MedAlerts Home
  Read the MedAlerts Blog Subscribe to the MedAlerts Blog 

Found 489662 cases in entire database

Case Details (Sorted by Vaccination Date)

This is page 1709 out of 1959

Result pages: prev   1460 1461 1462 1463 1464 1465 1466 1467 1468 1469 1470 1471 1472 1473 1474 1475 1476 1477 1478 1479 1480 1481 1482 1483 1484 1485 1486 1487 1488 1489 1490 1491 1492 1493 1494 1495 1496 1497 1498 1499 1500 1501 1502 1503 1504 1505 1506 1507 1508 1509 1510 1511 1512 1513 1514 1515 1516 1517 1518 1519 1520 1521 1522 1523 1524 1525 1526 1527 1528 1529 1530 1531 1532 1533 1534 1535 1536 1537 1538 1539 1540 1541 1542 1543 1544 1545 1546 1547 1548 1549 1550 1551 1552 1553 1554 1555 1556 1557 1558 1559 1560 1561 1562 1563 1564 1565 1566 1567 1568 1569 1570 1571 1572 1573 1574 1575 1576 1577 1578 1579 1580 1581 1582 1583 1584 1585 1586 1587 1588 1589 1590 1591 1592 1593 1594 1595 1596 1597 1598 1599 1600 1601 1602 1603 1604 1605 1606 1607 1608 1609 1610 1611 1612 1613 1614 1615 1616 1617 1618 1619 1620 1621 1622 1623 1624 1625 1626 1627 1628 1629 1630 1631 1632 1633 1634 1635 1636 1637 1638 1639 1640 1641 1642 1643 1644 1645 1646 1647 1648 1649 1650 1651 1652 1653 1654 1655 1656 1657 1658 1659 1660 1661 1662 1663 1664 1665 1666 1667 1668 1669 1670 1671 1672 1673 1674 1675 1676 1677 1678 1679 1680 1681 1682 1683 1684 1685 1686 1687 1688 1689 1690 1691 1692 1693 1694 1695 1696 1697 1698 1699 1700 1701 1702 1703 1704 1705 1706 1707 1708 1709 1710 1711 1712 1713 1714 1715 1716 1717 1718 1719 1720 1721 1722 1723 1724 1725 1726 1727 1728 1729 1730 1731 1732 1733 1734 1735 1736 1737 1738 1739 1740 1741 1742 1743 1744 1745 1746 1747 1748 1749 1750 1751 1752 1753 1754 1755 1756 1757 1758 1759 1760 1761 1762 1763 1764 1765 1766 1767 1768 1769 1770 1771 1772 1773 1774 1775 1776 1777 1778 1779 1780 1781 1782 1783 1784 1785 1786 1787 1788 1789 1790 1791 1792 1793 1794 1795 1796 1797 1798 1799 1800 1801 1802 1803 1804 1805 1806 1807 1808 1809 1810 1811 1812 1813 1814 1815 1816 1817 1818 1819 1820 1821 1822 1823 1824 1825 1826 1827 1828 1829 1830 1831 1832 1833 1834 1835 1836 1837 1838 1839 1840 1841 1842 1843 1844 1845 1846 1847 1848 1849 1850 1851 1852 1853 1854 1855 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958   next


VAERS ID:467333 (history)  Vaccinated:2012-10-02
Age:56.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 0
Location:North Carolina  Entered:2012-10-02
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
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12050010IMRA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Injection site pain, Injection site reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Approximately 10 min. after administration, the patient complained of pain in the muscle at injection site as well as tingling sensation from shoulder to hand with some pain in elbow and wrist.

VAERS ID:467367 (history)  Vaccinated:2012-10-02
Age:26.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 0
Location:Pennsylvania  Entered:2012-10-02
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: She has had similar vasovagal responses to vaccines prior
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B089AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Loss of consciousness, Paraesthesia, Peripheral coldness
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Within 10 seconds lost consciousness for 10 seconds probable vasovagal reaction. Tongue & hands were cool, felt tingling. BENADRYL given at 10:05, pulse ox raised from 83 to 99% in 15 minutes. It took 1 hour to recover.

VAERS ID:467372 (history)  Vaccinated:2012-10-02
Age:84.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 0
Location:Oklahoma  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4524AA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:467317 (history)  Vaccinated:2012-10-02
Age:31.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Male  Submitted:2012-10-02, Days after onset: 0
Location:Oregon  Entered:2012-10-03, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU43930A0UNLA
Administered by: Private     Purchased by: Other
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Dizziness

VAERS ID:467342 (history)  Vaccinated:2012-10-02
Age:0.3  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 1
Location:Illinois  Entered:2012-10-03
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUH732AB IDUN
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Body temperature increased, Chills, Decreased appetite, Dizziness, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Sudden onset of chills, temp of 102.5, generalized body ache, weakness, nauseous, loss of appetite, dizziness, headache.

VAERS ID:467344 (history)  Vaccinated:2012-10-02
Age:57.0  Onset:2012-10-03, Days after vaccination: 1
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Virginia  Entered:2012-10-03
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: Other
Symptoms: Headache, Lacrimation increased, Neck pain, Sinus operation, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Lacrimal disorders (narrow), Arthritis (broad)
Write-up: WATERY EYES, SINUS DRAINAGE, SCRATCHY THROAT, NECK ACHE, MILD HEADACHE.

VAERS ID:467345 (history)  Vaccinated:2012-10-02
Age:94.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 1
Location:New Jersey  Entered:2012-10-03
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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Dizziness, vomiting, nausea.

VAERS ID:467835 (history)  Vaccinated:2012-10-02
Age:7.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 2
Location:Washington  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No - getting over cold
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AH21092IN 
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC044AA1IMUN
Administered by: Public     Purchased by: Public
Symptoms: Immediate post-injection reaction, Loss of consciousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: Immediately after receiving vaccines, while sitting on chair, became faint, leaned forward at mother''s instruction, I supported him as he collapsed, I slowly lowered him to floor. He regained conscious, responded to mother''s voice & moved over to put his head in her lap on floor. Very pale. After resting 10 minutes, drank 6 oz fruit punch, felt better, after 20 minutes got up & walked out with mother. Pulse WNL.

VAERS ID:467782 (history)  Vaccinated:2012-10-02
Age:2.0  Onset:2012-10-03, Days after vaccination: 1
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:Illinois  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergies (confirmed with blood draw) to raw eggs (can tolerate eating cooked eggs with no reaction), dairy (can tolerate cooked dairy with no reaction), nuts & peanuts (apparent in blood draw), Kiwi
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMLL
Administered by: Unknown     Purchased by: Other
Symptoms: Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash on trunk of body started to appear 24 hours after flu vaccine given. Rash worsened (red and more profuse) on 10/4/2012 (24-48 hours post dose). Rash started to improve on 10/5/12. Not yet resolved.

VAERS ID:467783 (history)  Vaccinated:2012-10-02
Age:54.0  Onset:2012-10-03, Days after vaccination: 1
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:Mississippi  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Military     Purchased by: Other
Symptoms: Erythema, Local reaction, Pain, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Large swelling area, Very Red with slight streak, Feverish, Sore to touch. I took the recommended Tylenol or Motrin. I had to go to our Occupational Health office on 10/4/12 because the swelling was still present, redness area had tripled, pain/fever. Was provided Hydrocortisone Cream for itching (helped) and instructed to place warm compresses hourly and after 48 hours to begin the cold compresses.

VAERS ID:467788 (history)  Vaccinated:2012-10-02
Age:50.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 3
Location:Florida  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Public     Purchased by: Other
Symptoms: Chills, Heart rate increased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad)
Write-up: Chills, severe body aches, fever, increased HR for 3 days.

VAERS ID:467797 (history)  Vaccinated:2012-10-02
Age:12.0  Onset:2012-10-03, Days after vaccination: 1
Gender:Male  Submitted:2012-10-05, Days after onset: 2
Location:Ohio  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None noted
Preexisting Conditions: None noted
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0112321SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm where shot was given started swelling, turning red, and warm to touch. Mom stated PCP is out of town and she didn''t want to go there, advised going to local urgent care as ther was no doctor at The Health Dept. today.

VAERS ID:467799 (history)  Vaccinated:2012-10-02
Age:28.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 3
Location:Florida  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Polycystic ovarian disease, hypothyroidism, gastritis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Abdominal pain upper, Chills, Dizziness, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Severe headache, chills, vomiting, stomach cramps, dizziness.

VAERS ID:467987 (history)  Vaccinated:2012-10-02
Age:65.0  Onset:2012-10-03, Days after vaccination: 1
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:California  Entered:2012-10-05
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: doxycycline
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 4IMLA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC. 0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Drug administered at inappropriate site, Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Raised red area around site about size of silver dollar. Warm and hard. Itchy. Was not given in deltoid but in lower floppy part of arm toward back of arm. Symptoms persist today 10/05/2012.

VAERS ID:467990 (history)  Vaccinated:2012-10-02
Age:64.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Male  Submitted:2012-10-05, Days after onset: 3
Location:Kansas  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: I have Meniere''s and I believe it aggravated my current condition. Experienced dizzy spells for 3 days after the shot.
Preexisting Conditions: Meniere''s, and Heart condition
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS 1 LA
Administered by: Other     Purchased by: Other
Symptoms: Condition aggravated, Dizziness, Gastric mucosal hypertrophy
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: I have Meniere''s, it aggravated my condition with multiple dizzy spells with in hours of having the shot. The afternoon and two days later. I''m better today. And didn''t need Doctor care.

VAERS ID:467991 (history)  Vaccinated:2012-10-02
Age:54.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 3
Location:Texas  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH748AA IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Erythema, Induration, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt received vaccine in afternoon and by evening noticed arm was red, hard and warm to touch. Pt states she has not felt well since receiving vaccine. At time incident reported, pt has a softball size hard, red, raised and warm to touch area at location received vaccine.

VAERS ID:467993 (history)  Vaccinated:2012-10-02
Age:32.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 3
Location:Florida  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N /A
Preexisting Conditions: COMMON ALLERGIES
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204521 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Eye pruritus, Rash, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: STAFF MEMBER REPORTED ABOUT SIX HOURS AFTER ADMINISTRATION OF THE VACCINE SHE BEGAN WHEEZING, HAVING ITCHY EYES AND NOSE AND COMPLAINED OF RASH ON ARMS AND FACE. EMPLOYEE WENT HOME, TOOK BENADRYL AND SYMPTOMS RESOLVED. SHE RETURNED TO WORK THE FOLLOWING DAY.

VAERS ID:467997 (history)  Vaccinated:2012-10-02
Age:49.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 3
Location:Pennsylvania  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Healthy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA708BA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H010661 SCLA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis
SMQs:
Write-up: Cellulitis.

VAERS ID:467998 (history)  Vaccinated:2012-10-02
Age:55.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 3
Location:New Jersey  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No. I was having a physical; no fever, BP & pulse normal; EKG normal; auscultation of lungs clear; hearts sounds normal; I felt fine, after receiving the shots, I went to have my labs drawn immediately and they were all normal. No elevated white blood cells or lymphocytes.
Preexisting Conditions: none
Diagnostic Lab Data: My vitals, chest exam and blood work were all normal and can be easily documented 24 hours before this adverse illness began. I am a physician-a radiologist. In my mind, the case for cause and effect is very strong. In the ER, my vitals were abnormal as was the CXR. I was essentially without any of these symptoms before the vaccines were administered.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA716BA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC528093DA0IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Asthenia, Blood pressure abnormal, Blood test normal, Chest X-ray abnormal, Chills, Dizziness, Haemoptysis, Headache, Laboratory test normal, Lymphocyte count normal, Nausea, Pain, Pneumonia, Pulse abnormal, Pyrexia, Sputum discoloured, White blood cell count normal
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: In afternoon, felt aches, then nausea which got worse, with nausea came dizziness, weakness and headache. No vomiting or diarrhea. No coughing then. I lay down. Over the night, the nausea and headache worsened; when I rolled on my right side, it hurt. Still no couching yet. I had chills by now. I wanted to go to the ER, but I didn''t want to wake my husband. In the early Am, I asked him to take me to the ER where they examined me. Then I had a 102.4 fever. My blood pressure was 79/56?; the ER doctors listened to my lungs and "heard something" leading to a CXR, which showed an obvious right sided pneumonia. Before the CXR, I started to cough up blood, mostly pink to orange stained sputum. This was the first time I actually started to cough. They treated me with IV fluids, anti metics and added antibiotics in the IV. I was in to ER for a few hours. They gave me a prescription for antibiotics which I have been taking. I am drinking fluids (as I always use to do).

VAERS ID:468819 (history)  Vaccinated:2012-10-02
Age:23.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 0
Location:Pennsylvania  Entered:2012-10-10, 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:
Current Illness: None known
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ20240IN 
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Approx. 70 mins. past receiving nasal FLUMIST client started with dizziness. B/P 102/60, P-80. Client reclined without additional symptoms until 3pm. At that time reports less dizziness but now has nausea/headache. 330p - B/P 110/64, P-78 & nausea. Client in touch on phone with primary doctor, arranged for ride home. Told to go to ER if any additional problems. Returned to work on 10/3/12 feeling fine.

VAERS ID:468825 (history)  Vaccinated:2012-10-02
Age:54.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-10, Days after onset: 8
Location:Minnesota  Entered:2012-10-10
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: Hyperlipidemia; Goiter
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0709AE0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Body temperature increased, Joint range of motion decreased, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: On 10/2/12 received pneumococcal vaccine had swelling and pain afterwards for 6-8 hours then swelling spread, pain increased, had limited range of motion and temp 100.7 for 12 hours.

VAERS ID:469025 (history)  Vaccinated:2012-10-02
Age:51.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 2
Location:Arizona  Entered:2012-10-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Routine visit follow up procedure
Preexisting Conditions: Hypertension; Post menopausal
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH733AD IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0106610IMRA
Administered by: Private     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injection site warmth, Local reaction, Lymphadenopathy
SMQs:, Hypersensitivity (narrow)
Write-up: Immediate local reaction - spread to upper arm, hot to touch, glands swollen under arm where received shot - reaction on right arm where received PPSV - no reaction to Flu.

VAERS ID:469105 (history)  Vaccinated:2012-10-02
Age:63.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 2
Location:Wyoming  Entered:2012-10-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.N0105150IMAR
Administered by: Other     Purchased by: Private
Symptoms: Inflammation
SMQs:
Write-up: MD diagnosed with extreme inflammatory response.

VAERS ID:469107 (history)  Vaccinated:2012-10-02
Age:29.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 2
Location:California  Entered:2012-10-10, Days after submission: 6
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 allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH733AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Back pain, Chills, Dyspnoea, Feeling hot, Nervousness
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)
Write-up: 2012-13 Flu vaccination at 130pm on 10/2/12 - OK until approximately 530-6pm, felt weak/shaky, pain to lower back, SOB, hot/chills, next day still felt weak, chills decreased - now feels better (10/4/12).

VAERS ID:469199 (history)  Vaccinated:2012-10-02
Age:75.0  Onset:2012-10-03, Days after vaccination: 1
Gender:Female  Submitted:2012-10-10, Days after onset: 7
Location:Texas  Entered:2012-10-10
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: Codeine allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0105150IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient had red & tender arm from the injection site at the deltoid to her elbow.

VAERS ID:469839 (history)  Vaccinated:2012-10-02
Age:47.0  Onset:2012-10-04, Days after vaccination: 2
Gender:Female  Submitted:2012-10-05, Days after onset: 1
Location:Texas  Entered:2012-10-15, Days after submission: 10
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: Recent hysterectomy (5 wks)
Diagnostic Lab Data: I called pt up at 7:49 pm. Pt said she has allergic reaction (10/05/12) actually to MD, MD gave steroid shot, the symptom under control.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1205000IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0336AE0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Hypersensitivity, Pain in extremity, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Vaccines administered 10-2-12; patient states arm was extremely sore; on morning of 10-4-12 she noticed a red swollen area on arm, warm to the touch located 12 inches below the injection sites; no irritation at injection sites, but continued pain treating w/Ibuprofen.

VAERS ID:474913 (history)  Vaccinated:2012-10-02
Age:  Onset:2012-10-02, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-18, Days after onset: 16
Location:Unknown  Entered:2012-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA003572
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1515Y UNUN
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: This spontaneous report as received from a nurse refers to a patient of unknown age and gender. The patient was vaccinated with an expired dose of PEDVAXHIB on 02-OCT-2012. Route was not reported. Lot # was 666299/1515Y with an expiry date of 27-SEP-2012. No symptoms were reported. Additional information is not expected.

VAERS ID:472348 (history)  Vaccinated:2012-10-02
Age:26.0  Onset:2012-10-03, Days after vaccination: 1
Gender:Female  Submitted:2012-10-22, Days after onset: 19
Location:Ohio  Entered:2012-10-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH721AB IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Induration, Influenza like illness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: 50 x 40mm red induration. Flu-like symptoms, temp 98.8.

VAERS ID:472231 (history)  Vaccinated:2012-10-02
Age:38.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-10-31, Days after onset: 29
Location:Utah  Entered:2012-10-31
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: Hypothroidism
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 4IMRA
Administered by: Public     Purchased by: Other
Symptoms: Bone pain, Drug administered at inappropriate site, Injection site pain, Musculoskeletal pain, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Osteonecrosis (broad), Arthritis (broad)
Write-up: Shot was given very high in my arm and hurt worse than any previous shot given. After shot my shoulder hurt and ached, and has continued to hurt. It has been almost 4 weeks and I have pain and aching through my neck and shoulder and down my arm. Feels like the pain is in my bone.

VAERS ID:476214 (history)  Vaccinated:2012-10-02
Age:43.0  Onset:2012-10-03, Days after vaccination: 1
Gender:Female  Submitted:2012-11-06, Days after onset: 34
Location:Minnesota  Entered:2012-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hyperlipidemia; Allergies to seasonal, bananas, carrots
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B094AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt. developed pain and 1 mm firm mobile lump at injection site. Treated with antibiotics for cellulitis. Pain continued. Primary MD ordered physical therapy.

VAERS ID:476122 (history)  Vaccinated:2012-10-02
Age:29.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2012-12-03, Days after onset: 62
Location:Mississippi  Entered:2012-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: None reported
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204501 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H010515 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chest discomfort, Chills, Dyspnoea, Erythema, Muscle tightness, Pain, Pain in extremity, Pyrexia, Sensation of heaviness
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: 3 hours after shot Left arm felt heavy and sore, fever, and achy, chills. Arm painful from midnight on. Muscle felt knotted up. 2nd day arm turned really red and was better within 4 days. Went to doctor and started on anti-inflammatory medication. Chest tight and hard to breathe, Dr. Prescribed Z-pak.

VAERS ID:477851 (history)  Vaccinated:2012-10-02
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2012-12-12
Location:Unknown  Entered:2012-12-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1212USA000913
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0420AE UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report as received from a Licensed Practical nurse refers to 8 patients of unknown age and gender. On 02-OCT-2012, the patients were vaccinated with GARDASIL (lot # 0420AE and expiry date was 02-NOV-2014, route and dose were not reported) that was exposed to 25 degree Fahrenheit for an unknown period of time. No concomitant medications were reported. No adverse symptoms reported. This is one of the several reports received from the same reporter (MARRS# 1212USA000914, 1212USA003709, 1212USA003710, 1212USA003711, 1212USA003712, 1212USA003713, 1212USA003714 and 1212USA004285) Additional information has been requested.

VAERS ID:481109 (history)  Vaccinated:2012-10-02
Age:61.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2013-01-10, Days after onset: 100
Location:Delaware  Entered:2013-01-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No, maybe a UTI
Preexisting Conditions:
Diagnostic Lab Data: ESR, 100 on 10/6/12; CPK, 63
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP50508 IMUN
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase normal, Headache, Pain, Red blood cell sedimentation rate increased, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Could not make her words make sense 10/3 achy all over - severe 10/4 weak in shoulder girdle headache.

VAERS ID:482111 (history)  Vaccinated:2012-10-02
Age:65.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2013-01-22, Days after onset: 112
Location:Ohio  Entered:2013-01-22
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) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4491AA0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Arm redness and swelling that went away. Arm soreness that continues today.

VAERS ID:484689 (history)  Vaccinated:2012-10-02
Age:22.0  Onset:2012-11-01, Days after vaccination: 30
Gender:Female  Submitted:2013-02-16, Days after onset: 107
Location:Utah  Entered:2013-02-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  SYR 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Injection site induration, Injection site mass, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Large, hard bump at injection site, quarter-sized. All-over severe body, joint aches/pain.

VAERS ID:504936 (history)  Vaccinated:2012-10-02
Age:66.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Male  Submitted:2013-10-01, Days after onset: 364
Location:Maine  Entered:2013-10-01
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Various brain, lung and cervical MRIs and CTs. Spinal tap. Blood tests for auto immune diseases, abnormal cells and vasculities. Blood in urine. Surgery for bladder inflammation and ulcers, Suspected Sjogren''s and or IGG4.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)NOVARTIS VACCINES AND DIAGNOSTICS500011A2SYRRA
Administered by: Unknown     Purchased by: Private
Symptoms: Agitation, Asthenia, Blood test, Blood urine present, Burning sensation, Chills, Computerised tomogram head, Computerised tomogram thorax, Cystitis noninfective, Dizziness, Dyspnoea, Headache, Hyperacusis, Hyperaesthesia, Immediate post-injection reaction, Immunoglobulin G4 related sclerosing disease, Immunology test, Irritability, Lumbar puncture, Malaise, Muscle tightness, Nausea, Neck pain, Nervousness, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging spinal, Nuclear magnetic resonance imaging thoracic, Ocular hyperaemia, Oropharyngeal pain, Sinus congestion, Sjogren's syndrome, Surgery, Tension headache, Tremor, Ulcer, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal ulceration (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: The Side Effects [I was told that these side effects following the improper injection of Dose #3 on 10/2/12 of the Rabies vaccine were not reported to the CDC by the ER. [1] The immediate side effect [within 30 seconds] following the 10/2 injection was an intense burning, hot sensation that started in my abdomen area and then traveled up into my upper chest [heart and lung areas] and throat. I informed the nurse of this side effect. She did not respond, nor check my vital signs, nor inform the ER physician. I sat there until this intense burning sensation diminished; and then I left the ER. [2] The next side effect happened about 30 minutes after the injection. I suddenly and rapidly developed major breathing problems, including forceful inhalation efforts and loud wheezing. My breathing was labored. In short order, my head and neck began to ache. There was a substantial tightness [in muscles] in the back of the neck, the sides around the head [very bad at the forehead, sinus areas]. My sinus areas felt blocked. Upper body nervousness and chills set in. My eyes were bloodshot; and my throat became more painful. These side effects continued for about 30 minutes. [3] The issues described in [2] lessened somewhat about noontime. I then tried to eat some lunch, but quickly developed nausea and a general feeling of illness. [4] Shortly thereafter, I became extremely agitated and irritable to any/all stimuli, including all touch and noise. My entire body felt like it was trembling in a significant way. There was obvious trembling in arms, hands and upper body. I then became very dizzy. The hot, burning sensation in the throat and upper chest/lungs continued. My whole body was weak. My eyes were bloodshot.

VAERS ID:523793 (history)  Vaccinated:2012-10-02
Age:25.0  Onset:2012-10-02, Days after vaccination: 0
Gender:Female  Submitted:2013-07-26, Days after onset: 297
Location:Montana  Entered:2014-02-24, Days after submission: 213
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: 2012SE76366
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ2024 IN 
Administered by: Other     Purchased by: Other
Symptoms: Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: A report has been received from a Health Professional concerning a 25 years old female patient. The patient''s medical history and concomitant medications were not reported. On 02-Oct-2012, the patient FLUMIST (Intranasal). The patient was pregnant at the time she received vaccine. Upon follow-up patient stated she had her baby girl delivered with weight: 6 pounds and 8 ounces, length: 20 inches and she was a healthy baby with no medication use or health issues. At the time of reporting the outcome of the event was unknown. The report was considered to be non-serious by company physician. Corrected report: Drug start and stop date, Event start date as 02-Oct-2012 added. Age at onset calculated. Summary of follow-up information received by AstraZeneca/MedImmune from registered nurse on 23-Oct-2012: Patient contact details added. Corrected report 19-Nov-2012: The event of administration to newly pregnant female has become a KUR term: therefore the case has been updated accordingly. Summary of follow-up information received by AstraZeneca/MedImmune 26-Jul-2013 from consumer: pregnancy and date, result added.

VAERS ID:467346 (history)  Vaccinated:2012-10-03
Age:23.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Michigan  Entered:2012-10-03
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) (FLUZONE)SANOFI PASTEURUH745AD0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Erythema, Pain, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, swelling, itchiness, soreness. Benadryl 25 mg taken and ice applied.

VAERS ID:467365 (history)  Vaccinated:2012-10-03
Age:4.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Texas  Entered:2012-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: After giving vaccine had rash on face, chest and back.
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B213AA4IMLL
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ21061IN 
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB586BA0IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0233AE1IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0076081IMLL
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash on face chest and back.

VAERS ID:467397 (history)  Vaccinated:2012-10-03
Age:46.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Texas  Entered:2012-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH734AD IMAR
Administered by: Private     Purchased by: Unknown
Symptoms: Lip swelling, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Mouth and lip tingling, swollen lips.

VAERS ID:467459 (history)  Vaccinated:2012-10-03
Age:72.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:D.C.  Entered:2012-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4490AA IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Nausea, Pallor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient was given FLUZONE High dose at 12:00 pm after 10 minutes she was nauseated & threw up was pale in color & sweating & difficulty breathing & almost passed out. Called 911 who came & took pt to the hospital.

VAERS ID:467465 (history)  Vaccinated:2012-10-03
Age:55.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Connecticut  Entered:2012-10-03
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
Administered by: Unknown     Purchased by: Other
Symptoms: Heart rate increased, Muscular weakness, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Racing pulse (over 100 bpm); tingling of hands and feet; weakness.

VAERS ID:467477 (history)  Vaccinated:2012-10-03
Age:61.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:California  Entered:2012-10-03
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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AH21090IN 
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: No adverse effect occurred.

VAERS ID:467479 (history)  Vaccinated:2012-10-03
Age:30.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Wisconsin  Entered:2012-10-03
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) (FLUZONE)SANOFI PASTEUR    
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Fatigue, Headache
SMQs:, Arthritis (broad)
Write-up: Headache, achy joints, fatigue.

VAERS ID:467486 (history)  Vaccinated:2012-10-03
Age:11.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:New York  Entered:2012-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4052AD0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC526093AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1062AA1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Throat tightness, shortness of breath, urticaria. Treatment: Albuterol nebulizer treatment, Benadryl, Epinephrine.

VAERS ID:467534 (history)  Vaccinated:2012-10-03
Age:69.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:California  Entered:2012-10-03
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: DM; HTN; CAD; PVD; CKD; Heart failure; Stroke; Carotid artery stenosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH718AB IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Immediate post-injection reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: After patient was injected with influenza into (Rt) deltoid, IM patients arm, site of injection, immediately started to swell up into about a 40mm circle around injection site. Dr. came in and advised to place an ice pack. Ice pack was placed and monitored for 15 min. Patient denied prior reactions to flu injection. Also denied any SOB, itching or chest pain.

VAERS ID:467489 (history)  Vaccinated:2012-10-03
Age:11.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:California  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diarrhea for six days.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1SYRLL
Administered by: Private     Purchased by: Other
Symptoms: Hypersomnia, Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: My Son has a rectal fever of 103.5 that won''t stay down he is extremely fussy and has slept most of the day.

VAERS ID:467490 (history)  Vaccinated:2012-10-03
Age:34.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Virginia  Entered:2012-10-04
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: PCOS
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNLA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNLA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Burning sensation, Dizziness, Injected limb mobility decreased, Injection site warmth, Pyrexia, Respiratory rate increased
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: Fever of 100-102 that won''t break with Motrin, can''t lift arm where I received the shot, injection site really hot, resting pulse between 110-120, dizzy, no energy, increased respiratory rate, joint aches, burning sensation in chest wall.

VAERS ID:467503 (history)  Vaccinated:2012-10-03
Age:39.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-04, Days after onset: 0
Location:New Jersey  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA727AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site reaction, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Minimal blotching upper arms, torso (anter) pruritus. ALLEGRA OTC with f/u appt 10/5/12 expect full recovery with returned to full day 10/5.

VAERS ID:467509 (history)  Vaccinated:2012-10-03
Age:11.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Indiana  Entered:2012-10-04
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: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH745AD0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0104260IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4289AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4170AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0117211SCRA
Administered by: Public     Purchased by: Private
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Client receive Tdap; MCV4; influenza; varicella; HAV. After GARDASIL given client passed out in chair. Mother reports she had not eaten since 12PM. Client recovered within 1/2 hour, Sprite & crackers given. Client left 1/2 hour later.

VAERS ID:467566 (history)  Vaccinated:2012-10-03
Age:57.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Ohio  Entered:2012-10-04
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: Arthritis, PTSD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUM756AA SYRLA
Administered by: Other     Purchased by: Public
Symptoms: Chills, Influenza, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: I began to have a very high fever and uncontrollable chills. I have never had a reaction to a shot before in my life. I felt I was getting the flu and fighting it for all I was worth. I never vomited; however, I had to lie under a heating blanket and at around 1:00 AM I was better.

VAERS ID:467573 (history)  Vaccinated:2012-10-03
Age:63.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:Iowa  Entered:2012-10-04
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: Had a echocardiogram on 10/01/12 - injected with dye for the procedure.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP58306 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Nauseated for two hours. No vomiting/diarrhea.

VAERS ID:467574 (history)  Vaccinated:2012-10-03
Age:44.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Arizona  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: none reported
Diagnostic Lab Data: unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206001 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Oedema peripheral, Throat tightness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Red raised area to injection site approx 2x3, bilateral pedal edema and edema in L calf. Tightness in throat at 2:20 PM 0.5 mg epi administered sq to l arm. EMT arrived at 2:35 PM. Client transported to hospital for observation.

VAERS ID:467578 (history)  Vaccinated:2012-10-03
Age:8.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:Maryland  Entered:2012-10-04
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: Allergy
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH745AD8IMLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling abnormal, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Hypersensitivity (narrow)
Write-up: Child told mother he felt weird and had itchy tongue. Shortly thereafter he broke out in hives.

VAERS ID:467579 (history)  Vaccinated:2012-10-03
Age:56.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:Texas  Entered:2012-10-04
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: patient reported that he previously had a triple bypass in 1996
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12251P16IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0098250IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B099AA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Hyperhidrosis, Injected limb mobility decreased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Patient reports waking up in the night (10/3/12) with a sweat and that the next morning (10/4/12) he could not move his right arm from his shoulder to his elbow. Patient states he does not have a fever and there is no redness or swelling at the injection site. Patient is following up with his primary physician.

VAERS ID:467580 (history)  Vaccinated:2012-10-03
Age:30.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:Nebraska  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR 5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash erythematous, Rash generalised, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Red, raised hives all over body. Went to PCP the next day, given prednisone and sent home. Later that day, went to ER with swollen tongue, given Pepcid and Benadryl, will see PCP again today as spots that went away are now starting to reappear.

VAERS ID:467581 (history)  Vaccinated:2012-10-03
Age:31.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Michigan  Entered:2012-10-04
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
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA735BA10IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Feeling hot, Induration, Injection site pruritus, Oedema, Pain, Pain in extremity, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Started out itching at site within 5 min. of administration. Then developed soreness, redness, warmth and edema within 30 min. I took Phenergan 12.5mg and Motrin 800mg 1 hour after vaccine administration. I repeated Phenergan 6.25mg 5 hours after vaccine administration. Took Motrin 800mg at 08:00 AM on 10/4/12. Arm remains sore, red, and hard to touch. Also have itching over entire arm, but no visible rash on remainder of arm.

VAERS ID:467584 (history)  Vaccinated:2012-10-03
Age:47.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:California  Entered:2012-10-04
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH715AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad)
Write-up: Headache, fatigue, sore joints, 102 degree fever.

VAERS ID:467585 (history)  Vaccinated:2012-10-03
Age:62.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Michigan  Entered:2012-10-04
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEUR4928103900IDLA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Asthenia, Chills, Dizziness, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Fever, 103* chills (teeth were chattering) severe aches, dizziness, vomiting, abdominal pain, severe weakness.

VAERS ID:467603 (history)  Vaccinated:2012-10-03
Age:56.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-04, Days after onset: 0
Location:Oregon  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Rheumatoid Arthritis
Preexisting Conditions: Latex Bee Stings
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12251P IMLA
Administered by: Private     Purchased by: Public
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Generalize non blanching rash from head to toe.

VAERS ID:467606 (history)  Vaccinated:2012-10-03
Age:0.3  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-04, Days after onset: 0
Location:California  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: none known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4260AB1IMLL
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC093AA1IMRL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF709961IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0277AE1PO 
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever of 101.3 F.

VAERS ID:467651 (history)  Vaccinated:2012-10-03
Age:72.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Florida  Entered:2012-10-04
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4498BA IMUN
Administered by: Other     Purchased by: Private
Symptoms: Hypertension, Influenza, Restlessness, Sinus disorder, Swollen tongue, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (narrow)
Write-up: Vaccine given approx 5PM 10-3-12. 9PM Scratchy throat - tongue swelling - hypertension did not go to ER or take anything restless night. 10-4-12 Sinus problems - flu symptoms.

VAERS ID:467655 (history)  Vaccinated:2012-10-03
Age:59.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:North Carolina  Entered:2012-10-04
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) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Headache, Lacrimation increased, Nasal congestion, Ocular hyperaemia, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (narrow), Glaucoma (broad), Lacrimal disorders (narrow), Hypersensitivity (broad)
Write-up: Received the shot about 1:15 pm on 10-03-2012. By 5:30pm my eyes were bloodshot. By 8:30 pm I couldn''t breathe from my nose. Clogged nasal passages, sniffles, red-runny eyes, head-achy. A little coughing & sneezing. Took 2 CORICIDIN''S HBP, drank orange juice (a cup) & a cup of water. Ate & went to bed.

VAERS ID:467657 (history)  Vaccinated:2012-10-03
Age:52.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:California  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Back pain
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1205801 IMRA
Administered by: Private     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: Swelling, redness 10 x 10 cm in area around injection site within 1 hr injection.

VAERS ID:467673 (history)  Vaccinated:2012-10-03
Age:69.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:Texas  Entered:2012-10-04
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: no known drug allergies or previous existing medical conditions
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1205001 IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt called the next day, 10/04/2012 to report itching and swelling at the injection site. She took over the counter Benadryl which temporarily helped but symptoms returned not long after. Other symptoms denied.

VAERS ID:467677 (history)  Vaccinated:2012-10-03
Age:43.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:Hawaii  Entered:2012-10-04
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: Patient developed itchy all over today around 9:30pm to 2:00am. At 1:00-1:30am felt feverish. At 2:00am throat felt tightening and took 25mg of Benadryl. At 3:00am stop itching and felt better. Followed with BAS at 9:30am(04Oct2012). Patient sent to lab for basic lab drawn. Will follow up with patient when lab result is complete.
Diagnostic Lab Data: Ordered labs: CBC, Lipid, BMP
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURG113011IMRA
Administered by: Military     Purchased by: Military
Symptoms: Feeling hot, Full blood count, Lipids, Metabolic function test, Pruritus generalised, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Patient developed itchy all over today around 9:30pm to 2:00am. At 1:00-1:30am felt feverish. At 2:00am throat felt tightening and took 25mg of Benadryl. At 3:00am stop itching and felt better. Followed with BAS at 9:30am (04Oct2012). Patient sent to lab for basic lab drawn. Will follow up with patient when lab result is complete.

VAERS ID:467678 (history)  Vaccinated:2012-10-03
Age:32.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-04, Days after onset: 0
Location:Massachusetts  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI
Preexisting Conditions: pregnancy (9 weeks), but no complications or nausea/morning sickness
Diagnostic Lab Data: not yet established
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 3IMLA
Administered by: Other     Purchased by: Private
Symptoms: Aphagia, Chills, Fluid intake reduced, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Noticed nausea and slight fever upon waking. Vomited at 9:30 and 10:30 am, fever and chills from 8:30am-4:30 pm when this report was completed, still nauseous and vomited at 4:15 pm. Cannot eat or drink anything.

VAERS ID:467682 (history)  Vaccinated:2012-10-03
Age:37.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Wisconsin  Entered:2012-10-04
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, treated at home
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH714AA1IMLA
Administered by: Public     Purchased by: Other
Symptoms: Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Sore, achy body, headache, fever of 101.3 on 10/03/2012 @ 930pm. Took Tylenol and Aleve relieved fever and aches. Felt better by 7 am on 10/04/2012.

VAERS ID:467691 (history)  Vaccinated:2012-10-03
Age:44.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Texas  Entered:2012-10-04
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: Rubella IgG and Rubella IgM temp taken 98.6 no axillary nodes injection site clear.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1874AA SCRA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Fatigue, Myalgia, Ocular hyperaemia, Pyrexia, Rubella antibody test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad)
Write-up: Chills low grade fever tiredness myalgia, right eye redness.

VAERS ID:467708 (history)  Vaccinated:2012-10-03
Age:5.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-04, Days after onset: 0
Location:Idaho  Entered:2012-10-04
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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Severe redness, and swelling of the whole thigh/leg area. Painful to touch and leg is fevering/hot to touch.

VAERS ID:467733 (history)  Vaccinated:2012-10-03
Age:0.6  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-04, Days after onset: 0
Location:Pennsylvania  Entered:2012-10-04
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: Eczema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4299AA2UNLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4544EA0UNLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Lt leg with 3 separate erythema rash - raised - (1) -$g 10cm x 12cm (Lt buttocks) (2) -$g 10 cm x 20 cm (vastus lateralis) (3) 15 cm x 30 cm (vastus lateralis).

VAERS ID:467734 (history)  Vaccinated:2012-10-03
Age:59.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Arizona  Entered:2012-10-04
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: Allergic to penicillin, PRAVACHOL
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Pt reported swelling of the tongue at night, was seen in office on 10/4/12 for tongue and facial swelling. Loratadine was prescribed.

VAERS ID:467737 (history)  Vaccinated:2012-10-03
Age:84.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Arizona  Entered:2012-10-04
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: Hx Poliomyelitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AA5IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Headache, Paraesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Tongue tingling, headache, dizziness.

VAERS ID:467745 (history)  Vaccinated:2012-10-03
Age:65.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:California  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Thyroid disease
Preexisting Conditions: TORADOL; CIPRO; SEPTRA; DEMEROL; Erythromycin; AUGMENTIN; Codeine; Iodine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12043011IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Abdominal discomfort, Blood pressure increased, Diarrhoea, Eye pain, Feeling hot, Headache, Injection site warmth, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (broad), Noninfectious diarrhoea (narrow)
Write-up: About 1 hour post flu shot administration, patient experienced hot sensation starting from injection site radiating throughout the rest of the body. Other symptoms included blurry vision, eye pain, severe headache, nausea, upset stomach, diarrhea. BP elevated to 174/105.

VAERS ID:467829 (history)  Vaccinated:2012-10-03
Age:38.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:Oregon  Entered:2012-10-04
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: NKMA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA689AA0IMLA
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: Redness & swelling at injection site (L) deltoid.

VAERS ID:467786 (history)  Vaccinated:2012-10-03
Age:4.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-05, Days after onset: 2
Location:North Carolina  Entered:2012-10-05
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
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B213BA0IMLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AB3IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0233AE1SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0075271SCRL
Administered by: Private     Purchased by: Public
Symptoms: Ear infection, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient presented with upper right thigh redness, swelling, hot to the touch, and covered most of the upper thigh, Started oral treatment of sulfamethoxazole-trimethoprim 200/40 mg per 5mL 17 mL twice daily X 10 days but patient also had ear infect. and patient is sched. for follow-up on 10/05/2012.

VAERS ID:467791 (history)  Vaccinated:2012-10-03
Age:30.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:New York  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Sulfa Allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12051210IMLA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Feeling hot, Induration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Local induration, swelling, heat, redness 4 cm x 8 cm.

VAERS ID:467798 (history)  Vaccinated:2012-10-03
Age:39.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:Indiana  Entered:2012-10-05
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
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206001 IMRA
Administered by: Other     Purchased by: Other
Symptoms: Acne, Blood glucose decreased
SMQs:
Write-up: Low blood sugar and acne.

VAERS ID:467802 (history)  Vaccinated:2012-10-03
Age:83.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-05, Days after onset: 2
Location:Mississippi  Entered:2012-10-05
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: COPD, HYPERTENSION
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP5960811IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1706AA1IMRA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site swelling, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: LOCAL PAIN, REDNESS, AND SWELLING AT THE SITE OF THE INJECTION (RIGHT ARM). SWELLING AND REDNESS TRAVELING DOWN THE ARM.

VAERS ID:467813 (history)  Vaccinated:2012-10-03
Age:72.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Male  Submitted:2012-10-05, Days after onset: 0
Location:Wisconsin  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS120381 IMLA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0068AE SCRA
Administered by: Public     Purchased by: Other
Symptoms: Pain of skin, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Red rash, approx. size of a lemon, tender to rt. arm.

VAERS ID:467815 (history)  Vaccinated:2012-10-03
Age:15.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:Texas  Entered:2012-10-05
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: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1636AE2IMRA
Administered by: Unknown     Purchased by: Other
Symptoms: Chills, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Fever, chills, and sore throat

VAERS ID:467820 (history)  Vaccinated:2012-10-03
Age:51.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:Minnesota  Entered:2012-10-05
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
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Abdominal pain upper, Chills
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Extreme chills & later stomach ache chills were treated w/ibuprofen & stomach ache by no food intake until pain subsided early next morning.

VAERS ID:467894 (history)  Vaccinated:2012-10-03
Age:11.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-05, Days after onset: 1
Location:Oregon  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anorexia - 4/3/2007; Claw toe - 3/30/2009
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AH2109 IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0629AE IMRA
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURU4264AB IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Local swelling, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Local red swollen reaction to vaccines given 2 days prior.

VAERS ID:467976 (history)  Vaccinated:2012-10-03
Age:37.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:California  Entered:2012-10-05
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1231030IMLA
Administered by: Other     Purchased by: Private
Symptoms: Feeling cold, Feeling hot, Headache, Hypotension, Muscular weakness, Pain, Pain in extremity, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad)
Write-up: Patient reports on 10/3/12 was experienced temple soreness, hypotension, heart palpitations, icy cold/warm feeling, body achiness of entire body and chest/back/shoulder and legs were achy and weak.

VAERS ID:468001 (history)  Vaccinated:2012-10-03
Age:0.8  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-05, Days after onset: 0
Location:Wyoming  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: None.
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4481BA0IMLL
Administered by: Military     Purchased by: Military
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: She woke up with urticaria on legs, chest, and face. Also fever to 101.

VAERS ID:468003 (history)  Vaccinated:2012-10-03
Age:19.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-05, Days after onset: 1
Location:Ohio  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC111AA1IMRA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Hypoaesthesia oral, Nausea, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: States became noticed a few hives, became nauseated, lightheaded, lips became numb. She put cold compress on her head, layed down and symptoms, except for hives subsided after approx. 7 min. On 10/05/2012, in PM, states hives began to worsen, with itching.

VAERS ID:468010 (history)  Vaccinated:2012-10-03
Age:32.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-05, Days after onset: 2
Location:New York  Entered:2012-10-05
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Back pain, Chills, Decreased appetite, Hyperhidrosis, Injection site erythema, Injection site pain, Injection site swelling, Myalgia, Neck pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Started with pain at injection site, then pain throughout back, neck, muscle aches in legs, abdomen, chills, fever, loss of appetite, then sweats persisting through October 5. The injection site became red and swollen and remained tender.

VAERS ID:468015 (history)  Vaccinated:2012-10-03
Age:39.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-05, Days after onset: 2
Location:California  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Lip swelling, Oedema peripheral, Palatal oedema, Swelling face, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Swelling of face, lip and uvula. Swelling and tenderness right axilla and lateral chest. Face swelling improved with Allegra.

VAERS ID:468363 (history)  Vaccinated:2012-10-03
Age:76.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-05, Days after onset: 1
Location:Minnesota  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Tetanus immunization allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12052017IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0074AE2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: She had redness, swelling, warmth and tenderness involving the entire lateral aspect of the left upper arm.

VAERS ID:468367 (history)  Vaccinated:2012-10-03
Age:65.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-05, Days after onset: 1
Location:Illinois  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA; none
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206701 UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.N013581 UNRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Day after injection, redness at injection site, fever. Advised pt to see doctor. Doctor prescribed Doxycycline 100mg BID & Hydroxyzine 25mg TID prn.

VAERS ID:468022 (history)  Vaccinated:2012-10-03
Age:62.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-06, Days after onset: 3
Location:New Jersey  Entered:2012-10-06
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
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   RA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Soreness, redness, swelling spreading down arm to elbow joint, worsening each day.

VAERS ID:468024 (history)  Vaccinated:2012-10-03
Age:65.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-06, Days after onset: 3
Location:Alaska  Entered:2012-10-06
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: Hypertension
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AA3IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1417AA1IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pain, redness and swelling of the left arm where the Pneumovax and flu shots were given.

VAERS ID:468031 (history)  Vaccinated:2012-10-03
Age:32.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-06, Days after onset: 3
Location:Ohio  Entered:2012-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Sulfa; Penicillin; Cephalosporins
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Injection site warmth, Pain in extremity, Pyrexia, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Hives, swelling, high fever, warm at site of injection, and severe pain in entire upper arm.

VAERS ID:468034 (history)  Vaccinated:2012-10-03
Age:68.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-06, Days after onset: 3
Location:Virginia  Entered:2012-10-06
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: Hypertension (well controlled with medication) Osteoarthritis in lower back; no symptoms at time of vaccination or flare-up in months Occasional sciatica pain and numbness, left hip and leg; not active at time of vaccination
Diagnostic Lab Data: I assume I will recover. This has been a nuisance, not a life threatening reaction. So it goes. . . .
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Back pain, Condition aggravated, Hypoaesthesia, Joint stiffness, Mobility decreased, Musculoskeletal stiffness, Pain, Pain in jaw, Sciatica
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Osteonecrosis (broad), Arthritis (broad)
Write-up: Gradual onset in the twelve hours follow vaccination of lower back and left hip pain and stiffness. I think of this reaction as a "Flare-Up" of sciatica and lower back pain. I first attributed it to sitting at my computer desk for an extended period, but I was getting up and walking the stairs frequently. By the next morning pain in lower back and left hip was so severe I had a hard time getting out of bed, with shooting pains, stiffness, and numbness in the left leg. The pain persisted to the point of throbbing until several hours later I retired to bed and slept several hours, which eased the severity of pain. Walking was possible, but painful. I spend much of the first day (Thursday) in bed. The next day (Friday) I actually went back to the facility for scheduled tests, where I reported the reaction to my doctor''s nurse. The pain seemed to lessen Friday evening, but returned worse on Saturday. I sit here on Saturday afternoon submitting this report with nagging lower back pain, stiffness and "hip pointer" pain. I also today have had some neck stiffness and jaw pain. I am a teeth grinder and have osteoarthritis in the cervical spine also. Is it possible that this is a reaction to the vaccine of my worn body parts resulting in a flareup?

VAERS ID:468069 (history)  Vaccinated:2012-10-03
Age:47.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-06, Days after onset: 1
Location:Oregon  Entered:2012-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Delayed 2 days later
Preexisting Conditions: Pancreatitis
Diagnostic Lab Data: Allergic reaction at/around injection, localized to arm
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP59207 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Hypersensitivity, Injection site swelling, Local reaction
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Swelling below injection site, received Rx for hydroxyzine HCL 10mg/ml dose 25mg TID. Patient reacts to lots of meds due to pancreatitis.

VAERS ID:468050 (history)  Vaccinated:2012-10-03
Age:72.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-07, Days after onset: 4
Location:Arizona  Entered:2012-10-07
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) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS    
Administered by: Other     Purchased by: Other
Symptoms: Chills, Cough, Headache, Lung disorder, Muscular weakness, Oropharyngeal pain, Pyrexia, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Sore Throat, Chills, Fever, Headache muscle weakness, progressing into respiratory symptoms (i.e. cough. congestion, lung problems, etc.) by the 4th day (i.e., October 7th). Never had symptoms in previous 10 years.

VAERS ID:468051 (history)  Vaccinated:2012-10-03
Age:0.2  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-07, Days after onset: 4
Location:Pennsylvania  Entered:2012-10-07
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: Urine and Blood culture; Chest x-ray; Flu and Viral cultures; Complete CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4275AA1IMLG
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF959421IMLG
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0283AE PO 
Administered by: Private     Purchased by: Private
Symptoms: Blood culture, Chest X-ray, Culture urine, Cyanosis, Decreased appetite, Diarrhoea, Dyspnoea, Fatigue, Full blood count, Influenza virus test, Lethargy, Pyrexia, Viral test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow)
Write-up: Fever above 100.4. Vomiting - mulitple times, diarrhea, lethargic, difficulty breathing - tongue/lips turned blue, decrease in appetite, extreme tiredness.

VAERS ID:468099 (history)  Vaccinated:2012-10-03
Age:62.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-06, Days after onset: 2
Location:California  Entered:2012-10-07, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0169AE0SCUN
Administered by: Other     Purchased by: Private
Symptoms: Pruritus generalised, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Generalized itching. Rash on chest. BENADRYL helped with itching.

VAERS ID:468271 (history)  Vaccinated:2012-10-03
Age:52.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-05, Days after onset: 1
Location:New York  Entered:2012-10-07, Days after submission: 2
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: HTN; Allergies to wheat, pollen, dust, trees
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12051210IMLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site oedema, Injection site pain, Musculoskeletal pain, Musculoskeletal stiffness
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Lt. upper arm erythema, edema, and pain. Lt. shoulder stiffness and pain, headache, stiff neck. Prescribed OMNICEF 300mg bid x 10 days.

VAERS ID:468109 (history)  Vaccinated:2012-10-03
Age:0.3  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-08, Days after onset: 4
Location:Pennsylvania  Entered:2012-10-08
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Born at 33 5/7 weeks gestation
Diagnostic Lab Data: Stool for WBC (-); Stool Cx - pending; Blood Cx - (-) x 4d: UA - WNL; LP - WNL; Glucose - 15, repeat 30; Chest/abdominal x-ray - WNL; CSF viral - still (-)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B326CA1IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUH527AA1IMLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF636671IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0056AE1PO 
Administered by: Public     Purchased by: Public
Symptoms: Abdominal X-ray, Blood culture negative, Blood glucose decreased, CSF virus no organisms observed, Chest X-ray normal, Convulsion, Culture stool, Cyanosis, Diarrhoea, Dyskinesia, Dyspnoea, Feeling abnormal, Hyperhidrosis, Lethargy, Listless, Lumbar puncture normal, Pyrexia, Urine analysis normal, White blood cells stool negative, X-ray normal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Dyskinesia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (narrow)
Write-up: Pt described as "fuzzy" day of vaccination. Day following, fed and napped normally at 9am. Found at 11:15am and found to be diaphoretic, listless, & heavy breathing, possibly status post unwitnessed seizure. Then 2 witnessed seizures x3min with unilateral arm/leg movement in ER with fever $g105 degrees F, given APAP rectally. Presented with diarrhea, lethargy, and cyanosis.

VAERS ID:468111 (history)  Vaccinated:2012-10-03
Age:0.3  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 5
Location:Florida  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4257AA0IMLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF724951IMRL
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALSA41FB288A1PO 
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:468130 (history)  Vaccinated:2012-10-03
Age:63.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-08, Days after onset: 3
Location:Ohio  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: hypothyroid
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA733BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site cellulitis
SMQs:
Write-up: Developing Cellulitis at injection site.

VAERS ID:468137 (history)  Vaccinated:2012-10-03
Age:43.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 5
Location:Florida  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic rhinitis, chronic sinusitis
Preexisting Conditions: Allergic Rhinitis, chronic sinusitis Allergy to benzonatate and ofloxacin
Diagnostic Lab Data: Treated with NS and IV Solumedrol 125 mg
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0098260IMLA
Administered by: Private     Purchased by: Other
Symptoms: Hypoaesthesia, Hypoaesthesia oral, Paraesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: Numb and tingling left side of face and tongue; itching on face.

VAERS ID:468176 (history)  Vaccinated:2012-10-03
Age:9.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-08, Days after onset: 4
Location:Indiana  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Nasal Allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH752AB IMLA
Administered by: Private     Purchased by: Private
Symptoms: Induration, Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness, tenderness and warmth at injection site; induration 14 x 16 cm.

VAERS ID:468327 (history)  Vaccinated:2012-10-03
Age:47.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 5
Location:Oregon  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR 0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Lymphadenopathy, Oropharyngeal pain, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: CHILLS, SORE THROAT, SWOLLEN THROAT GLANDS, VOMITING. TOOK EXCEDRIN IN THE MIDDLE OF THE NIGHT FOR SORE THROAT. RESTED FOR 48 HOURS.

VAERS ID:468335 (history)  Vaccinated:2012-10-03
Age:55.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-08, Days after onset: 4
Location:Connecticut  Entered:2012-10-08
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: Hypothyroidism
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED 0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Dizziness, Dyspnoea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)
Write-up: Vomiting, diarrhea, dizziness, difficulty breathing.

VAERS ID:468341 (history)  Vaccinated:2012-10-03
Age:60.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 5
Location:New Hampshire  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: COPD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Mobility decreased, Pain in extremity, Pyrexia, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad)
Write-up: Severe arm pain. Pain was so severe that I could not move it for 24 hours and pain was severe for 3 days. Today is day 6 and it is still sore and feel hot when moved. Fever of 100.5 for 12 hours and heart rate between 104 - 111 while lying down.

VAERS ID:468346 (history)  Vaccinated:2012-10-03
Age:70.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 5
Location:Florida  Entered:2012-10-08
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: Office visit, called in by clinic doctor
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4499AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Cough, Dysphagia, Eye swelling, Retching
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow)
Write-up: Coughing, difficulty swallowing, swollen eyes, gagging. Benadryl, Advil.

VAERS ID:468353 (history)  Vaccinated:2012-10-03
Age:60.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-08, Days after onset: 4
Location:Massachusetts  Entered:2012-10-08
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: COPD
Diagnostic Lab Data: Pt is treating cellulitis with Doxycycline 100 mg BID
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0467AE0UNRA
Administered by: Other     Purchased by: Public
Symptoms: Cellulitis
SMQs:
Write-up: Pt. developed ''cellulitis'' after her ZOSTAVAX injection was given.

VAERS ID:468395 (history)  Vaccinated:2012-10-03
Age:41.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-08, Days after onset: 5
Location:Florida  Entered:2012-10-08
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: Seizures
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12052010IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Headache, Musculoskeletal stiffness
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: Pt presented 10/4 complaining of stiff neck and persistent headache. Stated neck became very stiff in the evening of flu shot, stiffness from left shoulder up into left side of neck. Had slight headache all day - but worsened after flu shot & still had slight stiffness and lightheaded on Thursday 10/4/12.

VAERS ID:468422 (history)  Vaccinated:2012-10-03
Age:84.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 5
Location:Wisconsin  Entered:2012-10-08
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: Unknown
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204521 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Contusion, Oedema peripheral, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt reported badly bruised arm that swelled and was black. Pt also on blood thinner, so told that she may experience worse bruising. Pt requested report filed.

VAERS ID:468433 (history)  Vaccinated:2012-10-03
Age:73.0  Onset:2012-10-07, Days after vaccination: 4
Gender:Male  Submitted:2012-10-08, Days after onset: 1
Location:Pennsylvania  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4525AA0UNLA
Administered by: Other     Purchased by: Other
Symptoms: Cyanosis, Injection site discolouration, Injection site reaction
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt was administered FLUZONE High Dose on Left arm (Bicep) claims that it''s all black & blue.

VAERS ID:468445 (history)  Vaccinated:2012-10-03
Age:11.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-08, Days after onset: 4
Location:Unknown  Entered:2012-10-08
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB523AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1273AA1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:468450 (history)  Vaccinated:2012-10-03
Age:13.0  Onset:2012-10-08, Days after vaccination: 5
Gender:Male  Submitted:2012-10-08, Days after onset: 0
Location:Kentucky  Entered:2012-10-08
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: Scoliosis
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.H0156220UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4263AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Lymph node pain, Oedema peripheral, Similar reaction on previous exposure to drug
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt received Hep B #2 at our office on 10/3/12. Retrd to office 10/8/12 with red swollen arm and tender lymph node in axilla (L) side. Had same reaction 03/12 after receiving Hep B #1.

VAERS ID:468390 (history)  Vaccinated:2012-10-03
Age:58.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-09, Days after onset: 5
Location:Massachusetts  Entered:2012-10-09
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4482AA IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Chills, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Headache, Nausea, body ache, fever to 103F, chills.

VAERS ID:468392 (history)  Vaccinated:2012-10-03
Age:58.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-09, Days after onset: 5
Location:Massachusetts  Entered:2012-10-09
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4482AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Headache, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Headache, body aches, low grade fever, cills, nausea.

VAERS ID:468393 (history)  Vaccinated:2012-10-03
Age:60.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-09, Days after onset: 5
Location:Massachusetts  Entered:2012-10-09
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4482AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Low grade fever, body aches, chills, nausea.

VAERS ID:468396 (history)  Vaccinated:2012-10-03
Age:0.4  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-03, Days after onset: 0
Location:Pennsylvania  Entered:2012-10-09, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Well child
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B344C1IMUN
HIBV: HIB (ACTHIB)SANOFI PASTEURUH541AA1IMUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHF657321IMUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0208AE1PO 
Administered by: Private     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injection site erythema, Rash macular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 11:55 AM - PEDIARIX, Hib and PREVNAR vaccines given. Almost immediate localized red reaction around every injection site. Hives noted above diaper line on lower back, red blotchy area noted (R) lower leg. No treatment given resolved on its own. Evaluated by MD (L) thigh erythematous areas. 1 inj. site about 6cm 1 inj site about 4cm (R) thigh injection site abt 4cm.

VAERS ID:468427 (history)  Vaccinated:2012-10-03
Age:58.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 5
Location:Maine  Entered:2012-10-09, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH715AA IMUN
Administered by: Military     Purchased by: Unknown
Symptoms: Cough, Diarrhoea, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)
Write-up: Difficulty breathing. Coughing. Diarrhea. Symptoms started about 2-3 hrs after injections lasting next 24 hr. No treatment.

VAERS ID:468492 (history)  Vaccinated:2012-10-03
Age:9.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Male  Submitted:2012-10-08, Days after onset: 3
Location:Washington  Entered:2012-10-09, Days after submission: 1
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: Allergic rhinitis; croup as young child
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501103P2IN 
Administered by: Private     Purchased by: Public
Symptoms: Croup infectious, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad)
Write-up: 9 year old developed acute onset croup and respiratory distress 2 days after FLUMIST. He received oral steroids, antibiotics and albuterol / ATROVENT in ER. No history of asthma. It had been years since previous croup.

VAERS ID:468498 (history)  Vaccinated:2012-10-03
Age:46.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-09, Days after onset: 6
Location:Connecticut  Entered:2012-10-09
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP504081IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Choking sensation, Eye irritation, Feeling abnormal, Headache, Increased upper airway secretion, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Hypersensitivity (broad)
Write-up: 10/3/12 Sore throat, headache, chills, fever. Increased mucus production - felt like she was "choking", burning eyes. 10/4/12 Headache, feeling like "run over by a truck".

VAERS ID:468507 (history)  Vaccinated:2012-10-03
Age:59.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-09, Days after onset: 4
Location:Massachusetts  Entered:2012-10-09
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: Allergy meloxicam
Diagnostic Lab Data: Negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED06949221A IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0493AE1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site cellulitis, Injection site erythema, Injection site swelling, Injection site warmth, Laboratory test normal
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Severe cellulitis left upper arm. Erythema, warmth, swelling. Methylprednisolone 125mg IM & prednisone PO.

VAERS ID:468509 (history)  Vaccinated:2012-10-03
Age:57.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-09, Days after onset: 5
Location:Oregon  Entered:2012-10-09
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 known Has h/o fibromyalgia and asthma
Diagnostic Lab Data: Pt saw her private physician. Was given antiemetic for nausea and vomiting.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP587077IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site streaking, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Red streaks going down arm from injection site and nausea and vomiting.

VAERS ID:468511 (history)  Vaccinated:2012-10-03
Age:36.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-09, Days after onset: 6
Location:Nevada  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO ILLNESSES AT TIME OF VACCINATION.
Preexisting Conditions: PATIENT IS 20 WEEKS PREGNANT
Diagnostic Lab Data: NO DIAGNOSTIC TESTING OR LABORATORY DATE COMPLETED FOR ADVERSE EVENT.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ21580IN 
Administered by: Other     Purchased by: Military
Symptoms: Maternal exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: PATIENT EXPERIENCED ZERO SIGNS AND SYMPTOMS OF RECEIVING FLUMIST.

VAERS ID:468535 (history)  Vaccinated:2012-10-03
Age:33.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-09, Days after onset: 5
Location:California  Entered:2012-10-09
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: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4468BA IDRA
Administered by: Other     Purchased by: Private
Symptoms: Blister, Erythema, Pain, Skin warm, Swelling
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Tues: Injection Thurs: Called to let us know arm is hot to the touch, some redness and swelling, also blisters in the area. Fri: Arm getting better, still swollen & sore. Used Benadryl topical & Zyrtec. Doing better.

VAERS ID:468638 (history)  Vaccinated:2012-10-03
Age:82.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-04, Days after onset: 1
Location:Wisconsin  Entered:2012-10-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data: CBC, sed rate, c-reactive protein
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1786AA1IMUN
Administered by: Private     Purchased by: Other
Symptoms: C-reactive protein, Decreased appetite, Full blood count, Inflammation, Malaise, Pyrexia, Red blood cell sedimentation rate
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Acute local inflammation w/in 5-6 hours with associated fever 101 p.o., malaise, anorexia.

VAERS ID:468671 (history)  Vaccinated:2012-10-03
Age:60.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-10, Days after onset: 7
Location:Massachusetts  Entered:2012-10-10
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: environmental allergies i.e. Ragweed
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUH734AA IDLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Chest discomfort, Chills, Dysphagia, Myalgia, Pharyngeal oedema, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Throat began to swell; difficulty swallowing - took allergy medicine. After few hours swallowing difficulty eased. Around 7pm uncontrollable body shaking shivers, aching muscles and feverish. - took hot tea and Tylenol. Around 8pm body temperature was 102.5. Throughout the night - felt like an elephant was on my chest. Next day- weak but functional. Reminder to self -never get FLU shot again!

VAERS ID:468674 (history)  Vaccinated:2012-10-03
Age:37.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-10, Days after onset: 5
Location:Nebraska  Entered:2012-10-10
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: seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206001 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal discomfort, Fatigue, Headache, Musculoskeletal stiffness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Headache, followed by stiff neck, in addition on 10/6/2012 101 fever, fatigue, upset stomach lasting until 10/07.

VAERS ID:468675 (history)  Vaccinated:2012-10-03
Age:68.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-10, Days after onset: 7
Location:Massachusetts  Entered:2012-10-10
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: np
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4499AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Hyperhidrosis, Nasal congestion, Throat irritation
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: 5 hours after vaccination patient experienced minor HA, nasal congestion, "funny" throat. Next morning PT went to clinic with extreme HA, sweats, nasal congestion, "funny" throat. Clinic dispensed APAP and Benadryl. Told PT to continue these meds and rest. PT to return if symptoms persisted or worsened.

VAERS ID:468685 (history)  Vaccinated:2012-10-03
Age:22.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-10, Days after onset: 7
Location:Kansas  Entered:2012-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
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
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICSP50208 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: SOB, coughing, shortness of breath.

VAERS ID:468703 (history)  Vaccinated:2012-10-03
Age:  Onset:2012-10-08, Days after vaccination: 5
Gender:Male  Submitted:2012-10-10, Days after onset: 2
Location:Puerto Rico  Entered:2012-10-10
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: CBC/dif
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP58907 IMRA
Administered by: Military     Purchased by: Military
Symptoms: Differential white blood cell count, Erythema, Full blood count, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: (Rt) arm red, pain, swelling.

VAERS ID:468711 (history)  Vaccinated:2012-10-03
Age:30.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-10, Days after onset: 5
Location:Nebraska  Entered:2012-10-10
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: WENT TO CHIROPRACTOR AND IT MADE MY NECK HURT WORSE AND IN A NEW LOCATION.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNLA
Administered by: Public     Purchased by: Other
Symptoms: Headache, Hyperhidrosis, Musculoskeletal stiffness, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: STIFF NECK, BODY ACHES, SORE THROAT, SWEATY, FEVERISH, HEAD ACHE, ETC.

VAERS ID:468715 (history)  Vaccinated:2012-10-03
Age:57.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Male  Submitted:2012-10-10, Days after onset: 5
Location:West Virginia  Entered:2012-10-10
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: pre-diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRLA
Administered by: Other     Purchased by: Private
Symptoms: Contusion, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow)
Write-up: A hive like rash appeared on my left arm. The same arm that I received the shot in, arm was also bruised. I took Benadryl for itching. Arm still itching but not as bad on 10/10/2012.

VAERS ID:468732 (history)  Vaccinated:2012-10-03
Age:35.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Georgia  Entered:2012-10-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Penicillin; ADD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH711AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Haemorrhage, Rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt. bled. Small circumference bump rose. Swelling became worse. Applied ice pack. Patient there is no pain.

VAERS ID:468752 (history)  Vaccinated:2012-10-03
Age:63.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-10, Days after onset: 6
Location:California  Entered:2012-10-10
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: DM,
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0106611IMLA
Administered by: Military     Purchased by: Public
Symptoms: Injection site cellulitis
SMQs:
Write-up: Cellulitis in Left Deltoid where vaccine administered. Admitted to hospital on 10/06/2012 and received Vancomycin IV.

VAERS ID:468798 (history)  Vaccinated:2012-10-03
Age:75.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:Illinois  Entered:2012-10-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12072010IMAR
Administered by: Other     Purchased by: Other
Symptoms: Haemorrhage, Immediate post-injection reaction, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)
Write-up: Right after giving Flu vac, she bled quite a lot, and a 1/2 dollar size welt came up. No other adverse reaction occurred. Patient went to ER. MD said I hit a small vein and that vac could still be effective per patient. Patient was fine!

VAERS ID:468813 (history)  Vaccinated:2012-10-03
Age:69.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-10, Days after onset: 7
Location:Ohio  Entered:2012-10-10
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: High blood pressure, hypothyroidism, high cholesterol
Diagnostic Lab Data: Blood cultures, urine cultures, scan for possible embolism, oxygen by cannula, heparin shots, pneumonia vaccine, ?
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4489AA IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Blood culture, Chills, Culture urine, Nausea, Oxygen supplementation, Scan, Vomiting
SMQs:, Acute pancreatitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Sudden nausea, repeated vomiting for 2/12 hours, chills over the next several hours.

VAERS ID:468865 (history)  Vaccinated:2012-10-03
Age:86.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-10, Days after onset: 6
Location:Ohio  Entered:2012-10-10
Life Threatening? No
Died? Yes
   Date died: 2012-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204201 IM 
Administered by: Other     Purchased by: Other
Symptoms: Death
SMQs:
Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.

VAERS ID:470025 (history)  Vaccinated:2012-10-03
Age:18.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-10, Days after onset: 7
Location:Unknown  Entered:2012-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypothyroidism
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA002519
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, Fall, Head injury, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: This spontaneous report was received from a healthcare worker who refers to a 18 years old female patient (who was not in pregnant) with hypothyroid and no drug allergies/reactions. On 03-OCT-2012, the patient was vaccinated intramuscularly with a first dose of GARDASIL lot # (672233/1561AA, expiry date 26-AUG-2012) (dose and anatomical location not reported). Concomitant medications included: ARMOUR THYROID TABLETS. On 03-OCT-2012, a few minutes after vaccination the patient fainted, after she stood up in the exam room. It was reported that the patient hit her head "very hard" on the floor and E.M.S. was called to transport the patient to the emergency room for unspecified treatment. The patient was "not very responsive" and fainted a second time after "smelling salts" were used after she fainted the first time. The patient did not receive any treatment for adverse events. No lab diagnostic tests were performed. At the time of the report patient''s status was reported as not recovered. Additional information has been requested.

VAERS ID:473112 (history)  Vaccinated:2012-10-03
Age:61.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-10, Days after onset: 7
Location:Unknown  Entered:2012-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA003391
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site vesicles, Malaise, Poor quality sleep, Pyrexia, Thinking abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad)
Write-up: This spontaneous report was received from a 61 years old physician reporting on himself who on 03-OCT-2012, was vaccinated with a dose ZOSTAVAX (dose, route and lot number not reported). No other co-suspects were reported. No concomitant medications were reported. The physician reported that "last night" on 03-OCT-2012, he slept poorly, and then "today" on 04-OCT-2012, noted low grade fever, malaise and erythema at the injection site with four vesicles. Not thinking clearly, he took an took an aspirin 325 mg tablet. At the time of the report, the patient''s outcome was unknown. The physician was wondering to know of he was at risk for Reye''s syndrome. It was unspecified if the patient sought medical attention. The relatedness for I sleep poorly last night, not thinking clearly, injection site with four vesicles, erythema at the injection site, malaise and low grade fever was unknown for ZOSTAVAX. Additional information has been requested.

VAERS ID:468898 (history)  Vaccinated:2012-10-03
Age:60.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-11, Days after onset: 8
Location:Arizona  Entered:2012-10-11
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1203901 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Injection site is sore, hard, achy, painful, red and swollen.

VAERS ID:468974 (history)  Vaccinated:2012-10-03
Age:43.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-11, Days after onset: 8
Location:Illinois  Entered:2012-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
Administered by: Other     Purchased by: Private
Symptoms: Decreased appetite, Diarrhoea, Fatigue, Headache, Pain
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Body aches, severe diarrhea, loss of appetite, headache, fatigue that has continued since time of vaccination.

VAERS ID:468987 (history)  Vaccinated:2012-10-03
Age:78.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-11, Days after onset: 8
Location:Maryland  Entered:2012-10-11
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH713AA2IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0653AE1IMLA
Administered by: Military     Purchased by: Military
Symptoms: Axillary pain, Breast pain, Lethargy, Pain, Skin discolouration
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Soreness, Lethargic, Skin discoloration, sore breasts and under arm soreness.

VAERS ID:469120 (history)  Vaccinated:2012-10-03
Age:26.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-11, Days after onset: 7
Location:Washington  Entered:2012-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient denies illnesses at time of vaccination.
Preexisting Conditions: Patient with history of bilateral shoulder trauma (2010); other past medical history denied.
Diagnostic Lab Data: Directed physical examination of affected area performed on 10/10/2012; no neurological deficits noted; examination otherwise unremarkable.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURERFAV3080UNRA
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AH21392IN 
SMALL: SMALLPOX (NO BRAND NAME)UNKNOWN MANUFACTURERVV04003A0IDLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Headache, Injection site reaction, Musculoskeletal pain, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad)
Write-up: Patient reports local erythema and musculo-skeletal pain at injection site, as well as intermittent tremor of right arm, headache, and subjective fever.

VAERS ID:469126 (history)  Vaccinated:2012-10-03
Age:65.0  Onset:2012-10-06, Days after vaccination: 3
Gender:Male  Submitted:2012-10-11, Days after onset: 5
Location:Ohio  Entered:2012-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denies fever
Preexisting Conditions: HTN and DM
Diagnostic Lab Data: Recommended f/u to evaluate other causes of dizziness
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4490AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Dizziness, that slowly improved over next 96 hours.

VAERS ID:469289 (history)  Vaccinated:2012-10-03
Age:36.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-11, Days after onset: 8
Location:Colorado  Entered:2012-10-11
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:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH755AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B073CA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Pain in right shoulder and neck starting in the evening of 10/03/2012. No pain, inflammation or redness around injection site. Pt. reported to clinic to receive medical care on 10/11/12.

VAERS ID:469661 (history)  Vaccinated:2012-10-03
Age:80.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-12, Days after onset: 8
Location:North Carolina  Entered:2012-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4524AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Oral discomfort, Pain, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Redness, pain, burning of oral cavity and throat beginning on day after injection of FLUZONE HIGH DOSE.

VAERS ID:469765 (history)  Vaccinated:2012-10-03
Age:63.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-12
Location:Pennsylvania  Entered:2012-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH72AD IMLA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0467AE0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Patient received ZOSTAVAX injection 10/3/12 seen PCP office 10/11/12 for rash right side ABD Dx: Zoster - treated with Famciclovir.

VAERS ID:473346 (history)  Vaccinated:2012-10-03
Age:70.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-12, Days after onset: 9
Location:California  Entered:2012-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug hypersensitivity; Asthma; Fibromyalgia
Preexisting Conditions: Hypertension
Diagnostic Lab Data:
CDC Split Type: WAES1210USA003411
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0709AE IMAR
Administered by: Other     Purchased by: Other
Symptoms: Chills, Mobility decreased, Myalgia, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad)
Write-up: This spontaneous report as received from two registered pharmacists refers to a 70 years old female patient with fibromyalgia, asthma and allergic reaction to quinolones. The patient''s medical history included hypertension. The patient was vaccinated with a dose of PNEUMOVAX 23 (Lot # reported as 0709AE) IM on 03-OCT-2012. No other co-suspects were reported. Concomitant medications included: MOBIC. On the same date, the patient developed chills, fever, myalgia and pain after receiving PNEUMOVAX 23. The reporter mentioned the patient said she had so much pain she could not lift her arm. No treatment was given for the events. The pharmacist reported that the patient''s fever and chills were gone but she still had arm pain. The outcome of myalgia was reported as not recovered/not resolved. The relationship between the events and PNEUMOVAX 23 was not reported. Additional information has been requested.

VAERS ID:470528 (history)  Vaccinated:2012-10-03
Age:  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-12, Days after onset: 9
Location:Unknown  Entered:2012-10-13, 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:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA002225
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report as received from a nurse practitioner refers to a female patient of unknown age. In May, 2011 the patient was vaccinated with her first dose of GARDASIL (lot # not reported). On 03-OCT-2012 the patient was vaccinated with her second dose of GARDASIL (lot # not reported). No adverse symptoms reported. It was unknown if the patient sought medical attention. Additional information has been requested.

VAERS ID:469625 (history)  Vaccinated:2012-10-03
Age:53.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-15, Days after onset: 12
Location:Minnesota  Entered:2012-10-15
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: Allergy Sulfa Hypertension
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH714AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Hypoaesthesia, Local swelling, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen left thumb, left index finger swollen, both being numb. Pain in upper arm.

VAERS ID:469792 (history)  Vaccinated:2012-10-03
Age:56.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Illinois  Entered:2012-10-15
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: Ampicillin allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH7594A0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Fatigue, Influenza like illness, Pain, Pain in extremity
SMQs:, Arthritis (broad)
Write-up: Evening 10/31/12 felt "getting flu", upper arm sore/bothersome. Body achiness/arm throbbing. 10/15/12 upper arm still sore. Felt run down past week; joints ache more than usual.

VAERS ID:469852 (history)  Vaccinated:2012-10-03
Age:65.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-06, Days after onset: 3
Location:Louisiana  Entered:2012-10-15, Days after submission: 9
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) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4524AA IMLA
Administered by: Other     Purchased by: Public
Symptoms: Chills, Lip swelling, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: About 3 hours after injection patient reported experiencing high fever, shivers & swollen lips. By the next morning all symptoms were gone.

VAERS ID:469856 (history)  Vaccinated:2012-10-03
Age:8.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Florida  Entered:2012-10-15, 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: Had been out sick for 3 days before
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AH21094IN 
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Hypersensitivity (narrow)
Write-up: Child came to clinic with red rash on both inner arms, thigh (L) and abdominal area. Afebrile. No resp. distress noted lungs clear. 10cc of BENADRYL was given PO. Mom called: child has been of school for the past 3 days with an illness.

VAERS ID:469858 (history)  Vaccinated:2012-10-03
Age:60.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-08, Days after onset: 5
Location:Missouri  Entered:2012-10-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: DM; Hypertension
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH478AA10IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Injection site urticaria, Local reaction
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Localized reaction at site of injection rash, hives, wheal (or welt) appeared.

VAERS ID:469903 (history)  Vaccinated:2012-10-03
Age:17.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-05, Days after onset: 0
Location:Florida  Entered:2012-10-15, Days after submission: 10
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH731AB0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0129730IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA120131IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, swelling to LA.

VAERS ID:469913 (history)  Vaccinated:2012-10-03
Age:1.3  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-11, Days after onset: 8
Location:Massachusetts  Entered:2012-10-15, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Seizure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC4186AA3UNLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4481BA3UNRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUH415AB3UNLL
Administered by: Private     Purchased by: Public
Symptoms: Condition aggravated, Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Fever and seizure 2 hours post immunizations. Seen in ED.

VAERS ID:469915 (history)  Vaccinated:2012-10-03
Age:40.0  Onset:2012-10-06, Days after vaccination: 3
Gender:Male  Submitted:2012-10-14, Days after onset: 8
Location:Connecticut  Entered:2012-10-15, 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:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: CMP - CBC - CPK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12245P7UNLA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Full blood count, Metabolic function test, Myalgia, Rhabdomyolysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: 3 days after receiving flu vaccine, started to experience severe incapacitating myalgia and weakness - CPK $g 1,000 Dx with Rhabdomyolysis - No Rx at this time - monitoring blood work.

VAERS ID:470098 (history)  Vaccinated:2012-10-03
Age:10.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-05, Days after onset: 1
Location:Connecticut  Entered:2012-10-15, Days after submission: 10
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: Nephrotic syndrome
Diagnostic Lab Data: Rev in 3 days at PCC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF654410IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site abscess, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt. began with (R) upper arm swelling/redness and pain within 24 hrs of receiving vaccine, slightly itchy. (R) arm abscess (13cm x 13cm induration). Started on KEFLEX 500mg 4x/dy x10 days, TYLENOL/antihistamines.

VAERS ID:473353 (history)  Vaccinated:2012-10-03
Age:  Onset:2012-10-03, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-15, Days after onset: 12
Location:Maine  Entered:2012-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA006192
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: This spontaneous report as received from a physician refers to a pediatric patient of unknown age. On 03-OCT-2012, the patient was vaccinated with a dose of ZOSTAVAX (dose, route, lot number not reported) instead of VARIVAX (Merck) due to human error. No concomitant medications were reported. No adverse effect reported. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:473366 (history)  Vaccinated:2012-10-03
Age:  Onset:2012-10-03, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-15, Days after onset: 12
Location:Maine  Entered:2012-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA002637
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: This spontaneous report as received from a physician refers to a pediatric patient of unknown age. On 03-OCT-2012, the patient experienced vaccinated with a dose of ZOSTAVAX (dose, route, lot number not reported) instead of VARIVAX (Merck) due to human error. No concomitant medications were reported. No adverse effect reported. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:473377 (history)  Vaccinated:2012-10-03
Age:79.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-15, Days after onset: 12
Location:Unknown  Entered:2012-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA002785
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H009826 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This spontaneous report as received from a registered pharmacist refers to a 79 year old male patient with no drug reactions or allergies. On 03-OCT-2012, the patient was vaccinated with a dose of PNEUMOVAX23, 0.5 ml, intramuscular (lot# reported as H009826, expiration date 11-FEB-2014). No other co-suspects were reported. Concomitant medications included: FLUZONE. On 03-OCT-2012, the patient developed tenderness at the injection site after receiving a dose of PNEUMOVAX23. There was no treatment given for tenderness at the injection site. No laboratory tests were performed. The patient''s outcome of tenderness at the injection site was unknown. The patient sought medical attention, called the pharmacist. The relatedness for tenderness at the injection site was not reported for PNEUMOVAX23. Additional information is not expected.

VAERS ID:469734 (history)  Vaccinated:2012-10-03
Age:71.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-10, Days after onset: 7
Location:Wisconsin  Entered:2012-10-16, Days after submission: 6
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: Diabetes mellitus; CAD; CABG; Essential hypertension, benign; Hypertrophy of prostate with urinary obstruction and other lower urinary tract symptoms; Esophageal reflux; Dyslipidemia; Obesity; Coronary artery bypass; Cardiovascular procedure; Amoxicillin, angioedema swelling and anaphylaxis; Penicillins, angioedema
Diagnostic Lab Data: See attached
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH746AC6IMLA
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Erythema, Feeling abnormal, Headache, Hyperhidrosis, Malaise, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Patient is a 71 year old male with a PMHx to include diabetes, coronary artery disease, hypertension, reflux, dyslipidemia presents from his apartment with dizziness, headache, diaphoresis, and fevers. Patient reports he saw his primary care physician early this morning for a routine examination and toward the end of the examination he received a flu shot. Patient reports as he was driving home from his appointment he began to feel ill. When he got home he continued to feel ill, however finished up some chores around the house. The couple of hours later he began to feel worse with development of some lightheadedness/dizziness and beginning to feel feverish. Patient was painting a deck at the time and had to stop because of how poorly he felt. Patient attempted to go inside and rest however her symptoms continued to worsen. He also reports developing a headache and some diaphoresis. Patient reports that his headache is severe. "Worst headache of his life", diffuse, dull/achy, nonradiating, no alleviating factors. Patient denies any new neck stiffness/pain. When his wife got home at approximately 1630 she did give him some naproxen. Patient then tended to rest however after a couple hours of rest he continued to feel poor with new redness to his face. His wife he didn''t hurt that time which was 102.8 orally at home. After calling the nursing hotline, they were prompted to report him or his department for evaluation. The patient reports prior to examination and flu shot this morning he was feeling quite well. He denies any recent illnesses, cough, congestion, sore throat, chest pain, dyspnea, abdominal pain, nausea, vomiting, diarrhea, rashes. Patient denies any numbness, tingling, or any weakness. Patient has had flu shots in the past, has never had a reaction to his knowledge.

VAERS ID:469782 (history)  Vaccinated:2012-10-03
Age:62.0  Onset:2012-10-06, Days after vaccination: 3
Gender:Female  Submitted:2012-10-16, Days after onset: 10
Location:North Carolina  Entered:2012-10-16
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
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206001  LA
Administered by: Public     Purchased by: Other
Symptoms: Cough, Dyspnoea, Headache, Lacrimation increased, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Lacrimal disorders (narrow)
Write-up: Runny eyes, cough, headache, then within 3 days after this, trouble breathing, fever, ache, and coughing.

VAERS ID:469795 (history)  Vaccinated:2012-10-03
Age:52.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-16, Days after onset: 13
Location:Wisconsin  Entered:2012-10-16
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: DIABETES TYPE 1
Diagnostic Lab Data: HEAD CT, BLOOD WORK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEUR  ID 
Administered by: Private     Purchased by: Other
Symptoms: Blood test, Computerised tomogram head, Dizziness, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: DIZZINESS, SWEATING, NAUSEA.

VAERS ID:469886 (history)  Vaccinated:2012-10-03
Age:31.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-16, Days after onset: 13
Location:North Carolina  Entered:2012-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none that we are aware of
Current Illness: none known
Preexisting Conditions: none reported at time of vaccination
Diagnostic Lab Data: Admitted 10/15/12 and LP was scheduled to be performed along with other diagnostic tests.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12069010IMRA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Burning sensation, Laboratory test, Lumbar puncture, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Since the day of the vaccination, patient has had myalgias and joint pain affecting his lower back and both legs. He has also had a constant burning sensation involving his thighs. He talked to his primary physician and he thinks this is related to the flu vaccine. He also spoke to a rheumatologist who thinks the same.

VAERS ID:469957 (history)  Vaccinated:2012-10-03
Age:48.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-16, Days after onset: 12
Location:Texas  Entered:2012-10-16
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: Unknown
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204501 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site vesicles, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Had flu shot and the next morning woke up and had blisters around the injection site. It was itchy and red and had some swelling. Called doctor and she started on Benadryl. Also got a fever blister on lower lip.

VAERS ID:469959 (history)  Vaccinated:2012-10-03
Age:75.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-16, Days after onset: 13
Location:Michigan  Entered:2012-10-16
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: Penicillin Allergy, high blood pressure (medication controlled), High Cholesterol (medication controlled), Gerd (medication controlled), no other medical conditions
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEUR    
Administered by: Other     Purchased by: Public
Symptoms: Chills, Fear, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Uncontrollable chills and shaking from jaws to entire body lasting about 45 minutes--7 hours after receiving hi-dose flu shot--very scary. Couldn''t stop it and thought I was going to die--but it was transient.

VAERS ID:469960 (history)  Vaccinated:2012-10-03
Age:1.0  Onset:2012-10-15, Days after vaccination: 12
Gender:Male  Submitted:2012-10-16, Days after onset: 1
Location:California  Entered:2012-10-16
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0607AE0SCLL
Administered by: Unknown     Purchased by: Public
Symptoms: Viral rash
SMQs:
Write-up: Viral Exanthem 8 days after MMR & Varivax Vaccine.

VAERS ID:470092 (history)  Vaccinated:2012-10-03
Age:13.0  Onset:2012-10-14, Days after vaccination: 11
Gender:Male  Submitted:2012-10-15, Days after onset: 1
Location:Ohio  Entered:2012-10-16, 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:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4273AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4030AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0105571SCRA
Administered by: Public     Purchased by: Public
Symptoms: Rash papular, Rash pustular, Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Pt woke on 10/14 AM w/rash - papules, pustules, & vesicles all noted on exam about 1 pm 10/14. Pt o/w well, no fever, no known exposure to CPOX.

VAERS ID:470185 (history)  Vaccinated:2012-10-03
Age:11.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-08, Days after onset: 4
Location:California  Entered:2012-10-16, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ21060IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0101AE0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA100570UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3947BA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: (R) deltoid localized vaccine reaction noticed by mother on 10/4/12 with redness, warm, minor tender to touch, no pain measured at 4 x 3 inches on 10/5/12 at 16:00.

VAERS ID:470188 (history)  Vaccinated:2012-10-03
Age:72.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-08, Days after onset: 3
Location:Illinois  Entered:2012-10-16, 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:
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH720AB1IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0025AE1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Arthralgia, Bone pain, Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Patient called pharmacy on 10-5-12 complaining of her left arm being red and swollen. Her bones and knees were hurting as well. The pharmacist suggests she take BENADRYL and call her doctor, patient states she is fine today, 10-9-12. Her doctor told her to wait until Sunday 10-7-12 for further directions. No directions necessary she also used cold compresses.

VAERS ID:470276 (history)  Vaccinated:2012-10-03
Age:42.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-16, Days after onset: 13
Location:Pennsylvania  Entered:2012-10-16
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH747AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Musculoskeletal stiffness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Employee (physician) states following flu shot she developed a stiff neck, left upper extremity muscular pain and headache.

VAERS ID:470227 (history)  Vaccinated:2012-10-03
Age:48.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:Arizona  Entered:2012-10-17, 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: EKG and O2 Sat.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH713AA UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Electrocardiogram, Eyelid oedema, Respiratory distress, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow)
Write-up: Respiratory system, (lungs) distress, eyes swollen shut, vomiting.

VAERS ID:470343 (history)  Vaccinated:2012-10-03
Age:31.0  Onset:2012-10-12, Days after vaccination: 9
Gender:Male  Submitted:2012-10-17, Days after onset: 5
Location:Louisiana  Entered:2012-10-17
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
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206701 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Client came to my pharmacy 14 days after flu shot was given and stated he was experiencing a rash on his left side of neck and left arm. Same arm shot given.

VAERS ID:474726 (history)  Vaccinated:2012-10-03
Age:73.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-17, Days after onset: 14
Location:Unknown  Entered:2012-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Tobacco user; Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA002800
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H009826 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injected limb mobility decreased, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a registered pharmacist concerning a 73 years old, smoker female patient with no drug reactions/allergies, who on 03-OCT-2012, was vaccinated with a dose of PNEUMOVAX 23 0.5 ml IM (lot # reported as H009826, exp: 11-FEB-2014 - in validation process). Concomitant medications included: FLUZONE (injection site and date of vaccination not reported). The pharmacist reported that on 03-OCT-2012 a patient developed redness, swelling, and burning sensation at the injection site after receiving a dose of PNEUMOVAX 23. The patient had hard time lifting her arm. No treatment was given. The outcome of the events was reported as not recovered. No laboratory diagnostic studies were performed. The patient sought medical attention via calling pharmacist. The relatedness for the events was unknown for PNEUMOVAX 23. Additional information has been requested.

VAERS ID:470211 (history)  Vaccinated:2012-10-03
Age:49.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-18, Days after onset: 14
Location:West Virginia  Entered:2012-10-18
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: Fibromyalgia
Diagnostic Lab Data: Bloodwork for C. diff and CVC (?), both were negative; follow-up bloodwork on Oct. 15 to check white blood cell count and it was normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP50408 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Blood test normal, Clostridium test, Inflammation, Lymph node pain, Lymphadenopathy, White blood cell count normal
SMQs:
Write-up: Lymph nodes under left arm were painful and inflamed when I woke up the morning after I received the shot. The lymph nodes by my collar bone were painful and inflamed when I woke up the second morning after the shot. I went to my PCP on Monday, October 8, 2012. he gave me a course of antibiotics (Augmentin) and I was told to return to see him on October 15. I did so and the swelling had gone down but was not completely gone. To this day the glands are still a little swollen and painful.

VAERS ID:470414 (history)  Vaccinated:2012-10-03
Age:30.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-16, Days after onset: 11
Location:New York  Entered:2012-10-19, Days after submission: 3
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: The patient had a medical history of hypertension (HTN), hypercholesterol, vitamin deficiency and an ulcer. The report stated no known allergies, other than a "pain killer" (not specified). She denied any illness at time of vaccination.
Diagnostic Lab Data:
CDC Split Type: 201209529
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood pressure increased, Dyspnoea, Electrocardiogram normal, Heart rate increased, Panic attack, X-ray normal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad)
Write-up: Initial report was received from a consumer, who was also the patient, on 11 October 2012. A 30-year-old female patient received an injection of INFLUENZA VACCINE, manufacturer unknown (lot number, route, site, side and dose in series not reported) on 03 October 2012. On 05 October 2012, two days post vaccination she reported adverse event onset. On 07 October 2012, four days after vaccination, the patient went to the emergency room (ER) and was told she "had a panic attack", was given XANAX and sent home. On 08 October 2012, five days after vaccination, she went back to the ER because she "could not breathe". She was told it was a "panic attack and heart rate and blood pressure (BP) went up". X-rays (site unspecified) and electrocardiogram (EKG) were all negative. On 10 October 2012, she went to the doctor office to tell him what happened. Her doctor said it was not anxiety and had to do with her heart and he told her to come back for more EKGs. The patient reported she used her boyfriend''s nebulizer treatment on unspecified date. The patient had a medical history of hypertension (HTN), hypercholesterol, vitamin deficiency and an ulcer. The report stated no known allergies, other than a "pain killer" (not specified). She denied any illness at time of vaccination. The patient''s outcome was not reported. Documents held by sender: None.

VAERS ID:470467 (history)  Vaccinated:2012-10-03
Age:32.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Male  Submitted:2012-10-19, Days after onset: 14
Location:Georgia  Entered:2012-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Vaccination during mass immunization. Provider contacted me and I have no further details than provided. No illness at time of vaccination, all patients were screened.
Preexisting Conditions: No Known Allergies
Diagnostic Lab Data: MRI was consistent with a neuritis. Given 1 Gram Solumedrol IM and tapering prednisone. Is recovering well.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AK2026 IN 
Administered by: Military     Purchased by: Military
Symptoms: Eyelid function disorder, Hypoaesthesia oral, Neuritis, Nuclear magnetic resonance imaging abnormal, Paralysis, VIIth nerve paralysis
SMQs:, Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)
Write-up: Started with a numb tongue and eventually could not close Right eye. Was admitted on 17 OCT to rule out other possible conditions only. DX of Bells Palsy on Right and 5th nerve palsy on the left side of his face.

VAERS ID:475533 (history)  Vaccinated:2012-10-03
Age:80.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-19
Location:Unknown  Entered:2012-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA004725
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H0125750SCUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a registered pharmacist concerning an 80 year old female patient. The patient had no pertinent medical history and no known drug allergies. On 03-OCT-2012, the patient was vaccinated subcutaneously with a dose of ZOSTAVAX vial, 1 vial (Lot #: H012575: Expiration Date: 28-SEP-2013). Concomitant medications included: FLUZONE. In October 2012, the patient developed 2 inches of redness and soreness at the site of ZOSTAVAX. The patient sought medical attention by calling the pharmacist. No treatment was given for the events. No lab diagnostic studies were performed. At the time of the report, in October 2012, the patient''s outcome of 2 inches of redness and soreness at the site of vaccination was reported as recovered/resolved. The relatedness for 2 inches of redness and soreness at the site of ZOSTAVAX vaccination was unknown for ZOSTAVAX. Additional information has been requested.

VAERS ID:475956 (history)  Vaccinated:2012-10-03
Age:68.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-21, Days after onset: 18
Location:Unknown  Entered:2012-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA005448
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  SCLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site inflammation, Injection site pruritus, Injection site swelling, Injection site vesicles, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This spontaneous report as received from a 68 years old female patient concerning herself with no medical history and no drug allergies. The patient was vaccinated with ZOSTAVAX (subcutaneous, lot# was unknown) on 03-OCT-2012. Concomitant medications included: vitamins (unspecified). On 03-OCT-2012 the patient had an inflamed area on her left arm at the injection site. She had itching, and it was swollen, she also had a pinching feeling. The patient said the area had white welt type bumps, which her pharmacist advised he had not seen. The patient sought medical attention and hydrocortisone was given for the treatment of the adverse events on 09-OCT-2012. No lab diagnostics studies performed. The outcome of the adverse events was unknown at the time of the report. Additional information has been requested.

VAERS ID:470690 (history)  Vaccinated:2012-10-03
Age:36.0  Onset:2012-10-16, Days after vaccination: 13
Gender:Male  Submitted:2012-10-22, Days after onset: 6
Location:New York  Entered:2012-10-22
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Stated. Had a 2 day viral infection approx 1 week previously no fever.
Preexisting Conditions: diabetic
Diagnostic Lab Data: Lab work
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH745AD1IMRA
Administered by: Private     Purchased by: Other
Symptoms: Idiopathic thrombocytopenic purpura, Petechiae, Platelet count decreased, Platelet transfusion, Viral infection
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow)
Write-up: Noticed Petechiae on his arms and legs went to primary sent for lab work PLT count 3 repeated lads PLT 1 given solucortef and 10 unit platelet pack @ 6 AM on 10/17/2012 transfered from one hospital to Hematologist told pt that they may never know what caused drop n PLT most likley viral stated textbook ITP plan to remain in hospital till PLT 15 or $g as of 10/18/2012 plt 12 remains asymptomatic other than Petechaie

VAERS ID:470734 (history)  Vaccinated:2012-10-03
Age:27.0  Onset:2012-10-18, Days after vaccination: 15
Gender:Male  Submitted:2012-10-22, Days after onset: 4
Location:California  Entered:2012-10-22
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
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSUNK1IMRA
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEURW04003A0 LA
Administered by: Military     Purchased by: Military
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: NOTICED BUMPS BILAT ON ARMS, THEN NEXT DAY ON TRUNK AND LEGS. TREATED WITH OTC BENADRYL CREAM AND ORAL BENADRYL CAPSULES. TWO DAYS LATER, NOTICED IT ON HIS FACE.

VAERS ID:470996 (history)  Vaccinated:2012-10-03
Age:32.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-22
Location:California  Entered:2012-10-22
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4466BA IDRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This patient is one of a cluster of 15 patients that had an injection site reaction characterized by erythema, pruritus and nodule at the injection site. Lasted 24 hrs to 1 week. No treatment given.

VAERS ID:471000 (history)  Vaccinated:2012-10-03
Age:43.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-22
Location:California  Entered:2012-10-22
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4466BA IDLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This patient is one of a cluster of 15 patients that had an injection site reaction characterized by erythema, pruritus & nodule at the injection site. Lasted 24 hrs to 1 week. No treatment given.

VAERS ID:471025 (history)  Vaccinated:2012-10-03
Age:7.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-15, Days after onset: 11
Location:Ohio  Entered:2012-10-22, 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: No
Preexisting Conditions: Asthma; Speech delay
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AB UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Cellulitis, Erythema, Feeling hot, Hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Patient with itching about 6 hrs after vaccine, followed by swelling, warmth, erythema. Allergic reaction cellulitis.

VAERS ID:471032 (history)  Vaccinated:2012-10-03
Age:51.0  Onset:2012-10-06, Days after vaccination: 3
Gender:Female  Submitted:2012-10-15, Days after onset: 9
Location:California  Entered:2012-10-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Seasonal
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH713AA0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Head to toe hives and fever - ZYRTEC.

VAERS ID:471145 (history)  Vaccinated:2012-10-03
Age:88.0  Onset:2012-10-10, Days after vaccination: 7
Gender:Female  Submitted:2012-10-19, Days after onset: 9
Location:Alabama  Entered:2012-10-22, Days after submission: 3
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: Unknown
Diagnostic Lab Data: USG on right arm 10/17/12
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH721AC IMRA
Administered by: Other     Purchased by: Other
Symptoms: Nodule, Ultrasound scan normal
SMQs:
Write-up: Patient notified agency on 10/10/12 to inform me that she had a knot on her arm from the flu shot I gave her at the center on 10/3/12. I informed her to follow up with her primary doctor. Patient saw Dr 10/15/12 and had USG done 10/17/12. I spoke with RN at Dr''s office this morning (10/19/12) she informed me that the USG done on patient was negative and no further treatment was ordered, but Dr did call in pain medication on 10/19/12 for patient.

VAERS ID:471347 (history)  Vaccinated:2012-10-03
Age:31.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Male  Submitted:2012-10-22, Days after onset: 19
Location:New York  Entered:2012-10-23, 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:
Preexisting Conditions:
Diagnostic Lab Data: None as of this report, but patient seeing another doctor
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP591070IMLA
Administered by: Other     Purchased by: Private
Symptoms: Mobility decreased, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad)
Write-up: Patient is experiencing shoulder pain and mobility issues since receiving an influenza vaccination on 10/3/12.

VAERS ID:476074 (history)  Vaccinated:2012-10-03
Age:66.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-23
Location:California  Entered:2012-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension; Anxiety; Lupus-like syndrome
Preexisting Conditions: Muscle spasms
Diagnostic Lab Data:
CDC Split Type: WAES1210USA007574
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H01132 SCUN
Administered by: Other     Purchased by: Other
Symptoms: Influenza like illness, Malaise, Nasopharyngitis
SMQs:
Write-up: This spontaneous report as received from a pharmacist refers to a 66 years old female patient with drug induced lupus, anxiety and hypertension. The patient''s medical history included muscle spasms. The patient had none drug allergies. On 03-OCT-2012 the patient was vaccinated subcutaneously with a dose of 0.65 ml ZOSTAVAX (lot # reported as H01132, expiration date reported as 08-SEP-2013). The pharmacist stated that the patient was taking prednisone, PLAQUENIL, and IMURAN, when she received ZOSTAVAX, and may also have been taking VALTREX at that time. The pharmacist reported that he received a call on 12-OCT-2012, from the patient who reported that she was "not feeling well" and felt like she might be getting a cold or the flu. No treatment was given. Lab diagnostics studies performed were reported as none. The outcome was reported as not recovered. Additional information has been requested.

VAERS ID:471126 (history)  Vaccinated:2012-10-03
Age:16.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-24, Days after onset: 21
Location:North Carolina  Entered:2012-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
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) (AFLURIA)CSL LIMITEDP585071SYRLA
Administered by: Public     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives began as small spots around 8:30 pm. Benadryl was given. Hives grew to cover much of her arms, legs and torso by morning. Benadryl continued as prescribed. Hives persisted for several days.

VAERS ID:471774 (history)  Vaccinated:2012-10-03
Age:81.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-10, Days after onset: 7
Location:New Hampshire  Entered:2012-10-25, Days after submission: 15
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: Heart disease
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12050010IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1502AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient was in pharmacy 10/9/12 and reported her left arm was swollen and painful the evening she was administered PNEUMOVAX for which she sought medical treatment. Patient reported on 10/9/12 she had made full recovery.

VAERS ID:472435 (history)  Vaccinated:2012-10-03
Age:17.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-25
Location:Unknown  Entered:2012-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA003512
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Maternal exposure during pregnancy, No adverse event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: This spontaneous prospective pregnancy report as received from a physician refers to a 17 years old female patient. The patient''s history of previous pregnancies and live births is not known. The patient was vaccinated with the first dose GARDASIL (lot number not reported) on 25-SEP-2008. The physician reported that the patient received the third dose in the GARDASIL immunization series on 03-OCT-2012, while she was 14 weeks pregnant. No adverse effect reported. Physician reports that the patient is due on 03-APR-2013. The patient had sought medical attention, the AE occurred in provider''s office. Additional information has been requested.

VAERS ID:471752 (history)  Vaccinated:2012-10-03
Age:45.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-29, Days after onset: 24
Location:Arizona  Entered:2012-10-29
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: Sulfa allergy, ulcerative colitis, hypothyroidism
Diagnostic Lab Data: CBC, cmet, UA, sed rate
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH755AA IMRA
Administered by: Public     Purchased by: Other
Symptoms: Activities of daily living impaired, Asthenia, Back pain, Chills, Dizziness, Exercise test normal, Fatigue, Full blood count normal, Headache, Hyperhidrosis, Malaise, Nausea, Pain, Paraesthesia, Presyncope, Pulmonary function challenge test normal, Pyrexia, Red blood cell sedimentation rate normal, Tachycardia, Urine analysis normal
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Extreme weakness, tiredness, fatigue, severe low back pain, fever, body aches, chills, headaches, lightheaded, near fainting, tachycardia, diaphoresis, tingling in feet, nausea. Symptoms began on Oct 5th and have been progressively worsened. Went to my PCP who ordered CBC, cmet, UA, sed rate and prescribed a Medrol dose pak and Levaquin prophylactically. All labs were normal. As of today I am still sick with all of the above symptoms despite finishing the medications. I have missed several days of work this past week due to nearly passing out at work from these symptoms.

VAERS ID:472128 (history)  Vaccinated:2012-10-03
Age:56.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 2
Location:New York  Entered:2012-10-29, Days after submission: 24
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: Allergic to adhesives
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH729AB IMUN
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Itching, swelling, erythema at site of injection - approximately 2 hrs following vaccination.

VAERS ID:472064 (history)  Vaccinated:2012-10-03
Age:25.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-10-17, Days after onset: 13
Location:Illinois  Entered:2012-10-30, 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:
Preexisting Conditions: Cystic Fibrosis; Allergies to PCN, Sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH748AB IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1309AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Cough, Injection site pain, Injection site swelling, Malaise, Nausea, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Vaccine given 10/3 -$g to ED 10/6 with aches, N/V, cough, malaise for 2 days. Site swollen & tender. Received IV antibiotics for cellulitis as well as ongoing CF therapy. D/C home with home health 10/10 with PO clindamycin.

VAERS ID:472290 (history)  Vaccinated:2012-10-03
Age:49.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-10-06, Days after onset: 1
Location:Colorado  Entered:2012-10-30, Days after submission: 24
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: No allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP503085IMRA
Administered by: Public     Purchased by: Public
Symptoms: Activities of daily living impaired, Arthralgia, Injection site erythema, Injection site warmth, Muscular weakness, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Severe 103 degrees F fever, joint pain 10/10, baseball size red site 3" x 3", hot to touch, muscle weakness. unable to get out of bed. 10/6/12 Pain 6/10. Went to PCP. CIPRO taken. All symptoms resolved.

VAERS ID:476828 (history)  Vaccinated:2012-10-03
Age:0.3  Onset:2012-10-03, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-30, Days after onset: 27
Location:Unknown  Entered:2012-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA003719
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1420Y UNUN
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:
Write-up: This spontaneous report was received from a pharmacy student refers to a 4 months old patient. On 03-OCT-2012 (also reported as on 04-OCT-2012), the patient was vaccinated with a dose of LIQUID PEDVAXHIB (lot # reported as 1420Y, expiry: 03-AUG-2012, route not reported). No adverse effect were reported. It was not specified if the patient sought medical attention. Additional information has been requested.

VAERS ID:472587 (history)  Vaccinated:2012-10-03
Age:57.0  Onset:2012-10-18, Days after vaccination: 15
Gender:Male  Submitted:2012-11-01, Days after onset: 14
Location:California  Entered:2012-11-01
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: Type 1 Diabetes, hypertension.
Diagnostic Lab Data: It is still itchy on 11/01/2012.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Itchiness on the hands, back of the neck, torso sides and back.

VAERS ID:472613 (history)  Vaccinated:2012-10-03
Age:48.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Male  Submitted:2012-11-01, Days after onset: 27
Location:Pennsylvania  Entered:2012-11-01
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: CBC and tests for Lyme, Mono, HIV all results were negative all results were entirely in normal range
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER07749211A0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Borrelia test negative, Fatigue, Full blood count normal, HIV test negative, Influenza like illness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Achy muscles and exhaustion off & on for 4 weeks and continuing to this day. Peaked Oct 23-29 with severe flu-like symptoms but no fever.

VAERS ID:472961 (history)  Vaccinated:2012-10-03
Age:52.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 1
Location:California  Entered:2012-11-01, Days after submission: 28
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: Exercise induced asthma
Diagnostic Lab Data: Blood donor 2 wks. ago
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP586070IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chills, Eye swelling, Fatigue, Pain, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Approximately 1:30 PM received vaccine. 6:30 PM could not stay awake - exhausted. 10:00 PM woke up by husband, LUE "like an egg" applied ice, went to bed, husband felt something wrong. 12:00 AM - aches/pain/chills/swollen eyes & face. 5:00 AM - ice pack to swollen face.

VAERS ID:473260 (history)  Vaccinated:2012-10-03
Age:61.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-11-04, Days after onset: 31
Location:Rhode Island  Entered:2012-11-04
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
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP508080SYRRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site reaction, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Quarter-sized, red rash persisted at injection site for 2 weeks post-injection.

VAERS ID:473654 (history)  Vaccinated:2012-10-03
Age:6.0  Onset:2012-10-08, Days after vaccination: 5
Gender:Female  Submitted:2012-10-10, Days after onset: 2
Location:Georgia  Entered:2012-11-05, Days after submission: 26
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: GA1512
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ20251IN 
Administered by: Other     Purchased by: Public
Symptoms: Dermatitis contact, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 10/18/12 - Woke up with rash - covered all over body. Seen in ER dx contact dermatitis, PRELONE Rx given.

VAERS ID:477286 (history)  Vaccinated:2012-10-03
Age:68.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-11-05, Days after onset: 32
Location:Florida  Entered:2012-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA003753
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 1SYRUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This spontaneous report as received from a 68-year-old female patient regarding herself with no drug reactions or allergies and no pertinent medical history. The patient was vaccinated with dose 2, 0.5 milliliter PNEUMOVAX 23 (lot# not reported) either subcutaneously or intramuscularly on 03-OCT-2012. Concomitant medications included unspecified thyroid and blood pressure medications (meds). On 04-OCT-2012 the patient noticed that the injection site was sore, very tender and contained a bump. She claimed to have gotten a PNEUMOVAX 23 shot 6-7 years ago, and worried maybe it was some kind of overdose. There were no laboratory diagnostic tests performed. Treatment was not given for the adverse events. Patient did not seek medical attention but called FDA. The reported events did not resolve at the time of this report. Additional information has been requested.

VAERS ID:473620 (history)  Vaccinated:2012-10-03
Age:35.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 0
Location:Rhode Island  Entered:2012-11-06, Days after submission: 34
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) (AFLURIA)CSL LIMITED07049211A IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Dry skin, Feeling hot, Skin warm
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: C/O feeling hot, dizzy, lightheaded. Skin warm & dry. BP 120/80 82 - 18. Went in cool area. Felt better. VS stable, returned to work at desk. Symptoms returned. Primary Care MD called - told to take Ibuprofen & rest. BP 134/84 - 92. After 15 min - felt better & to return home. BP 118/70 - 72 - 18.

VAERS ID:473726 (history)  Vaccinated:2012-10-03
Age:77.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Connecticut  Entered:2012-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NKA
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4499AA0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Injection site anaesthesia, Injection site pain, Injection site reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient complaining of soreness and numbness/tingling of the upper left shoulder from 10/3/12.

VAERS ID:476188 (history)  Vaccinated:2012-10-03
Age:73.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-31
Location:Texas  Entered:2012-11-06, Days after submission: 6
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
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site swelling, Pain in extremity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Shot made my arm get red, was very sore and had red welts. A lot of pain in arm. Right arm, took aspirin for pain. Arm got swollen from shot to elbow for 4 days.

VAERS ID:473392 (history)  Vaccinated:2012-10-03
Age:0.5  Onset:2012-10-16, Days after vaccination: 13
Gender:Male  Submitted:2012-11-01, Days after onset: 16
Location:Florida  Entered:2012-11-07, Days after submission: 6
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Reflux
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4297AA2IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHF451302IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0060AE2PO 
Administered by: Private     Purchased by: Private
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)
Write-up: Intussusception requiring open surgical reduction 10/16/2012 - 13 days after vaccine administration.

VAERS ID:474538 (history)  Vaccinated:2012-10-03
Age:51.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Male  Submitted:2012-10-16, Days after onset: 12
Location:Wyoming  Entered:2012-11-07, Days after submission: 22
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH746AA1UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4196AA1UNRA
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Fever & rash.

VAERS ID:477634 (history)  Vaccinated:2012-10-03
Age:70.0  Onset:2012-10-05, Days after vaccination: 2
Gender:Female  Submitted:2012-11-07, Days after onset: 33
Location:Unknown  Entered:2012-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug hypersensitivity, Naloxone; Drug hypersensitivity
Preexisting Conditions: NALOXONE; SULFA
Diagnostic Lab Data:
CDC Split Type: WAES1210USA005775
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H0114300SCLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Oedema peripheral, Pruritus, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: This spontaneous report was received from a pharmacist concerning a 70 year old female patient with no pertinent medical history. Patient current condition included sulfa and naloxone allergy. On 03-OCT-2012, the patient was vaccinated with a dose of 0.65 milliliter ZOSTAVAX, subcutaneously in the left arm. Lot number and expiry date was reported as H011430 and 12-SEP-2013 respectively. No concomitant medications were reported. On 05-OCT-2012, the patient entire left arm was red, itchy, swollen and tender to the touch. The patient called to the pharmacist and visited to her daughter who was a nurse. The patient was treated with hot compress, hydrocortisone and BENADRYL cream. No laboratory studies were performed. The outcome of entire left arm was red, itchy, swollen and tender to the touch was reported as resolving as the swelling and itching went down and localized at injection site. The relatedness for entire left arm was red, itchy, swollen and tender to the touch was unknown for ZOSTAVAX. Additional information has been requested.

VAERS ID:473787 (history)  Vaccinated:2012-10-03
Age:49.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-11-09, Days after onset: 37
Location:Florida  Entered:2012-11-09
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: Sulfa, Cipro, Macrobid, Zofran, Omnipaque
Diagnostic Lab Data: Chest x-ray, pulmonary function test.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   RA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Asthma, Bronchitis, Chest X-ray, Malaise, Pulmonary function test, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Wednesday 10/3 2 p.m. - weak and not feeling well and reported symptoms to employee health nurse. Thursday 10/4 Severe malaise, followed by weakness, high fevers, and followed by severe asthma attacks starting Friday and multiple trips to ER/MD office for evaluation/nebulizer treatments. Asthma attacks remain mod-severe for weeks following vaccination. Numerous respiratory/steroid treatments required. Developed bronchitis after asthma flared.

VAERS ID:474145 (history)  Vaccinated:2012-10-03
Age:64.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-11-14, Days after onset: 41
Location:California  Entered:2012-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Per pt said roday "Last month following day after Zostavax Immunization I observed a redness swollen lateral left side arm up to my below elbow.
Preexisting Conditions: Asthma moderate persistent (See Medical Records note)
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H0106561SCLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Injection site erythema, Injection site swelling
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, swollen Left lateral arm til below the elbow.

VAERS ID:474390 (history)  Vaccinated:2012-10-03
Age:71.0  Onset:2012-10-13, Days after vaccination: 10
Gender:Female  Submitted:2012-11-14, Days after onset: 32
Location:Minnesota  Entered:2012-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: DM; Cholesterol
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4499AA UNLA
Administered by: Private     Purchased by: Other
Symptoms: Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Systemic pruritic rash.

VAERS ID:474249 (history)  Vaccinated:2012-10-03
Age:75.0  Onset:2012-10-04, Days after vaccination: 1
Gender:Female  Submitted:2012-11-15, Days after onset: 42
Location:Illinois  Entered:2012-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: History of bronchitis; at time of visit dyspnea and cough
Preexisting Conditions: History of bronchitis; at time of visit dyspnea and cough; possible COPD
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0138470SCLA
Administered by: Unknown     Purchased by: Other
Symptoms: Chest discomfort, Injection site erythema, Injection site pain, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Raised redness area with ring around area where shot given, pain down to elbow, hives on face, and chest tightness. Patient was advised to go to the ER and follow up with primary care physician and take Benadryl.

VAERS ID:474566 (history)  Vaccinated:2012-10-03
Age:65.0  Onset:2012-10-14, Days after vaccination: 11
Gender:Male  Submitted:0000-00-00
Location:Connecticut  Entered:2012-11-16
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: ? Doxycycline
Diagnostic Lab Data: Clinical hx - DX: Guillain-Barre Syndrome
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206001 IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Muscular weakness, Pain in extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow)
Write-up: Onset between 10/14/12 and 10/20/12- bilateral leg weakness and pain, paresthesia. Saw PCP and neurologist.

VAERS ID:474885 (history)  Vaccinated:2012-10-03
Age:41.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-10-23, Days after onset: 20
Location:Tennessee  Entered:2012-11-19, Days after submission: 27
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: Diabetes; Hypertension; Depression
Diagnostic Lab Data:
CDC Split Type: TN12016
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURH733AD SYRLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Hyperhidrosis, Injection site rash, Pruritus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow)
Write-up: 10/22/12 Rec''d p/c from pt stating after vaccination developed rash on (L) arm at site of injection. Itching, headache, afebrile, diaphoretic. Per RN 10/23/12 e-mail "had reaction to Flu shot".

VAERS ID:475518 (history)  Vaccinated:2012-10-03
Age:60.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-11-28, Days after onset: 56
Location:Oregon  Entered:2012-11-28
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) (AFLURIA)CSL LIMITEDPS01080IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt complains of moderate to severe pain in injection site arm on and off since the date of injection.

VAERS ID:478679 (history)  Vaccinated:2012-10-03
Age:65.0  Onset:2012-11-13, Days after vaccination: 41
Gender:Female  Submitted:2012-11-28, Days after onset: 15
Location:New Jersey  Entered:2012-11-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Pain
Diagnostic Lab Data:
CDC Split Type: WAES1211USA009932
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H011050 SCUN
Administered by: Other     Purchased by: Other
Symptoms: Condition aggravated, Nuclear magnetic resonance imaging, Pain, Paraesthesia, Rash macular
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: This spontaneous report as received from a registered nurse refers to a 65 years old female patient with no drug allergy. The patient was vaccinated with 0.65 ml ZOSTAVAX subcutaneously on 03-OCT-2012. Lot# was reported as H011050, expiry date on 05-SEP-2013. Concomitant medications included LOVAZA and FLONASE. On 13-NOV-2012, the patient had "electrical shock like pain" in her both legs and right arm after receiving ZOSTAVAX. Patient also presented with flat macular rash on her leg bilaterally. According to patient''s chart, patient stated that shock sensation came and went, lasting several seconds to a minute and the area where patient felt the electrical shock sensation was painful to touch. Patient reported to physician that if she touched the affected area after shock sensation was gone, the area was painful and the pain would last little longer than electrical shock sensation. Nurse reported that patient did have history of "electrical zap type of pain" in her chart prior to ZOSTAVAX administration but it never affected more than one spot at a time before. Patient had a daughter with multiple sclerosis and physician ordered magnetic resonance imaging(MRI) to rule out diagnostic of multiple sclerosis. The test result was not provided. Physician believed that flat macular rash on legs were not related to ZOSTAVAX. No treatment was given. The outcome of patient was unknown. The patient sought medical attention via office visit. Additional information has been requested.

VAERS ID:476007 (history)  Vaccinated:2012-10-03
Age:60.0  Onset:2012-10-03, Days after vaccination: 0
Gender:Female  Submitted:2012-12-02, Days after onset: 60
Location:Puerto Rico  Entered:2012-12-02
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: Asthma; Aspirin Allergies
Diagnostic Lab Data: Patient inform some test was CT and Lumbar studies
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1205501 IM 
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1160AA SC 
Administered by: Other     Purchased by: Private
Symptoms: Abasia, CSF test, Computerised tomogram, Guillain-Barre syndrome, Hypoaesthesia, Injection site erythema, Injection site swelling
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Demyelination (narrow)
Write-up: 10/04/2012 Swelling and redness in left arm (vaccine area). 10/06/2012 Patient was in hospital and received antibiotics and cortisone. 10/14/2012 Patient inform she was hospitalized because of numbness in arms and legs and she can''t walk. 10/16/2012 Patient notify she was diagnosed with Guillain-Barre Syndrome.

VAERS ID:476167 (history)  Vaccinated:2012-10-03
Age:11.0  Onset:2012-10-06, Days after vaccination: 3
Gender:Male  Submitted:2012-12-04, Days after onset: 59
Location:California  Entered:2012-12-04
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 48-72 hrs after the flu vaccination my son became sick. After about 1 week his right eye started watering. We went to the ophthalmologist a week later and they and she advised us that my son has optic neuritis. He lost partial vision in his right eye due to this and was admitted into hospital for 6 days.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206001 IMUN
Administered by: Other     Purchased by: Private
Symptoms: Blindness unilateral, Cough, Lacrimation increased, Loss of consciousness, Optic neuritis, Oropharyngeal pain, Rhinorrhoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Retinal disorders (broad), Lacrimal disorders (narrow), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Runny nose, sore throat, cough, watery eye with 10-15 minute blackouts numerous times a day.

VAERS ID: