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VAERS ID:359511 (history)  Vaccinated:2009-09-29
Age:42.0  Onset:2009-09-29, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 7
Location:New Jersey  Entered:2009-10-06
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LA
Administered by: Public     Purchased by: Private
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Severe Arm pain -- now lasting for a week and not ending. Extra strength Tylenol has helped very little.

VAERS ID:359512 (history)  Vaccinated:2009-09-24
Age:55.0  Onset:2009-09-24, Days after vaccination: 0
Gender:Female  Submitted:2009-09-24, Days after onset: 0
Location:Louisiana  Entered:2009-10-05, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97841P20IMUN
Administered by: Other     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injection site haematoma, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Immediate swelling at injection site w/ bruising.

VAERS ID:359513 (history)  Vaccinated:2009-09-30
Age:42.0  Onset:2009-09-30, Days after vaccination: 0
Gender:Male  Submitted:2009-10-05, Days after onset: 5
Location:California  Entered:2009-10-05
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: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURV3186AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient reported itchiness at injection site that spread moving down left arm. No swelling noted redness noted down left arm to hand. Pt continued to report itchiness. Pt treated with BENADRYL 50mg/ml IM right deltoid at 10:56 am by PHN.

VAERS ID:359514 (history)  Vaccinated:2009-10-03
Age:12.0  Onset:2009-10-03, Days after vaccination: 0
Gender:Female  Submitted:2009-10-03, Days after onset: 0
Location:Arizona  Entered:2009-10-05, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Denies
Current Illness: No
Preexisting Conditions: Denies
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0072X1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Malaise
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Rec''d shot in L arm and states feel "sick" lightheaded-protected on chair lowered head & knees -encouraged to take deep deep breaths- Mom @side. Stated this always happens "she''ll be fine" assisted to BR per request. Mom @ side helped to toilet seat, voided, cool cloths to back if sick. "I want to go home"- Mom went to get car stayed with pt. assisted safely to car encouraged to call prn for assist 1330 called LMom if any questions call prn. a take to family dr. a ER if concerns.

VAERS ID:359515 (history)  Vaccinated:2009-09-24
Age:0.5  Onset:2009-09-27, Days after vaccination: 3
Gender:Female  Submitted:2009-10-05, Days after onset: 8
Location:Arizona  Entered:2009-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TOPAMAX
Current Illness: Well
Preexisting Conditions: Infantile spasms
Diagnostic Lab Data: (+) Hz of infantile spasms; Last E*EG in 9/14/09, no hyperarrythmia
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3397AB2IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.007172PO 
Administered by: Private     Purchased by: Public
Symptoms: Electroencephalogram normal, Injection site mass, Opisthotonus, Screaming, Staring
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (narrow), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad)
Write-up: (+) arching back; (+) screaming after waking up; (+) staring spells; lump in (L) thigh (injection site).

VAERS ID:359516 (history)  Vaccinated:2009-10-01
Age:5.0  Onset:2009-10-01, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Missouri  Entered:2009-10-05
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
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSSPAC20B115AA0UNLA
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500688P0IN 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0563Y1UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0978Y1UNUN
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling at injection site. Tx: BENADRYL

VAERS ID:359517 (history)  Vaccinated:2009-09-29
Age:4.0  Onset:2009-09-30, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:2009-10-06
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
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500673P1IN 
Administered by: Private     Purchased by: Unknown
Symptoms: Rash macular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 24 hours post vaccination, started with blotchy rash to back of neck and ankles, was given BENADRYL and woke in AM of 10/01/2009 with rash that was raised welts, whitish extending onto face and head. Diagnosed as urticaria.

VAERS ID:359518 (history)  Vaccinated:2009-09-25
Age:57.0  Onset:2009-09-27, Days after vaccination: 2
Gender:Female  Submitted:2009-10-05, Days after onset: 8
Location:Wisconsin  Entered:2009-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CELEBREX, PROZAC, CHLORAZEPAN
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED01749211A8IMLA
Administered by: Other     Purchased by: Private
Symptoms: Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: started with red rash (looked like mosquito bites) on (L) arm 2 days after received shot. Spread to (R) arm, to abdomen then to back and (L) leg. Saw MD for different issue & addressed rash. MD recommended HYDROCORTISONE cream & BENADRYL as needed. Rash started lessening on 10/3/09.

VAERS ID:359519 (history)  Vaccinated:2009-10-02
Age:68.0  Onset:2009-10-03, Days after vaccination: 1
Gender:Female  Submitted:2009-10-05, Days after onset: 2
Location:Kansas  Entered:2009-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Arthritis; Diabetes,
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2346CA0UNRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 10/03/2009 Mild Other Redness and swelling at site measuring 80x55MM.

VAERS ID:359520 (history)  Vaccinated:2009-10-01
Age:5.0  Onset:2009-10-02, Days after vaccination: 1
Gender:Female  Submitted:2009-10-05, Days after onset: 3
Location:Ohio  Entered:2009-10-05
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2471BA UNLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURB0476 UNLL
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Approximately 12-15 hours after vaccination, patient developed erythema / induration at site. Left thigh); this became worse after treatment with Cephalexin and ultimately, resolved quickly after taking corticosteroid and changing ABV to Bacteria. (Cellulitis vs. vaccine reaction)

VAERS ID:359521 (history)  Vaccinated:2009-09-14
Age:55.0  Onset:2009-09-14, Days after vaccination: 0
Gender:Female  Submitted:2009-09-21, Days after onset: 7
Location:Illinois  Entered:2009-10-05, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED07949111A UNRA
Administered by: Other     Purchased by: Unknown
Symptoms: Cough, Headache, Pain, Respiratory tract congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 930 AM - Injection. 11 AM - Cough dry. 1 PM - Increased congestion. 3 PM - Wheezing - headache - overall body ache.

VAERS ID:359522 (history)  Vaccinated:2009-08-27
Age:41.0  Onset:2009-08-29, Days after vaccination: 2
Gender:Female  Submitted:2009-09-25, Days after onset: 27
Location:New York  Entered:2009-10-06, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Oral birth control pills.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD58337000301 PO 
Administered by: Public     Purchased by: Private
Symptoms: Rash generalised, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Skin rash appeared 1 day after 1st dose and spread further and to more parts of body over the 8 days of treatment. Very itchy. Did not go away with prescription CORTICOSTEROID cream. Suddenly went away 1 day after last dose.

VAERS ID:359523 (history)  Vaccinated:2007-11-12
Age:29.0  Onset:0000-00-00
Gender:Male  Submitted:2009-09-29
Location:Unknown  Entered:2009-10-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none; none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV1101UNUN
Administered by: Military     Purchased by: Military
Symptoms: Activities of daily living impaired, Arthralgia, Influenza like illness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: After receiving anthrax #2 on 12 Nov 07, he reports he developed bilateral elbow and bicep pain that interfered with exercise. He also reports experiencing flu-like sxs that lasted for 4-5 days. This UE pain never resolved. After receiving anthrax #3 on 13 Mar 2008 he reports a worsening of the UE pain that has continued until the present. It occurs only with activity or physical strain such as lifting heavy objects. Reports no increase in UE pain with anthrax #4 on 11 Jun 09. Symptom: Joint Pain, isolated, Muscle Pain.

VAERS ID:359524 (history)  Vaccinated:2009-09-21
Age:1.5  Onset:2009-09-22, Days after vaccination: 1
Gender:Female  Submitted:2009-09-23, Days after onset: 1
Location:Virginia  Entered:2009-10-06, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)PFIZER/WYETHD619202IMLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site nodule, Livedo reticularis
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Moderate erythema on left thigh (10 cm), no induration, slightly mottled appearance, non-tender, small knot at injection site.

VAERS ID:359525 (history)  Vaccinated:2009-08-20
Age:1.6  Onset:0000-00-00
Gender:Male  Submitted:2009-09-28
Location:Michigan  Entered:2009-10-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: No testing
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B102CA3IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB312AA1IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUF694AA3IMLL
Administered by: Private     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Gave HAVRIX #2 6 days early. No adverse events from administration.

VAERS ID:359526 (history)  Vaccinated:2009-08-31
Age:40.0  Onset:2009-08-31, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Illinois  Entered:2009-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VIVACTIL; BELLERGAL; TOPAMAX; ZYRTEC
Current Illness:
Preexisting Conditions: Rheumatoid arthritis; SJOGREN''S
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0625Y0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Chest pain, Dyspnoea, Injection site erythema, Injection site pain
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Pt received PNEUMOVAX on 8/31/09. Noted on the evening of the injection, sensitivity and very painful, very reddened. Using ice right deltoid. Pt has R A. Noted right elbow painful. Complaining of chest and back achiness with shortness of breath, noted on Tuesday. 9/2/09 redness, swelling and pain subsiding.

VAERS ID:359527 (history)  Vaccinated:2009-09-23
Age:70.0  Onset:2009-09-23, Days after vaccination: 0
Gender:Female  Submitted:2009-09-24, Days after onset: 1
Location:Delaware  Entered:2009-10-06, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIPITOR 20 mg; XANTANO .005 %; SYNTHOID 0.05 mg; NORVASC 5 mg; ARIMIDEX 1 mg.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0632Y0UNRA
Administered by: Other     Purchased by: Private
Symptoms: Confusional state, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient was confused on night she received the vaccine stating she didn''t know if she was on the 1st or 2nd floor of her house. Also, she is still having pain that''s radiating down her arm and into her thumb in the arm the injection was given. Last night & this AM her leg & ankle itched & she had to scratch hard to relieve it but that''s gone now.

VAERS ID:359528 (history)  Vaccinated:0000-00-00
Age:15.0  Onset:2009-09-23
Gender:Female  Submitted:2009-09-24, Days after onset: 1
Location:California  Entered:2009-10-06, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1321X1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash

VAERS ID:359529 (history)  Vaccinated:2009-09-29
Age:22.0  Onset:0000-00-00
Gender:Female  Submitted:2009-09-29
Location:Texas  Entered:2009-10-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB340AA1UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated. Contacted pt. by phone denies any adverse reactions.

VAERS ID:359530 (history)  Vaccinated:2009-09-08
Age:11.0  Onset:2009-09-09, Days after vaccination: 1
Gender:Female  Submitted:2009-09-10, Days after onset: 1
Location:Virginia  Entered:2009-10-06, Days after submission: 26
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0929Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt administered varicella (subq) L arm, Tdap in L deltoid, MENACTRA (R deltoid) Hep A (R deltoid) on 9/8/09. Presented with erythematous 6cm x 3 1/2 area @ varicella administration site.

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