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Found 583703 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:440168 (history)  Vaccinated:2011-10-26
Age:23.0  Onset:0000-00-00
Gender:Female  Submitted:2011-10-26
Location:Virginia  Entered:2011-10-26
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
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC003AA2IMLA
Administered by: Other     Purchased by: Private
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Tuberculin 0.5 Ml given IM instead of Flu Vaccine.

VAERS ID:440194 (history)  Vaccinated:2011-10-26
Age:55.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 0
Location:Delaware  Entered:2011-10-26
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)SANOFI PASTEUR 0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Severe chills, fever reaching 102, severe, very severe, headache. Body aches. Recovered in less than 12 hours.

VAERS ID:440206 (history)  Vaccinated:2011-10-26
Age:48.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 0
Location:Ohio  Entered:2011-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11014011IMLA
Administered by: Other     Purchased by: Other
Symptoms: Immediate post-injection reaction, Local swelling
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Immediate swelling of area locally to about the area size of a silver dollar, 1/2 inch high in center.

VAERS ID:440225 (history)  Vaccinated:2011-10-26
Age:51.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 0
Location:Washington  Entered:2011-10-26
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: Diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Chills, Facial pain, Fatigue, Headache, Memory impairment, Neck pain, Visual impairment
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Within 15 min of vaccine, Severe headache. Impaired vision. Returned to work unable to carry on conversation. Pain mostly on left side of head, face and neck. Unable to recall coworkers names. Chills. Took Excedrine for headache. 7 hours later headache less severe however, neck, back and left shoulder ache. Very tired and weak.

VAERS ID:440234 (history)  Vaccinated:2011-10-26
Age:23.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 0
Location:Massachusetts  Entered:2011-10-26
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: asthma; codeine allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED13849111A1IMRA
Administered by: Other     Purchased by: Private
Symptoms: Eye irritation, Eye pruritus, Rash generalised
SMQs:, Anaphylactic reaction (broad), Corneal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Itchy and burning eyes. Rash all over. 50 mg BENADRYL.

VAERS ID:440345 (history)  Vaccinated:2011-10-26
Age:70.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 0
Location:Texas  Entered:2011-10-26
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 DIAGNOSTICS1102701 IMUN
Administered by: Other     Purchased by: Unknown
Symptoms: Erythema, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Red, swelling (moderate-severe), warm to touch.

VAERS ID:440228 (history)  Vaccinated:2011-10-26
Age:53.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Washington  Entered:2011-10-27
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALS  IMLA
Administered by: Other     Purchased by: Private
Symptoms: Facial pain, Pain in extremity, Rhinalgia, Throat tightness, Toothache
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Arm started to really ache. Started to get a toothache in the left hand side of my jaw that was extremely intense and it (pain) traveled up the check and into nose. Throat started to close.

VAERS ID:440264 (history)  Vaccinated:2011-10-26
Age:68.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Florida  Entered:2011-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Public
Symptoms: Chest discomfort, Cough, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Constant cough, Difficulty with breathing - heavy chest - nausea with no vomiting.

VAERS ID:440265 (history)  Vaccinated:2011-10-26
Age:69.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-27, Days after onset: 1
Location:Florida  Entered:2011-10-27
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
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Public
Symptoms: Cough, Diarrhoea, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Cough, extreme nausea and vomiting, diarrhea.

VAERS ID:440268 (history)  Vaccinated:2011-10-26
Age:75.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-27, Days after onset: 1
Location:Ohio  Entered:2011-10-27
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: Idiopathic neuropathy of toes.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Cough, Dysphonia, Eye irritation, Headache, Pain, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Hypersensitivity (broad)
Write-up: Hoarseness, constricted throat, aches, headache, cough, irritated eyes, on verge of emergency room visit.

VAERS ID:440275 (history)  Vaccinated:2011-10-26
Age:59.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-27, Days after onset: 1
Location:Montana  Entered:2011-10-27
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: NKDA; HTN; Diabetes; ETOH abuse; Rheumatic fever
Diagnostic Lab Data: Creatinine increased.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT465AA0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood creatinine increased, Electrocardiogram, Nausea, Pyrexia, Tachycardia, Tachypnoea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Tachycardia, tachypnea, low grade fever, nausea, vomiting. 4-5 hour course IV fluids. ZOFRAN, SOLUMEDROL, BENADRYL. ER monitoring EKG, ATIVAN.

VAERS ID:440297 (history)  Vaccinated:2011-10-26
Age:2.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-27, Days after onset: 0
Location:Texas  Entered:2011-10-27
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
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4024AA2IMLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH477AC1IMRL
HEPA: HEP A (VAQTA)MERCK & CO. INC.1005AA1IMLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF255791IMRL
Administered by: Unknown     Purchased by: Private
Symptoms: Tonic clonic movements
SMQs:, Convulsions (narrow), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: 2 episodes of tonic-clonic activity.

VAERS ID:440300 (history)  Vaccinated:2011-10-26
Age:29.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Ohio  Entered:2011-10-27
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: Allergies to Corn, glycerine, dairy and auto exhaust
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH4868F0 LA
Administered by: Unknown     Purchased by: Private
Symptoms: Back pain, Fatigue, Headache, Muscle spasms, Nasal congestion, Neck pain, Sensation of heaviness
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Arthritis (broad)
Write-up: Headache, fatigue, heavy limbs, neck and back ache, muscle cramps, stuffy nose. Currently experiencing symptoms.

VAERS ID:440301 (history)  Vaccinated:2011-10-26
Age:61.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Maryland  Entered:2011-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS    
Administered by: Public     Purchased by: Other
Symptoms: Headache, Injection site pain, Local swelling, Pruritus, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pain in arm where vaccine given, itching and swelling of face and neck, headache all continue on 10/27/2011. Putting cold compresses on face and neck, aspirin and Benadryl taken.

VAERS ID:440357 (history)  Vaccinated:2011-10-26
Age:63.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Georgia  Entered:2011-10-27
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: Sulfa, opiates; Type II diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH505AA0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Eyelid oedema, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approx 4 hours after receiving FLUZONE vaccine, pt experienced swelling of eyelids & lips - advised to take diphenhydramine and seek physician if not resolved.

VAERS ID:440379 (history)  Vaccinated:2011-10-26
Age:30.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-27, Days after onset: 0
Location:Texas  Entered:2011-10-27
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)SANOFI PASTEURUH478AA0UNRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness at site (R) deltoid 2.5 inches x 2 inches. No induration.

VAERS ID:440386 (history)  Vaccinated:2011-10-26
Age:62.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Georgia  Entered:2011-10-27
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 PASTEURUH486AE IMLA
Administered by: Other     Purchased by: Private
Symptoms: Activities of daily living impaired, Amnesia, Headache
SMQs:, Dementia (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Patient stated after going home from getting vaccine she had a headache experienced memory loss and had trouble texting on her phone.

VAERS ID:440412 (history)  Vaccinated:2011-10-26
Age:0.5  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Colorado  Entered:2011-10-27
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
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Heart rate increased, Pyrexia, Respiratory rate increased, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever of 102, panting, elevated heart beat, vomiting.

VAERS ID:440413 (history)  Vaccinated:2011-10-26
Age:50.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:South Carolina  Entered:2011-10-27
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
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Insomnia, Mass, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Raised lump, erythema, hot to touch, febrile, unable to sleep.

VAERS ID:440414 (history)  Vaccinated:2011-10-26
Age:69.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Kansas  Entered:2011-10-27
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 were done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1111Z0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Immediate post-injection reaction, Incorrect route of drug administration, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Medication errors (narrow)
Write-up: Client reports immediately following vaccine administration that she had pain at injection site and then later in the day significant swelling and redness at injection site. She went to the ER at local hospital and reports that the ER physician said that injection had gone in an artery and client reports she was prescribed prednisone for this. The client had come to the Health Department the following noon to report the incident to the secretary but refused to speak to a nurse during her visit. This writer phoned the client to discuss the adverse event which from her explaination appears to be redness and pain at the injection site. It is explained to client that about half of people who get PPSV vaccine will have some redness and swelling at the site. She reports that the site is better now and denies any bleeding at the site after injection or any bruising at the site (left deltoid).

VAERS ID:440416 (history)  Vaccinated:2011-10-26
Age:2.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-27, Days after onset: 0
Location:Colorado  Entered:2011-10-27
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 known birth defects, no known allergies, in good condition without symptoms.
Diagnostic Lab Data: Gave neb treatment and better.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH467AD1IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia, Rhinorrhoea, Upper respiratory tract congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Runny nose, upper airway throat congestion/ noise. Fever.

VAERS ID:440427 (history)  Vaccinated:2011-10-26
Age:70.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-27, Days after onset: 1
Location:California  Entered:2011-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Muscle Soreness and Shivering through part of the night, symptoms had gone away by morning.

VAERS ID:440429 (history)  Vaccinated:2011-10-26
Age:25.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:California  Entered:2011-10-27
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) (FLUZONE INTRADERMAL)SANOFI PASTEUR  IDRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site pain, Injection site swelling, Mobility decreased, Pain
SMQs:, Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: I received the injection at around noon. I had injection site pain and swelling at the site of injection in the afternoon and at night. I had difficulty and pain moving my arm even slightly. The swelling was big enough to show as a protrusion through my shirt at work. I did not take anything to treat the pain.

VAERS ID:440444 (history)  Vaccinated:2011-10-26
Age:25.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Oregon  Entered:2011-10-27
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
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness, Erythema, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Dizzy, redness, tenderness, swelling.

VAERS ID:440447 (history)  Vaccinated:2011-10-26
Age:65.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-27, Days after onset: 1
Location:Illinois  Entered:2011-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1102701 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt vomited 4 times, 5 hrs after receiving vaccine.

VAERS ID:440448 (history)  Vaccinated:2011-10-26
Age:39.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Tennessee  Entered:2011-10-27
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 penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11024012IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0453AA0IMRA
Administered by: Private     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: (R) deltoid area red, swollen, painful received in afternoon 10-26-11. Symptoms started late PM and during night. Dexamethasone 4 mg given for inflammation.

VAERS ID:440474 (history)  Vaccinated:2011-10-26
Age:1.6  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-27, Days after onset: 1
Location:Michigan  Entered:2011-10-28, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURU4231BB1UNLL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Shortly after receiving flu shot pt. collapsed on the floor. His father and the MA observed him having a seizure. Completely recovered within 3 min. Pt. has a hx. of a febrile seizure 1 mo. ago hours after receiving imms. including flu vaccine. Has been referred to neuro.

VAERS ID:440494 (history)  Vaccinated:2011-10-26
Age:46.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-28, Days after onset: 2
Location:North Carolina  Entered:2011-10-28
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: high blood pressure, high cholestrol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH478AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dyspnoea, Exophthalmos, Eye pruritus, Ocular hyperaemia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Hyperthyroidism (narrow), Ocular infections (broad), Hypersensitivity (broad)
Write-up: Eyes red, itchy and bulging, throat closing up, couldn''t breathe.

VAERS ID:440503 (history)  Vaccinated:2011-10-26
Age:58.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-28, Days after onset: 1
Location:Kansas  Entered:2011-10-28
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: Diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0986AA0IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site discomfort, Injection site reaction, Injection site swelling, Injection site warmth, Pain in extremity, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Injection site right deltoid. Lower deltoid developed red blotchy areas, warm to touch w/ min discomfort and min swelling. Pt stated that 24 hours after injection arm was very sore and had difficulty raising arm. Then the next day had minimal pain but by evening noticed red blotchy area. Instructed pt to apply cool compresses and take an antihistamine. Also instructed to f/u prn for worsening s/s.

VAERS ID:440526 (history)  Vaccinated:2011-10-26
Age:38.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 2
Location:New York  Entered:2011-10-28
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: no
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN0 RA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Chills, Mobility decreased, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: My joints began to ache, I developed a fever and chills and by 8:00pm, I was in so much pain I could hardly move (9-10 on the pain scale). I was completely nauseous and could not keep down any food. The pain lessened the next day (7-8) but continued. I''m now in day 3 -- and I still have pain at the 7-8 scale. The fever has dropped, but I can''t even smell food.

VAERS ID:440532 (history)  Vaccinated:2011-10-26
Age:65.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-28, Days after onset: 2
Location:California  Entered:2011-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N0
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA668BA5IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1200AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Body temperature increased, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling in arm, then temp to 101 x 24 hrs. Tylenol and warm compresses.

VAERS ID:440547 (history)  Vaccinated:2011-10-26
Age:56.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 2
Location:New Mexico  Entered:2011-10-28
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH978AC0IMLA
Administered by: Other     Purchased by: Military
Symptoms: Cough, Dizziness, Dry eye, Eye pruritus, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Corneal disorders (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4 hours after vaccine was administered pt. experienced hives all over body, dizziness, itchiness, dry and itchy eyes and has developed a cough.

VAERS ID:440554 (history)  Vaccinated:2011-10-26
Age:34.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 2
Location:California  Entered:2011-10-28
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
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJLA
Administered by: Public     Purchased by: Private
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Intense, severe pain in my upper arm, radiating out from the site of the shot. The pain was so intense that I could not use my arm. This pain stayed at the same intensity for about 3 hours, even though I took ibuprofen and Tylenol about an hour after I received the vaccine. The pain started to subside VERY slightly after about 4 hours, and was much better the next day. I have never experienced such an adverse reaction to the flu shot.

VAERS ID:440561 (history)  Vaccinated:2011-10-26
Age:59.0  Onset:0000-00-00
Gender:Male  Submitted:2011-10-28
Location:Minnesota  Entered:2011-10-28
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
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Chills, Diarrhoea, Headache
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Headache, chills, diarrhea.

VAERS ID:440563 (history)  Vaccinated:2011-10-26
Age:4.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-28, Days after onset: 1
Location:Pennsylvania  Entered:2011-10-28
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: asthma otherwise healthy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LL
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LL
Administered by: Unknown     Purchased by: Other
Symptoms: Injection site erythema, Injection site mass, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Baseball sized lump hot and red at injection site. Dr said give Benadryl and Benadryl cream but it''s just getting bigger.

VAERS ID:440565 (history)  Vaccinated:2011-10-26
Age:0.2  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:West Virginia  Entered:2011-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4044AB0IMRL
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC070AA2IMRL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169750IMLL
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALSA41B232A PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Irritability, Rash
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Rash that began on neck and extended down chest, abdomen, back. Extreme irritability.

VAERS ID:440567 (history)  Vaccinated:2011-10-26
Age:71.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-28, Days after onset: 1
Location:Texas  Entered:2011-10-28
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: HTN, HLD, mitral valve prolapse, hypothyroidism
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1101201 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0453AA IJLA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Local swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling and redness of ~10cm in diameter, improved with Benadryl and cool compresses.

VAERS ID:440573 (history)  Vaccinated:2011-10-26
Age:42.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-28, Days after onset: 1
Location:Indiana  Entered:2011-10-28
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
Preexisting Conditions: Type 2 Diabetes, Hypertension
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR 8IMLA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Chills
SMQs:, Guillain-Barre syndrome (broad)
Write-up: Weakness, chills.

VAERS ID:440574 (history)  Vaccinated:2011-10-26
Age:11.0  Onset:2011-10-28, Days after vaccination: 2
Gender:Male  Submitted:2011-10-28, Days after onset: 0
Location:California  Entered:2011-10-28
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4023AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B072DA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Local swelling
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large local swelling, improved w/ Benadryl.

VAERS ID:440627 (history)  Vaccinated:2011-10-26
Age:78.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 2
Location:California  Entered:2011-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness - she was in for a routine follow up
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1157Z1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain, Injection site reaction, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Severe left upper arm pain. Red blotchy skin tone to left upper arm.

VAERS ID:440629 (history)  Vaccinated:2011-10-26
Age:0.2  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Alabama  Entered:2011-10-28, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3924AA0IMLL
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB845AA0IMRL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHF255780IMLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1137Z0PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Apnoeic attack, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)
Write-up: Patient had syncope/apneic episodes x 4-5 starting 3 min. after immunizations.

VAERS ID:440650 (history)  Vaccinated:2011-10-26
Age:24.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 2
Location:Washington  Entered:2011-10-28
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: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT440AA1IMUN
Administered by: Other     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Patient fainted slightly after administration of FLUZONE 2011-12 vaccine. She was later conscious again and all vitals (verified by paramedic) are fine. Patient was followed up by doctor.

VAERS ID:440661 (history)  Vaccinated:2011-10-26
Age:55.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 2
Location:Louisiana  Entered:2011-10-28
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: Seafood & BACTRIM allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH455AA3IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives to face per patient''s report and itching to skin of trunk and arms. Pt managed symptoms with BENADRYL.

VAERS ID:440667 (history)  Vaccinated:2011-10-26
Age:41.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:Florida  Entered:2011-10-28
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: Allergies; migraines; eczema
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH464AA1IMRA
Administered by: Other     Purchased by: Other
Symptoms: Axillary pain, Oedema peripheral, Paraesthesia, Sensation of heaviness
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Day after vaccine administered pt felt swelling & discomfort in (R) axilla & heaviness in (R) arm with tingling of (R) hand.

VAERS ID:440694 (history)  Vaccinated:2011-10-26
Age:32.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:Oregon  Entered:2011-10-28
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0337AA0SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient received Varicella vaccine on 10/26/11 at 7:58am. Patient noticed very large red lump at site of injection next morning while taking a shower. 5 1/2 cm x 4 cm.

VAERS ID:440678 (history)  Vaccinated:2011-10-26
Age:5.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:Colorado  Entered:2011-10-29, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B171BA0UNRL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.1435Z0UNLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site vesicles, Vaccination site erythema, Vaccination site pain
SMQs:
Write-up: Erythema, blisters at vaccine site, painful. Tx with KEFLEX for possible cellulitis.

VAERS ID:440602 (history)  Vaccinated:2011-10-26
Age:73.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-30, Days after onset: 3
Location:Kentucky  Entered:2011-10-30
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: Type II diabetic. No medication
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  IJ 
Administered by: Other     Purchased by: Private
Symptoms: Abdominal discomfort, Chills, Decreased appetite, Dizziness, Feeling cold, Feeling hot, Respiration abnormal, Retching, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Respiratory failure (broad), Hypoglycaemia (broad)
Write-up: I received a Shingles Vaccine shot (ZOSTAVAX injection single dose vial 10PK) on Wednesday, October 26, 2011 about 11:00 AM at a local drug Store. For the first 12 hours I had no reaction to the shot. About 11:00 PM, on the same day, I stated have upset stomach problems. About one hour later I started having serious chills or shakes of my body. I felt like I was extremely cold. I put on more clothes and blankets to get warm. After about 1/2 hour the chills or shakes subsided. About an hour later I got extremely hot. After about another hour I was back to just a plain upset stomach and light headed. The next morning (Thursday, October 27) after I got up I still felt an upset stomach, light headed and did not want anything to eat or drink. This continued all day Thursday. Around 3:00 PM the same day I did eat an egg sandwich and a 1/2 glass of milk. Around 6:00 PM I had a little soft food and some water. On Friday, October 28, I felt a little better, but still no appetite and a little upset stomach and light headed. I had a few spoons full of oatmeal and a little milk about 8:00 AM. About 9:00 the same day, I went for a slow walk for about a mile. Around 11:00 AM I started having serious shakes, chill's and was freezing. I also was breathing very heavy during these shakes, I got into bed with a electric blanket set on high along with three other blankets to stop the shaking and get warm. After about 45 minutes the shaking subsided. Near the end of the shaking period I had the dry heaves. At the end of this period I again got very hot and cooled off after about 1/2 hour. Around 4:00 PM that afternoon I started feeling better and had some food and started drinking more liquids. Saturday, October 29 I got up and felt fine. Had a normal breakfast and went for a three mile walk and as of Sunday, October 30 I am doing fine. I do not have any allergies or heart problems. I am a type II diabetic, but I take no medications for this. I take a Simvastin 40 mg. daily for cholesterol.

VAERS ID:440662 (history)  Vaccinated:2011-10-26
Age:74.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-30, Days after onset: 4
Location:Wisconsin  Entered:2011-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AD0UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0614AA0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Immediate post-injection reaction, Myalgia, Myositis
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rotator cuff inflammation and pain starting immediately after vaccines administered and progressively worsened over two days. Then patient sought emergency room attention.

VAERS ID:440714 (history)  Vaccinated:2011-10-26
Age:47.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 5
Location:New York  Entered:2011-10-31
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) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA625BA0UNLA
Administered by: Public     Purchased by: Other
Symptoms: Bone pain, Chills, Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient c/o tired, fever, chills, bone pain, nausea, vomiting, x 4 1/2 days.

VAERS ID:440775 (history)  Vaccinated:2011-10-26
Age:64.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-31, Days after onset: 4
Location:New Jersey  Entered:2011-10-31
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: No.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Private
Symptoms: Injection site pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives on stomach, continued soreness in area where shot was administered.

VAERS ID:440778 (history)  Vaccinated:2011-10-26
Age:59.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-31, Days after onset: 4
Location:Virginia  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Paresthesia in toes
Preexisting Conditions: Developed asthma 2009, sinus polyps 2010, hypogonadism 1994, paresthesia in toes last month. Suffered sinus allergies through out life, but otherwise I''m in good shape!
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Unknown     Purchased by: Private
Symptoms: Eyelid function disorder, Hemiplegia, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)
Write-up: Could not blink left eye, numbness in left side of face particularly cheek. Progressed overnight to 10/28/2010 to near total paralysis of left side, including eyelids, eyebrows, forehead on left, left cheek, left half of lips, and left half of tongue.

VAERS ID:440781 (history)  Vaccinated:2011-10-26
Age:9.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-31, Days after onset: 5
Location:Michigan  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.YK20150  
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB518CA0IMLL
VARCEL: VARICELLA (VARILRIX)GLAXOSMITHKLINE BIOLOGICALS0408AA1SCLL
Administered by: Public     Purchased by: Public
Symptoms: Cough, Dysphonia, Erythema, Injection site urticaria, Nasopharyngitis, Rhinorrhoea, Vaccination complication
SMQs:, Anaphylactic reaction (narrow), Parkinson-like events (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approx. 2 hours after vaccinations small hive developed near injection site, L. Leg. On 10/27/2011 hive approx. size of "silver dollar". Benadryl given, .25mg. On 10/28/2011 hoarseness, runny nose, cough developed, hive still present. Benadryl, .25 given. On 10/29/2011 Hive and redness nearly gone, pt. still has head cold per mom and is back in school today. Mom states was told be nurse at E.R. that reaction was a severe reaction to the Hep A vaccine.

VAERS ID:440782 (history)  Vaccinated:2011-10-26
Age:69.0  Onset:2011-10-29, Days after vaccination: 3
Gender:Female  Submitted:2011-10-31, Days after onset: 2
Location:Oregon  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Musculoskeletal chest pain
SMQs:
Write-up: Pain right chest wall, shingles to right chest and back. Prescription given for Valtrex 1 gm TID times 7 days.

VAERS ID:440785 (history)  Vaccinated:2011-10-26
Age:53.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 5
Location:Texas  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient reported afterwards that had not been feeling well and had experienced some dizziness prior to getting the vaccine.
Preexisting Conditions: none reported
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1101801 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Immediate post-injection reaction, Injection site inflammation, Injection site pain, Injection site swelling, Malaise
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Soreness at injection sight right away, inflammation and swelling 18 hrs later, dizziness and general malaise within few hours; still reporting pain at sight 5 days later but no swelling.

VAERS ID:440786 (history)  Vaccinated:2011-10-26
Age:60.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-31, Days after onset: 4
Location:Utah  Entered:2011-10-31
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
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Chills, Muscular weakness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Severe muscle pain and weakness all day 10/27. Night of 10/29/2011 fever and chills.

VAERS ID:440790 (history)  Vaccinated:2011-10-26
Age:51.0  Onset:2011-10-28, Days after vaccination: 2
Gender:Male  Submitted:2011-10-31, Days after onset: 3
Location:Washington  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA640AA  LA
Administered by: Other     Purchased by: Other
Symptoms: Headache, Oropharyngeal pain, Pyrexia, Respiratory tract congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Sore throat, fever, chest congestion, head ache.

VAERS ID:440799 (history)  Vaccinated:2011-10-26
Age:49.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 5
Location:Georgia  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Not ill
Preexisting Conditions: Dx with allergy to tomatoes 1996
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B063CA0IMLA
Administered by: Public     Purchased by: Public
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: Pt reported that she started experiencing aching, swelling and redness of upper left arm early evening 10-26-2011. Used ADVIL and heating pad for symptom relief.

VAERS ID:440833 (history)  Vaccinated:2011-10-26
Age:55.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 2
Location:Ohio  Entered:2011-10-31, Days after submission: 3
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: Allergic to peanuts, DEMEROL, Penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11021010IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1241AA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pruritus, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Patient came in for a flu shot and pneumonia shot on 10-26-11. She received the flu shot in her left arm and PNEUMOVAX in her right arm. She came back on 10-27-11 & said her right shoulder started itching the night of 10-26-11 & her arm was sore. She said she would take some BENADRYL & see her Dr. if it persisted.

VAERS ID:440838 (history)  Vaccinated:2011-10-26
Age:65.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-31, Days after onset: 5
Location:Maryland  Entered:2011-10-31
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: Dyslipidemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AD IMRA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Chills
SMQs:, Arthritis (broad)
Write-up: Patient received vaccine at 10:00 AM. At 3:00 pm that same day he began experiencing aches from head to toe in all joints and began shivering. Wife called pharmacy, was advised to see MD. The MD sent him to the E.R. was given TORADOL injection (per wife) and sxs resolved in 1/2 hour.

VAERS ID:440810 (history)  Vaccinated:2011-10-26
Age:60.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-01, Days after onset: 6
Location:Virginia  Entered:2011-11-01
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: Allergies
Diagnostic Lab Data: 2 EKGs. Going for an echocardiogram on 11/4.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0619AA0 LA
Administered by: Other     Purchased by: Private
Symptoms: Atrial fibrillation, Electrocardiogram
SMQs:, Supraventricular tachyarrhythmias (narrow)
Write-up: Went to ER and was diagnosed with Arterial Fibrillation. First time event.

VAERS ID:440850 (history)  Vaccinated:2011-10-26
Age:31.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Georgia  Entered:2011-11-01, 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: UTI - taking CIPRO
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AA0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Back pain, Dyspepsia, Nausea, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad)
Write-up: Patient received a flu shot 10/26/11 in the AM at her place of work by H.D nurse. School nurse called H.D when patient came to her c/o eyes being blood shot red, nausea, indigestion, pain in back between shoulder blades.

VAERS ID:440863 (history)  Vaccinated:2011-10-26
Age:8.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-01, Days after onset: 5
Location:North Carolina  Entered:2011-11-01
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: spastic diplegia, developmental delays, seizures
Diagnostic Lab Data: neck films
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501103P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Croup infectious, X-ray
SMQs:
Write-up: Severe sudden onset of croup. Racemic epi neb give, decadron in office. Transferred by ambulance to hospital for overnight observation.

VAERS ID:440886 (history)  Vaccinated:2011-10-26
Age:11.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-31, Days after onset: 4
Location:North Carolina  Entered:2011-11-01, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4149DB2UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1317AA0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4036AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 7 x 8 cm of erythema and edema surrounding injection site.

VAERS ID:440900 (history)  Vaccinated:2011-10-26
Age:2.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-11-01, Days after onset: 6
Location:California  Entered:2011-11-01
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC. 0IN 
Administered by: Unknown     Purchased by: Other
Symptoms: Asthma, Condition aggravated, Contraindication to vaccination, Dyspnoea, Nasal congestion, Respiratory tract congestion, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Medication errors (broad)
Write-up: Started with a very runny nose. By Thursday evening he was having severe asthma! It was about 24hrs after that of constant treatment. We were using the nebulizer every 2-3 hrs to keep his breathing under control. Plus the albuterol inhaler in between that and I started his Flomax prescription Thursday as well. Never had a fever but struggled with his breathing through Sat morning. Sat through Monday he had some residual stuffiness and congestion but we were able to stop with the treatments. He only gets asthma when he is sicků but never near how bad it was after the Flumist. It was horrible! I called the advice nurse during the night Thursday and she said all you could do was treat the symptoms after the flu vaccine. We almost took him to the ER but the advice nurse just told me to treat the symptoms so I didnt. When the doctor's office opened Friday I called and he said he shouldn't have gotten the Flumist with asthma. He admitted fault but everyone has told me to report the incident to you guys so I am.

VAERS ID:440947 (history)  Vaccinated:2011-10-26
Age:38.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-01, Days after onset: 6
Location:Iowa  Entered:2011-11-01
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
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH462AC IMLA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Diarrhoea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Stomach cramps, diarrhea. 8 - 10 episodes/day x 3 days.

VAERS ID:440970 (history)  Vaccinated:2011-10-26
Age:58.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 0
Location:Virginia  Entered:2011-11-01, 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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AE IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Signs and symptoms: area around injection site began to swell. Swelling stopped with a width of about 4-5cm. Time: <1 minute. Treatment: 2 capsules of BENADRYL 25mg (WAL-DRYL). Advised patient to monitor the area, if worsens go to ER. Side note: the patient had gotten flu shot for many years and never had a reaction.

VAERS ID:440972 (history)  Vaccinated:2011-10-26
Age:45.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-01, Days after onset: 6
Location:South Carolina  Entered:2011-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: Hypertension, eczema. Allergic to Trilafon
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4163AA IDLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, 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: Swelling, redness, itching, soreness, and warmth at injection site.

VAERS ID:440979 (history)  Vaccinated:2011-10-26
Age:60.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-01, Days after onset: 5
Location:Wisconsin  Entered:2011-11-01
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, Chronic Pain Syndrome, Type 2 DM, Hypertension--Allergies: alcohol, codeine, compazine, cow''s milk, olive oil
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0617AA0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Musculoskeletal discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: c/o redness, swelling (2X2 area) at site of injection. Shoulder discomfort which improved 2 days later. Denied appointment for evaluation with physician.

VAERS ID:441019 (history)  Vaccinated:2011-10-26
Age:46.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 1
Location:Wisconsin  Entered:2011-11-01, Days after submission: 5
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: PCN allergy; no medical conditions
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT499AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site haematoma, Injection site swelling, Joint lock, Muscle spasms, Pain, Rotator cuff syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (narrow)
Write-up: Received vaccine at 0930 10/26/11. Developed pain at rest & with mvt. within 2 hrs of receiving. No redness, swelling or bruising at site but feels like joint "locked up". Spasm later in evening & felt like "rotator cuff injury".

VAERS ID:441066 (history)  Vaccinated:2011-10-26
Age:61.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-02, Days after onset: 6
Location:Illinois  Entered:2011-11-02
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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1056AA0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Within 24 hrs the injection site was reddened (50 cent size). In 48 hrs it was baseball sized and warm to touch. The client saw her physician. Was advised to put heat on the site and was given a course of KEFLEX.

VAERS ID:441080 (history)  Vaccinated:2011-10-26
Age:40.0  Onset:2011-10-29, Days after vaccination: 3
Gender:Female  Submitted:2011-11-02, Days after onset: 4
Location:Florida  Entered:2011-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALSAHABB204BA1IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURG108310SCRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3828AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: CLIENT STATED SHE NOTICED RAISED AREA TO RIGHT UPPER ARM WHICH SPREAD AND ALSO HAD ITCHING TO THE AREA. STATED IT WAS RELIEVED WITH TOPICAL CORTISONE. STATED SHE HAD NOT STARTED TYPHOID PO YET.

VAERS ID:441082 (history)  Vaccinated:2011-10-26
Age:4.0  Onset:2011-10-28, Days after vaccination: 2
Gender:Male  Submitted:2011-10-31, Days after onset: 3
Location:New Jersey  Entered:2011-11-02, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH916921 UNLA
Administered by: Private     Purchased by: Public
Symptoms: Vaccination site swelling
SMQs:
Write-up: 6 cm by 4 cm swollen below vaccine site.

VAERS ID:441108 (history)  Vaccinated:2011-10-26
Age:0.5  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:Michigan  Entered:2011-11-02, Days after submission: 5
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
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DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3957AA2IMRL
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB960EA1IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURG106810IMRL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169710IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site mass, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Vaccines at 5 mo WCE. The next morning when she woke up at 8:30, red swelling & lump at site of DTaP.

VAERS ID:441176 (history)  Vaccinated:2011-10-26
Age:18.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-11-02, Days after onset: 7
Location:California  Entered:2011-11-02
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: Autism
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA672AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Agitation, Decreased appetite, Headache, Restlessness
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)
Write-up: Within 6 hours of flu vaccine he became agitated, restless, anorexic, had headache. H/A resolved, still restless, anorexic.

VAERS ID:441327 (history)  Vaccinated:2011-10-26
Age:1.0  Onset:2011-10-28, Days after vaccination: 2
Gender:Female  Submitted:2011-11-03, Days after onset: 6
Location:Massachusetts  Entered:2011-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4118CA0IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0984AA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0103AA0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0786AA0SCLA
Administered by: Other     Purchased by: Public
Symptoms: Pyrexia, Rash generalised
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The child has developed fever 2 days after vaccination, followed by whole body rash 8 day later.

VAERS ID:441339 (history)  Vaccinated:2011-10-26
Age:62.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 2
Location:Georgia  Entered:2011-11-03, 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: Aspirin intolerance
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH460AC1IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0985AA1IMLA
Administered by: Public     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: Rec''d pneumonia vaccine in (L) deltoid & FLUZONE in (R) deltoid on 10/26/11. Returned to clinic 10/28/11 AM c/o pain & redness at injection site in (L) deltoid. Redness & swelling present at injection site. Advised client to ice & alternate heat.

VAERS ID:441460 (history)  Vaccinated:2011-10-26
Age:37.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-06, Days after onset: 10
Location:Louisiana  Entered:2011-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Going to Dr tomorrow
CDC Split Type:
Vaccination
Manufacturer
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FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Fatigue, Muscular weakness, Oral herpes, Oropharyngeal blistering, Photophobia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever blisters on mouth....now extreme fatigue, light sensitivity, muscle weakness has presented in last 4 days.

VAERS ID:441577 (history)  Vaccinated:2011-10-26
Age:64.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-07, Days after onset: 12
Location:South Carolina  Entered:2011-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT427AA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Dyspnoea, Ocular hyperaemia
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad)
Write-up: Short of breath, red eyes.

VAERS ID:441621 (history)  Vaccinated:2011-10-26
Age:1.0  Onset:2011-11-02, Days after vaccination: 7
Gender:Female  Submitted:2011-11-07, Days after onset: 5
Location:Ohio  Entered:2011-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness at time of vaccination
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4231CA1IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB5150IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0807AA0SCLA
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169223IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0826AA0SCRA
Administered by: Private     Purchased by: Other
Symptoms: Irritability, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Daughter had a fever around 102 degrees and was clingy and fussy for 4 days. After the fever broke on 11/6/11, she developed a rash.

VAERS ID:441622 (history)  Vaccinated:2011-10-26
Age:28.0  Onset:2011-11-04, Days after vaccination: 9
Gender:Male  Submitted:2011-11-07, Days after onset: 3
Location:Oregon  Entered:2011-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11005013 LA
Administered by: Other     Purchased by: Private
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left anterior lymphadenopathy x 3 days. Dr prescribed Amoxicillin Caps 500mg PO TID x 7 days.

VAERS ID:441633 (history)  Vaccinated:2011-10-26
Age:52.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-07, Days after onset: 12
Location:California  Entered:2011-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH498AA0IMAR
Administered by: Other     Purchased by: Private
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt. says arm is still sore and she cannot lift it above her head. Pt. will see MD Tue 11/8.

VAERS ID:441793 (history)  Vaccinated:2011-10-26
Age:1.1  Onset:2011-11-04, Days after vaccination: 9
Gender:Male  Submitted:2011-11-08, Days after onset: 4
Location:New York  Entered:2011-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none; possibly teething, but no fever, no cough
Preexisting Conditions: URIs, IUGR, but good growth after birth
Diagnostic Lab Data: CBC, Blood culture, CSF studies, viral studies, and Head CT all normal. Did have a rash 2 days later - ?roseola: HHV6 or HHV 7
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4159BB0IMLG
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0351AA0SCLG
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF227213IMLG
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0768AA0SCLG
Administered by: Unknown     Purchased by: Private
Symptoms: Blood culture negative, CSF test normal, Computerised tomogram head, Computerised tomogram normal, Dyskinesia, Febrile convulsion, Full blood count normal, Gaze palsy, Musculoskeletal stiffness, Pyrexia, Rash, Viral test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Complex febrile seizure: clenching of mouth, stiff arms, eyes rolled up, with fever of 103.

VAERS ID:441808 (history)  Vaccinated:2011-10-26
Age:0.7  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-11-08, Days after onset: 12
Location:Virginia  Entered:2011-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Possible lower extremity weakness (retrospective report)
Preexisting Conditions: No acute illnesses
Diagnostic Lab Data: Physical exam, history, lumbar puncture and MRI findings suggestive of acute infectious polyneuropathy (Guillain-Barre Syndrome)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4184BA0IMLL
Administered by: Private     Purchased by: Private
Symptoms: Acute polyneuropathy, Guillain-Barre syndrome, Lumbar puncture abnormal, Musculoskeletal disorder, Nuclear magnetic resonance imaging abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: Patient developed progressive loss of lower extremity function.

VAERS ID:441857 (history)  Vaccinated:2011-10-26
Age:69.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 0
Location:Pennsylvania  Entered:2011-11-09, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Local reaction, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Seemingly local reaction with induration erythema, warmth within 24 hrs of vaccination which improved on its own (8-11cm) (L) arm.

VAERS ID:441859 (history)  Vaccinated:2011-10-26
Age:10.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-10-30, Days after onset: 4
Location:Oklahoma  Entered:2011-11-09, 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: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AB0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: - Significant pain in arm vaccine was injected (L arm) around 15 min after gave vaccine. - Administered ice pack with ibuprofen & ORAPRED patient. - No swelling or redness. - Called patient 4 hrs later & pain was reduced, no other symptoms.

VAERS ID:441884 (history)  Vaccinated:2011-10-26
Age:75.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-03, Days after onset: 8
Location:Wisconsin  Entered:2011-11-09, 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:
Preexisting Conditions: NKA; no birth defects; HTN
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEUR 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Chills, Cough, Dysphagia, Headache, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), 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 (broad)
Write-up: On 10/26/11 patient received HIGH DOSE flu vaccine through her local pharmacy with 2hrs developed coughing/wheezing headache, swallowing difficulty & chills on way to event dinner stopped at pharmacy to ask for advice. They recommended BENADRYL. Her 101.1 F temp went down & symptoms dissipated within the hour. When she returned home called an EMT friend who recommended TYLENOL. Pt went to bed & symptoms absent on AM.

VAERS ID:441900 (history)  Vaccinated:2011-10-26
Age:48.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-02, Days after onset: 7
Location:Washington  Entered:2011-11-09, 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:
Preexisting Conditions: Hypothyroidism; positive ANA; Keyloids; Reynauds; h/o thrombocytopenia; baseline platelet count 107 K/cmm
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Chest discomfort, Chills, Dysphonia, Fatigue, Hypoaesthesia, Injection site erythema, Injection site swelling, Injection site warmth, Musculoskeletal stiffness, Nasal congestion, Pain, Pain in extremity, Rash, Rhinorrhoea, Sinus congestion, Sinus headache, Sneezing, Tendonitis
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Day 1, 10/26/11, Patient symptoms: warm, red, swollen area (approximately 6" oval) around injection site on left arm. Left arm felt stiff, painful. Patient had sensation of tendonitis in deltoid musculature (popping, catching, sensation) when actively using left arm. Patient felt fatigued around 1600. Symptoms waxed and waned. Treatment: Patient took 400 mg of ADVIL at 11:30 and at 18:30. Day 2, 10/27, Patient symptoms: generalized fatigue; mild runny nose, chills. Left upper arm pain radiated into the left side of neck, chest wall, axilla, scapula region and extended through the full length of the left arm. Patient''s tendonitis sensations increased, involving shoulder flexor and extensor muscles, elbow flexor, extensor and supinator muscles and wrist flexors. Left arm joint pain increased, especially in the elbow. Deltoid region felt warm to the touch. Symptoms waxed and waned. Day 3-4, 10/28-29, Patient symptoms: generalized fatigue, mild runny nose, heaviness in chest, rash on chest, left arm and face, chills. Left arm tendonitis sensations as described in day 2 increased, and on day 4, included mild numbness on the left side of face, left axilla and throughout length of left arm. The numb sensations lasted for a few hours. Symptoms waxed and waned. Day 5, 10/30, Patient symptoms: generalized fatigue, mild runny, stuffy nose and sinuses; left arm tendonitis decreased; warmth in deltoid region, chills. Symptoms waxed and waned. Day 6, 10/31, patient symptoms: sneezing, mild runny nose, sinus pain, hoarse voice, chills. Symptoms waxed and waned. Symptoms stopped by day 7, Nov 1.

VAERS ID:441907 (history)  Vaccinated:2011-10-26
Age:1.4  Onset:2011-10-28, Days after vaccination: 2
Gender:Male  Submitted:2011-10-28, Days after onset: 0
Location:Pennsylvania  Entered:2011-11-09, Days after submission: 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: Prior episode angio-edema 8/2011.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3834AA3IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4196AA2IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0984AA0IMRA
PNC: PNEUMO (PREVNAR)PFIZER/WYETH9166172IMLA
Administered by: Private     Purchased by: Public
Symptoms: Ear infection, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Woke up today with swelling of upper lip. No hx trauma. Previous episode 8/2011. * Received immuniz x 4 - 10/26/11. Also has ear infection - started antib 10/28/11.

VAERS ID:441908 (history)  Vaccinated:2011-10-26
Age:24.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-09, Days after onset: 13
Location:Illinois  Entered:2011-11-09
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: Sulfa allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11051P IMLA
Administered by: Other     Purchased by: Private
Symptoms: Back pain, Injection site pain, Musculoskeletal pain, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Persistent soreness at injection site and radiating to shoulder and back.

VAERS ID:441985 (history)  Vaccinated:2011-10-26
Age:23.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-09, Days after onset: 13
Location:Illinois  Entered:2011-11-09
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11051P IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Persistent soreness at injection site, radiating to neck.

VAERS ID:441990 (history)  Vaccinated:2011-10-26
Age:56.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-09, Days after onset: 13
Location:Illinois  Entered:2011-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy to morphine; AUGMENTIN; bee sting
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11051P IMRA
Administered by: Other     Purchased by: Private
Symptoms: Inflammation, Musculoskeletal pain, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Soreness of shoulder, radiating to arm and neck. Dr diagnosed as rotator cuff inflammation.

VAERS ID:442064 (history)  Vaccinated:2011-10-26
Age:11.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-28, Days after onset: 1
Location:Maryland  Entered:2011-11-09, 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: Aspergers; Neurologic neglect syndrome
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4077BA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4103CA0IMLA
Administered by: Private     Purchased by: Private
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: Given vaccines on 10-26-11. Mom called 10-28-11 & said sites were red, swollen & warm. Looked at it at 1:00 PM. Red area size of baseball on both arms. Slightly raised & warm. Has no fever. Mom said getting much better.

VAERS ID:442078 (history)  Vaccinated:2011-10-26
Age:1.0  Onset:2011-10-30, Days after vaccination: 4
Gender:Male  Submitted:2011-10-31, Days after onset: 1
Location:Kentucky  Entered:2011-11-09, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Well child check
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3834AA2UNLL
Administered by: Private     Purchased by: Public
Symptoms: Induration, Pain, Skin discolouration, Skin lesion
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Noted 10-30-11 per mom on exam 1/2" x 1/2" indurated lesion, skin color painful to touch. Examined on 10-31-11.

VAERS ID:442082 (history)  Vaccinated:2011-10-26
Age:43.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-28, Days after onset: 1
Location:Pennsylvania  Entered:2011-11-09, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH462AA0UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0813AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Had area that was red and tender. Measured 14cm x 11 1/2cm.

VAERS ID:442089 (history)  Vaccinated:2011-10-26
Age:54.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-03, Days after onset: 7
Location:Mississippi  Entered:2011-11-09, 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: None
Preexisting Conditions: Polymyxin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT500AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Rash, Rash macular, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient called reporting "red blotches" on face - 10/27/11 AM. Recommended patient take BENADRYL and call in pm if not resolved. Patient called again on 10/29 reporting unresolved facial swelling & blotches. Was recommended to seek treatment. Pt had NP prescribe steroids & antihistamines.

VAERS ID:442096 (history)  Vaccinated:2011-10-26
Age:11.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-11-02, Days after onset: 7
Location:Missouri  Entered:2011-11-09, 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: NOVOLOG, IU per carb eaten; LANTUS, 17U at bedtime
Current Illness: None
Preexisting Conditions: Diabetes, Type 1
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0306AA1IMLA
Administered by: Public     Purchased by: Other
Symptoms: Abdominal pain upper, Body temperature increased, Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: S.E. started the evening after the immunization was given. Child had complaints of headache, temp of 101 degrees F, nausea, stomach ache, & dizziness. Physician recommended that he not receive the 3rd dose; no treatment was given.

VAERS ID:442098 (history)  Vaccinated:2011-10-26
Age:48.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-01, Days after onset: 5
Location:North Carolina  Entered:2011-11-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT; KLONIPIN; WELLBUTRIN; HCTZ; metformin SR; simvastatin; trazodone; TOPROL XL; SYNTHROID
Current Illness: None
Preexisting Conditions: Latex; hydrocodone
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU4090BA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left arm swelling and tenderness.

VAERS ID:442053 (history)  Vaccinated:2011-10-26
Age:0.2  Onset:2011-10-29, Days after vaccination: 3
Gender:Female  Submitted:2011-11-10, Days after onset: 12
Location:Georgia  Entered:2011-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: GERD Tried Zantac, but it didn''t help. Zantac had been stopped by the parent before 2 month visit. Unable to fill in field for birth wt = 7lbs 1 oz and 1 sibling, sister 8 years old
Diagnostic Lab Data: Treated with phenobarbi in ER and sent home on phenobarb. No seizure-like activity observed in the hospital. Negative EEG and MRI.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B0140AA0IMRL
HIBV: HIB (ACTHIB)SANOFI PASTEURUH130AC0IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURG11450SCLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169750IMLL
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALSA41DB098A0PO 
Administered by: Unknown     Purchased by: Private
Symptoms: Cyanosis, Drooling, Electroencephalogram normal, Foaming at mouth, Gaze palsy, Hypotonia, Mydriasis, Nuclear magnetic resonance imaging normal, Posture abnormal, Posturing, Seizure like phenomena, Staring, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: 2 episodes of seizure-like activity lasting about 30 seconds each. First episode was eye and head deviation to the left and second that happened 3-5 minutes later invoved dilated pupils, upper extremity flexor posturing, glassy stare, perioral cyanosis frothy drool. Unresponsive/limp for 30 min past 2nd episode. On 10/26 also had 30 sec episode of head & eye deviation to the left.

VAERS ID:442233 (history)  Vaccinated:2011-10-26
Age:4.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-10, Days after onset: 14
Location:Connecticut  Entered:2011-11-10
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: Eggs; Milk.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA614BA1IMUN
Administered by: Other     Purchased by: Public
Symptoms: Asthenia, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Vomiting, weakness, wheezing for one day. No treatment.

VAERS ID:442363 (history)  Vaccinated:2011-10-26
Age:1.3  Onset:2011-11-09, Days after vaccination: 14
Gender:Male  Submitted:2011-11-14, Days after onset: 5
Location:Pennsylvania  Entered:2011-11-14
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) (FLUZONE)SANOFI PASTEURUH469AB2UNLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0597AA0UNLA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHF227213UNLA
Administered by: Private     Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash - 2 wks after shot. High fever.

VAERS ID:444434 (history)  Vaccinated:2011-10-26
Age:1.0  Onset:2011-11-08, Days after vaccination: 13
Gender:Male  Submitted:2011-11-10, Days after onset: 2
Location:Kentucky  Entered:2011-11-14, Days after submission: 4
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: RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4149DB0IMRL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB533BA0IMRL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF255783IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0608AA0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Activities of daily living impaired, Otitis media, Pyrexia, Rash papular, Upper respiratory tract infection, Varicella post vaccine
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever with papular vesicular rash and UR with sxs 2 weeks after VARIVAX. Toddler diagnosed with OM & probable chickenpox rash. Rx fever with TYLENOL, x 1 week and OM with Amox. No daycare or out in public until afebrile x 48hours & rash resolved.

VAERS ID:442593 (history)  Vaccinated:2011-10-26
Age:62.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-15, Days after onset: 20
Location:North Carolina  Entered:2011-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Noted
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1453Z1IMLA
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: After injection and next few days she noted a red warm tender raised area on left deltoid. Returned to MD on 10/31/11 for check of area.

VAERS ID:442641 (history)  Vaccinated:2011-10-26
Age:5.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-10-29, Days after onset: 2
Location:Massachusetts  Entered:2011-11-16, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: Dermatitis Atopic; On screening form completed 10/26/11 by parent, no checked for question related to having asthma, wheezing.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.YK2014 IN 
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Cough, Decreased appetite, Dysphonia, Nasal congestion, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever & hoarseness 10/27/11 onset x 5 days duration; maximum temperature 101.5 degrees F. Cough, sore throat & nasal congestion 10/28/11 onset x 2-3 day duration. Decreased appetite & "weakness" 10/28/11 onset x 3-4 days.

VAERS ID:442652 (history)  Vaccinated:2011-10-26
Age:61.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-11-15, Days after onset: 20
Location:Unknown  Entered:2011-11-16, 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:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1111USA00721
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral, Rash, Rash erythematous
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician assistant concerning a 61 year old male who on 26-OCT-2011 was vaccinated with 0.5ml PNEUMOVAX 23 (route and lot # not reported). Concomitant therapy included various unspecified medications. On 26-OCT-2011 the patient experienced arm swelled up with a red "infectious looking" rash that went down the whole arm. The patient was working with their healthcare provider to address the situation. The patient was given "RODEPHEN" and other unspecified medication to treat the events. Vaccine with PNEUMOVAX 23 was discontinued. On 29-OCT-2011 the patient recovered from all the events. The reporter considered that red "infectious looking" rash that went down the whole arm and arm swelled up to be other important medical events. Additional information has been requested.

VAERS ID:442861 (history)  Vaccinated:2011-10-26
Age:53.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-17, Days after onset: 21
Location:South Carolina  Entered:2011-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient does not take medications.
Current Illness: No. Excellent health.
Preexisting Conditions: No allergies or diseases.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS 0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injected limb mobility decreased, Injection site nerve damage, Injection site pain, Insomnia, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Patient has had dozens of flu shots, but none have hurt as much as this one did when it was administered or for such a long time afterward - more than three weeks later! Arm is so sore patient can barely move it and has lost sleep. Apparently the pharmacist/technician hit a nerve in the deltoid area. Whatever the case, it was not administered correctly. Patient has applied heat and taken NSAIDS, but should not have to do this almost a month after receiving a shot. Next year, patient is going to a real nurse and getting the shot in the hip.

VAERS ID:443001 (history)  Vaccinated:2011-10-26
Age:40.0  Onset:2011-10-29, Days after vaccination: 3
Gender:Male  Submitted:2011-11-18, Days after onset: 20
Location:California  Entered:2011-11-18
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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV2814IMLA
Administered by: Military     Purchased by: Military
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Dizziness.

VAERS ID:443077 (history)  Vaccinated:2011-10-26
Age:74.0  Onset:2011-10-29, Days after vaccination: 3
Gender:Female  Submitted:2011-11-18, Days after onset: 20
Location:North Carolina  Entered:2011-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None reported
Diagnostic Lab Data: Discharge papers indicated GI disturbance and possible diverticulosis flare. No mention of flu vaccine reaction.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA636AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain upper, Gastrointestinal disorder, Hallucination, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vomiting, hallucinations, stomach pain.

VAERS ID:443079 (history)  Vaccinated:2011-10-26
Age:18.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-11-18, Days after onset: 22
Location:D.C.  Entered:2011-11-18
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 allergies or medical problems except myopia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501113P3IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM100551IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Oedema peripheral, Skin warm, 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness, swelling, warmth and tenderness of L upper arm extending all the way to lower arm, not quite to wrist.

VAERS ID:443229 (history)  Vaccinated:2011-10-26
Age:5.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-11-21, Days after onset: 26
Location:California  Entered:2011-11-21
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: tree nut, peanut and Gelatin allergy, asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR 0IM 
Administered by: Public     Purchased by: Public
Symptoms: Aortic aneurysm, Cough, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Abdominal pain, cough, wheezing, hives treated with epinephrine, diphenhydramine, albuterol.

VAERS ID:443320 (history)  Vaccinated:2011-10-26
Age:4.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Utah  Entered:2011-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3916AA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURG10833IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURE04420IMRA
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: Increase swelling redness of (R) upper arm. No c/o pain. Patient praying with other siblings.

VAERS ID:443339 (history)  Vaccinated:2011-10-26
Age:58.0  Onset:0000-00-00
Gender:Male  Submitted:2011-11-16
Location:Massachusetts  Entered:2011-11-21, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTUREROH476AB UNLA
Administered by: Other     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: Reported by the employer that one employee that received a flu vaccine on an on-site program 10-26-2011.

VAERS ID:443792 (history)  Vaccinated:2011-10-26
Age:4.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-13, Days after onset: 18
Location:Florida  Entered:2011-11-22, Days after submission: 9
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3718AA4IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1613E1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling of (L) arm golf ball size.

VAERS ID:443474 (history)  Vaccinated:2011-10-26
Age:67.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-23, Days after onset: 28
Location:Virginia  Entered:2011-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: recovering from conjuctivitis/URI
Preexisting Conditions: none
Diagnostic Lab Data: Seen in the ED treated with steroid and bronchdilator. D/c to home no further problem.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT498AB6IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Tightness in chest; difficulty taking a deep breathing.

VAERS ID:443565 (history)  Vaccinated:2011-10-26
Age:11.0  Onset:2011-10-28, Days after vaccination: 2
Gender:Male  Submitted:2011-11-23, Days after onset: 26
Location:California  Entered:2011-11-23
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3850AA UNRA
Administered by: Private     Purchased by: Public
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 and redness on (R) upper deltoid.

VAERS ID:443519 (history)  Vaccinated:2011-10-26
Age:40.0  Onset:2011-11-01, Days after vaccination: 6
Gender:Female  Submitted:2011-11-25, Days after onset: 24
Location:Maine  Entered:2011-11-25
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: CT Neck, various blood tests
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Public     Purchased by: Other
Symptoms: Activities of daily living impaired, Blood test, Chills, Computerised tomogram, Dysphagia, Laryngitis, Lymph node pain, Lymphadenopathy, Pharyngitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Unable to swallow, lymph nodes on the same side as injection huge, swollen and painful, fever/chills, vomiting. DX: Acute Pharyngitis, Laryngitis ... missed 2 weeks of work, still sick following 2 weeks.

VAERS ID:443893 (history)  Vaccinated:2011-10-26
Age:67.0  Onset:2011-11-06, Days after vaccination: 11
Gender:Male  Submitted:0000-00-00
Location:Maryland  Entered:2011-11-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pericardial effusion
Preexisting Conditions: Did have previous pericardial effusion related to CABG
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUH109AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Condition aggravated, Pericardial effusion, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed pericarditis/pericardial effusion 1 wk after. Does have a previous h/o pericardial effusion.

VAERS ID:444114 (history)  Vaccinated:2011-10-26
Age:29.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-28, Days after onset: 33
Location:Minnesota  Entered:2011-11-30, 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: Albuterol; Vitamin D3; Naproxen; PRILOSEC; MAXAIR
Current Illness: None known of
Preexisting Conditions: GE Reflux; Vitamin D deficiency
Diagnostic Lab Data: None known of
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB493BA0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)SANOFI PASTEURG04810IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injected limb mobility decreased, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Patient reported pain in her (L) arm with limited range of motion first reported within 24 hours of vaccine. Was evaluated by primary care provider. Pain & limited range of motion persisting.

VAERS ID:444195 (history)  Vaccinated:2011-10-26
Age:66.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-12-01, Days after onset: 36
Location:North Dakota  Entered:2011-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor, Cozaar, Synthroid, diltiazem, clobetasol propionate, aspirin, omega 3, red yeast rice tabs, vitamin D, calcium, multivitamin, Spiriva handihaler, Ventolin, omeprazole
Current Illness:
Preexisting Conditions: COPD, hypothyroidism, coronary artery disease
Diagnostic Lab Data: NA
CDC Split Type: ND1131
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0211AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received injection at 4:50 PM and then went to lab. Lab called patient at 4:55 Pm to come to the lab to check on patients arm. Red area the size of a grapefruit without itching. Dr. notified and checked area at 5:00 PM. No difficult breathing, no increase in redness and no further itching.

VAERS ID:444197 (history)  Vaccinated:2011-10-26
Age:58.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-12-01, Days after onset: 35
Location:North Dakota  Entered:2011-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: cold symptoms
Preexisting Conditions: n/a
Diagnostic Lab Data: na
CDC Split Type: ND1132
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT474AB0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Skin warm, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient came in to have flu shot reaction examined on left arm. Spot is 3 cm x 3 cm and is mildly red and warm. Patient can move arm full range and does not have any other symptoms, denied fever. Patient informed to watch spot, if it gets bigger, redder, or a fever develops to go to ER. Patient informed to put ice on arm to help swelling. Patient has never had a flu shot before.

VAERS ID:444305 (history)  Vaccinated:2011-10-26
Age:39.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-12-02, Days after onset: 37
Location:North Dakota  Entered:2011-12-02
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: HYPOTHYROID
Diagnostic Lab Data: NA
CDC Split Type: ND1133
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AF IMRA
Administered by: Public     Purchased by: Private
Symptoms: Body temperature increased, Cough, Dry eye, Ocular hyperaemia, Pain, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: RECEIVED FLU SHOT AT 1300 ON 10/26/2011. REPORTS DRY "BEET RED" EYES, DRY COUGH, TEMP OF 99.8, WHEEZING "NOT BAD" BODY ACHES. DID NOT REPORT TO PHYSICIAN, CLINIC OR ER. TOOK IBUPROFEN AND SYMPTOMS LASTED ABOUT 12 HOURS.

VAERS ID:444355 (history)  Vaccinated:2011-10-26
Age:54.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-28, Days after onset: 33
Location:Pennsylvania  Entered:2011-12-02, Days after submission: 4
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: Rheumatoid Arthritis x 3 yrs
Diagnostic Lab Data: None done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH462AC IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B072AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)
Write-up: Started as a sore arm in early evening. By midnight was in severe pain & unable to move arm. Put off going to doctor, but did not improve. Went to PCP on 11/11/11 and put on steroids & 1 week later given another Rx for another week of steroids.

VAERS ID:444482 (history)  Vaccinated:2011-10-26
Age:26.0  Onset:2011-10-29, Days after vaccination: 3
Gender:Female  Submitted:2011-11-28, Days after onset: 30
Location:Kentucky  Entered:2011-12-05, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDN55306 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site reaction, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Delayed muscle pain, especially at site of injection.

VAERS ID:444597 (history)  Vaccinated:2011-10-26
Age:0.6  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-12-05, Days after onset: 40
Location:Missouri  Entered:2011-12-05
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4119AA0UNRL
Administered by: Public     Purchased by: Public
Symptoms: Eye swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient received influenza vaccine 10/26/11. 2 hours after patient received vaccine, hives developed generalized to body and swelling to periorbital area relieved within 36 hours.

VAERS ID:444722 (history)  Vaccinated:2011-10-26
Age:0.5  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-12-06, Days after onset: 41
Location:Virginia  Entered:2011-12-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Two days previous to the visit patient had a fever of 100.6 F and a cough. These symptoms had cleared at time of the doctor''s visit.
Preexisting Conditions: Patient has a known allergy to Propylene Glycol and Isopropyl Alcohol. She has a "possible" allergy to Hydrocortisone cream. She has a small growth at the front of her left ear. It was discovered at time of birth and determined benign.
Diagnostic Lab Data: Doctor''s visit at 3pm on 10/28/2011. Saw a different doctor than primary physician. Described symptoms were ignored and an ear infection was diagnosed from a physical exam. No tests were run. An antibiotic was prescribed.
CDC Split Type:
Vaccination
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Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURIMM21000000992IJLG
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERIMM220IJLG
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHIMM21000001102IJLG
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.IMM21000000912IJLG
Administered by: Private     Purchased by: Public
Symptoms: Crying, Diarrhoea, Ear infection, Fatigue, Hyperaesthesia, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Non-stop crying. Crying worsened when not held. Crying continued until child fell asleep from exhaustion. When given a bottle gulped it for 5-6 swallows then pushed it away and screamed. Ate 4-5 bites of baby food and pushed it away screaming. Stomach sensitive to touch for 48 hours. Diarrhea for 24 hours after shot. Light fever (99.3 F) for 24 hours.

VAERS ID:445220 (history)  Vaccinated:2011-10-26
Age:43.0  Onset:2011-10-28, Days after vaccination: 2
Gender:Female  Submitted:2011-12-12, Days after onset: 45
Location:California  Entered:2011-12-12
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
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALS 1IMLA
Administered by: Other     Purchased by: Private
Symptoms: Influenza, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives over all of body, face, chest included. Itching. Followed by flu symptoms.

VAERS ID:445278 (history)  Vaccinated:2011-10-26
Age:34.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-12-05, Days after onset: 39
Location:Florida  Entered:2011-12-13, Days after submission: 8
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
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11022011SYRLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Injection site pain, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pain, numbness running down arm ROM pain injection site only at bedtime.

VAERS ID:445622 (history)  Vaccinated:2011-10-26
Age:68.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-11-12, Days after onset: 17
Location:Ohio  Entered:2011-12-15, Days after submission: 33
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
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT473AB1UNLA
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Symptoms: Nausea Vomiting.

VAERS ID:445682 (history)  Vaccinated:2011-10-26
Age:11.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-12-16, Days after onset: 51
Location:Wisconsin  Entered:2011-12-16
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 known
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501105P IN 
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB533CA0IMUN
Administered by: Public     Purchased by: Public
Symptoms: Crying, Gait disturbance, Hypoaesthesia, Panic attack, Staring, Unresponsive to stimuli, Visual impairment
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Nurse administered FluMist, then proceeded to give Hepatitis A vaccine IM. After shot patient stated the room looks funny. Then nurse noticed patient having a blank stare and not responding to her name (approx. 20-30 seconds). Lips normal color. Respirations normal. Then she responded, but had the blank stare again, lasting approx. 10 seconds. Patient was put on cot. Patient crying. Mother asking patient how she was feeling. Patient not answering but continued to cry. Asked her if she had difficulty breathing, continued to cry. Pulse 78, respirations normal. Did not seem to have difficulty breathing. Patient continued to cry, but responded to how she felt. She stated her body felt numb. Asked her to squeeze nurse''s hands. Both hands equal and strong. Able to move legs. Still stated body felt numb. 911 was called as a precaution. No changes when ambulance arrived. Paramedics took O2 saturation, blood pressure, pulse. All normal. Patient continues to cry. Paramedics assisted patient to chair. Patient continued to cry and refused to walk out of room to car. Paramedics put patient on cot and transported to mothers car. Mother was given instructions on what to do: Monitor pt at home, go to ER if conditions worsen, call HD tomorrow with update, call physician tomorrow with incident. Mother denied any medical Hx including seizure, medications, having a recent virus. Stated patient had Tdap last week. Pt went home. Did not go to hospital. Paramedics and mother felt child was having a panic attack. PHN attempted to call family a few times, left messages, but have no call back from parent. PHN called patient''s doctor and there has been no call from parent on this child recently.

VAERS ID:446087 (history)  Vaccinated:2011-10-26
Age:50.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-12-22, Days after onset: 57
Location:North Dakota  Entered:2011-12-22
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: ND1139
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUTT462AC IMLA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Eye swelling, Ocular hyperaemia, Pain
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: RED SWOLLEN EYES, BODY ACHES AND CHILLS.

VAERS ID:446303 (history)  Vaccinated:2011-10-26
Age:70.0  Onset:2011-11-03, Days after vaccination: 8
Gender:Female  Submitted:2011-12-27, Days after onset: 54
Location:Idaho  Entered:2011-12-27
Life Threatening? Yes
Died? Yes
   Date died: 2012-04-18
   Days after onset: 167
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 60 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Peripheral neuropathy History of Bells palsy 2009
Diagnostic Lab Data: Nerve conduction test and lumbar puncture consistent with diagnosis. Pls note pt is now in acute care hospital setting.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA651AA IMUN
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Diplopia, Facial paresis, Guillain-Barre syndrome, Hypoaesthesia, Lumbar puncture abnormal, Nerve conduction studies abnormal, Ophthalmoplegia, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Demyelination (narrow), Ocular motility disorders (narrow), Hypoglycaemia (broad)
Write-up: Facial weakness, double vision, numbness tingling of extremities. Progressed to ophthalmoplegia, severe weakness, DX as Guillain Barre syndrome pt hospitalized.

VAERS ID:446450 (history)  Vaccinated:2011-10-26
Age:62.0  Onset:2011-12-15, Days after vaccination: 50
Gender:Male  Submitted:2011-12-29, Days after onset: 14
Location:Washington  Entered:2011-12-29
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Initial stool cx negative Botulinum toxin serum negative Botulism cx negative Campylobacter EIA negative LP increased protein EMG classic Guillain-Barre
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA697AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Areflexia, Asthenia, CSF protein increased, Culture negative, Culture stool negative, Diarrhoea haemorrhagic, Diplegia, Diplopia, Electromyogram abnormal, Endotracheal intubation, Gastrostomy tube insertion, Guillain-Barre syndrome, Helicobacter test negative, Laboratory test normal, Lumbar puncture, Plasmapheresis, Tracheostomy, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (narrow), Ischaemic colitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Pt vaccinated at work on 25OCT2011. Experienced bloody diarrhea from 10DEC2011 to 12DEC2011. Received abx, had urticarial rash, abx d/c''d and steroids started 14DEC. Diplopia noted 15DEC, worsened on 16DEC, went to ER. Admitted with rapid worsening to absent gag and cough reflex, paralysis of upper and lower extremiies, intubated. Received botulinum antitoxin but weakness progressed, EMG on 17DEC inconclusive, repeat EMG on 21DEC classic for Guillain-Barre. Pt plasmapharesed five times between 21DEC and 29DEC with moderate improvement. Received trach and peg and discharged to long-term care facility on 29DEC.

VAERS ID:446862 (history)  Vaccinated:2011-10-26
Age:3.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2011-12-28, Days after onset: 62
Location:California  Entered:2012-01-05, 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: Born with small heart murmur that has closed.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Private     Purchased by: Private
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: On 10/26/11 at 10:30 AM my daughter received the flu/H1N1 combo mist. On 10/27/11 in the AM she had a nose bleed that lasted about 5 min to stop. And again on 10/29/11 in the afternoon.

VAERS ID:447004 (history)  Vaccinated:2011-10-26
Age:57.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2012-01-07, Days after onset: 73
Location:New York  Entered:2012-01-07
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
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FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Symptoms: SkinRash & UrticariaPruritus. Treatment: PREDNISONE 2 TAB ONCE, DIPHENHYDRAMINE 1 TAB ONCE.

VAERS ID:447189 (history)  Vaccinated:2011-10-26
Age:41.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2012-01-04, Days after onset: 70
Location:Montana  Entered:2012-01-11, 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: None
Preexisting Conditions: Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURVH453AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injection site pain, Musculoskeletal pain, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Pain on vaccine administration. Ache and pain 1 week severe. Ice, ibuprofen. Pain decreasing slowly over next 8 weeks. Currently sharp pain on specific movement, in shoulder.

VAERS ID:447277 (history)  Vaccinated:2011-10-26
Age:59.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2012-01-12, Days after onset: 78
Location:California  Entered:2012-01-12
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
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FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA63AA3IMRA
Administered by: Private     Purchased by: Private
Symptoms: Blood pressure increased, Dyspnoea, Erythema, Heart rate increased, Hyperhidrosis, Immediate post-injection reaction, Paraesthesia
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Became very red-faced and had trouble breathing immediately upon receiving flu vaccine- this lasted approximately 10-15 minutes - BP elevated, HR elevated on admission to E.D. Diaphoretic, felt "tingly" all over.

VAERS ID:447610 (history)  Vaccinated:2011-10-26
Age:64.0  Onset:2011-10-29, Days after vaccination: 3
Gender:Female  Submitted:2012-01-11, Days after onset: 74
Location:Georgia  Entered:2012-01-19, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: .05 mg XANAX daily for sleep
Current Illness: None
Preexisting Conditions: Allergies: penicillin, sulfa; Occasional GERD
Diagnostic Lab Data: CSF protein elevated at 70
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH405AA0UNLA
Administered by: Private     Purchased by: Other
Symptoms: CSF protein increased, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: Guillain-Barre syndrome beginning early Nov 2011 requiring hospitalization.

VAERS ID:449469 (history)  Vaccinated:2011-10-26
Age:51.0  Onset:2011-11-01, Days after vaccination: 6
Gender:Female  Submitted:2012-02-13, Days after onset: 104
Location:Maine  Entered:2012-02-13
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: Not known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA688AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Muscular weakness, Myelitis transverse
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow)
Write-up: Patient states she began experiencing leg and knee weakness. Initially saw orthopedist who administered a cortisone shot. When symptoms did not go away, she was referred to a neurologist who diagnosed transverse myelitis.

VAERS ID:450401 (history)  Vaccinated:2011-10-26
Age:5.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-03, Days after onset: 8
Location:Texas  Entered:2012-02-23, Days after submission: 112
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0013819
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.YK2086 IN 
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A non-serious spontaneous report of bilateral facial redness and bilateral facial swelling after FLUMIST has been received from a physician concerning a five-year-old female, subsequent to FLUMIST. Neither relevant medical history nor concomitant medications have been reported for this patient. The patient received FLUMIST on 26-Oct-2011. On 26-Oct-2011, the patient experienced bilateral facial swelling (left side) along the jaw line; There were no redness and no tenderness on examination. On 27-Oct-2011, the patient experienced some redness in same area. The outcome of child experienced bilateral facial swelling after FLUMIST was resolved on 28-Oct-2011 and outcome of event bilateral facial redness was unknown.

VAERS ID:450425 (history)  Vaccinated:2011-10-26
Age:70.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2012-02-25, Days after onset: 122
Location:Pennsylvania  Entered:2012-02-27, Days after submission: 2
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
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA692AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Tenderness
SMQs:
Write-up: Patient complains that his arm is still tender after administration. Administration was 4 months ago.

VAERS ID:451991 (history)  Vaccinated:2011-10-26
Age:25.0  Onset:2011-11-17, Days after vaccination: 22
Gender:Female  Submitted:2011-11-20, Days after onset: 3
Location:Oklahoma  Entered:2012-03-16, Days after submission: 116
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: X-ray
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH478AA UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Immediate post-injection reaction, Muscular weakness, Vaccination site pain, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow)
Write-up: Stated vaccination site was painful immediately after injection and that her arm was very weak.

VAERS ID:465860 (history)  Vaccinated:2011-10-26
Age:0.5  Onset:2012-06-24, Days after vaccination: 242
Gender:Male  Submitted:2012-09-18, Days after onset: 86
Location:Wisconsin  Entered:2012-09-21, 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 subject had received two prior doses of PENTACEL; lot number C3842AA received on 30 June 2011 and lot number C3926AC received on 26 August 2011.
Diagnostic Lab Data:
CDC Split Type: 201208436
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3977AA2UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest X-ray normal, Cough, Laboratory test normal, Pertussis, Polymerase chain reaction
SMQs:, Anaphylactic reaction (broad)
Write-up: Initial report received on 10 September 2012 from the Investigator participating in a post-marketing study under the reference number M5A16. A case of pertussis disease in a 13-month-old male subject was identified by the investigator based on review of data from the Electronic Disease Surveillance (EDSS) electronic database. The subject had received 3 doses of PENTACEL; lot number C3842AA received on 30 June 2011, lot number C3926AC received on 26 August 2011 and lot number C3977AA received on 26 October 2011 (routes and sites of administration not reported). The subject developed a cough on 24 June 2012, approximately eight months after the last dose. The subject also developed a paroxysmal cough (date of onset unknown). Laboratory testing included negative PCR on 26 June 2012. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of an unknown antibiotic starting on 24 June 2012 (duration unknown). The subject was not hospitalized. At the time of final contact on 10 July 2012, the subject''s cough was still persisting. The duration of the cough was reported at that time as 16 days. According to the investigator, this case was epidemiologically linked to a laboratory confirmed case. Investigator causality assessment is not required as per protocol. Documents held by sender: None.

VAERS ID:467724 (history)  Vaccinated:2011-10-26
Age:18.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-04
Location:New Jersey  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: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Alpha 1 foetoprotein amniotic fluid, 03-feb-2012; 01/20/2012, diagnostic, 14617, consistent with dates
CDC Split Type: WAES1201USA03137
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0841AA1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Alpha 1 foetoprotein amniotic fluid normal, Face presentation, Maternal exposure during pregnancy, Prolonged labour, Ultrasound antenatal screen normal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning an 18 year old female patient who on 26-OCT-2011, was vaccinated IM with a 0.5 ml dose of GARDASIL (Lot #668262/0841AA, expiration date: 08-APR-2013). The patient did not know that she was pregnant at the time of vaccination. No adverse effect was known. The patient visited doctor''s office. At the time of the report, the patient''s outcome was unknown. The patient''s last menstrual period was 30-SEP-2011 and estimated delivery date would be 06-JUL-2012. Follow up information was received from a physician concerning an 18 year old female patient with a history of one pregnancy and 0 full term deliveries who on 26-OCT-2011, was vaccinated IM with the second 0.5 ml dose of GARDASIL (Lot # 668262/0841AA, expiration date: 08-APR-2013). On 20-JAN-2012, ultrasound was performed - result reported as 14617 - consistent with dates. At the time of the report, the patient''s outcome was unknown. Follow-up information was received regarding the patient who on 19-JUL-2012 at 41.5 weeks gave birth to a full term female (7 lbs., 9oz) infant. Apgar scores were 7 and 8. It was reported that the patient experienced failure to progress/occiput posterior. The infant was reported as being normal with no congenital anomalies, abnormalities or other complications. It was also reported that the patient did not use any other medications during her pregnancy. Obstetric information included a negative/normal QUAD screen on 03-FEB-2012. Additional information has been requested.

VAERS ID:472213 (history)  Vaccinated:2011-10-26
Age:16.0  Onset:2011-12-06, Days after vaccination: 41
Gender:Female  Submitted:2012-10-24, Days after onset: 322
Location:New York  Entered:2012-10-30, 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; Celiac; Hypothyroid; Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1261AA1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Condition aggravated, Depression
SMQs:, Depression (excl suicide and self injury) (narrow)
Write-up: Precipitating depression after HPV #2 (Seen and was Rx''d by psychiatrists).

VAERS ID:475776 (history)  Vaccinated:2011-10-26
Age:63.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Female  Submitted:2012-03-27, Days after onset: 152
Location:Pennsylvania  Entered:2012-11-09, Days after submission: 227
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Respiratory tract congestion; Sinus congestion; Cold symptoms; Headache; Fever; Chills; Productive cough~Influenza (Seasonal) (F
Other Medications:
Current Illness:
Preexisting Conditions: Illness at the time of vaccination was reported as none. Medical history included asthma, osteoporosis and allergic rhinitis.
Diagnostic Lab Data: Relevant labs was reported as none.
CDC Split Type: 201110707
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH462AB IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Headache, Nasopharyngitis, Productive cough, Pyrexia, Respiratory tract congestion, Sinus congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report was received from a health care professional on 03 November 2011. A 63-year-old female patient had received a FLUZONE intramuscular injection in left deltoid, lot number UH462AB on 26 October 2011. On 27 October 2011, the patient developed chest and sinus congestion, headache, fever, chills, cold symptoms and productive cough. In 2010, the patient had the similar symptoms but not as severe. No further information was available at the time of the report. The patient outcome was reported as unknown. Follow-up information was received from a healthcare professional on 17 January 2012. The reported stated that the symptoms in 2010 were the same as 2011, but not as severe. The patient has two daughters who are medical doctors (MD) and they both agreed on this reaction to the flu vaccine. The patient did not receive any corrective treatment by our doctors for the symptoms in 2010 and 2011. The patient outcome was reported as recovered/resolved on 02 November 2011. Follow-up information was received 19 March 2012 from a health care professional. The patient received an intramuscular injection of FLUZONE, lot number U3728AA prior to experiencing the same symptoms as the current event (but not as severe) in 2010. The reporter had no further additional information to provide. Documents held by sender: none.

VAERS ID:475892 (history)  Vaccinated:2011-10-26
Age:  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2011-11-15, Days after onset: 19
Location:Ohio  Entered:2012-11-09, Days after submission: 360
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin; NORVASC; Benazepril Hydrochloride
Current Illness:
Preexisting Conditions: Illness at time of vaccination was reported as none. Medical history included no known allergies.
Diagnostic Lab Data: Relevant lab was not reported.
CDC Split Type: 201110709
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486A IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Erythematous rash - Itchy.

VAERS ID:477153 (history)  Vaccinated:2011-10-26
Age:51.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2012-12-07, Days after onset: 408
Location:Arizona  Entered:2012-12-07
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: Penicillin, latex sensitive, ADR Relafen
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSUNK0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Vaccinated arm went numb and I lost control of it for several hours post vaccination.

VAERS ID:484060 (history)  Vaccinated:2011-10-26
Age:70.0  Onset:2011-10-27, Days after vaccination: 1
Gender:Male  Submitted:2013-01-24, Days after onset: 455
Location:Pennsylvania  Entered:2013-02-11, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltiazem hydrochloride; HClthiazide+lisinopril; Pravastatin; Glipizide
Current Illness: Unknown
Preexisting Conditions: The subject had no relevant medical history. The subject had not experienced any adverse events following previous vaccinations including flu shots.
Diagnostic Lab Data: UNK
CDC Split Type: A0968088A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA692AA SYRLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This case was reported by a pharmacist and described the occurrence of injection site tenderness in a 70-year-old male subject who was vaccinated with FLULAVAL (GlaxoSmithKline). Concurrent medications included Diltiazem, Lisinopril + hydrochlorothiazide, Pravastatin and GLIPIZIDE XL. On 26 October 2011 "in the morning about 11:00" the subject received a dose of FLULAVAL (.5 ml, unknown route, left arm). On 27 October 2011, 1 day after vaccination with FLULAVAL, the subject experienced injection site tenderness. At the time of reporting the event was unresolved. The pharmacist considered the event was probably related to vaccination with FLULAVAL.

VAERS ID:516455 (history)  Vaccinated:2011-10-26
Age:16.0  Onset:0000-00-00
Gender:Female  Submitted:2013-12-13
Location:Unknown  Entered:2013-12-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ALBUTEROL SULFATE; vitamins (unspecified); PHENERGAN
Current Illness: Drug hypersensitivity, allergy to amoxicillin, allergy to ZITHROMAX
Preexisting Conditions: Amoxicilin, Drug Reaction: Drug hypersensitivity; ZITHROMAX, Drug Reaction: Drug hypersensitivity
Diagnostic Lab Data: 11/11/2011, Human chorionic gonadotropin, 11 weeks pregnant; 11/15/2011, Ultrasound scan, 11 weeks pregnant
CDC Split Type: WAES1111USA01837
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0963AA1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Exposure during pregnancy, Human chorionic gonadotropin positive, Ultrasound abdomen
SMQs:, Tumour markers (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from a nurse (L.P.N), for GARDASIL, a Pregnancy Registry product, concerning a 15 year old white female with drug allergy to ZITHROMAX and amoxicillin and no history of pregnancy who on 08-AUG-2011 was vaccinated IM with the first dose of GARDASIL(Lot # 666596/0766Z). On 26-OCT-2011 the patient was vaccinated IM with the second dose of GARDASIL (Lot # 670048/0963AA). Concomitant therapy included prenatal vitamins, "PHENERGAN" and albuterol. On 11-NOV_2011 the patient presented to the office and was determined to be "11 weeks pregnant by HCG test and ultrasound (performed on 15-NOV-2011)". Her LMP was 24-AUG-2011 (reported as September 2011) and EDD was 30-MAY-2012. Follow up information received. The reporter''s office was called at, for the pregnancy outcome information but they had no additional information to provide. The pregnancy outcome and case was to be considered lost to follow up. All telephone attempts to obtain follow up information had been unsuccessful. Additional information is not expected.

VAERS ID:525372 (history)  Vaccinated:2011-10-26
Age:26.0  Onset:0000-00-00
Gender:Female  Submitted:2014-03-10
Location:Texas  Entered:2014-03-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: iron (unspecified) (+) minerals (unspecified) (+) vitamins (unspecified)
Current Illness: Unknown
Preexisting Conditions: Rhesus antibodies negative, O-negative
Diagnostic Lab Data:
CDC Split Type: WAES1112USA00322
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
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: Information has been received from a 26 year old female patient for GARDASIL, a Pregnancy Registry product, concerning herself with no drug reaction/allergy and a medical history of O negative who on 26-OCT-2011 was vaccinated with a 0.5 ml dose of GARDASIL. Concomitant therapy included iron (unspecified) (+) minerals (unspecified) (+) vitamins (unspecified) (reported as prenatal Vitamins). Subsequently the patient was found pregnant. There was a laboratory studies performed on 23-NOV-2011 and the result was unknown. The patient sought unspecified medical attention and was given no treatment for AE. At the time of the report, the patient was 6 weeks and 3 days pregnant. The LMP was 17-OCT-2011 (also reported as 15-OCT-2011), estimated delivery date is 24-JUL-2012. The therapy of GARDASIL was discontinued. Follow up was received that this case had mail that was returned as non-deliverable and a memo that noted the physician was not with the practice and the patient was not registered with the practice. Pregnancy outcome was lost to follow up. The case was lost of follow up. Additional information is not expected.

VAERS ID:527477 (history)  Vaccinated:2011-10-26
Age:48.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2014-04-03, Days after onset: 890
Location:Minnesota  Entered:2014-04-03
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 23 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lyrica; Linisinopril blood pressure medication; HCTZ; Zanax
Current Illness: None
Preexisting Conditions: Chronic Back Pain; Anxiety; PTSD
Diagnostic Lab Data: Ventricular Tachycardia; Heart pace maker with defibrillator; Heart Medication
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH460AB0IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Abdominal pain upper, Cardiac arrest, Flushing, Gallbladder operation, Headache, Implantable defibrillator insertion, Myalgia, Pain in extremity, Pancreatitis, Respiratory disorder, Rhinorrhoea, Surgery, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Gallbladder related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Ache in arms and leg muscles. 10/23/2011 Stomach pain. 10/23/20111 Headache. 10/23/2011 Runny nose. 10/23/2011 Flushed feeling in face. 10/2011 Respiratory symptoms. 10/2011 Pancreatitis 11/2011 - 03/2014 hospitalized 4 times for Pancreatitis. Each hospital stay one week to two. Gallbladder surgery 7/2013 out patient surgery Cardiac Arrest 3/22/2014 Treatment at hospital Hospital Four days Heart pacemaker and defibrillator implanted 3/24/2014

VAERS ID:441765 (history)  Vaccinated:2011-10-26
Age:13.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-08, Days after onset: 13
Location:Foreign  Entered:2011-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pranlukast
Current Illness: Asthma
Preexisting Conditions:
Diagnostic Lab Data: Alanine aminotransferase, 27Oct2011, 297; Aspartate aminotransferase, 27Oct2011, 387; Aspartate aminotransferase, 01Nov2011, 60; Creatine phosphokinase, 27Oct2011, 111IU/L; Gamma glutamyl transpeptidase, 27Oct2011, 45; Lactate dehydrogenase, 27Oct2011, 405IU/L
CDC Split Type: B0759909A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALS 1IMRA
Administered by: Other     Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood creatine phosphokinase normal, Blood lactate dehydrogenase increased, Gamma-glutamyltransferase increased, Headache, Hepatic function abnormal, Musculoskeletal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a physician and described the occurrence of liver function disorder in a 13-year-old female subject who was vaccinated with CERVARIX (GlaxoSmithKline). Concurrent medical conditions included asthma. Concurrent vaccination included CERVARIX; GlaxoSmithKline. Concurrent medications included ONON. On 26 October 2011, the subject received the 2nd dose of CERVARIX (0.5 ml, intramuscular, right upper arm). On 26 October 2011, less than one day after vaccination with CERVARIX, the subject experienced liver function disorder, shoulder pain, fever and headache. On 27 October 2011, the subject was admitted to the reporting physician''s hospital just to be on the safe side because abnormal hepatic function was observed. Only fluid therapy was performed. On 1 November 2011, because the subject''s hepatic function had improved, she was discharged from the hospital and the events were considered resolved. The physician considered the events were related to vaccination with CERVARIX.

VAERS ID:443158 (history)  Vaccinated:2011-10-26
Age:25.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-18, Days after onset: 23
Location:Foreign  Entered:2011-11-21, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: diagnostic laboratory test, rheumatological check up were all negative; diagnostic laboratory test, search for infectious causes (unspecified) were normal
CDC Split Type: WAES1111USA01614
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMAR
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthritis, Cast application, Laboratory test normal, Oedema peripheral, Pain in extremity, Polyarthritis, Rheumatoid factor negative, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: This case was received from a physician on 27-OCT-2011. The case is medically confirmed. A 25 year old female patient received Dose 1 of GARDASIL (lot # not reported) IM into the upper arm in the morning of 26-OCT-2011 (side was unknown, reporter is not the vaccinating physician). The same day at about 3 PM the patient presented with arthritis of the wrist with swollen lower arm and pain at the contralateral arm. The patient was referred to an outpatient clinic where a plaster cast was fitted. At the time of the report the symptoms were persisting. The reporter stated that she rather does not see a causal relation to the vaccination. Previous unspecified vaccinations were tolerated well. Follow up information was received on 10-NOV-2011: the reporter was contacted by phone. Meanwhile the patient''s condition had worsened and she was hospitalized (case upgraded to serious). Arthritis had changed from arm to knee and ankle joint (polyarthritis). Additionally for short time the patient''s abdominal wall was swollen. Diagnostics including rheumatological check up and search for infectious causes (not specified) were all negative or normal respectively. Crohns disease was ruled out. No diagnosis was established. The hospital physicians did not see a causal relation to the vaccination, they assumed an unspecified viral infection. Therapy was carried out with ibuprofen. At the time of this report the patient was free of complaints. Other business partner number included E2011-06542.

VAERS ID:443617 (history)  Vaccinated:2011-10-26
Age:64.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-11-23, Days after onset: 28
Location:Foreign  Entered:2011-11-28, Days after submission: 5
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type: 2011030337
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER098621002 IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.9C077381462 IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cyanosis, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This regulatory report (initial receipt 16-Nov-2011) concerns a 64 year old male patient, who had a medical history of asthma. On 26-Oct-2011 the patient received 0.5 mL of ENZIRA (batch number: 21002) intramuscularly. On the same day the patient also received 0.5 mL of PNEUMOVAX II (batch number: 9C07738146/2) intramuscularly. On 26-Oct-2011 the patient experienced respiratory distress and was cyanosed. He was given adrenalin via Epi-pen and hydrocortisone 100 mg. The event outcome was resolving. Action taken with drug was not applicable. Rechallenge was unknown.

VAERS ID:443857 (history)  Vaccinated:2011-10-26
Age:13.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2011-11-28, Days after onset: 33
Location:Foreign  Entered:2011-11-28
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:
Diagnostic Lab Data: Electrocardiogram, 26Oct2011, Normal; Oxygen saturation, 26Oct2011, Normal; Pulse rate, 26Oct2011, Normal
CDC Split Type: B0763334A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB720AL IMUN
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood pressure increased, Convulsion, Electrocardiogram normal, Heart rate normal, Oxygen saturation normal, Presyncope
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: This case was reported by another health professional via a regulatory authority (ES-AGEMED-724511341) and described the occurrence of vasovagal reaction in a 13-year-old male subject who was vaccinated with ENGERIX B (GlaxoSmithKline), DIFTAVAX (non-gsk). On 26 October 2011, the subject received unspecified dose of ENGERIX B (.5 ml, intramuscular, injection site unknown) and unspecified dose of DIFTAVAX (intramuscular, injection site unknown). DIFTAVAX was administered 5 minutes before ENGERIX B. On 26 October 2011, 7 minutes after vaccination with DIFTAVAX and 2 minutes after vaccination with ENGERIX B, the subject experienced convulsion and elevated blood pressure which lasted 2 to 3 minutes. When he was being sit up, he experienced again convulsions, recovering in two minutes afterwards. He was referred to the emergency room where he was monitored. The regulatory authority reported that the events were clinically significant (or requiring intervention). Relevant tests were performed and showed normal pulse, normal electroencephalogram and normal oxygen saturation. The subject was diagnosed in the emergency room with vasovagal syndrome. At the time of reporting, the events were resolved. No further information is expected, the regulatory Authority has provided GSK with all the available information for the time being, if they ever get any further information they will send it to GSK.

VAERS ID:443764 (history)  Vaccinated:2011-10-26
Age:12.0  Onset:2011-11-02, Days after vaccination: 7
Gender:Female  Submitted:2011-11-28, Days after onset: 26
Location:Foreign  Entered:2011-11-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1111USA03204
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Chest pain, Dizziness, Muscular weakness, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Case received from a physician (working at the hospital where the patient was admitted) through a company representative, on 21-NOV-2011, who had seen the news on the internet about a girl that had been hospitalized after the administration of GARDASIL. Case medically confirmed. A 12 year old girl had received the first dose of a GARDASIL, (batch number, route and site not reported) on 26-OCT-2011. One week after vaccination the patient presented syncopal picture, dizziness and chest pain. 1 week after these first events, the patient started with fever, asthenia and muscular weakness and was hospital admitted (date not reported), due to chest pain. At the time of reporting, the patient continued to be hospitalized. Other business partner numbers included: E2011-07272. No further information is available.

VAERS ID:443901 (history)  Vaccinated:2011-10-26
Age:12.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-11-21, Days after onset: 26
Location:Foreign  Entered:2011-11-30, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Throat pain
Diagnostic Lab Data: Body temp, 26Oct11, 39 C
CDC Split Type: WAES1111USA01828
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.NK44350 UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Depressed level of consciousness, Dizziness, Feeling hot, Headache, Immediate post-injection reaction, Injection site joint pain, Injection site pain, Pallor, Presyncope, Pyrexia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Case received from a health care professional via the Health Authorities on 10-NOV-2011 under the reference number NO-NOMAAOVRE-FHI-2011-13151, 11/2105-1 Case medically confirmed. A 12-year-old female patient had received an injection of GARDASIL (batch number#: NM18120, lot#: NK44350, 1 df parenteral) on 26-OCT-2011 and later on the same day developed consciousness decreased, pallor, fever, vomiting, dizziness, syncope, pain injection site, headache and shivering. The night before vaccination, she had throat pain. Immediately after vaccination the patient fainted. She made sounds and slumped into the chair. Adrenaline (dose not reported) was given with positive effect and after 10 seconds she was conscious again. Ambulance was called and a physician was consulted. The patient vomited when lying on the floor after the syncope and she was also shivering. She was hospitalized (dates not reported), 1.5 hours p.v. she developed headache after sleeping some minutes at the clinic. Paracetamol was given (dose not reported). Some hours p.v. the patient also experienced pain in her left shoulder on the injection site. She was feeling warm. Body temperature was 39 degrees C, in the evening, and she had pain in her throat. At the time of reporting, the outcome was recovering for fever, pain injection site and headache. The patient recovered from consciousness decreased and syncope after 10 seconds p.v. and from pallor some hours p.v. She also recovered from vomiting, dizziness and shivering on the same day, on 26-OCT-2011. According to the reporter, pain injection site was probably related to vaccination whilst the other reactions were possibly related to vaccination. Stated by health agency (HA): Based on the description of the event, this is consistent with a vasovagal reaction. Such reactions are not related specifically to the content of the vaccine, but to the circumstance around the vaccination procedure. It is recommended that the patient should lie down for future vaccinations due to risk of recurrence. Other business partner numbers include E2011-06967. All the symptoms were considered to be other important medical event by the reporter. No further information expected.

VAERS ID:444273 (history)  Vaccinated:2011-10-26
Age:0.2  Onset:2011-10-26, Days after vaccination: 0
Gender:Unknown  Submitted:2011-12-02, Days after onset: 37
Location:Foreign  Entered:2011-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: B0766078A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER20909004B IMUN
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURERUVA10011 IMUN
HIBV: HIB (HIBERIX)GLAXOSMITHKLINE BIOLOGICALSA72CA668A IMUN
Administered by: Other     Purchased by: Other
Symptoms: Crying, Cyanosis, Pallor
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: This case was reported by a physician via a regulatory authority (PL-URPL-OCR-20111116003) and described the occurrence of lip cyanosis in a 2-month-old subject of unspecified gender who was vaccinated with HIBERIX (GlaxoSmithKline), hepatitis b (non-gsk) and DTPA (non-gsk). On 26 October 2011, the subject received unspecified dose of HIBERIX (intramuscular, unknown injection site), unspecified dose of hepatitis B (Non-GSK) (intramuscular, injection site), unspecified dose of DTPa (Non-GSK) (intramuscular, injection site). On 26 October 2011, less than one day after vaccination with DTPA (Non-GSK), hepatitis B (Non-GSK) and HIBERIX, the subject experienced lip cyanosis, generalized paleness of skin and loud crying. The cardio-respiratory efficiency was correct during the whole time. The regulatory authority reported that the events were clinically significant (or requiring intervention). The subject was treated with oxygen (6 L/min) which improved subject''s condition. At the time of reporting the events were resolved.

VAERS ID:444600 (history)  Vaccinated:2011-10-26
Age:0.4  Onset:2011-10-28, Days after vaccination: 2
Gender:Female  Submitted:2011-11-28, Days after onset: 31
Location:Foreign  Entered:2011-12-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No medical history (including allergy). The patient''s body temperature was 37.2 degrees C before vaccination.
Diagnostic Lab Data: Respiratory Syncytial Virus test was negative.
CDC Split Type: 201111263
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)SANOFI PASTEURG12300SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Croup infectious, Pyrexia, Respiratory syncytial virus test negative, Viral infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Case received from the Health Authority through the local affiliate on 15 November 2011 under the reference number HIB-294 (local reference number A201100664). A 05-month-old female patient, with no medical history (including allergy), had received her 1st subcutaneous dose of ACT-HIB (batch number G1230) in the right upper arm, on 26 October 2011 at 03:50pm. The patient''s body temperature was 37.2 degrees C before vaccination. She had received her dose of PREVENAR (other manufacturer, batch number, route and anatomical site of administration not reported) on 14 October 2011. On 28 October 2011, the patient developed coughing. On 29 October 2011, at night, she presented with croup-like coughing. On 30 October 2011, at around 08:00am, the patient developed pyrexia at 39 degrees C. The diagnosis was croup syndrome. She was hospitalized from 30 to 31 October 2011. Respiratory Syncytial Virus test was negative. The event was considered to be a symptom associated with viral infection. The patient''s symptoms resolved on 11 November 2011. Physician''s comment; This case was serious and not related to ACT-HIB. Croup syndrome could be related to pyrexia. Documents held by sender: none.

VAERS ID:445989 (history)  Vaccinated:2011-10-26
Age:3.0  Onset:2011-10-28, Days after vaccination: 2
Gender:Female  Submitted:2011-12-20, Days after onset: 53
Location:Foreign  Entered:2011-12-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: B0769411A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (FOREIGN)GLAXOSMITHKLINE BIOLOGICALS 4IMUN
Administered by: Other     Purchased by: Other
Symptoms: Epistaxis, Fatigue, Idiopathic thrombocytopenic purpura, Injection site inflammation, Injection site swelling, Joint stiffness, Petechiae, Skin discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: This case was reported by a physician via a regulatory authority (NL-LRB-130516) and described the occurrence of idiopathic thrombocytopenia in an 3-year-old female subject who was vaccinated with INFANRIX-POLIO (GlaxoSmithKline). The subject didn''t experience common cold nor other disease in the past months. On 26 October 2011, the subject received 5th dose of INFANRIX-POLIO (intramuscular, unknown injection site, batch number not provided). On 28 October 2011, 2 days after vaccination with INFANRIX-POLIO, the subject injection site inflammation and swelling injection site. In October 2011, the days after vaccination with INFANRIX-POLIO, the subject experienced fatigue and joint stiffness. On 7 November 2011, 12 days after vaccination with INFANRIX-POLIO, the subject experienced idiopathic thrombocytopenia and a few blue spots on skin. Within the following week blue spots became worse. On 7 November 2011 the subject was hospitalised for 2 days. In November 2011, 17 days after vaccination with INFANRIX-POLIO, the subject experienced petechiae which worsened. On 13 November 2011 the subject was hospitalised. She got no treatment and was discharged from hospital after 2 days. In November 2011, within the month of vaccination with INFANRIX-POLIO, the subject experienced epistaxis (3 times). At the time of reporting the events were improved. A blood test was performed every week. The regulatory authority reported that injection site inflammation and swelling injection site were almost certainly related to vaccination with INFANRIX-POLIO. Idiopathic thrombocytopenia and blue spots on skin were possibly related to vaccination with INFANRIX-POLIO. No further information could be obtained, therefore this case was closed.

VAERS ID:446587 (history)  Vaccinated:2011-10-26
Age:12.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-12-30, Days after onset: 65
Location:Foreign  Entered:2012-01-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cytomegalovirus infection
Preexisting Conditions:
Diagnostic Lab Data: clinical serology test, cytomegalovirus positive
CDC Split Type: WAES1112USA02894
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Cytomegalovirus test positive, Hypoaesthesia, Lymphadenopathy, Muscle spasms, Muscular weakness, Pain, Pyrexia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: Case received from Health Authorities (reported to them by a physician) on 19-DEC-2011 under the reference number ES-AGEMED-231441347. Case medically confirmed. A 12 year old female patient (weight 36 kg) had received a dose of GARDASIL (batch number not reported) via intramuscular (site of administration not reported) 0.5 ml on 26-OCT-2011, and on the same day the patient presented with asthenia, muscle weakness upper limb, cramp muscle, hypoesthesia, fever and vaccination site pain. On 28-OCT-2011, the patient developed ipsilateral cervical lymphadenopathy and painful supraclavicular lymphadenopathy (coded by HAs as vaccination site lymphadenopathy). Upon medical review, the company decided to code hypoasthesia, mentioned in the negative for everything except cytomegalovirus which was positive because of an old infection. The patient recovered from asthenia on 08-NOV-2011 form muscle weakness upper limb on 02-NOV-2011, and from cramp muscle, fever and vaccination site pain on 27-OCT-2011. On 08-NOV-2011, lymphadenopathy had decreased and the patient had no pain in arm, at time of reporting she was recovering from lymphadenopathy. Case reported as serious by the Health Authorities with other medically important condition as criteria. No further information reported. Other business partner numbers include: E2011-08201. No further information is available.

VAERS ID:449497 (history)  Vaccinated:2011-10-26
Age:29.0  Onset:2011-10-26, Days after vaccination: 0
Gender:Male  Submitted:2012-02-13, Days after onset: 110
Location:Foreign  Entered:2012-02-14, 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: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: B0781022A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB895AC IMRA
JEVX: JAPANESE ENCEPHALITIS (NO BRAND NAME)UNKNOWN MANUFACTURERJEV10F55C IMLA
Administered by: Other     Purchased by: Other
Symptoms: Blood pressure decreased, Cold sweat, Dry mouth, Sensation of foreign body, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: This case was reported by a healthcare professional (nurse) via a regulatory authority (# FI-FIMEA-20120123) and described the occurrence of faint in a 29-year-old male subject who was vaccinated with ENGERIX B (GlaxoSmithKline), Japanese encephalitis vaccine (non-gsk). Before the vaccination, the explained that he was very nervous. On 26 October 2011, the subject received unspecified dose of ENGERIX B (intramuscular, right arm) and unspecified dose of Japanese encephalitis vaccine (Non-GSK) (intramuscular, left arm). On 26 October 2011, 5 minutes after vaccination with ENGERIX B and Japanese encephalitis vaccine (Non-GSK), the subject experienced faint with decreasing in blood pressure, drying of mouth, lump feeling in throat and cold sweat. No decreased level of consciousness and no skin reaction were reported. The patient was at health centre for follow-up during two hours. This case was assessed as medically serious by GSK. At the time of reporting, the events were resolved.

VAERS ID:450606 (history)  Vaccinated:2011-10-26
Age:  Onset:2011-10-26, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 0
Location:Foreign  Entered:2012-02-23, Days after submission: 120
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: MEDI0013789
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)
Write-up: A non-serious spontaneous report of pulled head back was received from a health professional concerning an adult female. Neither relevant medical history nor concomitant medications have been reported for this patient. On 26-Oct-2011, the patient pulled her head back while being administered FLUMIST in first nostril. The patient did not get FLUMIST in second nostril. The nurse thought that only one quarter was administered. There was no adverse event associated with this medication error; therefore, treatment and reporter causality assessments are not applicable, and the event is considered resolved.

VAERS ID:454335 (history)  Vaccinated:2011-10-26
Age:1.3  Onset:2012-04-19, Days after vaccination: 176
Gender:Male  Submitted:2012-04-25, Days after onset: 6
Location:Foreign  Entered:2012-04-25
Life Threatening? No
Died? Yes
   Date died: 2012-04-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: meningococcal bactery A 39, department for neuro- infective diseases,
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (NO BRAND NAME)SANOFI PASTEUR    
Administered by: Public     Purchased by: Public
Symptoms: Choking, Cyanosis, Death, Dehydration, Disseminated intravascular coagulation, Haematoma, Meningitis, Meningococcal sepsis, Neisseria test positive, Pyrexia, Respiratory arrest, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: At 14:30 high temperature, only ears at nape, Voltaren suppositories, temperature disappeared, he played, smiled, at 20:00 PM first vomit, at 23:00 PM become pimping, started to vomit several times every half of hour or every hour, at 04:00 AM at dawn black and brown spots appeared on his body, of different size, like hematoma, he dehydrated, missed air, he began to choke, his lips were blue, and he died, Dg: sepsis meningococicca A 39, DIC- disseminated intravascular coagulopathy, susp. meningitis.

VAERS ID:474278 (history)  Vaccinated:2011-10-26
Age:0.5  Onset:2012-10-30, Days after vaccination: 370
Gender:Male  Submitted:2012-11-14, Days after onset: 15
Location:Foreign  Entered:2012-11-14
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Stool analysis, showed presence
CDC Split Type: B0844214A
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALS 1PO 
Administered by: Other     Purchased by: Other
Symptoms: Dehydration, Gastroenteritis rotavirus, Rotavirus test positive, Vaccination failure, Vomiting
SMQs:, Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This case was reported by a physician and described the occurrence of rotaviral gastroenteritis in a 18-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). On 19 August 2011 and 26 October 2011, the subject received respectively 1st dose and 2nd dose of ROTARIX (oral, batch number not provided). On 30 October 2012, 14 months after vaccination with 1st dose of ROTARIX, 12 months after vaccination with 2nd dose of ROTARIX, the subject experienced severe rotaviral gastroenteritis with vomiting for 1.5 days which resulted in dehydration. On 30 October 2012, the subject was hospitalised for 3 days for treatment with intravenous fluid(s). The physician considered the events were life threatening and clinically significant (or requiring intervention). This case was assessed as a vaccination failure by GSK. The stool test showed presence of rotavirus but no other virus was detected. On 1 November 2012, the subject was discharged from hospital and the events were resolved.

VAERS ID:513890 (history)  Vaccinated:2011-10-26
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2013-11-20
Location:Foreign  Entered:2013-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: 12/02/2011, Blood smear test, Normal; 12/02/2011, Full blood count, Normal, other cell lines except thrombocytes were normal; 12/02/2011, Immunglobulins, Normal; 12/02/2011, Platelet count, LOW; 02/05/2013, Platelet count
CDC Split Type: WAES1206USA01948
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Blood smear test normal, Contusion, Full blood count normal, Gingival bleeding, Idiopathic thrombocytopenic purpura, Immunoglobulin therapy, Immunoglobulins normal, Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gingival disorders (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Case received from physician via a company representative in a foreign country on 07-Jun-2012. Case medically confirmed. A 12-year-old female patient had received an injection of GARDASIL (dose 1, i.m., batch number unknown) on 26-Oct-2011. Previously the girl had received an injection of MMR vaccine (mfr unk, batch number A69CC748A) on 21-Sep-2011. Later on 02-Dec-2011 she developed Idiopathic thrombocytopenic purpura. The company judged the case serious due to ITP as an important medical event. At the time of reporting, the outcome was not provided. No assessment of causality was provided. Follow-up information received from Health Authority in a foreign country on 12-Jul-2012 with reference number DK-DKMA-ADR 21715034. FOLLOW-UP: The case was also received on 29-Jun-2012 by the Health Authority from a General Practitioner: The 26-Oct-2011 the patient received the first injection of GARDASIL. On 02-Dec-2011 the patient developed idiopathic thrombocytopenic purpura. Low platelets on 12. Still the patient is followed on the Pediatric Hematology Department. Note that GP has only reported GARDASIL (and not PRIORIX) as suspect drug to the Health Authority (where E2B transmission received from Sanofi Pasteur MSD indicates both PRIORIX and GARDASIL as suspect drugs)! SUMMARY: Severity criterion hospitalisation added. Outcome of idiopathic thrombocytopenic purpura changed from unknown to not recovered. The dose of GARDASIL (0.5 ml) added. Follow-up information received from Newsletter via the Health Authority in a foreign country on 06-Nov-2012. According to the reporter, the reaction was possible related to the vaccinations. Contradictory information received regarding dose. According to the newsletter the girl developed thrombocytopenia after dose 2, and not dose 1 as indicated in the initial report. No further information expected. Follow up information received from the Health Authority in a foreign country on 18-Nov-2012. They confirmed that the girl experienced the reactions after dose 1. No further information expected. Follow up information received from the health authority on 12-Nov-2013. HA received information from patient''s physician on 01-Oct-2013 by request of GSK. The adverse reactions requires extensive treatment. She has received Cyklokapron (other MFR) and IVIG infusion (intravenous immunoglobulin, other MFR, given on 15-Feb-2013 before vaccination) to treat the AEs. The patient was treated as medical center, haematology/oncology department, hospital. Patient had bruises and bleeding gums in addition to previous reported adverse event. Onset not reported and outcome unknown. Laboratory results: On 02-Dec-2011, thrombocyte count was 12, other cell lines were normal, normal peripheral smear and normal immunoglobulins. On 05-Feb-2013 thrombocyte count was 50 (IVIG given on 15-Feb-2013). Patient has not received other medications. Patient had received PRIORIX. The patient has no relevant medical history concerning viral infections and clinical conditions.

VAERS ID:440648 (history)  Vaccinated:2011-10-27
Age:65.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-29, Days after onset: 2
Location:Oklahoma  Entered:2011-10-31, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0614AA UNLA
Administered by: Other     Purchased by: Military
Symptoms: Pain, Rash erythematous, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pain Thursday evening, painful red rash upon awakening, swollen.

VAERS ID:440763 (history)  Vaccinated:2011-10-27
Age:19.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-10-31, Days after onset: 3
Location:New York  Entered:2011-10-31
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: Seasonal Allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDN551050IMLA
Administered by: Other     Purchased by: Private
Symptoms: Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Nausea the day following the vaccine administration. Pt reported vomiting as well. As of today, 10/31/2011, pt reports resolution of nausea and vomiting and that she is feeling better.

VAERS ID:440768 (history)  Vaccinated:2011-10-27
Age:40.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 4
Location:Texas  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: TX20110076PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1110Z1 LA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Oedema peripheral, Rash, Rash erythematous, Rash pruritic, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: SIGNS/SYMPTOMS - SWOLLEN, RED, ITCHY, WARM, RASH ON ARM. SHE IS FEELING WARM, TOOK MOTRIN 30 MINUTES BEFORE SHOT. SHE HAS HAD THIS SHOT BEFORE AND HAD NO REACTIONS. SHE WENT TO HER PCP TO HAVE IT CHECKED OUT.

VAERS ID:440801 (history)  Vaccinated:2011-10-27
Age:34.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:Kansas  Entered:2011-10-31, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Denies illness
Preexisting Conditions: PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURUH451AB0IJRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 1000 Administered injection. 1020 pt stated pain at site with some pain radiating down across clavicle area. 1030 taken to occupational health. Advised to go on to ER for evaluation. 1035 ER for triage. Was given MOTRIN at 1040.

VAERS ID:440802 (history)  Vaccinated:2011-10-27
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2011-10-31
Location:Arizona  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4041AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site cellulitis
SMQs:
Write-up: Cellulitis at the site of MENACTRA vaccine went to hospital Emergency Room, placed on KEFLEX by Emergency Room personnel.

VAERS ID:440805 (history)  Vaccinated:2011-10-27
Age:79.0  Onset:2011-10-29, Days after vaccination: 2
Gender:Female  Submitted:2011-10-31, Days after onset: 2
Location:Wisconsin  Entered:2011-10-31
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: NIDDM
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1102601 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Feeling cold, Headache, Hot flush, Pain
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: 2 days (10/29/11) after receiving vaccine on 10/27/11 pt reported dizziness, HA, body aches, hot & cold flushes. Dizziness was relieved by meclizine that pt had at home. Pt called pharm on 10/31/11.

VAERS ID:440812 (history)  Vaccinated:2011-10-27
Age:4.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-30, Days after onset: 3
Location:Wisconsin  Entered:2011-10-31, 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: Acute sinusitis
Preexisting Conditions: Asthma; allergic rhinitis; eczema; ex 25 weeker preterm
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B184AA IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0048AA1SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0149AA1SCRL
Administered by: Private     Purchased by: Public
Symptoms: Flushing, Lip swelling, Pruritus, Swelling face, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient returned to office 30-45 mins after vaccines given, complaining of itching, facial swelling, no difficulty breathing. Exam positive flushing, urticaria and slight wheezing, swollen lips. Treated with BENADRYL, Prednisone and Epinephrine.

VAERS ID:440834 (history)  Vaccinated:2011-10-27
Age:26.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-10-31, Days after onset: 3
Location:New York  Entered:2011-10-31
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; Chronic kidney disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH477AD0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vaccine administered 10/27/11, the next day patient started w/ general body aches and hives. Hives were over about 40% of body. Took BENADRYL w/ relief of symptoms over a couple of days.

VAERS ID:440887 (history)  Vaccinated:2011-10-27
Age:8.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 0
Location:Hawaii  Entered:2011-11-01, 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:
Preexisting Conditions: Allergies to cats
Diagnostic Lab Data:
CDC Split Type: HI1104
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.YK20120IN 
Administered by: Other     Purchased by: Private
Symptoms: Cough, Crying, Dyspnoea, Oropharyngeal pain, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad)
Write-up: Child received LAIV - dev. sneezing at monitoring station. Sneezing progressively got worse with mucus production. Started coughing. Offered water. C/o sore throat. 110/68 98.9. No difficulty swallowing. Notified parents. Coughing progressed. Appeared to have difficulty catching her breath during coughing episode. Called 911 EMT - not avail - fire unit to be sent. Coughing subsided & pt caught her breath. Declined fire rescue. 911 said if grandpa taking child nurse must go with them. Grandpa & child walked to car, RN followed with ER kit. In vehicle child noted to have change in breathing. Child crying asked if she was having difficulty EPIPEN Jr given. Administered in ER.

VAERS ID:441034 (history)  Vaccinated:2011-10-27
Age:28.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Male  Submitted:2011-11-01, Days after onset: 4
Location:Oregon  Entered:2011-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA637AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Lymphadenopathy, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 10/27/11 soreness in left arm, swelling of lymph nodes - axillary area 2 days post vaccination. Soreness eased by 11/1/11, swelling same 11/1/11. Referred to private physician.

VAERS ID:441048 (history)  Vaccinated:2011-10-27
Age:4.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-11-01, Days after onset: 4
Location:Arizona  Entered:2011-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B184AA0UNLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0646Z1SCUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1178Z1SCUN
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Positive swelling, redness, hot to touch, shininess (+) itching.

VAERS ID:441050 (history)  Vaccinated:2011-10-27
Age:10.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-11-01, Days after onset: 4
Location:Oklahoma  Entered:2011-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sore throat, cough, fever and runny nose
Preexisting Conditions: LP Shunt; Pseudotumor cerebri behind (R) eye
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH505AB0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3781AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0993Z0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC51B062AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 3-4 in. area of erythema and swelling to (R) upper arm/deltoid. Treatment: Cool compress, TYLENOL/Ibuprofen, BENADRYL.

VAERS ID:441065 (history)  Vaccinated:2011-10-27
Age:60.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:Georgia  Entered:2011-11-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 mg 1 PO BID; ZESTRIL 1 PO daily; cholesterol med
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Injection site erythema, Injection site swelling, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Flu shot was given yesterday. Client stated injection site was swollen and red last night. This morning swelling and redness had moved below injection site.

VAERS ID:441073 (history)  Vaccinated:2011-10-27
Age:4.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Male  Submitted:2011-11-02, Days after onset: 5
Location:Missouri  Entered:2011-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None mom knew of
Preexisting Conditions: None reported
Diagnostic Lab Data: Not informed of any.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3957AA4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURG10683IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0399AA1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0573AA1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Increased appetite, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Running fever that increased to 102 & vomited. Taken to ER & was then adm for 24 hour observation.

VAERS ID:441087 (history)  Vaccinated:2011-10-27
Age:33.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Male  Submitted:2011-11-02, Days after onset: 6
Location:North Carolina  Entered:2011-11-02
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: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH456AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Hypoaesthesia, Hypotonia, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient reports normal arm pain after receiving vaccination, a few hours later began to experience numbness and tingling in left extremity. Arm became limp. Went to PCP and seen by neurologist. Unsure of treatment provided to patient.

VAERS ID:441089 (history)  Vaccinated:2011-10-27
Age:30.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 4
Location:Montana  Entered:2011-11-02, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to Codeine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH477AD IMLA
Administered by: Public     Purchased by: Private
Symptoms: Cough, Eye discharge, Headache, Ocular hyperaemia, Pyrexia, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: One hour after vaccinated began coughing - eyes turned bright red and began having eye discharge. Got a fever, started throwing up, headache & throat tightness. Took Albuterol Inhaler with some relief.

VAERS ID:441107 (history)  Vaccinated:2011-10-27
Age:66.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Male  Submitted:2011-11-02, Days after onset: 5
Location:Illinois  Entered:2011-11-02
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) (FLUZONE HIGH-DOSE)SANOFI PASTEURUH459AC IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0595AA IMRA
Administered by: Other     Purchased by: Public
Symptoms: Injected limb mobility decreased
SMQs:
Write-up: Pt cannot elevate left arm more than 2-3 inches away from body.

VAERS ID:441262 (history)  Vaccinated:2011-10-27
Age:40.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-03, Days after onset: 7
Location:Illinois  Entered:2011-11-03
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: BACTRIM, LATEX
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501088P IN 
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: ITCHY NOSE, MOUTH & FOREHEAD WITH REDNESS.

VAERS ID:441317 (history)  Vaccinated:2011-10-27
Age:33.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 0
Location:Connecticut  Entered:2011-11-03, Days after submission: 7
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 known allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT480AB0IJLA
Administered by: Private     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Presented with urticaria on arms, legs, neck & abdomen 30 min. post injection.

VAERS ID:441611 (history)  Vaccinated:2011-10-27
Age:35.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-01, Days after onset: 5
Location:Texas  Entered:2011-11-07, 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: Celiac disease; Hx bronchitis appx 1 month ago. Non-productive cough remains
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1111011IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness, Malaise, Muscle spasms
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Vestibular disorders (broad)
Write-up: C/o not feeling well, leg cramps, feeling as though BP dropping, dizzy.

VAERS ID:441615 (history)  Vaccinated:2011-10-27
Age:62.0  Onset:2011-10-29, Days after vaccination: 2
Gender:Female  Submitted:2011-10-31, Days after onset: 2
Location:Washington  Entered:2011-11-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT437AB1IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site infection
SMQs:
Write-up: On 10/27/11 patient received FLUZONE vaccine Lot UT437AB exp 6/30/12 into right deltoid. On 10/29/11 called back and said that skin under bandage looks infected. Patient stated that has infection of the skin. Tried to reach pt on 10/31/11 for more info no response.

VAERS ID:441750 (history)  Vaccinated:2011-10-27
Age:68.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-07, Days after onset: 11
Location:Texas  Entered:2011-11-08, 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUH468AC0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Fatigue, Oedema peripheral, Pain, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Swelling in arm achy -$g after 2-3 days achy from hips up fatigue after 2 weeks still achy & fatigue. Going to Dr today 11/7/11.

VAERS ID:441836 (history)  Vaccinated:2011-10-27
Age:  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-11-02, Days after onset: 5
Location:Texas  Entered:2011-11-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CBC, TFTs, CMP all normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Fatigue, Full blood count normal, Metabolic function test, Thyroid function test normal
SMQs:
Write-up: Patient developed fatigue the day after receiving her 2nd HPV vaccine (no problems after the 1st/dose). I saw her on 11/2/11 - normal exam/normal neuro exam. I explained HPV not likely a problem but mom wanted it reported. We discussed other possible causes of fatigue.

VAERS ID:441875 (history)  Vaccinated:2011-10-27
Age:66.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 1
Location:Maine  Entered:2011-11-09, 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: None
Preexisting Conditions: Elevated blood pressure; Osteoporosis; Hyperlipidemia
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AC UNLA
Administered by: Private     Purchased by: Private
Symptoms: Eye irritation, Fatigue, Headache, Ocular hyperaemia, Oropharyngeal pain, Pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Corneal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 3 hours after flu shot symptoms started with low grade fever, eyes burning and red, scratchy sore throat, shaking body aches, headache & fatigue. No rash, no difficulty breathing no swelling at injection site. Plan: BENADRYL, fluids, ibuprofen.

VAERS ID:441891 (history)  Vaccinated:2011-10-27
Age:82.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-10-30, Days after onset: 3
Location:Florida  Entered:2011-11-09, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUH488AC0UNLA
Administered by: Other     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash on arm 4" x 3 " left arm itching. Reported starting after shot & still present after 3 days.

VAERS ID:441925 (history)  Vaccinated:2011-10-27
Age:31.0  Onset:2011-10-31, Days after vaccination: 4
Gender:Male  Submitted:2011-11-09, Days after onset: 9
Location:Virginia  Entered:2011-11-09
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: Patient reports possible allergy to raw egg fours ago, but eats eggs now regularly with no allergic reaction.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH463AB0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Pyrexia, Rash, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient reports onset of rash and itching accompanied by fever (he did not take his temperature) on the evening of Monday, 10/31/2011. patient took Tylenol and Benadryl at home, and saw a physician the next day, who prescribed Prednisone for the symptoms and told patient the reaction was likely from the flu vaccine, since no other cause could be determined.

VAERS ID:441927 (history)  Vaccinated:2011-10-27
Age:26.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-09, Days after onset: 13
Location:Michigan  Entered:2011-11-09
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) (FLUZONE)SANOFI PASTEUR492810011500IMLA
Administered by: Other     Purchased by: Private
Symptoms: Activities of daily living impaired, Dizziness, Fatigue, Headache, Hypoaesthesia, Injection site pain, Injection site swelling, Myalgia, Nausea, Oedema mouth, Pyrexia, Swollen tongue, Throat tightness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Extremely fatigue-7-14 days. Injection site swollen- 4 days. Mouth, throat and tongue swollen- 2 days. Injection site pain and left side muscle pain and numbness at times-7 days. Fever- 2 days. Headache- 2 days. Nausea- 5 days. Dizziness- 2 days. Treatment- Bed rest, took time off work.

VAERS ID:441979 (history)  Vaccinated:2011-10-27
Age:0.4  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-09, Days after onset: 13
Location:Georgia  Entered:2011-11-09
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
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B3050A1UNRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1263AA1UNLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHF255791UNLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1035AA1PO 
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever - 103, diarrhea - no treatment.

VAERS ID:442086 (history)  Vaccinated:2011-10-27
Age:58.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-11-01, Days after onset: 4
Location:Massachusetts  Entered:2011-11-09, 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: PROAIR inhaler; Omeprazole; VIVELLE-DOT; LASIX; CLARITIN; MIRENA IUD
Current Illness: None - Post-op hernia repair
Preexisting Conditions: Allergy - Codeine; Clindamycin; Adhesive tape; Obesity; Fibromyalgia; Edema; Sleep apnea; Hx positive PPD; Hx fatty liver
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3927AA IMLA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0747AA0SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Blister, Erythema, Headache, Pain, Pruritus
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vaccine given right arm - redness about 6" in length, raised as well - 1 1/2" cluster of blister - itching of raised, red area. Body aches x 1 day with HA.

VAERS ID:442097 (history)  Vaccinated:2011-10-27
Age:47.0  Onset:2011-10-31, Days after vaccination: 4
Gender:Female  Submitted:0000-00-00
Location:Oklahoma  Entered:2011-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH471AA SYRUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Asthma, Dizziness, Gait disturbance, Headache, Heart rate increased, Muscular weakness, Musculoskeletal stiffness, Nausea, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: It choked my asthma (up) really bad. Heart speeded up - my whole body is weak, sick to my stomach and stiff body whole - headaches - dizzy headed. Hives big as silver dollars on entire body. Can''t pick up anything with my arm they gave it in. Can''t hardly walk.

VAERS ID:442113 (history)  Vaccinated:2011-10-27
Age:0.3  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-11-03, Days after onset: 6
Location:Arizona  Entered:2011-11-09, 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
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC3954AB1UNLA
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9166181UNLA
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1237PA1PO 
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red swollen at injection site.

VAERS ID:442235 (history)  Vaccinated:2011-10-27
Age:61.0  Onset:2011-10-29, Days after vaccination: 2
Gender:Female  Submitted:2011-11-02, Days after onset: 4
Location:California  Entered:2011-11-10, 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: Unknown
Current Illness: None
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11065P0 LA
Administered by: Public     Purchased by: Public
Symptoms: Axillary pain, Headache, Local swelling, Pain
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Developed HA evening of vaccination - lasted 1-2 days 2 day post-vaccine developed soreness, feeling of swelling (L) axilla. No lump felt, but area remains sore. Increased discomfort with arm movement. No notable swelling or soreness at injection site (L) arm.

VAERS ID:442241 (history)  Vaccinated:2011-10-27
Age:10.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Male  Submitted:2011-11-09, Days after onset: 13
Location:Wisconsin  Entered:2011-11-10, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH493AA2UNLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Pyrexia, Respiratory tract congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever to 105 degrees with dizziness, some congestion. Treated with ibuprofen & cool baths. Improved to 102 degrees, lasted at 48 hrs.

VAERS ID:442286 (history)  Vaccinated:2011-10-27
Age:40.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-10-28, Days after onset: 0
Location:North Carolina  Entered:2011-11-11, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD; RLS; Hiatal hernia; Irritable colon; Migraine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AC IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3947BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chest discomfort, Flushing, Headache, Lip oedema, Myalgia, Oedema peripheral, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Symptoms occurred several hours after receiving the flu vaccine. Symptoms included low-grade fever, facial flushing, headache, edema of lower lip and hands, chest tightness, and myalgia. Symptoms improved with administration of BENADRYL.

VAERS ID:442259 (history)  Vaccinated:2011-10-27
Age:72.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:California  Entered:2011-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH506AB IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0813AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Mobility decreased, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt''s left arm has been painful since 10/27/11 & weak. She has problem lifting her arm up high. She cannot lie on left side because it hurts.

VAERS ID:442428 (history)  Vaccinated:2011-10-27
Age:44.0  Onset:2011-10-29, Days after vaccination: 2
Gender:Male  Submitted:2011-11-15, Days after onset: 17
Location:North Carolina  Entered:2011-11-15
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 LIMITED14549121A10IMRA
Administered by: Military     Purchased by: Military
Symptoms: Decreased appetite, Diarrhoea, Fatigue, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Fatigued, diarrhea, nausea, loss of appetite, general muscle aches, stayed home in bed and hydrated for seven days.

VAERS ID:442527 (history)  Vaccinated:2011-10-27
Age:5.0  Onset:0000-00-00
Gender:Male  Submitted:2011-11-07
Location:Wisconsin  Entered:2011-11-15, 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501090P IN 
Administered by: Private     Purchased by: Public
Symptoms: No adverse event
SMQs:
Write-up: Split family - biological mother brought child to local medical clinic - FLUMIST given 10/27/11. Biological father signed school flu consent form FLUMIST administered at school on 10/27/11. Both parents contacted. No adverse side effects from receiving 2 doses. Error found when trying to enter data into state immun registry.

VAERS ID:443121 (history)  Vaccinated:2011-10-27
Age:54.0  Onset:0000-00-00
Gender:Female  Submitted:2011-11-17
Location:Kentucky  Entered:2011-11-21, Days after submission: 4
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''s medical history include supraventricular tachycardia (SVT) with a rapid heart rate for which she takes atenolol. She had no illness at the time of vaccination and had no other medications within 4 weeks of the ADACEL.
Diagnostic Lab Data: Not reported
CDC Split Type: 201110870
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR 0IJUN
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Condition aggravated, Fatigue, Heart rate increased, Supraventricular tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad)
Write-up: Initial report received from a consumer on 08 November 2011. A female patient received an injection (route and site not reported) of ADACEL, sanofi pasteur Ltd. lot number not reported, on 27 October 2011. The patient''s medical history includes supraventricular tachycardia (SVT) with a rapid heart rate for which she takes atenolol. She had no illness at the time of vaccination and had no other medications within 4 weeks of the ADACEL. The patient received the ADACEL as part of treatment for a cut on the leg at an Emergency Room. Since receiving the ADACEL, the patient has been having increased episodes of SVT and increased rapid heart rate. The patient was tired and had no energy. The patient stated that she has a cardiologist but has not seen him yet. The outcome was reported as not recovered. Documents held by sender: None.

VAERS ID:443214 (history)  Vaccinated:2011-10-27
Age:50.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-11-21, Days after onset: 25
Location:South Carolina  Entered:2011-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Skin infection, Cavilon Cream prescribed by other physician
Preexisting Conditions: Allergies: PCN, Darvon, Biaxin, Keflex, Phenergan, Lortab. Medical condition: Hypertension
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4163AA0IDRA
Administered by: Public     Purchased by: Other
Symptoms: Chills, Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Enlarged lymph node in R axilla (x 2 weeks), fever, chills, body aches w/i 12hrs after injection.

VAERS ID:443958 (history)  Vaccinated:2011-10-27
Age:76.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Male  Submitted:2011-11-17, Days after onset: 21
Location:Vermont  Entered:2011-11-30, Days after submission: 13
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: Allergy: Statin (intolerance); Medical conditions: HTN; Hyperlipidemia; DM; BPH; Peripheral neuropathy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B070BA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal discomfort, Activities of daily living impaired, Chills, Diarrhoea, Dyspepsia, Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: I am requesting that your office file this Vaccine Adverse Event Report. Here is my experience regarding Tdap vaccine. Prior tetanus shots (alone and with other vaccines) in the military and locally provided no adverse reactions. 10/27 9:30am. Vaccine administered. 12 noon Had lunch. 2pm Felt tightness in upper digestive tract. 5pm Could not eat supper. Upper tract still blocking digestion. 6pm Went to bed. Slept the night with poor digestion. Had chills and then fever. Did not take temperature. 10/28 Stayed in bed all day and night. Had continuing diarrhea and headache. Very tired not wanting to accomplish anything. No pains or redness at site of vaccination. 10/29 Continuing diarrhea. No headache. Tired, not wanting to accomplish anything. 10/30 Better, still some stomach discomfort. I have checked all symptoms experienced on the yellow sheet attached. This was supposed to be just a tetanus booster. I accepted that Tdap was appropriate. My concern is that this process was just part of a trial for the combined vaccine. Why would it be administered to a 76 year old? Your feedback will be appreciated and that the report was filed. 10/31/11 Call placed to pt, pt feeling better. He would like his symptoms reported.

VAERS ID:444133 (history)  Vaccinated:2011-10-27
Age:30.0  Onset:2011-10-28, Days after vaccination: 1
Gender:Female  Submitted:2011-11-14, Days after onset: 17
Location:Georgia  Entered:2011-11-30, Days after submission: 16
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) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA608AA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site reaction, Injection site vesicles, Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Yellowish blister to (L) upper arm 24 hour after immunization, lasted for 5 days. Papular rash noted to site.

VAERS ID:444764 (history)  Vaccinated:2011-10-27
Age:7.0  Onset:2011-11-03, Days after vaccination: 7
Gender:Male  Submitted:2011-11-29, Days after onset: 26
Location:New Hampshire  Entered:2011-12-07, Days after submission: 8
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
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.YK20151IN 
Administered by: Private     Purchased by: Public
Symptoms: Tic, Vaccine positive rechallenge
SMQs:, Dyskinesia (broad), Dystonia (broad)
Write-up: Facial motor tic developed about 1 wk after receiving intranasal flu vaccine. Same reaction may have occurred last year after intranasal vaccine but was not reported & resolved spontaneously. Last years dose given 10/13/2010 FLUMIST lot 501019P.

VAERS ID:445036 (history)  Vaccinated:2011-10-27
Age:49.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Female  Submitted:2011-12-09, Days after onset: 43
Location:Massachusetts  Entered:2011-12-09
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: none known
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH469AB1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Eye pruritus, Ocular hyperaemia, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad)
Write-up: Developed "pink and itchy eyes" shortly after receiving flu shot, duration ~4 hours. States same thing happened last time she received flu shot in 2009.

VAERS ID:445201 (history)  Vaccinated:2011-10-27
Age:46.0  Onset:2011-11-13, Days after vaccination: 17
Gender:Male  Submitted:2011-12-02, Days after onset: 19
Location:Louisiana  Entered:2011-12-12, 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: No allergies; High Blood Pressure; CHF; Diabetes; Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Haematospermia, Headache, Nasal congestion, Nausea, Pyrexia, Respiratory tract congestion, Sneezing, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Fertility disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Indicates seriousness - Nov. 13, 1230pm, during sexual intercourse, blood, mixed w/ semen. Nov. 14, 7:00 am, headaches, chill, fever, chest and throat congested, wheezing, short winded, stuffy nose, nausea, and sneezing. Over-the-counter-drugs: CORICIDIN (cough/depressant) TYLENOL, THERA-FLU, SUCRETS throat lozenges (still no changes).

VAERS ID:445357 (history)  Vaccinated:2011-10-27
Age:70.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Male  Submitted:2011-12-13, Days after onset: 47
Location:Maryland  Entered:2011-12-13
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 CORONARY ARTERY DISEASE
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURHD20112PFS0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Chills, Fatigue, Feeling abnormal, Hyperhidrosis, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Hypoglycaemia (broad)
Write-up: Aches & Pains, chills & sweating, extreme fatigue, felt like I had been run over by a truck! Symptoms lasted three+ days.

VAERS ID:445423 (history)  Vaccinated:2011-10-27
Age:82.0  Onset:2011-10-31, Days after vaccination: 4
Gender:Female  Submitted:2011-11-29, Days after onset: 29
Location:Illinois  Entered:2011-12-14, Days after submission: 15
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: Neomycin - but had no Rxn to regular flu shots prior
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUH458AB0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient noticed rash on scalp developed within a few days after flu shot, but could not say exactly when it had started. Rash has lasted about a month before coming back to pharmacy.

VAERS ID:446299 (history)  Vaccinated:2011-10-27
Age:11.0  Onset:2011-10-31, Days after vaccination: 4
Gender:Female  Submitted:2011-12-27, Days after onset: 57
Location:California  Entered:2011-12-27
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: Went in for an ultra sound.
CDC Split Type:
Vaccination
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HPV4: HPV (GARDASIL)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Other
Symptoms: Lymphadenopathy, Ultrasound scan
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On the side where there was an injection the lymph nodes on her neck above her clavicle bone were swollen. Three could be seen.

VAERS ID:446823 (history)  Vaccinated:2011-10-27
Age:45.0  Onset:2011-10-31, Days after vaccination: 4
Gender:Female  Submitted:2012-01-04, Days after onset: 65
Location:Utah  Entered:2012-01-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine .175mcg/d
Current Illness: None
Preexisting Conditions: Hypothyrodism
Diagnostic Lab Data: Blood Sugar level at 300 at Emergency Room 12/17/2011. HA1C at 12. CBC w/Diff, No prior diagnoses diabetes suspected. PT is in excellent health otherwise; fit and exercises.
CDC Split Type:
Vaccination
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0599AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Blindness unilateral, Blood glucose increased, Differential white blood cell count, Full blood count, Glycosylated haemoglobin increased, Latent autoimmune diabetes in adults, Pollakiuria, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad)
Write-up: Excess thirst, frequent urination. By mid-November, noticeable loss of vision in left eye (saw optometrist). Diagnosed with LADA Diabetes on 12/17/2011. Administered Metformin 2000 mg/d, and Glyburide 7.5 mg/d.

VAERS ID:446898 (history)  Vaccinated:2011-10-27
Age:59.0  Onset:2011-10-30, Days after vaccination: 3
Gender:Male  Submitted:2012-01-05, Days after onset: 67
Location:California  Entered:2012-01-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: It was unknown if other vaccines were given on the same date as the FLULAVAL. The subject had no known relevant medical history or no known adverse reactions following previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0959900A
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALS  UNAR
Administered by: Private     Purchased by: Other
Symptoms: Ill-defined disorder, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a healthcare professional (nurse practitioner) and described the occurrence of pericarditis in a 59-year-old male subject who was vaccinated with FLULAVAL (GlaxoSmithKline). On 27 October 2011 the subject received a dose of FLULAVAL (.5 ml, unknown route, unknown deltoid). On 30 October 2011, 3 days after vaccination with FLULAVAL, the subject experienced symptoms ("became symptomatic") and on an unknown date in 2011, less than a year after vaccination with FLULAVAL, the subject was diagnosed with pericarditis. The subject was hospitalised for 4 days and the healthcare professional considered the events were clinically significant (or requiring intervention). The healthcare professional reported that the subject was told by the hospital physicians that these events were related to his receiving the flu vaccine. At the time of reporting the events were resolved.

VAERS ID:448629 (history)  Vaccinated:2011-10-27
Age:42.0  Onset:2011-10-29, Days after vaccination: 2
Gender:Female  Submitted:2012-01-30, Days after onset: 93
Location:California  Entered:2012-02-02, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: B12 injection
Current Illness:
Preexisting Conditions: Illness at the time of vaccination was not reported. From new information received, the patient had upper respiratory infection (URI) at the time of vaccination with FLUZONE Intradermal on 27 October 2011.
Diagnostic Lab Data: Not reported
CDC Split Type: 201110556
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4163AA2IDLA
Administered by: Private     Purchased by: Private
Symptoms: Swelling, Type III immune complex mediated reaction
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: This is a non-serious cluster of 2 patients who experienced adverse events following administration of FLUZONE Intradermal (lot number not reported). Initial report was received on 31 October 2011 from a health care provider. Two patients (age and date of birth not reported) had received FLUZONE Intradermal, (lot number, route and site of administration were not reported). One of the patients an employee at a dental clinic experienced a bad reaction to the intradermal injection. The second patient ended up in the emergency room (ER) with swelling down to the elbow. No further informational was available at the time of the report. The patient''s outcome was not reported. Follow-up information received from a health care professional on 20 January 2012. It was clarified by the reported that a cluster of 4 patients (previously reported as 2 patients) had received FLUZONE Intradermal (lot number UT4163AA) on different days and experienced reactions. This case will now be the case of reference for 1 of the 4 patients who had been identified as a 43 year-old female patient who is discussed below. Due to the follow-up information received on this patient this case now meets seriousness criteria and has been upgraded to serious. Information regarding the other 3 patients (all non-serious cases) are captured in case numbers 2012-00783, 00784, 00785. A 43-year-old female patient who had concurrent illnesses of upper respiratory infection (URI), had received a left arm injection of FLUZONE Intradermal (lot number UT4163AA) on 27 October 2011 at 3 pm, and 2 days later on 29 October 2011 at 3:30 pm reported swelling down to the elbow. The patient presented to the emergency room and was administered steroid injection and antibiotics for arthus reaction. Concomitant medications included B12 injection. The patient recovered on an unspecified date. Documents held by sender: none.

VAERS ID:448929 (history)  Vaccinated:2011-10-27
Age:1.0  Onset:2011-11-03, Days after vaccination: 7
Gender:Female  Submitted:2012-02-06, Days after onset: 95
Location:Massachusetts  Entered:2012-02-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4231CA1IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0446AA0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.07113AA0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 20 vesicular lesions on arms.

VAERS ID:450605 (history)  Vaccinated:2011-10-27
Age:7.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Male  Submitted:2011-10-31, Days after onset: 4
Location:New York  Entered:2012-02-23, Days after submission: 115
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions: No known allergies
Diagnostic Lab Data:
CDC Split Type: MEDI0013790
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.YK2014 IN 
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A non-serious spontaneous report of hives has been received from a health professional concerning a sever-year-old male, subsequent to FLUMIST. The patient''s past medical history included no allergies and he had received FLUMIST last year with no reaction. No concomitant medications have been reported for this patient. The patient received FLUMIST on 27-Oct-2011 at 9.00AM. On 27-Oct-2011 at 04.00PM, the patient experienced hives and again at 8.00PM. The outcome of event hives was unknown.

VAERS ID:450608 (history)  Vaccinated:2011-10-27
Age:5.0  Onset:2011-10-27, Days after vaccination: 0
Gender:Male  Submitted:2011-10-27, Days after onset: 0
Location:Colorado  Entered:2012-02-23, Days after submission: 119
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0013777
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501105P IN 
Administ