b vaccine (manufacturer unknown). The patient did not take any concomitant medication. The patient entered nursing school and titer was drawn for hepatitis B in June 2014 but result was low titer and she was recommended for revaccination(also reported as a treatment for low titers). The patient started RECOMBIVAX HB (therapy type, dose, route, lot# and expiration date were not reported) series for revaccination in July 2014 and received second dose in August 2014 and third dose on 05-JAN-2015, The nurse reported that the third dose of RECOMBIVAX HB for revaccination was administered a few days earlier than recommended schedule. The outcome of the event of "low titers for hepatitis B" was unknown. The patient sought an unspecified medical attention. The relatedness between the event of "low titers for hepatitis B" and RECOMBIVAX HB was not reported. Additional information has been requested.


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