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VAERS ID:359496 (history)  Vaccinated:2009-09-24
Age:51  Onset:2009-10-02, Days after vaccination: 8
Gender:Male  Submitted:2009-10-05, Days after onset: 3
Location:Tennessee  Entered:2009-10-05
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No PMH: GERD, Anxiety, Hyperlipidemia Allergies: NKDA
Diagnostic Lab Data: MRI C spine showed enhancing T2 lesion at C3 to C7. CSF as above. further results pending. Labs: CBC, CMP, RA factor, Anti-DNA, blood, urine and csf cultures, ESR, CRP all normal/negative, Vit B12 high, ANA + at 1:160 Dx studies: MRI brain negative, MRI C-spine abnormal, noting an enhancing lesion C3-C7
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Antinuclear antibody positive, Bladder disorder, Blood culture negative, C-reactive protein normal, CSF bacteria no organisms observed, CSF glucose normal, CSF protein increased, CSF white blood cell count increased, Culture urine negative, DNA antibody negative, Full blood count normal, Hypoaesthesia, Metabolic function test, Muscular weakness, Myelitis transverse, Neck pain, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain normal, Paraesthesia, Plasmapheresis, Quadriparesis, Red blood cell sedimentation rate normal, Rheumatoid factor negative, Vitamin B12 increased
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad)
Write-up: numbness in left arm and weakness of the left arm followed by neck pain. Within 2 days it has progressed to quadraparesis. CSF showed Protein 81, normal glucose and 5 WBC 11/24/2009 MR, Consult records, DC summary for 10/3-10/15/2009. DC DX: C3-7 transverse myelitis Patient with c/o''s numbness/tingling in bilateral UE''s, lt worse than rt, progressing to bilateral LE weakness, neck pain and bladder dysfunction. LP, Tx: plasmapheresis, IV steroids, PT. ICD-9 codes: 341.22, 344.04, 599.o, 596.54, 272.4, 300.0, 530.81, 300.01, 722.52, 041.19, 272.0, 276.8, 787.6, 564.00, 287.5, 788.20, 788.60

VAERS ID:359497 (history)  Vaccinated:2009-09-28
Age:6  Onset:2009-09-30, Days after vaccination: 2
Gender:Female  Submitted:2009-10-05, Days after onset: 5
Location:New York  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: Motrin
Current Illness: no
Preexisting Conditions: Omnicef, Augmentin allergy in past
Diagnostic Lab Data: WBC 9.0 ESR 22 CPK 39 ASO pending
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500715P1IN 
Administered by: Private     Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Laboratory test, Muscle spasms, Red blood cell sedimentation rate increased, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Dystonia (broad)
Write-up: muscle cramps in thighs

VAERS ID:359498 (history)  Vaccinated:2009-01-23
Age:4  Onset:2009-01-24, Days after vaccination: 1
Gender:Male  Submitted:2009-10-05, Days after onset: 253
Location:Connecticut  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: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC26B08HAB4IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Decreased appetite, Depressed level of consciousness, Dyskinesia, Fatigue, Lethargy, Pyrexia, Somnolence, Staring, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), 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)
Write-up: Tiredness, lethargy, loss of appetite, sleepiness, jerking, staring, fever (102.1 oral around noon, 103.6 by 1:30 pm) with lowered consciousness and vomiting. First gave Tylenol then phoned on-call nurse who said it was just a coincidence and nothing to do with vaccine. Gave tepid sponge bath and Children''s Motrin followed by popsicle.

VAERS ID:359499 (history)  Vaccinated:2009-09-30
Age:36  Onset:2009-10-01, Days after vaccination: 1
Gender:Female  Submitted:2009-10-05, Days after onset: 4
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: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site swelling, Muscle tightness, Oedema peripheral, Pain, Pruritus, Pyrexia, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Began with severe chills and fever. Fever persisted through third day. Injection site became red and swollen. Swelling and redness spread down arm and became hot. Also became itchy. Muscle hard, not soft like other arm. Fatigue, body aches, headaches. All symptoms except chills still present 6 days after injection.

VAERS ID:359500 (history)  Vaccinated:2009-09-08
Age:19  Onset:2009-09-08, Days after vaccination: 0
Gender:Male  Submitted:2009-10-05, Days after onset: 27
Location:California  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: NONE
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB343CA1IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURB114720IMLA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUF645AA0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Muscle spasms, Pain in extremity, Palmar erythema
SMQs:, Dystonia (broad)
Write-up: Pt. rec''d yellow fever and typhoid IM left delt at 2:25, then hepatitis A#2 in R delt. At 2:31 pt. experienced c/o peculiar pain in the middle of his r. palm. Hand pink with CRT 1-2 secs. Ice pack applied to injection site. Over the next 15 minutes pt. began to experience cramping in his arm. Benadryl 50 mg given orally.B/P 156/90. Pt. then had some cramping in the right side of his neck in trapezius region, and then cramping in right thigh and calf. 3:00 Pt sent to ER for evaluation and was seen by Dr. who gave him IV steroids and observed the patient. By 4:00, symptoms stopped progressing but were still persistent. The pt. was sent home on oral SOMA. Pt. feeling slightly better the next day, but still sore. 48 hours later, pt. was called and the symptoms had completely subsided.

VAERS ID:359501 (history)  Vaccinated:2009-09-28
Age:42  Onset:2009-10-01, Days after vaccination: 3
Gender:Female  Submitted:2009-10-05, Days after onset: 4
Location:Virginia  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: very mild asthma under complete control
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97848P1C0IDLA
Administered by: Unknown     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pruritus generalised, Rash generalised, Skin burning sensation, Skin warm, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: I started with red hives. Three hours later they turned in to bright red masses all over my chest and back. Very itchy everywhere. By the next morning I had a red rash all over my whole body even my feet,hands and neck and face. My fingers and toes swelled like hotdogs. My skin felt like it was on fire it was literally hot to the touch but I didn''t have a fever. It also felt like I had a bad sunburn to touch. I went to the Dr. and she prescribed Benadryl and Prednesone (sp?) Sorry I am not where the bottle is for correct spelling. It is now 10/05/2009 I have been on the sertoids since Friday and I am still having sypmtoms and I am still very itchy. It itches deep under my skin. I don''t have a visible rash anymore.

VAERS ID:359502 (history)  Vaccinated:2009-09-25
Age:56  Onset:2009-09-26, Days after vaccination: 1
Gender:Female  Submitted:2009-10-05, Days after onset: 9
Location:Georga  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: none
Diagnostic Lab Data:
CDC 'Split Type': don''t know what this mean
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Private
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: High fever~ 102 degrees F Swelling of arm~ about the size of a softball Fever lasted for two days and swelling lasted for a week.

VAERS ID:359503 (history)  Vaccinated:2009-09-10
Age:0.4  Onset:2009-09-15, Days after vaccination: 5
Gender:Female  Submitted:2009-10-05, Days after onset: 20
Location:North Carolina  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: None PMH: None Allergies: NKDA
Diagnostic Lab Data: MRI - normal; EEG - normal; blood work - normal Labs: CBC, CMP, UA , MRSA panel, Hemmocult, stool, urine and blood cultures, all normal/negative Dx studies: EEG, MRI Brain wnl
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3428AB1  
PNC: PNEUMO (PREVNAR)PFIZER/WYETH0619171  
RVX: ROTAVIRUS (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood culture negative, Blood test normal, Culture stool negative, Culture urine negative, Electroencephalogram normal, Eye movement disorder, Full blood count normal, Grand mal convulsion, Metabolic function test normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Occult blood negative, Partial seizures, Staring, Urine analysis normal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (broad)
Write-up: Focal seizure approx 7:00 AM, tonic clonic seizure approx 12:00 PM and 1:30 PM. 12/10/2009 MR and DC summary for 9/19-9/21/2009, patient with staring episodes, eye deviation upwards and tonic-clonic movements. tx''d with Keppra and Diastat, DC DX new onset seizures

VAERS ID:359504 (history)  Vaccinated:2009-09-20
Age:56  Onset:2009-09-20, Days after vaccination: 0
Gender:Female  Submitted:2009-10-05, Days after onset: 15
Location:Virginia  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:
Current Illness: bladder infection
Preexisting Conditions: allergy to sulfa and bee stings medical conditions = Asthma, insulin dependent diabetes, degenerative joint disease, migraines, hypothyroidism, depression, osteoporosis, peripheral neuropathy, urinary incontinence, 10/19/09 Discharge summary and hospital records received for dates 9/22/09 to 9/24/09 PMH: Asthma, HTN, obesity, gastric bypass, osteoarthritis, IDDM, hypothyroidism, diabetic neuropathy.
Diagnostic Lab Data: lungs still recovering... again most likely not related to the flu shot... I also had minor surgery on my mouth(gums) at 3:00 that day after the flu shot before the pneumonia... also probably not related to the pneumonia or flu shot... just as a precaution am reporting it. 10/19/09 Discharge summary and hospital records received for dates 9/22/09 to 9/24/09 Diagnostics/Labs: CXR abnormal- bilateral infiltrates, CT abdomen/pelvis abnormal-diverticulosis, midline ventral hernia, fatty liver, WBC 13.28(H), HGB 11.5(L), HCT 34.9(L), RDW 15.8(H), alk phos 78(L), UA (+)Leukocytes, blood cx(-).
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED813-09-070491111IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood alkaline phosphatase, Blood culture negative, Chest X-ray abnormal, Computerised tomogram abnormal, Cough, Dyspnoea, Dysuria, Haematocrit decreased, Haemoglobin decreased, Micturition urgency, Nausea, Oxygen saturation decreased, Pneumonia, Pollakiuria, Pyrexia, Red cell distribution width increased, Urine analysis abnormal, Vomiting, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: FIRST let me say both my doctor and I do not feel my illness was related to the flu shot but I am reporting it only because it was so close to the time of my vaccination.... High fever 104 oral Nausea & vomiting for 5 hours temp down to 101 by 2 am after ASA and tylenol Called ambulance and was admitted to hospital with pnemonia bilaterally pulse ox 90 difficulty breathing... 10/19/09 Discharge summary and hospital records received for dates 9/22/09 to 9/24/09. DC DX: pneumonia. Presenting SX: Pt. seen by PCP with c/o difficulty urinating, frequency, burning. PCP gave abx, pt started abx 2 days later when fever developed along with shortness of breath, cough. Pt was admitted. Assessment: O2 sat 90% diagnostics performed, IV abx given. Pt improved and DC home. Follow: I want to make sure you know that I filed this report on the advice of my doctor only to be informative to you. Neither she nor I feel that my illness was at all related to the flu shot I received that day. Just as a precaution I filed the VAERS form but in fact it is most likely NOT a Reaction to the shot but just a coincidence that I look ill suddenly hours after the injection.

VAERS ID:359505 (history)  Vaccinated:2009-10-02
Age:24  Onset:2009-10-02, Days after vaccination: 0
Gender:Female  Submitted:2009-10-05, Days after onset: 3
Location:North Carolina  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: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJLA
Administered by: Public     Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: SOB, difficulty breathing, wheezing, coughing, burning sensation in throat

VAERS ID:359507 (history)  Vaccinated:2009-10-02
Age:43  Onset:2009-10-05, Days after vaccination: 3
Gender:Female  Submitted:2009-10-05, Days after onset: 0
Location:California  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: no
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives on the front neck, itching.

VAERS ID:359508 (history)  Vaccinated:2009-10-02
Age:30  Onset:2009-10-03, Days after vaccination: 1
Gender:Female  Submitted:2009-10-05, Days after onset: 2
Location:Indiana  Entered:2009-10-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Environmental allergies, athsma, oto-sclerosis, urticaria
Diagnostic Lab Data: No tests run yet.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS972165P10IMRA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER1314Y0 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Chills, Feeling cold, Injected limb mobility decreased, Injection site erythema, Injection site induration, Injection site mass, Injection site pain, Injection site swelling, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: I recieved the vaccination for pneumonia in my left arm and the seasonal flu shot in my right on 10/2/09. On 10/3/09 my Left arm started to hurt and got progressively worse, a red blotch appeared near the injection site and then more blotches presented below the site and continue to enlarge. There is currently a 4 inch x 1 inch band of red swelling below the injection site on my left arm. There is a palm-sized hardened painful red swollen lump at the injection site. It is VERY painful to touch or move and I cannot bear to sleep on it. It is hard to dress myself, or drive, reaching in an upward movement is nearly impossible for the pain. Seperate reaction: Around 9 pm on 10-3-09 I was cleaning my kitchen floor and suddenly became very very cold and started to ache. I put on my coat and went to get my friend upstairs for help. He bundled me up in a blanket and set me in front of the fireplace in my recliner but I kept shivering with fever for hours even though it was 72 in the house. I finally went to bed in a great deal of pain from my arm, freezing cold with fever, and sore all over. I had continued fever/chills/ache and severe arm pain on 10-4-09. The fever was gone by 10-5-09 but my arm is still very swollen and exceptionally painful and I hope to get into the doctor 10/6/09 for help and relief.

VAERS ID:359510 (history)  Vaccinated:2009-10-02
Age:1.5  Onset:2009-10-04, Days after vaccination: 2
Gender:Female  Submitted:2009-10-06, Days after onset: 2
Location:Illinois  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: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: After receiving the Varicella vaccination (1st time) Pox-like raised bumps on face, torso and legs appeared 2 days later.

VAERS ID:359511 (history)  Vaccinated:2009-09-29
Age:42  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:
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  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  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  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  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  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.

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