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Case Details

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VAERS ID:359624 (history)  Vaccinated:2008-09-11
Age:0.3  Onset:2008-09-27, Days after vaccination: 16
Gender:Female  Submitted:2009-10-05, Days after onset: 373
Location:Foreign  Entered:2009-10-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INFANRIX, 07Aug08
Current Illness: Rhinitis
Preexisting Conditions:
Diagnostic Lab Data: Platelet count, ??Sep08, 6000 cells/mm3; Platelet count, 28Sep08, 50000 cells/mm3; Platelet count, 29Sep08, 99000 cells/mm3
CDC 'Split Type': WAES0910USA00135
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEUR 1UNUN
HIBV: HIB (ACTHIB)SANOFI PASTEUR  UNUN
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR  UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH 1UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood product transfusion, Conjunctival hyperaemia, Haematemesis, Haematoma, Idiopathic thrombocytopenic purpura, Mouth haemorrhage, Petechiae, Platelet count decreased, Purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Conjunctival disorders (narrow), Hypersensitivity (narrow)
Write-up: This case has been received from a Health Authority (reference number: 200900208) concerning a 4 month old female patient with rhinitis who received a dose of ROTATEQ (batch number not reported) and an injection of PENTAVAC (batch number not reported) on 11-SEP-2009. She also received an injection of PREVENAR and a dose of INFANRIX on 07-AUG-2008. On 11-SEP-2008, the patient received a further dose of PREVENAR. On 25-SEP-2008, the patient developed purpuric rash. On 26-SEP-2008, she experienced hematoma. On 27-SEP-2009, the patient was found with idiopathic thrombocytopenic purpura and blood in regurgitation. She was hospitalized on 27-SEP-2008. Etiological investigations found major thrombocytopenia, purpuric rash on the whole body, petechial buccal and conjunctival mucosal rash, hematoma on the whole body and accentuated on the face and the limbs. Platelets count was found at 6000 cells/m3 on an unspecified date in September 2008, at 50000 on 28-SEP-2008 and 99000 cells/mm3 on 29-SEP-2008. Coagulation testing was normal, no inflammatory syndrome was found. On 27-SEP-2008, the patient received corrective intravenous treatment with immunoglobulins. The patient recovered from idiopathic thrombocytopenic purpura and hematoma on 29-SEP-2008. The outcome regarding and purpuric rash was not reported. On 09-OCT-2008, she received a further dose of ROTATEQ for which Rechallenge was reported as negative by the health authority. Health Authority assessed idiopathic thrombocytopenic purpura, hematoma, purpuric rash and regurgitation as unexpected. The investigator considered that the event of idiopathic thrombocytopenic purpura and hematoma were not related. The sponsor considered that there was a reasonable possibility that the event of idiopathic thrombocytopenic purpura was related to the study drug or other vaccines. All vaccines were considered suspect by the Health Authority. Other business partner numbers included: E2009-08794.

VAERS ID:359625 (history)  Vaccinated:2009-03-16
Age:0.2  Onset:2009-03-20, Days after vaccination: 4
Gender:Male  Submitted:2009-10-05, Days after onset: 199
Location:Foreign  Entered:2009-10-06, 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:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: renal ultrasound, 23Mar09, normal; WBC count, 23Mar09, 12.7 Giga/L; body temp, 23Mar09, 40.5 C; serum C-reactive protein, 23Mar09, 66.4 mg/L; urine WBC count, 23Mar09, 1200 ul, increased; urine culture, 23Mar09, 10^8 E.Coli/mL
CDC 'Split Type': WAES0910USA00133
Vaccination
Manufacturer
Lot
Dose
Route
Site
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN)GLAXOSMITHKLINE BIOLOGICALS  UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH  UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature increased, C-reactive protein increased, Culture urine positive, Hyperpyrexia, Pyelonephritis acute, Ultrasound scan normal, Vomiting, White blood cell count increased, White blood cells urine positive
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad)
Write-up: Case received from the Authorities on 15-SEP-2009 under the reference number 200900175. A 9-week-old male patient had received a dose of ROTATEQ (oral, lot number not reported) per os on 16-MAR-2009. On the same day, he received an injection of PREVENAR and an injection of INFANRIX HEXA. All vaccines were considered suspect by the health authorities (HA). On 20-MAR-2009 the patient developed acute pyelonephritis and vomiting. He was hospitalized on 23-MAR-2009. Tests performed on 23-MAR-2009 found white blood cell count at 12.7 Giga/L, C-reactive protein at 66.4 mg/L, urine white blood cells increased at 1200/ul. Urine culture found 10^8 E.Coli/mL; kidney ultrasound was normal. The patient also had hyperpyrexia at 40.5C. Corrective treatment with ceftriaxone sodium and antipyretics was implemented, then cefixime and acetaminophen on discharge. The patient recovered from vomiting on 25-MAR-2009 and from pyelonephritis on 25-May-2009. On 15-May-2009 he received a dose of ROTATEQ, an injection of PREVENAR and a INFANRIX HEXA; on 16-APR-2009 he received an injection of PENTAVAC. Rechallenge was reported as negative by the HA. HA assessed pyelonephritis as unexpected and vomiting as expected. The sponsor considered that there was a reasonable possibility that the event of pyelonephritis was related to the study drug. Other business partner numbers include: E2009-08753. No further information is available.

VAERS ID:359626 (history)  Vaccinated:2008-12-26
Age:0.2  Onset:2009-01-07, Days after vaccination: 12
Gender:Female  Submitted:2009-10-05, Days after onset: 270
Location:Foreign  Entered:2009-10-06, 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:
Current Illness:
Preexisting Conditions: Gastroenteritis
Diagnostic Lab Data: WBC, 06JAN09, 8000/mm3; Urine WBC count, 06JAN09, 200000/mm3; Urine bacteria screen, 06JAN09, positive
CDC 'Split Type': WAES0910USA00136
Vaccination
Manufacturer
Lot
Dose
Route
Site
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN)GLAXOSMITHKLINE BIOLOGICALS  UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH  UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bacteria urine identified, Pyelonephritis, Urine analysis abnormal, White blood cell count normal, White blood cells urine positive
SMQs:, Chronic kidney disease (broad)
Write-up: Case received from the Health Authorities in a foreign country on 15-SEP-2009 under the reference number200900185: Information has been received from an agency concerning a 10 week old female with a history of gastroenteritis who on 26-DEC-2008 was vaccinated with a dose of ROTATEQ (LOT# not reported) per agency. On the same day, she received an injection of INFANRIX HEXA (other manufacturer) and an injection of PREVENAR (other manufacturer). All vaccines were considered suspect by the health authorities. On 07-JAN-2009, the patient was found with abnormal urinalysis: tests performed on 06-JAN-2009 and revealed increased white blood cells in urine at 200000/mm3, white blood cell count at 8000/mm3 and Gram-negative bacterial infection at direct urine exam positive. She was hospitalized on 07-JAN-2009. No inflammatory syndrome was found; cultures were sterile. Corrective treatment with hydration was implemented. The health authority suspected pyelonephritis. The patient recovered from abnormal urinalysis on 08-JAN-2009. On 09-FEB-2009, she received a further dose of ROTATEQ (lot# not reported) and an injection of PENTAVAC. Rechallenge was reported as negative by the health authority. The health authority assessed urinalysis abnormal NOS as unexpected. The sponsor considered that there was a reasonable possibility that the event of urinalysis abnormal NOS was related to the study drug. Additional information has been requested.

VAERS ID:359627 (history)  Vaccinated:2009-09-22
Age:26.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-05
Location:New Jersey  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: Unknown
Current Illness: Asthma; Viral infection
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0909USA04052
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0507Y0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea, Injected limb mobility decreased, Injection site pain, Local reaction, Pain, Rash erythematous
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a nurse concerning a 26 year old female patient with asthma who on 22-SEP-2009 was vaccinated IM with 0.5 ml PNEUMOVAX 23 (Lot# 663486/0507Y). Subsequently the patient developed a severe local reaction. The patient experienced pain at the site and could barely move her arm. She had a pink speckled rash on both arms, neck and chest. Before receiving PNEUMOVAX 23 she had a mild virus. After the PNEUMOVAX 23 she was achy and short of breath, but they were not sure if those symptoms were related to the virus or vaccination. It was believed to be the first PNEUMOVAX 23 vaccine for this patient. It was the same lot as the other cases previously reported. A lot check was being done on 0507Y. The patient was taken to a local emergency room. Hospital name was not available. It was unknown if the patient was admitted or present status of the patient. Upon internal review, short of breath was determined to be an other important medical event. This is one of several reports for the same source. Additional information has been requested.

VAERS ID:359628 (history)  Vaccinated:0000-00-00
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2009-10-05
Location:Foreign  Entered:2009-10-06, 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: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0909USA04915
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Injection site pain
SMQs:, Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Initial case received from a foreign Health Authority, documentation number 31542, on 25-SEP-2009: It was reported, that about 50 patients with no medical history reported were vaccinated with MMR II (lot #, route and site not reported) on an unspecified date. It was reported, that the patients developed pain and burning sensation during vaccination. It was reported, that this vaccine was used from 16-JUN-2009 (before PRIORIX was used). The patients had recovered. This case was classified as medically significant from the reporter. Other business partner numbers include E2009-08990. No further information is available. The case is closed.

VAERS ID:359629 (history)  Vaccinated:0000-00-00
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:2009-10-05
Location:Foreign  Entered:2009-10-06, 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: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0910USA00102
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1301U SCUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Immediate post-injection reaction, Screaming
SMQs:, Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: This case was a part of a cluster of 37 cases (same vaccine, same reporter, same adverse event), the reference case of this cluster was E2009-09052. Initial case received as a line listing from the Health Authority on 29-SEP-2009, documentation number 31590: It was reported, that a 1 (12 month) year old male patient with no medical history reported was vaccinated with a MMR II (lot # 658515/1301U, batch # NK06130, site not reported), date of vaccination not reported. It was reported, that the male patient was screaming immediately post vaccination for some minutes and needed more time to calm down compared to other subcutaneous vaccines. The male patient had recovered. This case was classified as medically important from the reporter. Other business partner numbers include E2009-0999. This is one of several reports. No further information is available. The case is closed.

VAERS ID:359630 (history)  Vaccinated:0000-00-00
Age:0.3  Onset:0000-00-00
Gender:Female  Submitted:2009-10-05
Location:Foreign  Entered:2009-10-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness:
Preexisting Conditions: Relevant medical history was not provided.
Diagnostic Lab Data: Lumbar puncture, failed eight lumbar punctures; Blood test, infections parameters increased, not further specified - were done on an unspecified date.
CDC 'Split Type': DKWYEG04544709
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HIBV: HIB (ACTHIB)SANOFI PASTEUR  UNUN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood test abnormal, Eye rolling, Lumbar puncture, Nystagmus, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow)
Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a female patient, reported age 3-month-old, who experienced extensive rolling eyes and fever. The patient received a vaccination on an unknown date. Additional suspect medication included DITEKIPOL/ACTHIB administered on the same date as PREVENAR according to the vaccination program. Approximately 20-28 hours after the vaccination the patient experienced rolling eyes and fever. The fever disappeared, there were no focal symptoms, but the extensive rolling of eyes continued. A nurse observed the extensive rolling of eyes and the patient was hospitalized. Within the first 24 hours of hospitalization the patient developed fever, infections parameters increased and treatment for meningitis initiated. Treatment was initiated on suspicion as meningitis was not bacteriological verified. Approximately 6 weeks after the admission, the otherwise well-being patient still has nystagmus. There were normal eye movements and focusing before the vaccination. At the time of reporting the event experienced extensive rolling of eyes is ongoing. No additional information was available at the time of this report. Follow-up is pursued.

VAERS ID:359631 (history)  Vaccinated:2008-08-01
Age:29.0  Onset:2008-08-07, Days after vaccination: 6
Gender:Male  Submitted:2009-10-06, Days after onset: 425
Location:Hawaii  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: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  UN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Anthrax vaccination on right deloid Aug2008. Had other vaccinations on left deltoid at same time. Since that time has had recurrent (daily) small to large areas of urticaria on the right deltoid for over one year. Lasts usually 1/2 to 1 hour. Has had episode of entire upper arm swelling which lasted 2 hours.

VAERS ID:359632 (history)  Vaccinated:2009-09-28
Age:19.0  Onset:2009-09-29, Days after vaccination: 1
Gender:Female  Submitted:2009-10-06, Days after onset: 7
Location:Arizona  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: No other adverse reactions in the past. Taking no other medications.
Current Illness: NO
Preexisting Conditions: Hx of general allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3174EA0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Redness/itching generalized. Took Benadryl 25 mg orally. Redness/itching went away. Still has bumps on top half of body.

VAERS ID:359633 (history)  Vaccinated:2009-09-29
Age:3.0  Onset:2009-10-01, Days after vaccination: 2
Gender:Male  Submitted:2009-10-06, Days after onset: 5
Location:Virgin Islands  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: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURUF599AA3IMLA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3177BA0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURU2472AA3IMRA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHD210513IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0690Y0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injected limb mobility decreased, Pain
SMQs:
Write-up: mother called 10/2/09 stating that child not moving his leg, "dragging it behind him" when he walks. denies swelling. limping. mother had given advil once for pain the first day only. Advised Advil for pain and to f/u with child''s pediatrician. phone call several hours later to mother who stated that child was moving leg more after advil. follow up phone call 10/5 in which mother told me she administered advil over the weekend and child was "back to normal" and riding his bike and playing yesterday.

VAERS ID:359634 (history)  Vaccinated:2009-10-06
Age:7.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Male  Submitted:2009-10-06, Days after onset: 0
Location:North Carolina  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:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3177DA1 RA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB342EB0 LA
Administered by: Private     Purchased by: Public
Symptoms: Bradycardia, Hyperhidrosis, Hypotension, Pulse pressure decreased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Collapsed,pale ,sweating hypotension,bradycardia,feable pulse Epipen jr 0.15mg given,benedryl 2tsp given EMS called assessed, father didnt want to go to ER.Patient was observed in the office for 90 mins.His condition came back to normal and sent home

VAERS ID:359635 (history)  Vaccinated:2009-09-15
Age:50.0  Onset:2009-09-16, Days after vaccination: 1
Gender:Female  Submitted:2009-10-06, Days after onset: 20
Location:New Mexico  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: IBUPROFEN
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA456BA1IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Fatigue, Headache, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Headache,Lymphadenopathy,Fatigue,Muscle Aches lasting 2 weeks duration

VAERS ID:359636 (history)  Vaccinated:2009-10-02
Age:50.0  Onset:2009-10-03, Days after vaccination: 1
Gender:Female  Submitted:2009-10-06, Days after onset: 3
Location:Minnesota  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:
Current Illness: Twelve hours after injection patient reported symptoms of:"fever,uncontrollable shaking,all over body pain,weakness and disorien
Preexisting Conditions: Migraine,depresson,genital herpes,Lupus,mitral valve disorder
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3200AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1296X IMRA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Disorientation, Lymph node pain, Lymphadenopathy, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: See last screen for symptoms

VAERS ID:359637 (history)  Vaccinated:2009-09-09
Age:67.0  Onset:0000-00-00
Gender:Female  Submitted:2009-10-06
Location:Unknown  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: Perhaps a cold.
Preexisting Conditions: yes
Diagnostic Lab Data: chest x-ray
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Chest X-ray, Dizziness, Dysphonia, Dyspnoea, Heart rate increased, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Hoarseness, difficulty breathing, paleness, weakness, a fast heart beat, and dizziness.

VAERS ID:359638 (history)  Vaccinated:2009-10-02
Age:43.0  Onset:2009-10-02, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 4
Location:New York  Entered:2009-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: none
Diagnostic Lab Data: Employee not recovered yet.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS96033 4P0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Headache, Laryngitis, Oropharyngeal pain, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: severe headache, rash, severe pruritis, laryngitis/sore throat

VAERS ID:359639 (history)  Vaccinated:2009-09-22
Age:5.0  Onset:2009-09-22, Days after vaccination: 0
Gender:Male  Submitted:2009-10-06, Days after onset: 14
Location:Alabama  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:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type': AL0922
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B115AA4IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0984X0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1318X0SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Has swelling and redness on Lt. Arm. 70mm X 70mm lenght and width.

VAERS ID:359640 (history)  Vaccinated:2009-10-01
Age:59.0  Onset:2009-10-02, Days after vaccination: 1
Gender:Male  Submitted:2009-10-06, Days after onset: 4
Location:New York  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: Fleconide, Sotalol, Warfarin, Diovan, Zemplar
Current Illness: none reported
Preexisting Conditions: PCN allergy
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS96033 4P0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Atrial fibrillation, Chills, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: severe shaking chills with A. Fib (pt. has history of A fib)

VAERS ID:359641 (history)  Vaccinated:2009-09-22
Age:56.0  Onset:2009-09-23, Days after vaccination: 1
Gender:Female  Submitted:2009-10-06, Days after onset: 13
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: prempro,atenolol,clonacepam,amitriptyline
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3173DA10IMLA
Administered by: Public     Purchased by: Private
Symptoms: Hypokinesia, Injection site pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Administration of vaccine was painful in left deltoid. Arm remained sore that night after administration. Pain in left shoulder has gotten prgressively worse each day since administration of vaccine to the point is very painful and has limited movement of left shoulder. No reddness, swelling or hot to touch at injection site.

VAERS ID:359642 (history)  Vaccinated:2009-10-05
Age:21.0  Onset:2009-10-05, Days after vaccination: 0
Gender:Male  Submitted:2009-10-06, Days after onset: 1
Location:Utah  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: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Public     Purchased by: Public
Symptoms: Eye swelling, Lip swelling, Oedema mouth, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: First swelling above upper lip, within a couple hours mild swelling around mouth, cheeks, and eyes. Throat feels tight but still able to breathe and eat just fine.

VAERS ID:359646 (history)  Vaccinated:2009-09-29
Age:30.0  Onset:2009-09-29, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 7
Location:Colorado  Entered:2009-10-06
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: n/a
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLU468CA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Immediate post-injection reaction, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Vaccine positive rechallenge
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Immediately following vaccine, client reports arm was sore, red, and warm to touch. This was the same reaction client had to first flu vaccine one year previously. Symptoms did not go away after one day, and arm felt hotter, so client went to clinic on 30 Sep. Site was then red, hot, swollen, firm, raised, and about the size of her palm. Client was given 7-day course of antibiotics to take 4 times daily. No relief of symptoms by 1 Oct. Client also reporting pain in elbow and wrist joints on 1 Oct. Advised client to try NSAIDs for pain relief and Benadryl for allergy symptom relief.

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