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Found 502657 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:105340 (history)  Vaccinated:1997-11-26
Age:6.6  Onset:0000-00-00
Gender:Female  Submitted:1997-11-29
Location:California  Entered:1997-12-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications:
Current Illness:
Preexisting Conditions: NA
Diagnostic Lab Data:
CDC Split Type: CA970117
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: pt to this clinic for tx d/t adverse rxn;pt did not recv vax @ this clinics;pt exp skin rash on upper/lower extremities, fever & flushing;pt recv DPH prescription, calamine lotion & APAP for tx;

VAERS ID:105422 (history)  Vaccinated:1997-11-26
Age:13.3  Onset:1997-11-26, Days after vaccination: 0
Gender:Male  Submitted:1997-11-26, Days after onset: 0
Location:New York  Entered:1997-12-05, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: ?allergy PNC (via inj)
Diagnostic Lab Data: NONE
CDC Split Type: BASI040
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0336D0IM 
Administered by: Other     Purchased by: Other
Symptoms: Hypertension, Hyperventilation, Hypoxia, Injury, Pallor, Somnolence, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 845AM pt recv vax 847AM slid off chair sideways hitting side of head, unconscious under 1min, alert & oriented x 3, BP 110/40, P80, R24 extremely pale & lethargic, 02 via mass;

VAERS ID:105462 (history)  Vaccinated:1997-11-26
Age:11.6  Onset:1997-11-26, Days after vaccination: 0
Gender:Female  Submitted:1997-12-01, Days after onset: 5
Location:Massachusetts  Entered:1997-12-08, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2375A20IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0737E1SCLA
Administered by: Private     Purchased by: Other
Symptoms: Hypersensitivity, Laryngospasm, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Hypersensitivity (narrow)
Write-up: allergic rxn-went to ER @ 503PM was given DPH-epi, solumedrol;devel all hives w/in 1/2hr p/vax;also laryngospasms;

VAERS ID:105478 (history)  Vaccinated:1997-11-26
Age:9.6  Onset:1997-11-27, Days after vaccination: 1
Gender:Female  Submitted:1997-12-02, Days after onset: 5
Location:New Jersey  Entered:1997-12-08, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0900E1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: p/vax given mom remembered egg intolerance causes GI sx but not hives, etc;pt recv vax w/o known rxn;p/vax pt used DPH x 3 does: diarrhea x 2p/DPH stopped;

VAERS ID:105562 (history)  Vaccinated:1997-11-26
Age:55.8  Onset:1997-11-27, Days after vaccination: 1
Gender:Female  Submitted:1997-12-01, Days after onset: 4
Location:Texas  Entered:1997-12-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7E91657  RA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: the next day p/vax arm became red & painful, swollen;applied ice & was started on keflex;

VAERS ID:105578 (history)  Vaccinated:1997-11-26
Age:0.4  Onset:1997-11-26, Days after vaccination: 0
Gender:Female  Submitted:1997-12-04, Days after onset: 8
Location:Alabama  Entered:1997-12-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES448331IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM265RF1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.M12941SCLL
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)
Write-up: w/in 15min of vax pt began to cry inconsolably;pt gagged, wretched & spit up mucus;HR, RR, calm all were good;no fever;pt cried cont for 30min;

VAERS ID:105732 (history)  Vaccinated:1997-11-26
Age:1.3  Onset:1997-12-03, Days after vaccination: 7
Gender:Female  Submitted:1997-12-05, Days after onset: 2
Location:Michigan  Entered:1997-12-16, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MI97160
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4490983 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0898E0 RL
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 3DEC97 fever of 102 x 2 days;rash began 4DEC97 macular, erythematous areas approx 1-2min in size of abd & back;

VAERS ID:105892 (history)  Vaccinated:1997-11-26
Age:0.2  Onset:1997-11-26, Days after vaccination: 0
Gender:Male  Submitted:1997-12-04, Days after onset: 8
Location:Arizona  Entered:1997-12-29, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: recurrent constipation
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES 0 RL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4469800PO 
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Injection site hypersensitivity, Injection site oedema, Insomnia, Screaming
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax pt kept crying;mom called from wal-mart;pt still screaming told to bring child in;pt was screaming, RVL site very red, swollen;pt had been crying from 9:20 to 2PM;cont crying into noc;

VAERS ID:106949 (history)  Vaccinated:1997-11-26
Age:62.4  Onset:1997-11-26, Days after vaccination: 0
Gender:Female  Submitted:1997-11-26, Days after onset: 0
Location:Georgia  Entered:1998-01-26, Days after submission: 61
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: pt denies
Preexisting Conditions: elevated triglycerides, positive cardio family hx
Diagnostic Lab Data:
CDC Split Type: GA97146
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F819045IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)
Write-up: pt had light-headedness p/inj;BP was checked & found to be elevated 160/100 (seated);primary provider was called to see if wanted to see pt BP checked 10min;later was 170/100 (seated);MD advised to call amb & send pt to ER for further eval;

VAERS ID:108235 (history)  Vaccinated:1997-11-26
Age:1.5  Onset:1997-11-28, Days after vaccination: 2
Gender:Male  Submitted:1998-02-25, Days after onset: 89
Location:Pennsylvania  Entered:1998-03-03, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type: CO7805
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7B91824  RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 26NOV97 & 28NOV97 pt exp ecchymosis @ the inj site;pt also exp hives;one hive occurred in the area of the rt eblow (7.5c5.5cm) & another hive devel later on the rt upper thigh (4x2cm) ont he outside side;

VAERS ID:108609 (history)  Vaccinated:1997-11-26
Age:  Onset:1997-11-26, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES97120046
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0384E   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Injection site pain, Paraesthesia, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)
Write-up: pt recv vax 26NOV97 & w/in 10min of vax pt exp numbness & tingling of the lips, vertigo & abd pain which persisted throughout the day;also exp inj site pain when laying upon the arm which was vaccinated;

VAERS ID:108140 (history)  Vaccinated:1997-11-26
Age:70.8  Onset:1997-11-29, Days after vaccination: 3
Gender:Female  Submitted:1998-02-28, Days after onset: 91
Location:California  Entered:1998-03-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications:
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 10cm swelling above elbow @ inj site;tx w/DPH;

VAERS ID:108193 (history)  Vaccinated:1997-11-26
Age:2.4  Onset:1997-11-28, Days after vaccination: 2
Gender:Female  Submitted:1998-02-02, Days after onset: 66
Location:Georgia  Entered:1998-03-13, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: GA98010
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7B816020IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0345E0IMRL
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Neuropathy, Pruritus, Skin disorder
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 26NOV97 started itching;broke out on back, legs & buttocks w/bumps w/ clear fluid in center;scratched area;looks like chickenpox;dx peripheral neuropathy secondary to chickenpox;

VAERS ID:108897 (history)  Vaccinated:1997-11-26
Age:68.6  Onset:1997-11-27, Days after vaccination: 1
Gender:Female  Submitted:1998-03-11, Days after onset: 104
Location:Arizona  Entered:1998-03-26, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: diabetes mellitus
Preexisting Conditions: diabetes mellitus
Diagnostic Lab Data: NONE
CDC Split Type: AZ9819
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4381351IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt return to clinic 28NOV97 c/o painful lt shoulder p/getting a pneumovax shot 26OCT97;PE lt shoulder appeared red & swollen;tx given DPH & Keflex;

VAERS ID:109367 (history)  Vaccinated:1997-11-26
Age:59.0  Onset:1997-11-26, Days after vaccination: 0
Gender:Male  Submitted:1997-11-29, Days after onset: 3
Location:Tennessee  Entered:1998-03-26, Days after submission: 117
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: cervical osteoarthritis
Diagnostic Lab Data:
CDC Split Type: 898043009L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4978219 IMRA
Administered by: Other     Purchased by: Other
Symptoms: Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 26NOV97 & that evening exp aching of the back of neck;the next day the rt side of neck was sore & rt shoulder was painful;treated self w/medrol dosepak, SOMA, hydrocodone w/APAP & hot compresses;pain persisted as of 29NOV97;

VAERS ID:109941 (history)  Vaccinated:1997-11-26
Age:5.4  Onset:1998-01-02, Days after vaccination: 37
Gender:Male  Submitted:1998-04-15, Days after onset: 102
Location:Pennsylvania  Entered:1998-04-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: Depakote
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: chicken pox case medically confirmed
CDC Split Type: WAES98010077
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0805E0SC 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: pt recv vax 26NOV97 & 2JAN98 pt devel moderate chickenpox;

VAERS ID:116442 (history)  Vaccinated:1997-11-26
Age:72.5  Onset:1997-11-26, Days after vaccination: 0
Gender:Female  Submitted:1998-11-13, Days after onset: 352
Location:Ohio  Entered:1998-11-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: High blood pressure; Sulfa, steroids, bee sting, Posicor allergy
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Private     Purchased by: Other
Symptoms: Amblyopia, Dizziness, Dyspnoea, Pain, Paraesthesia, Pyrexia, Somnolence, Tooth disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: Pt recv vax on 11/26/97; on 11/26/97 pt exp dizziness & blurred vision, vax site red,itch &swelling; 12/1/97 pt exp fever (102) & shortness of breath; 3/23/98 pt exp Rt arm & thumb numbness & earaches, sleepiness; 5/26/98 pt exp sensitive t

VAERS ID:119244 (history)  Vaccinated:1997-11-26
Age:1.0  Onset:1999-02-09, Days after vaccination: 440
Gender:Female  Submitted:1999-02-11, Days after onset: 2
Location:Utah  Entered:1999-02-22, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0735E0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0808E0SCLL
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: varicella p/vaccine;

VAERS ID:122745 (history)  Vaccinated:1997-11-26
Age:26.0  Onset:0000-00-00
Gender:Female  Submitted:1999-05-14
Location:Massachusetts  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PCN allergy; sulfa allergy
Diagnostic Lab Data: ultrasound @ 18wk nl;
CDC Split Type: WAES98010116
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0638E1SCUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Complication of pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: pt recv vax 11/26/97 & became preg LMP 11/12/97, EDC 8/20/98;pt induced @ 36wk d/t hx of prev shoulder dystocia;

VAERS ID:105844 (history)  Vaccinated:1997-11-26
Age:5.0  Onset:1997-11-26, Days after vaccination: 0
Gender:Male  Submitted:1997-12-15, Days after onset: 19
Location:Foreign  Entered:1997-12-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: prophylaxis
Current Illness:
Preexisting Conditions: hx of "lowered resistance", endogenic exanthema; relapsing obstructive bronchitis and atopia;
Diagnostic Lab Data:
CDC Split Type: WAES97120591
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Injection site pain, Lymphangitis, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: approx 6 hrs after vax,pt exp abdominal pain; "resting pain and pain on palpation of abdominal inject site" tx w/ pcn; T was 38.3 C "with aggravation o sx"; hosp w/ dx of lymphangitis and placed on IV therapy; discharged from hosp;

VAERS ID:106697 (history)  Vaccinated:1997-11-26
Age:0.8  Onset:1997-11-26, Days after vaccination: 0
Gender:Female  Submitted:1998-01-14, Days after onset: 49
Location:Foreign  Entered:1998-01-21, Days after submission: 7
Life Threatening? No
Died? Yes
   Date died: 1997-11-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO7818
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES 1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Atrioventricular block, Cardiac failure
SMQs:, Cardiac failure (narrow), Conduction defects (narrow), Cardiomyopathy (broad)
Write-up: pt recv vax 26NOV97 & same day pt w/a complicated congenital heart disease & was operated for tracheomalacia;also presented w/the narrowing of the trachea d/t a ring of blood vessels around it;COD heart failure caused by total AV block;

VAERS ID:109555 (history)  Vaccinated:1997-11-26
Age:69.0  Onset:1997-11-28, Days after vaccination: 2
Gender:Male  Submitted:1998-04-01, Days after onset: 124
Location:Foreign  Entered:1998-04-07, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Spondylosis;Diclofenac sodium;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: plasma atrial natriuretic hormone test 1:1600 after suspect drug;
CDC Split Type: WAES98035249
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Antinuclear antibody, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax 26NOV97 & 28NOV97 pt exp swelling of the hands & was hosp;on exam anti-nuclear antibodies were positive 1:1600;

VAERS ID:113344 (history)  Vaccinated:1997-11-26
Age:  Onset:1997-11-26, Days after vaccination: 0
Gender:Unknown  Submitted:1998-08-07, Days after onset: 253
Location:Foreign  Entered:1998-08-11, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES98071946
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Lymphangitis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: On 11/26/97 pt recv vax and six hours later exp abdominal pain. On 11/27/98 pt exp lymphangitis, resting pain/pain on palpation (local), and temp of 38.3 degrees C.

VAERS ID:114017 (history)  Vaccinated:1997-11-26
Age:  Onset:1998-04-01, Days after vaccination: 126
Gender:Female  Submitted:1998-09-02, Days after onset: 153
Location:Foreign  Entered:1998-09-10, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: WAES98081770
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Stillbirth
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: female recv vax 26NOV97 during first month of pregnancy;sometime in APR98 @ 6mo of pregnancy pt underwent a cesarean section for intrauterine fetal death;

VAERS ID:105561 (history)  Vaccinated:1997-11-27
Age:37.5  Onset:1997-11-28, Days after vaccination: 1
Gender:Female  Submitted:1997-11-30, Days after onset: 2
Location:California  Entered:1997-12-09, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unk
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy codeine
Diagnostic Lab Data: CBC, UA, CSF
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7H91839 IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Headache, Meningitis, Nuchal rigidity, Pyelonephritis, Pyrexia, Tetany
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow)
Write-up: h/a, fever, stiff neck;MD dx acute h/a, r/o meningitis;pyelonephritis;poss tetanus rxn;

VAERS ID:105782 (history)  Vaccinated:1997-11-27
Age:32.7  Onset:0000-00-00
Gender:Female  Submitted:1997-12-04
Location:Missouri  Entered:1997-12-18, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: laceration finger
Preexisting Conditions: allergic codeine
Diagnostic Lab Data: NONE
CDC Split Type: MO97057
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7F91679  LA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Headache, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: swelling @ site w/in 24-48hr;pain @ site;h/a;backache;

VAERS ID:200420 (history)  Vaccinated:1997-11-27
Age:7.0  Onset:2003-03-07, Days after vaccination: 1926
Gender:Male  Submitted:2003-03-10, Days after onset: 3
Location:Michigan  Entered:2003-03-28, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0695E0 LA
Administered by: Public     Purchased by: Other
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: 03/07 was on amoxicillin , has thought it was allergic RX, but by late pm he was covered and had vesicles in various stages and remains that way with most on his trunk and hair.

VAERS ID:204625 (history)  Vaccinated:1997-11-27
Age:6.0  Onset:2003-05-01, Days after vaccination: 1981
Gender:Female  Submitted:2003-06-02, Days after onset: 32
Location:Michigan  Entered:2003-06-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Sensitive to soaps
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: 7-10 days after being around a child that developed chickenpox. Mom reports child had about 8 spots which lasted 4-5 days without fever.

VAERS ID:173955 (history)  Vaccinated:1997-11-27
Age:20.0  Onset:1998-06-01, Days after vaccination: 186
Gender:Male  Submitted:2002-02-03, Days after onset: 1343
Location:Foreign  Entered:2001-08-07, Days after submission: 180
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Depression; MS; Nystagmus; Pyramidal tract disorder; sensitive disorder; walking difficulty 2/97; 3/87 abscessed keratitits of the right eye; 1990 dyslexia-dysorthography; 10/95; vertigo on effort; 11/96 fatigue and hypersomnia
Diagnostic Lab Data: MRI-numerous hypersignals in white matter; parasite infection search-neg; LP-nml
CDC Split Type: 20010170861
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anxiety, Asthenia, Bacterial infection, Cerebellar syndrome, Coordination abnormal, Depression, Dizziness, Extensor plantar response, Gastritis, Gastrointestinal disorder, Multiple sclerosis, Nystagmus, Pyramidal tract syndrome, Sensory disturbance, Sinusitis, Vestibular disorder, Weight decreased
SMQs:, Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Optic nerve disorders (broad), Demyelination (narrow), Depression (excl suicide and self injury) (narrow), Vestibular disorders (narrow), Ocular motility disorders (narrow)
Write-up: On 11/27/97, the pt received a 1st injection of Engerix-B. With no delay precision, the pt developed asthenia. On 6/18/98, physical exam showed ataxia and nystagmus predominant in the right lateral glance. Audiogram was nml. Vestibular syndrome from central origin was observed. Then, the pt consulted a neurologist who observed multidirectional nystagmus predominant in the left lateral glance, lower limbs pyramidal disorder with predominant Babinski''s sign on the right side and superficial sensitive disorder (left hemi-body and face). Static cerebellar syndrome was observed. It was noticed that the pt''s condition was in progressive evolution from about 1 year. Thereafter, the pt''s condition had worsened. He was hospitalized. On 6/29/98, lab test showed negative result for Hep-B surface antigen and antibody. The pt initiated paracetamol/codeine (Efferalgan codeine). The pt also developed depression for which he was prescribed paroxetine (Deroxat). On 6/30/98, MRI showed hypersignals in white substance predominant in peri-ventricular area. At this time, the pt experienced also digestive disorder with greasy stools. In 6/98, the pt received bolus of an unspecified corticoid drug. In 7/98, gastroscopy revealed gastritis with antritis. Helicobacter Pylori were found. The pt was then treated with amoxicillin (Clamoxyl), clarithromycin (Zeclar) and antoprazole (Eupentol) for 7 days. At the beginning of 7/98, the pt was again hospitalized. MRI and LP were consistent with dx of multiple sclerosis. On 9/11/98, the pt''s condition had improved. Central cerebellar syndrome with multidirectional nystagmus was persistent but asymptomatic. In 11/98, the pt experienced MS flare-up, leading to hospitalization on 11/13/98. Moderate ataxia and nystagmus were observed, the pt was treated with corticoid drug (bolus) for 3 days. On 12/14/98, the pt''s condition had improved. On 12/29/98, the pt experienced another MS flare-up with medullary disturbance (D4 to D5). Sensitive disorder as well as pyramidal disorder were improving. Central c

VAERS ID:386021 (history)  Vaccinated:1997-11-27
Age:5.0  Onset:2000-04-01, Days after vaccination: 856
Gender:Male  Submitted:2010-04-26, Days after onset: 3676
Location:Foreign  Entered:2010-04-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Diagnostic laboratory test, 0.90, mercury level
CDC Split Type: WAES1004USA03653
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Allergy test, Autism, Blood count, Blood test, Disability, Hair metal test abnormal
SMQs:
Write-up: Initial information received on 26-OCT-2009, this case is not medically confirmed. This case is related to a general claim against the Foreign Ministry of Health related to all products containing thiomersal. The claim contains 65 cases among which 41 are related to vaccines. Furthermore, this case is also linked with 2 cases related to patients who dropped their complaints. The claim is not against Sanofi Pasteur MSD, this latter is only a third party, therefore some of the cases are poorly documented. Current case concerns a male patient (plaintiff n 27). The patient received the following vaccines: -4 doses of DTaP-Polio (manufacturer unknown, batch number, route and site of administration not reported) on 22-OCT-1994, DEC-1994 (exact date not reported), 07-MAR-1995 and AUG-2000 (exact date not reported). -2 doses of a MMR II (manufacturer unknown, batch number, route and site of administration not reported) on 19-OCT-1995 and JUN-2000 (exact -1 dose of Meningococcal C vaccine (manufacturer unknown, batch number, route and site of administration not reported) on 27-NOV-1997. According to the report, the patient was diagnosed with autism on APR-2000, exact date not reported, and had a disability grade of 75% which was evaluated on 30-DEC-2005. A test performed in a hair sample (dates not reported) showed that the patient had a mercury level of 0.90; normal range was below 0.40 (units not reported). According to the form received from the claimants, the following statements were included: Hair test, Blood count, Blood test, Food allergies test. In the form received from the claimants it was written "medical report: yes" but the company had not received it yet. Autism and hair mercury abnormal were considered to be disabling. This is one of several reports from the same source. Other business partner numbers included: E 2010-01896. Additional information has been requested.

VAERS ID:426022 (history)  Vaccinated:1997-11-27
Age:12.0  Onset:1999-12-27, Days after vaccination: 760
Gender:Female  Submitted:2011-06-23, Days after onset: 4195
Location:Foreign  Entered:2011-06-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Asthenia; Fever; Malaise; Ovarian cyst
Diagnostic Lab Data: UNK
CDC Split Type: B0726630A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 2IMRA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Appendicitis, Condition aggravated, Ovarian cyst, Surgery
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This case was reported by the foreign regulatory authority (RN20110398) and described the occurrence of appendicitis in a 14-year-old female subject who was vaccinated with ENGERIX B (GlaxoSmithKline). The patient had a medical history of fever, malaise, asthenia after unspecified vaccination and ovarian cyst. Co-suspect vaccination included non GSK combined diphtheria tetanus and poliomyelitis vaccine. On 27 March 1997, 22 May 1997 and 27 November 1997, the subject received one dose of ENGERIX B (intramuscular, batch number injection site unknown). On 05 December 1997, the subject received unspecified dose of non GSK combined diphtheria + tetanus and poliomyelitis vaccine (intramuscular, batch and injection site unknown). From 27 November to 29 December 1999, two years after the vaccination with ENGERIX B and diphtheria + tetanus and poliomyelitis vaccine, the subject was hospitalised for abdominal pain without identifiable etiology. On 31 December 1999, abdominal pain was persistent leading to the hospitalisation. She was found to have appendicitis and ovarian cyst and underwent surgery. At the time of reporting, the events were resolved without sequelae. According to the agency, based on the foreign method of assessment, the causal relationship between appendicitis and vaccination with ENGERIX B and combined diphtheria + tetanus and poliomyelitis vaccine was assessed as dubious.

VAERS ID:105465 (history)  Vaccinated:1997-11-28
Age:14.0  Onset:1997-11-29, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:1997-12-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma, migraine h/a;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)MASS. PUB HLTH BIOL LABDTP297 IM 
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2300A92IM 
Administered by: Private     Purchased by: Public
Symptoms: Oedema peripheral, Skin nodule, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt inadvertently given DTP (cellar) instead of Td;arm red, swollen, hard-cold compresses-Ibuprofen;

VAERS ID:105886 (history)  Vaccinated:1997-11-28
Age:26.0  Onset:1997-12-01, Days after vaccination: 3
Gender:Male  Submitted:1997-12-18, Days after onset: 17
Location:Florida  Entered:1997-12-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug ineffective, Infection, Injection site pain, Malaise
SMQs:, Lack of efficacy/effect (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: pt devel pain in lt upper arm @ inj site;pt also devel a varicella rash w/pustules on back & head;rash devel on trunk & arms, malaise & h/a;this occurred 11 days post vax;

VAERS ID:107207 (history)  Vaccinated:1997-11-28
Age:1.3  Onset:1997-12-04, Days after vaccination: 6
Gender:Female  Submitted:1997-12-11, Days after onset: 7
Location:Alaska  Entered:1998-02-02, Days after submission: 53
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling devel rash @ 15mo w/MMR dose 1
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: AK97027
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES4407442  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0736E0  
Administered by: Public     Purchased by: Public
Symptoms: Otitis media, Pyrexia, Rash, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: fever 4 1/2 days ago ( 6 days p/vax) fever ran for 3 days then a day later got a rash which has gotten worse;seen by provider 11 days p/vax for rash, runny nose, & OM w/temp of 98.9;

VAERS ID:107237 (history)  Vaccinated:1997-11-28
Age:  Onset:1997-11-28, Days after vaccination: 0
Gender:Female  Submitted:1998-01-14, Days after onset: 47
Location:New Mexico  Entered:1998-02-03, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49782720IM 
Administered by: Military     Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: tachycardia, syncope, localized itch which had onset of 30-40'' & lasted 6 hr;no tx necessary;

VAERS ID:110859 (history)  Vaccinated:1997-11-28
Age:15.3  Onset:1997-11-30, Days after vaccination: 2
Gender:Male  Submitted:1998-05-10, Days after onset: 160
Location:Michigan  Entered:1998-05-15, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2368A22 RA
Administered by: Private     Purchased by: Private
Symptoms: Injury, Oedema peripheral, Rash, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: black out-resulted in fall necessitating stitches on face-occurred p/last shot 36hr later;swelling in both hands, wrists & forearms occurred 36hr p/last host;migrating rash over 6wk period;tx antihistamines;

VAERS ID:111728 (history)  Vaccinated:1997-11-28
Age:1.3  Onset:1997-12-06, Days after vaccination: 8
Gender:Female  Submitted:1998-05-29, Days after onset: 173
Location:New Jersey  Entered:1998-06-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No Relevant Data;
Other Medications:
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98010884
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER 3IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0287E0IM 
Administered by: Private     Purchased by: Other
Symptoms: Cough, Infection, Pyrexia, Rash maculo-papular, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 28NOV97 & 6DEC97 pt exp nasal congestion & rectal temp 103+;fever persisted to 103 for 5 days;pt later exp a dry cough;9DEC97 pt devel small red dots neck & upper torso;dx measles rash;

VAERS ID:111891 (history)  Vaccinated:1997-11-28
Age:1.1  Onset:1998-05-01, Days after vaccination: 154
Gender:Male  Submitted:1998-06-08, Days after onset: 38
Location:Minnesota  Entered:1998-06-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0736E0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SCLL
Administered by: Public     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: got chickenpox;

VAERS ID:113094 (history)  Vaccinated:1997-11-28
Age:62.5  Onset:1997-11-28, Days after vaccination: 0
Gender:Female  Submitted:1998-07-30, Days after onset: 243
Location:Kentucky  Entered:1998-08-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: cerebral palsy;sulfa allergy
Diagnostic Lab Data:
CDC Split Type: WAES97120331
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Injection site hypersensitivity, Injection site mass, Injection site oedema
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 28NOV97 & pt exp a large local rxn of 5cm x 5cm w/swelling, redness & induration on the back of arm;also exp SOB:

VAERS ID:130621 (history)  Vaccinated:1997-11-28
Age:0.5  Onset:1997-12-01, Days after vaccination: 3
Gender:Male  Submitted:1999-09-28, Days after onset: 665
Location:Minnesota  Entered:1999-11-09, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: reactive airway disease
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM826A22IMLL
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURERM265RF2IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site atrophy
SMQs:
Write-up: p/vax 3.5 x 1.5cm defect in lt thigh w/complete loss of subcutaneous fat;sent to plastic surgery;

VAERS ID:315418 (history)  Vaccinated:1997-11-28
Age:1.0  Onset:2007-05-28, Days after vaccination: 3468
Gender:Female  Submitted:2008-05-16, Days after onset: 354
Location:Massachusetts  Entered:2008-05-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Fever, Nasal congestion
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0706USA01504
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0UNUN
Administered by: Private     Purchased by: Public
Symptoms: Cough, Rash, Varicella
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning a 10 year old white female with no known allergies or pertinent medical history who on 28-NOV-1997 was vaccinated with a first dose of varicella virus vaccine live (Oka/Merck). The patient had a fever and nasal congestion at the time of vaccination. On 28-MAY-2007 the patient developed a rash, nasal congestion, a cough and fever two days in duration. The patient was exposed to varicella and developed varicella lesions head to toe. It was unspecified if medical attention was sought. There were no lab studies performed. On 05-JUN-2007 the patient recovered. No further information is expected.

VAERS ID:107715 (history)  Vaccinated:1997-11-28
Age:0.4  Onset:1997-11-28, Days after vaccination: 0
Gender:Male  Submitted:1998-02-12, Days after onset: 76
Location:Foreign  Entered:1998-02-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: 29NOV97 head circumference 42.9cm;weight admission 6250GM;
CDC Split Type: 970310911
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM 0IM 
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS    
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Gait disturbance, Gastroenteritis, Hypertonia, Hypotonia, Somnolence, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (broad)
Write-up: pt recv vax 28NOV97 & 2-3hr p/vax pt devel hypotonic hyporesponsive episode;29NOV97 pt hosp;exp persisting head lag & step reflex still present;tone was down & needed to take weight on toes & fists clenched;v,gastroenteritis, lethargic;

VAERS ID:108661 (history)  Vaccinated:1997-11-28
Age:  Onset:1997-11-28, Days after vaccination: 0
Gender:Unknown  Submitted:1998-03-12, Days after onset: 104
Location:Foreign  Entered:1998-03-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: 1DEC97 alk phos 163;blood urea nitrogen 9;CSF protein 13;ESR 85;lymph 22;3DEC lymph 17;monocytes 2; 3DEC97 monocytes 7;lab test showed inc transaminase;1DEC97 segmented neutrophils 74;seg neutrophils 65;SGOT 137;SGPT 318;
CDC Split Type: 19980063731
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM219584   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, CSF test abnormal, Headache, Myalgia, Palpitations, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Pt recv vax 28NOV97 & the same day pt devel violent h/a, palpitation & fever 39-40C;30NOV97 fever had resolved;the same day pt hosp w/dx of febrile synd & typhoid fever obstruction;also myalgia & compromise of gen status;dx UTI

VAERS ID:108610 (history)  Vaccinated:1997-11-29
Age:6.0  Onset:1997-11-30, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: otitis;tonsillitis
Diagnostic Lab Data:
CDC Split Type: WAES97120242
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Bone pain, Gait disturbance, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Osteonecrosis (broad)
Write-up: pt recv vax 29NOV97 & evening of 30NOV97 pt devel a mild fever, bone aches, weakness & diff walking which lasted approx 12hr;

VAERS ID:153097 (history)  Vaccinated:1997-11-29
Age:1.0  Onset:2000-04-05, Days after vaccination: 858
Gender:Female  Submitted:2000-04-06, Days after onset: 1
Location:Arizona  Entered:2000-06-08, Days after submission: 63
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES70919053IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0482E0SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0964E0SC 
Administered by: Private     Purchased by: Other
Symptoms: Pyrexia, Rash pustular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Pustulant rash on trunk, chest, and thigh area. Also, had fever per mom.

VAERS ID:163191 (history)  Vaccinated:1997-11-29
Age:5.0  Onset:2000-11-10, Days after vaccination: 1077
Gender:Male  Submitted:2000-11-17, Days after onset: 7
Location:Texas  Entered:2000-12-06, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Healthy child
Diagnostic Lab Data: Viral culture sent 11/17/00
CDC Split Type: TX00154
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (TRI-IMMUNOL)LEDERLE LABORATORIES431966B3IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS431966A3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0877D SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0560D SCRA
Administered by: Public     Purchased by: 0
Symptoms: Herpes zoster, Infection
SMQs:
Write-up: The patient has extensive and severe shingles covering most of his right shoulder, anterior and posterior. Treatment started with Zovirax 11/17/00.

VAERS ID:521787 (history)  Vaccinated:1997-11-29
Age:24.0  Onset:2014-01-27, Days after vaccination: 5903
Gender:Female  Submitted:2014-02-04, Days after onset: 8
Location:Unknown  Entered:2014-02-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Titer drawn (27-JAN-2014): the patient was immune to measles and mumps but an equivocal rubella titer
CDC Split Type: WAES1402USA000421
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1SCUN
Administered by: Other     Purchased by: Other
Symptoms: Concussion, Road traffic accident, Rubella antibody negative
SMQs:, Accidents and injuries (narrow)
Write-up: This spontaneous report as received from a medical assistant refers to a 24 year old female patient. Patient''s medical history and drug reactions/allergies were not reported. On 03-NOV-1990, the patient was vaccinated with MMR II dose 1 for routine. On 29-NOV-1997, the patient was vaccinated with MMR II dose 2 for routine. On 17-JAN-2014, the patient was in a car accident and sustained mild concussion. On 27-JAN-2014, the patient had titer drawn and the titer results showed that she was immune to measles and mumps but an equivocal rubella titer. No treatment was given for the adverse event. The outcome of equivocal rubella titer and the patient was in a car accident and sustained mild concussion was unknown. Additional information has been requested.

VAERS ID:117196 (history)  Vaccinated:1997-11-29
Age:5.0  Onset:1998-03-24, Days after vaccination: 115
Gender:Female  Submitted:1998-03-24, Days after onset: 0
Location:Foreign  Entered:1998-12-08, Days after submission: 259
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: MAR98 ALAT 117;creatine phos 2440;MAR98 adenovirus serology negative;coxsackie virus serology negative;cytomegalovirus serology negative;echo virus serology negative;epstein barr virus serology positive;parainfluenza virus serology negative
CDC Split Type: 19980283641
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Blood creatine phosphokinase increased, Lymphocytosis, Myalgia, Myositis, Pyrexia, Rhinitis, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: pt recv vax 29NOV97 & JAN & FEB98 pt suffered from asthenia;pt then devel an episode of rhinitis, vomiting, fever & wash hosp MAR98 c/o pain in lower limbs w/fever;creatine phos inc; ALAT inc 117;dx myositis;

VAERS ID:120593 (history)  Vaccinated:1997-11-29
Age:  Onset:1997-12-29, Days after vaccination: 30
Gender:Female  Submitted:1999-03-23, Days after onset: 449
Location:Foreign  Entered:1999-03-26, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: WAES99031291
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: pt recv vax 29NOV97 & 29DEC97 pt had a voluntary termination of pregnant;

VAERS ID:112570 (history)  Vaccinated:1997-11-30
Age:31.5  Onset:1997-12-02, Days after vaccination: 2
Gender:Male  Submitted:1998-06-11, Days after onset: 190
Location:Foreign  Entered:1998-07-13, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: EML971019
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E71009BD1   
Administered by: Other     Purchased by: Other
Symptoms: Amnesia, Confusional state, Delirium, Headache, Paraesthesia, Pharyngitis
SMQs:, Agranulocytosis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad)
Write-up: pt devel memory loss, confusion, delirium, h/a, sore throat & numbness/tingling in arms;pt spouse called PMD who advised to take to hosp;

VAERS ID:105426 (history)  Vaccinated:1997-12-01
Age:0.3  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1997-12-02, Days after onset: 1
Location:California  Entered:1997-12-05, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: pending EEG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES4478331IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM165RH1IMLL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIESM11861IMLL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: tonic/clonic brief afeb sz;10hr p/vax no tx;

VAERS ID:105433 (history)  Vaccinated:1997-12-01
Age:0.2  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1997-12-02, Days after onset: 1
Location:Texas  Entered:1997-12-05, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES7J815440IM 
HIBV: HIB (PROHIBIT)CONNAUGHT LABORATORIES7H915490IM 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4490880PO 
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Anorexia, Injection site hypersensitivity
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: large red area surrounding site of immun;pt screaming w/in 30min of vax;fussy w/dec appetite, but not fever;no tx required;pt was better on 2DEC97;

VAERS ID:105447 (history)  Vaccinated:1997-12-01
Age:41.3  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1997-12-03, Days after onset: 2
Location:Virginia  Entered:1997-12-08, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: throat full of pus
CDC Split Type: VA97061
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2214A42IMLA
Administered by: Public     Purchased by: Private
Symptoms: Laryngospasm, Muscle twitching, Pharyngitis, Speech disorder, Tinnitus, Tongue oedema
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Oropharyngeal infections (narrow), Oropharyngeal allergic conditions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (narrow), Hypersensitivity (narrow)
Write-up: 6hr p/vax pt exp ringing in ears w/sore throat;during the noc devel muscle contraction (uncontrollable) of legs/feet & hands lasting 4-5hr;awoke w/thick tongue, unable to talk, cont ringing, felt like throat closing;

VAERS ID:105558 (history)  Vaccinated:1997-12-01
Age:60.6  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1997-12-01, Days after onset: 0
Location:Colorado  Entered:1997-12-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: severe local rxn, flu sx lasting 3-4wk p/inj age 45-45 flu vax
Other Medications: Furosemide, Atenolol, vasotec, cardizem, k-tabs, clariten, ogen, glynase, glucophage, keflex
Current Illness: diabetes mellitus type ii;controlled HTn, had oral surgery 24NOV;
Preexisting Conditions: PCN, cleocin, erythromycin, sulfa, codeine, ASA, phenobarb, morphine, darvon, APAP, thorazine, talwin, fluogen, housedust, molds,pollens & many foods;
Diagnostic Lab Data: blood sugar tested was 139;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2424A22IMLA
Administered by: Private     Purchased by: Private
Symptoms: Condition aggravated, Dizziness, Dyspepsia, Dyspnoea, Hyperglycaemia, Hypertension, Hypothermia, Hypoventilation, Visual disturbance
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Accidents and injuries (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: 10min p/vax pt devel spotty vision, lightheadedness, SOB, heaviness in chest, shakiness & nausea, BP 56/67, P65, R12 no wheezing;T96.6;solumedrol;230PM felt significantly better remainder of day cont w/sl epigastric discomfort & lethargy

VAERS ID:105634 (history)  Vaccinated:1997-12-01
Age:32.3  Onset:1997-12-03, Days after vaccination: 2
Gender:Female  Submitted:1997-12-04, Days after onset: 1
Location:Virginia  Entered:1997-12-12, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergies to dust, mold, dogs;
Diagnostic Lab Data: white count 27,900;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH   LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1054D0 RA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Leukocytosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: redness, swelling inj site, fever 101, white count 27,900;

VAERS ID:105710 (history)  Vaccinated:1997-12-01
Age:13.1  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1997-12-02, Days after onset: 1
Location:New York  Entered:1997-12-16, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: BA045
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0336P0 LA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Hyperventilation, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: pt c/o chest pain p/vax;breath sounds present & clear;P80, R20, skin warm to touch, negative urticaria, hives, & cyanosis;

VAERS ID:105817 (history)  Vaccinated:1997-12-01
Age:  Onset:1997-12-09, Days after vaccination: 8
Gender:Unknown  Submitted:0000-00-00
Location:New York  Entered:1997-12-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: unk
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0336D0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 1DEC97 & c/o 9DEC97 of redness & soreness @ site of inj;seen by PMD;10DEC97 dx cellulitis lt arm tx augmentin & DPH;f/u as 15DEC97 PMD & mom requests not recv #2 & #3 vax of hep b;

VAERS ID:105946 (history)  Vaccinated:1997-12-01
Age:1.7  Onset:1997-12-22, Days after vaccination: 21
Gender:Male  Submitted:1997-12-26, Days after onset: 4
Location:Vermont  Entered:1998-01-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM826A23IMLA
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM350PN3IMRA
Administered by: Private     Purchased by: Public
Symptoms: Abscess
SMQs:
Write-up: sterile abscess lt shoulder;

VAERS ID:106181 (history)  Vaccinated:1997-12-01
Age:0.2  Onset:1997-12-02, Days after vaccination: 1
Gender:Female  Submitted:1997-12-05, Days after onset: 3
Location:New Jersey  Entered:1998-01-07, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4478310 L
HIBV: HIB (HIBTITER)LEDERLE PRAXSISM165RH0  
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.M12950  
Administered by: Private     Purchased by: Unknown
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: episode high pitch screaming for 2-3hr since recv vax on 1DEC;diff to console;

VAERS ID:106858 (history)  Vaccinated:1997-12-01
Age:29.5  Onset:1997-12-14, Days after vaccination: 13
Gender:Female  Submitted:1998-01-12, Days after onset: 29
Location:New Jersey  Entered:1998-01-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: lab - varicell zoster was isolated & DFA was pos
CDC Split Type: WAES97121035
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0805E0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Arthralgia, Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: pt recv vax 1DEC97 & 15DEC97 pt exp rash, arthralgia & fever;

VAERS ID:106671 (history)  Vaccinated:1997-12-01
Age:39.6  Onset:1997-12-08, Days after vaccination: 7
Gender:Female  Submitted:1997-12-15, Days after onset: 7
Location:Virginia  Entered:1998-01-20, Days after submission: 36
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: VA97063
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7F91700 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site oedema, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax 1DEC approx 1 wk later arms swelled & became very tender;pt visited hlth dept today 15DEC & reporter saw no erythema;denies fever;swelling significant & covers entire deltoid;

VAERS ID:106953 (history)  Vaccinated:1997-12-01
Age:35.4  Onset:1997-12-02, Days after vaccination: 1
Gender:Female  Submitted:1997-12-04, Days after onset: 2
Location:Georgia  Entered:1998-01-26, Days after submission: 53
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications:
Current Illness: NONE
Preexisting Conditions: migraines/back pain
Diagnostic Lab Data:
CDC Split Type: GA97151
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81916 IMRA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM23000B60IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0950D0IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7C91574 IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Insomnia, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 1DEC97 & states 2DEC97 devel a rash-slept little that noc saw pvt MD 3DEC97 & was given med;T102.9;

VAERS ID:107694 (history)  Vaccinated:1997-12-01
Age:66.4  Onset:1997-12-02, Days after vaccination: 1
Gender:Female  Submitted:1998-02-16, Days after onset: 76
Location:Michigan  Entered:1998-02-17, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA, breast CA hx
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49781410IMRA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4481680SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: lt arm (upper) edematous & pruritic w/ 3" diameter erythema lasted couple days;used cool compress & DPH;resolved w/o further tx;

VAERS ID:108635 (history)  Vaccinated:1997-12-01
Age:12.1  Onset:1997-12-01, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Oklahoma  Entered:1998-03-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98010005
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Grand mal convulsion, Myasthenic syndrome, Urinary incontinence
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: pt recv vax & 15min post vax exp a typical sz which lasted 15min;pt was tired afterwards & recovered;

VAERS ID:109935 (history)  Vaccinated:1997-12-01
Age:  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-04-15, Days after onset: 134
Location:Maine  Entered:1998-04-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: Unk
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: DEC97 diagnostic lab test not immune p/1st dose of varicella virus vax;
CDC Split Type: WAES97121616
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 2 wk post vax pt devel "three red dots".

VAERS ID:110080 (history)  Vaccinated:1997-12-01
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:1998-04-15
Location:Connecticut  Entered:1998-04-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98012043
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0805E SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abscess, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: pt recv vax DEC97 & pt exp a sterile abscess @ inj site which was like a marble under the skin;

VAERS ID:110103 (history)  Vaccinated:1997-12-01
Age:  Onset:0000-00-00
Gender:Female  Submitted:1998-04-15
Location:Unknown  Entered:1998-04-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98012304
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pt recv vax DEC97 & exp a swollen arm w/a fever of 102;pt required a visit to ER;@ time of report pt had not yet been administered a second dose;

VAERS ID:110941 (history)  Vaccinated:1997-12-01
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:1997-12-10
Location:Louisiana  Entered:1998-05-15, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898015015L
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES447832 IM 
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: This is 1 of 3 infants from this facility to devel fever,inconsolable crying & irritability p/vax.

VAERS ID:110942 (history)  Vaccinated:1997-12-01
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:1997-12-10
Location:Louisiana  Entered:1998-05-15, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898015016L
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES447832 IM 
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS    
Administered by: Private     Purchased by: Other
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: This is 1 of 3 infants from this facility to devel high fever,inconsolable crying & irritability p/vax w/lot #447832

VAERS ID:110943 (history)  Vaccinated:1997-12-01
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:1997-12-10
Location:Louisiana  Entered:1998-05-15, Days after submission: 155
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898015017L
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES447832 IM 
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS    
Administered by: Private     Purchased by: Other
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: This is 1 of 3 infants from this facility to devel high fever,inconsolable crying & irritability p/vax w/lot #447832.

VAERS ID:111238 (history)  Vaccinated:1997-12-01
Age:53.3  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-02-05, Days after onset: 66
Location:Washington  Entered:1998-05-27, Days after submission: 110
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: other "skin reactions", for which no cause was found
Diagnostic Lab Data:
CDC Split Type: 898049001L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH 0IM 
Administered by: Private     Purchased by: Other
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 1 wk p/vax pt devel generalized rash of red,pruritic bumps.Pt seen by MD(allergist) & cause of rash not determined. Pt tx w/unspecified prescribed med. Exp most relief w/Benadryl oral & cream. Rash persisted as of 02/05/98.

VAERS ID:111715 (history)  Vaccinated:1997-12-01
Age:  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-05-29, Days after onset: 178
Location:Unknown  Entered:1998-06-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES97120177
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Face oedema, Hypersensitivity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax 1DEC97 & exp an allerg rxn described as urticaria & swelling of lips;there was no laryngeal edema;

VAERS ID:111718 (history)  Vaccinated:1997-12-01
Age:1.6  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-05-29, Days after onset: 178
Location:Pennsylvania  Entered:1998-06-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: 3DEC97 ultrasound 8-12 wk gestation;beta-human chorionic gon positive;lab test 1995 positive rubella titer;lab test 1997 negative rubella titers;
CDC Split Type: WAES97120808
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 2IM 
Administered by: 0     Purchased by: 0
Symptoms: Unevaluable event
SMQs:
Write-up: pt recv vax 1DEC97 & pt was found to be pregnant by a urine pregnancy test;An ultrasound was performed on 3DEC97 which indicated the fetus was 8-12wk gestation;

VAERS ID:113139 (history)  Vaccinated:1997-12-01
Age:12.9  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-07-30, Days after onset: 240
Location:New York  Entered:1998-08-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: UNK
Preexisting Conditions: Immunologic disorder
Diagnostic Lab Data: UNK
CDC Split Type: WAES98031458
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1278E0SC 
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax and one hour later exp fever, redness and swelling of her arm twice it''s normal size. Pt tx=prednisone for three days.

VAERS ID:113564 (history)  Vaccinated:1997-12-01
Age:0.3  Onset:1997-12-21, Days after vaccination: 20
Gender:Male  Submitted:1998-08-12, Days after onset: 233
Location:California  Entered:1998-08-24, Days after submission: 12
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: healthy term male infant
Diagnostic Lab Data: EEG hypsarrthythmia, negative metabolic workup;MRI minor atrophic, nl;bifrontal changes chromosomes;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7L816731 LL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1177E1 RL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.L12211 RL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Electroencephalogram abnormal, Mental retardation severity unspecified, Muscle spasms, Neuropathy
SMQs:, Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: pt recv vax 1DEC97 & devel myoclonic sz 21DEC97;hosp 25DEC-28DEC w/dx infantile spasms assoc w/ characteristic EEG hypsarrhythmia;sz have been uncontrolled despite med;severe delayed development;

VAERS ID:114574 (history)  Vaccinated:1997-12-01
Age:  Onset:1997-12-02, Days after vaccination: 1
Gender:Female  Submitted:1997-12-05, Days after onset: 3
Location:Pennsylvania  Entered:1998-09-30, Days after submission: 298
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 898006008L
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4481740IMA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: pt recv vax & w/in 24hr devel redness & pain @ the site of vax;tx w/DPH;

VAERS ID:115804 (history)  Vaccinated:1997-12-01
Age:11.0  Onset:1997-12-01, Days after vaccination: 0
Gender:Male  Submitted:1998-10-26, Days after onset: 329
Location:Illinois  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type: 19980007131
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IM 
Administered by: Public     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: pt recv vax 1DEC97 & that evening pt exp leg pain;pt cont to exp leg pain @ noc until 6DEC97;

VAERS ID:115813 (history)  Vaccinated:1997-12-01
Age:11.9  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 329
Location:California  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt recv vax & eyelids swelled up & eyelash loss w/engerix b #1 dose;
Other Medications: NONE
Current Illness:
Preexisting Conditions: allergy
Diagnostic Lab Data:
CDC Split Type: 19980030211
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Adverse drug reaction, Eye disorder, Face oedema, Similar reaction on previous exposure to drug
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: pt recv vax DEC97 & w/in 2 days had no eyelashes;follow up from responsible MD reveals 19JAN98 6 days p/vax pt mom called MD & stated child lost eyelashes & eyes puffy but not bad;

VAERS ID:115949 (history)  Vaccinated:1997-12-01
Age:30.0  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-10-26, Days after onset: 329
Location:Florida  Entered:1998-11-02, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp soreness @ inj site w/hep b dose 2 @ age 30
Other Medications:
Current Illness:
Preexisting Conditions: syncope
Diagnostic Lab Data:
CDC Split Type: 19980117491
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1  
Administered by: Private     Purchased by: Private
Symptoms: Adverse drug reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv 3rd dose of vax & exp a syncopal episode;pt was seen in ER where the event was considered to have resolved;MD did not feel that this event was r/t vax;

VAERS ID:117761 (history)  Vaccinated:1997-12-01
Age:24.3  Onset:1998-11-22, Days after vaccination: 356
Gender:Female  Submitted:1998-12-21, Days after onset: 29
Location:Indiana  Entered:1998-12-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations: Pt recv #1 HB vax 12/1/97; pt exp flu-like sx
Other Medications: Ventolin, Cough/cold/flu therapies, Herbal remedies, Ibuprofen, Insulin
Current Illness: UNK
Preexisting Conditions: Diabetes mellitus-insulin dependent
Diagnostic Lab Data: UNK
CDC Split Type: WAES98120875
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Public     Purchased by: Public
Symptoms: Adverse drug reaction, Condition aggravated, Hyperglycaemia, Pyrexia, Urinary tract infection
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt recv vax on 11/17/98; on 11/23/98 pt exp fever (103-104); pt hosp; 12/3/98 pt exp fever & glucose level was off

VAERS ID:118263 (history)  Vaccinated:1997-12-01
Age:27.8  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-03-25, Days after onset: 114
Location:Connecticut  Entered:1999-01-21, Days after submission: 302
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: 898085031A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (ACETONE INACTIVATED DRIED)PFIZER/WYETH49780070SCA
Administered by: Military     Purchased by: Military
Symptoms: Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Pt recv vax in 12/97; immediately post vax pt exp respiratory distress & nausea x 1 day

VAERS ID:119645 (history)  Vaccinated:1997-12-01
Age:41.4  Onset:1997-12-10, Days after vaccination: 9
Gender:Male  Submitted:1998-11-19, Days after onset: 344
Location:California  Entered:1999-02-26, Days after submission: 99
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Sciatica
Diagnostic Lab Data: EMG-confirms brachial neuritis
CDC Split Type: U199800106
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES49788167  LA
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain, Myasthenic syndrome, Neuritis
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt recv vax on 12/1/97; approx 12/10/97 pt exp brachial neuritis, pain at vax site-LA; weak left hand

VAERS ID:119647 (history)  Vaccinated:1997-12-01
Age:53.3  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-11-19, Days after onset: 353
Location:Pennsylvania  Entered:1999-02-26, Days after submission: 99
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U199800201
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES7F81740   
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt recv vax on 12/1/97; on same day pt exp local rxn of redness, swelling & soreness

VAERS ID:119655 (history)  Vaccinated:1997-12-01
Age:54.6  Onset:0000-00-00
Gender:Female  Submitted:1998-11-19
Location:Florida  Entered:1999-02-26, Days after submission: 99
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U199800209
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES    
Administered by: Other     Purchased by: Other
Symptoms: Chills, Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt recv vax in 12/97; 1-2 days post vax pt exp swollen vax site, fever (104F) w/ shaking chills

VAERS ID:119991 (history)  Vaccinated:1997-12-01
Age:31.0  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1999-03-01, Days after onset: 455
Location:California  Entered:1999-03-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98090480
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 1DEC97 & devel a rash;the pt rash occurred on a daily basis;tx w/unspecified med;pt noted that whenever she goes off the med the rash recurs;

VAERS ID:123155 (history)  Vaccinated:1997-12-01
Age:  Onset:1998-04-21, Days after vaccination: 141
Gender:Female  Submitted:1999-05-14, Days after onset: 388
Location:Michigan  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: lab te: virology test, 4/21/98 - no virus
CDC Split Type: WAES98051417
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0 RA
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Otitis media, Pyrexia, Skin discolouration
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: MD rpt pt recv varivax in 12/97 & in 4/98 pt exp herpes zoster rash, otitis media, & low grade fever. treated w/amoxicillin. recovered from rash but left hyperpigmented scar which healed

VAERS ID:123496 (history)  Vaccinated:1997-12-01
Age:1.1  Onset:1998-06-05, Days after vaccination: 186
Gender:Male  Submitted:1999-05-14, Days after onset: 343
Location:New York  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No Relevant Data
Other Medications: unk
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES98060930
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0344E0SC 
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster, Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: pt recv vax & presented to MD office w/fever & shingles;

VAERS ID:123735 (history)  Vaccinated:1997-12-01
Age:9.0  Onset:1998-06-19, Days after vaccination: 200
Gender:Female  Submitted:1999-05-14, Days after onset: 329
Location:Minnesota  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES98071792
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Cough, Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: p/ pt vax in 12/97 in 6/98 pt devel chickenpox rash, productive cough & fever. it was noted pt was densely covered.

VAERS ID:124156 (history)  Vaccinated:1997-12-01
Age:37.3  Onset:0000-00-00
Gender:Female  Submitted:1999-05-14
Location:Maryland  Entered:1999-05-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: neg varicella antibody titer
CDC Split Type: WAES98102106
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: p/ pt recv vax in 12/97 pt exp a lack of seroconversion

VAERS ID:150522 (history)  Vaccinated:1997-12-01
Age:5.0  Onset:1998-01-01, Days after vaccination: 31
Gender:Male  Submitted:2000-03-24, Days after onset: 813
Location:California  Entered:2000-03-29, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00031684
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Coordination abnormal, Eye disorder, Myoclonus, Nervous system disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: Information has been received from a doctor of pharmacy concerning a 5 year old male pt who in December of 1997 was vaccinated with MMR and Varicella vaccines. In January of 1998, the pt was dx with CNS complications including ataxia, myoclonus, opsoclonus.

VAERS ID:155838 (history)  Vaccinated:1997-12-01
Age:1.5  Onset:2000-03-05, Days after vaccination: 825
Gender:Female  Submitted:2000-05-16, Days after onset: 71
Location:Texas  Entered:2000-06-29, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00030749
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: 0     Purchased by: 0
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)
Write-up: Post vax, the pt developed varicella along with 3 of her classmates. The pt had between 50-75 lesions and sought unspecified medical attention. Follow up data states the patient was febrile. On an unspecified date in March, 2000 the patient recovered. No further information is available. .

VAERS ID:308422 (history)  Vaccinated:1997-12-01
Age:0.1  Onset:1998-12-31, Days after vaccination: 395
Gender:Male  Submitted:2008-03-27, Days after onset: 3373
Location:Texas  Entered:2008-03-27
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Premature Birth, Intercranial Hemorrhage
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSENG2424A20IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: No adverse reaction
SMQs:
Write-up: No adverse events noted. HepB given 3 days before discharge from NICU.

VAERS ID:423108 (history)  Vaccinated:1997-12-01
Age:2.0  Onset:1999-01-01, Days after vaccination: 396
Gender:Female  Submitted:2011-05-12, Days after onset: 4513
Location:Unknown  Entered:2011-05-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Sulfonamide allergy; Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1004USA03548
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Henoch-Schonlein purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Vasculitis (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 3 year old female with sulfonamide and amoxicillin allergy and no pertinent medical history, who in December 1997, was vaccinated with a dose of VARIVAX (Merck) (lot # ). There was no concomitant medication. The physician reported that in January 1999, the patient developed severe Henoch-Shonlein purpura after administration of VARIVAX (Merck). The patient was hospitalized and treated with steroids. On an unknown date, the patient recovered from Henoch-Shonlein purpura. Additional information has been requested.

VAERS ID:105664 (history)  Vaccinated:1997-12-01
Age:1.0  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Foreign  Entered:1997-12-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 970284221
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM 2  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Angioneurotic oedema, Injection site reaction
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: pt recv vax & exp quincke''s edema some min p/vax;

VAERS ID:106933 (history)  Vaccinated:1997-12-01
Age:74.0  Onset:1997-12-01, Days after vaccination: 0
Gender:Male  Submitted:1998-01-21, Days after onset: 51
Location:Foreign  Entered:1998-01-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions:
Diagnostic Lab Data: unk
CDC Split Type: WAES98010429
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypokinesia, Injection site pain, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: pt recv vax DEC97 & later that same day exp local pain in arm where the inj had been done;evening also presented a loss of mobility in that arm;next morning pain persisted & presented to MD;same evening became sick presenting n/v & malaise;

VAERS ID:107901 (history)  Vaccinated:1997-12-01
Age:23.0  Onset:1997-12-01, Days after vaccination: 0
Gender:Female  Submitted:1998-02-25, Days after onset: 86
Location:Foreign  Entered:1998-03-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hx of specific allergy (non-drug)
Diagnostic Lab Data:
CDC Split Type: 1998004873
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM    
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM533A6 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Chills, Dizziness, Laryngospasm, Paraesthesia oral, Shock, Tongue disorder
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: pt recv vax 1DEC97 & w/in 5min of vax pt felt faint, shivery & dizzy & devel throat tightness & a tingling tongue, numbness in mouth, tiredness & peripheral shutdown;pt hosp for the event;

VAERS ID:114477 (history)  Vaccinated:1997-12-01
Age:14.0  Onset:1998-03-18, Days after vaccination: 107
Gender:Male  Submitted:1998-09-25, Days after onset: 190
Location:Foreign  Entered:1998-09-29, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19980237011
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 2  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dysphagia, Laboratory test abnormal, Neuropathy, Tongue disorder
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)
Write-up: pt recv vax DEC97 & 18MAR98 approx 3mo p/vax pt devel a demyelinating disease;

VAERS ID:129614 (history)  Vaccinated:1997-12-01
Age:33.0  Onset:1999-08-01, Days after vaccination: 608
Gender:Female  Submitted:1999-10-18, Days after onset: 78
Location:Foreign  Entered:1999-10-21, Days after submission: 3
Life Threatening? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: WAES99031426
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Gastrointestinal haemorrhage, Hepatic neoplasm
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Tumours of unspecified malignancy (narrow), Liver tumours of unspecified malignancy (narrow)
Write-up: p/vax pt devel a liver tumor;pt died after experiencing an intra-abdominal hemorrhage as a result of a liver puncture;MD felt the tumor was not r/t vax;

VAERS ID:168613 (history)  Vaccinated:1997-12-01
Age:39.0  Onset:1998-04-01, Days after vaccination: 121
Gender:Female  Submitted:2001-04-09, Days after onset: 1103
Location:Foreign  Entered:2001-04-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Herbal remedies (unspecified)
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: SGOT-$g20-fold ULN; viral serology was negative; the immunological parameters were normal and there was no intake of pharmaceutical drugs. Transaminases essentially normalized within 6 weeks. A liver biopsy-showed non-specific moderate chron
CDC Split Type: 200100853221
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 2IM 
Administered by: 0     Purchased by: 0
Symptoms: Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Granuloma, Hepatitis, Laboratory test abnormal, Liver function test abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: In July 1997, a 1st dose of Engerix B was given. In 1997, a 2nd dose of Engerix B was given. In Dec 1997, a 3rd dose of Engerix B was given. In 1998, 5 months after the last vaccination, the subject developed abdominal pain. She was hospitalized and a diagnosis of Hepatitis was made. SGPT were found greater that 20-fold ULN upper limit normal value. The etiology was unclear, the viral serology was negative, the immunological parameters were normal and there was no intake of pharmaceuticals drugs. The subject recovered promptly and the transaminases essentially normalized within 6 weeks. On 01/22/01, 2 years later, she developed an almost identical Hepatitis. During hospitalization, the same investigations then also including HCV-RNA were made and were negative. A liver Biopsy showed a nonspecific moderate chronic Hepatitis without cholestasis, but with a single granuloma. The subject did not take drugs, but as before, a moderate intake of various herbal remedies of unknown origin. The subject recovered promptly and completely.

VAERS ID:179017 (history)  Vaccinated:1997-12-01
Age:29.0  Onset:2001-02-01, Days after vaccination: 1158
Gender:Male  Submitted:2002-05-31, Days after onset: 483
Location:Foreign  Entered:2001-12-14, Days after submission: 167
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U2001012500
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEUR  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Headache, Infection, Insomnia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: It was reported that 24 French soldiers (among a unit of about 100 soldiers based in the Ivory Coast) presented, between mid-August and mid-September 2001, with food-borne infections. For 5 of them, the dx of Typhoid fever was confirmed on blood culture. For the others, the dx was not confirmed at the time of the reports but they all presented with the same clinical signs. All the soldiers had been vaccinated within the 5 years preceding the onset of Typhoid fever. All pts were recovered at the time of the report (10/19/01) but duration of symptoms were not reported. After questioning of the soldiers, the suspect food was found to be a cucumber salad eaten on 8/14/01. Among the 45 persons exposed, 24 men developed Typhoid fever (among them 1 was vaccinated with Typherix, other mfr, the 23 others were vaccinated with Typhim VI). Only 5 blood cultures could be performed (because there was not enough material to perform them in all pts) and were positive for Salmonella Typhi. The other cases (with no blood culture performed), were considered as strongly probable cases of Typhoid fever because of the similar symptoms. The mean latency of onset of symptoms was 24 days. The mean temperature was 40.2C. All pts were hospitalized, treated with ofloxacin and recovered (duration not reported). Pt #14: False Typhoid Vaccine Failure: 29 year old man, vaccinated with Typhoid vaccine on 12/1/97, 4 years before onset of symptoms. To be noticed that army recommendation is to re-vaccinate soldiers every 5 years (not consistent with French official recommendation: every 3 years). According to this data, an analysis was performed: the mean period between vaccination and date of onset of symptoms (9/01) was longer in infected pts than in non-infected pts. The risk was multiplied by 4.4 in the pts vaccinated since more than 3 years compared to pts vaccinated since less than 3 years. File to be completed. From follow up correspondence received at manufacturer on 5/31/02 states: this survey was presented on 15-18 May 02. An abstract cou

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