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

VAERS ID:359647 (history)  Vaccinated:2009-10-01
Age:62.0  Onset:2009-10-02, Days after vaccination: 1
Gender:Female  Submitted:2009-10-06, Days after onset: 4
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: zyrtec, fluticasone propionate 2 days earlier had cortisone injection in rt hand for granular anulare
Current Illness: No
Preexisting Conditions: respiratory allergies
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Unknown     Purchased by: Private
Symptoms: Feeling of body temperature change, Headache, Induration, Lacrimation increased, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lacrimal disorders (narrow), Tendinopathies and ligament disorders (broad)
Write-up: headache, cold, hot, stomach queasy, overall soreness, tearing eyes, arm hurt

VAERS ID:359648 (history)  Vaccinated:2009-09-21
Age:36.0  Onset:2009-09-24, Days after vaccination: 3
Gender:Female  Submitted:2009-10-06, Days after onset: 12
Location:North Dakota  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: Buproprion
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Influenza rapid screen was negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC. 2  
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, Diarrhoea, Headache, Influenza serology negative, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: bodyaches (hips mostly), headache for first 18 hours then developed a fever $g103.5 for the next 48 hours. Also developed moderate diarrhea on 09/26/2009 which continued through 09/28/2009. Treated with tylenol and ibuprofen, fever did not go lower than 100.5 until the evening of 09/27/2009.

VAERS ID:359649 (history)  Vaccinated:2009-09-06
Age:47.0  Onset:2009-09-06, Days after vaccination: 0
Gender:Male  Submitted:2009-10-06, Days after onset: 30
Location:Virginia  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: none reported to this pharmacy
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none yet.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS96030 5P IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: patient says he has had continued pain in his arm at the site of the injection since the day he received it and has trouble lifting it above his head without pain. He states it is worse at night and has not changed much over the last month. I advised him that this was not a typical reaction and that if the pain continues or worsens to contact his physician for evaluation. He stated that if the pain is still present he will see a dr in 2 weeks.

VAERS ID:359650 (history)  Vaccinated:2009-10-04
Age:54.0  Onset:2009-10-04, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 2
Location:Georgia  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: valtrex - numbness,hives
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS960342P0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: severe hives, called on Dr, throat was feeling tight ,went to emergency room was given oral cortisone

VAERS ID:359651 (history)  Vaccinated:2009-10-06
Age:67.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 0
Location:Florida  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: Atenolol, Crestor
Current Illness: None
Preexisting Conditions: HTN, Hyperlipidemia
Diagnostic Lab Data: Flu test A/B negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3213AA0IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Chills, Diarrhoea, Fatigue, Hyperhidrosis, Influenza serology negative, Nausea, Ocular hyperaemia, Pain in extremity, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Red eyes, "goopy", feverish/ chills/ sweats, achiness in legs, fatigue, N&V and diarrhea

VAERS ID:359652 (history)  Vaccinated:2009-09-29
Age:89.0  Onset:2009-09-30, Days after vaccination: 1
Gender:Male  Submitted:2009-10-06, Days after onset: 6
Location:California  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: Epistaxis and septal erosions Allergic rhinitis
Diagnostic Lab Data: photographs of lesions available
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARZOS: ZOSTER (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Skin haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Developed hemorrhagic lesions left side of posterior neck. No pain or tingling.

VAERS ID:359653 (history)  Vaccinated:2009-09-22
Age:67.0  Onset:2009-09-30, Days after vaccination: 8
Gender:Male  Submitted:2009-10-06, Days after onset: 6
Location:California  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: NORTRIPTYLINE 10 MG ORAL CAP, Sig: Take 3 capsules orally every bedtime for nerve pain. GLIPIZIDE 10 MG ORAL TAB, Sig: Take 2 tablets orally 2 times a day for diabetes. AMIODARONE 200 MG ORAL TAB, Sig: Take 1/2 tablet orally daily FAM
Current Illness: no
Preexisting Conditions: penicillin, tetracycline Diabetes with nephropathy, neuropathy, retinopathy hypertension, CHF, coronary artery disease, hyperlipidemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0742V0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster
SMQs:
Write-up: shingles broke out R flank T8 level

VAERS ID:359654 (history)  Vaccinated:2009-09-30
Age:15.0  Onset:2009-09-30, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 6
Location:Vermont  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: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.    
Administered by: Private     Purchased by: Public
Symptoms: Discomfort, Erythema, Facial pain, Headache, Oedema, Rhinalgia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: given nasal flu vaccine - had nose pain, felling of needing to sneeze, later medial face discomfort left greater than right, no runny nose, no cough, some headache bilat temples and some throat clearing. Exam 10/6 reveals erythema and edema of nasal mucosa left $g right. treated with nasal steroid spray

VAERS ID:359655 (history)  Vaccinated:2009-09-16
Age:64.0  Onset:2009-09-17, Days after vaccination: 1
Gender:Male  Submitted:2009-10-05, Days after onset: 18
Location:Arizona  Entered:2009-10-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Osteomyelitis. 10/21/09 Hospital and ED records received DOS 9/17/09 to 9/19/09. Hypertension.
Diagnostic Lab Data: 10/21/09 Hospital and ED records received DOS 9/17/09 to 9/19/09. LABS and DIAGNOSTICS: EKG - Abnormal. CHEM - Potassium 3.3 mmol/L (L) Glucose 178 mg/dL (H). CBC - HGB 17.1 g/dL (H). Echocardiogram - Abnormal. Chest X-ray - Abnormal for interstitial prominence in the bases. 12/22/09 Diagnostics: Carotid Duplex scan: negative; CT Brain: normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3211AA UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Blood glucose increased, Blood potassium decreased, Chest X-ray abnormal, Diabetes mellitus, Echocardiogram abnormal, Electrocardiogram abnormal, Fatigue, Gait disturbance, Guillain-Barre syndrome, Haemoglobin increased, Hypertension, Malignant hypertension, Muscular weakness, Paralysis, Polyneuropathy, Scan brain, Ultrasound Doppler
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)
Write-up: Muscle weakness, partial paralysis. Fatigue, high blood pressure, Guillain-Barre syndrome. 10/21/09 Hospital and ED records received DOS 9/17/09 to 9/19/09. Assessment: Malignant hypertension. Diabetes mellitus, new onset. Patient presented with generalized weakness, more to his left side. BP 236/145 Heart rate 90. 11/12/09 Medical records received for date 9/19/09 DX: HTN. Assessment: no c/o SOB. pt. d/c home 12/22/09 Duplicate ED/ Hospital records received for DOS 9/17/09-09/19/09. 12/22/09 PCP Medical records received for DOS 11/20/09. Pt. presents with h/o continued fatigue but improved strength; is able to walk, but needs to stop and rest frequently. Assessment: recovering from Guillain-Barre syndrome; hypertension 12/22/09 Neurology consult records for DOS 10/01/09. Pt. gives h/o inability to walk up flight of stairs due to fatigue one day after getting flu shot. Drove himself to ED and was hospitalized for hypertension management . Did not have neurology consult or nerve conduction studies in hospital. Symptoms of weakness gradually improving. Assessment: polyneuropathy

VAERS ID:359656 (history)  Vaccinated:2009-09-30
Age:71.0  Onset:2009-10-01, Days after vaccination: 1
Gender:Male  Submitted:2009-10-06, Days after onset: 5
Location:California  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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97840P1 UNLA
Administered by: Public     Purchased by: Public
Symptoms: Hypoaesthesia facial, Mobility decreased
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)
Write-up: The patient experienced numbness on his face the day after the vaccine was administered which progressed to loss of functions of his right eyebrow. Pt was seen in ER 2 days after vaccine administered.

VAERS ID:359657 (history)  Vaccinated:2009-10-06
Age:63.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Male  Submitted:2009-10-06, Days after onset: 0
Location:Maine  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: Mechanical heart valve
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED01749211A0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever 30 minutes after vaccine administration.

VAERS ID:359658 (history)  Vaccinated:2009-09-29
Age:44.0  Onset:2009-10-01, Days after vaccination: 2
Gender:Female  Submitted:2009-10-06, Days after onset: 5
Location:Arizona  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
TDAP: TDAP (ADACEL)SANOFI PASTEURUF471CA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythema surrounding injection site 14 x 14 cm, no induration, itching.

VAERS ID:359659 (history)  Vaccinated:2009-10-06
Age:47.0  Onset:2009-10-06, Days after vaccination: 0
Gender:Female  Submitted:2009-10-06, Days after onset: 0
Location:Pennsylvania  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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS98432P10UNLA
Administered by: Other     Purchased by: Private
Symptoms: Consciousness fluctuating, Dizziness, Hyperhidrosis, Loss of consciousness, Nausea, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt complained of dizziness and nausea. She looked pale, broke out in a sweat. Had a pulse and was still breathing. Pt was in and out of consciousness 3 X w/in 15 min. loss of consciousness lasted no longer than 1 minute. EMT responded and took vitals. All normal. Pt''s father came to store to drive her home.

VAERS ID:359660 (history)  Vaccinated:2009-10-03
Age:68.0  Onset:2009-10-04, Days after vaccination: 1
Gender:Female  Submitted:2009-10-06, Days after onset: 2
Location:Tennessee  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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS97846P2A UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0632Y UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Injection site erythema, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received shot 10-3-09 (Sat. afternoon). Had some itching and redness Sun.10/4/09. Came into store Mon. 10/5/09; upper arm (R) swelling and redness 3-4 inches in shot area from PNEUMOVAX. FLUVIRIN in other arm. Given ADVIL.

VAERS ID:359661 (history)  Vaccinated:2009-10-06
Age:0.2  Onset:2009-10-06, Days after vaccination: 0
Gender:Male  Submitted:2009-10-06, Days after onset: 0
Location:Texas  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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3388AB UNRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1070U UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHD37052 UNLL
Administered by: Private     Purchased by: Public
Symptoms: Crying, Immediate post-injection reaction, Musculoskeletal stiffness, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (narrow)
Write-up: This is a 2 month old boy. He got 1st set of shots. ROTATEQ po, no problem. PENTACEL right thigh, no problem. RECOMBIVAX HB left thigh. Right after the pt stopped breathing, stiffened. Pt pink after stimulation, started to cry, OK. This lasted about 1/2 minute.

VAERS ID:359662 (history)  Vaccinated:2009-10-02
Age:73.0  Onset:2009-10-02, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Virginia  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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1162X IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Erythema, Pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left arm painful, sore, red, had fever, chills. Took ADVIL and TYLENOL. Use ice. Has gotten better with each day but wanted it. Still had soreness when raising arm above head.

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