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Found 493323 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:466694 (history)  Vaccinated:2012-09-27
Age:38.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-09-27, Days after onset: 0
Location:Illinois  Entered:2012-09-27
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: N/A
Diagnostic Lab Data: Emergency Room physician administered Benadryl, Decadron, and Epinephrine via IV
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNLA
Administered by: Other     Purchased by: Other
Symptoms: Dysgeusia, Dysphagia, Dyspnoea, Oral discomfort, Throat irritation
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Metallic taste in mouth, burning feeling in throat and top of mouth, difficulty swallowing, shortness of breath.

VAERS ID:466711 (history)  Vaccinated:2012-09-27
Age:64.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-09-27, Days after onset: 0
Location:Ohio  Entered:2012-09-27
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4496AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chest discomfort, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Tightness in throat, tightness in chest patient took Benadryl when got home.

VAERS ID:466751 (history)  Vaccinated:2012-09-27
Age:13.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-09-27, Days after onset: 0
Location:Georgia  Entered:2012-09-27
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: Seizures
Diagnostic Lab Data: Blood pressure within normal limits. Finger stick blood glucose within normal limits
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ21431IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.1860AA0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURG106814SCLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR02428AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood glucose normal, Hypotonia, Immediate post-injection reaction, Lethargy
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: HPV .5ml IM Rt deltoid/5 sec after injection at 1157. Pt became limp, lethargic NSQ pull code button & call for help. Staff MD arrive to assist. Nurse and asses patient.

VAERS ID:466781 (history)  Vaccinated:2012-09-27
Age:16.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-09-27, Days after onset: 0
Location:Texas  Entered:2012-09-27
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 PASTEURUH733AD UNRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.H0126421UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4286AA1UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: Dizziness, seeing black spots < 5 minutes.

VAERS ID:467010 (history)  Vaccinated:2012-09-27
Age:43.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 4
Location:Michigan  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: No known pre-existing allergies. Past medical history pertinent for hypothyroidism, asthma, kidney stones, recurrent pneumonia, left bundle branch block.
Diagnostic Lab Data: see above.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1203901 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.NO13581 IMRA
Administered by: Other     Purchased by: Other
Symptoms: C-reactive protein increased, Erythema, Leukocytosis, Mobility decreased, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: The patient is a pleasant 43-year-old female who got a pneumococcal vaccine the day prior to admission. She stated that she was having increasing pain and swelling of her left upper extremity to the point where she could not move her arm at all. She presented to the emergency department where she was found to have a leukocytosis and elevated CRP. An infectious disease consult was obtained who felt that this was most likely an adverse reaction to the pneumonia injection, but there was significant fever, erythema and swelling. So, the patient was started on clindamycin 900 milligrams IV every 8 hourly. The patient had significant improvement. She on the 09/29/2012, had a T-max of 101.1. However, has been afebrile over the last 36 hours. Patient was discharged with a prescription for clindamycin 450 mg PO every 8 hours, as well as vicodin for pain and told to resume home medications.

VAERS ID:467014 (history)  Vaccinated:2012-09-27
Age:61.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-01
Location:Texas  Entered:2012-10-01
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204001 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1241AA IMLA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Feeling hot, Induration, Mobility decreased, Oedema peripheral, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Arm swelled, Red Streaks, Could not bend arm, Hot, Hard bump.

VAERS ID:467105 (history)  Vaccinated:2012-09-27
Age:65.0  Onset:2012-09-28, Days after vaccination: 1
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Georgia  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none noted
Preexisting Conditions: floxin reported
Diagnostic Lab Data: None so far. Pharmacist did call and inform her primary doctor and it was noted on the chart.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA691BA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Hypersensitivity, Injection site erythema, Injection site mass, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Lump at injection site, red wheal approximately 1&1/2 inches across. Probable allergic reaction.

VAERS ID:467287 (history)  Vaccinated:2012-09-27
Age:4.0  Onset:2012-09-28, Days after vaccination: 1
Gender:Male  Submitted:2012-10-01, Days after onset: 3
Location:Texas  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.023AE1UNRL
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Edema to (R) thigh. Redness to (R) thigh. Warmth to (R) thigh.

VAERS ID:467148 (history)  Vaccinated:2012-09-27
Age:59.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 5
Location:Ohio  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Penicillin allergy; medical conditions = hypertension, hyperlipemia, osteoarthritis Right total knee replacement on 6/25/12
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12060012IMRA
Administered by: Public     Purchased by: Private
Symptoms: Activities of daily living impaired, Injection site erythema, Injection site pruritus, Injection site rash, Injection site warmth, Orbital oedema, Rash erythematous, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Itching at injection site, no redness or swelling; @ approx. 2 pm, developed warm red rash on right cheek, right side of neck and under chin; offered Benadryl IM (subject was given vaccine as part of employee vaccination program and is an LPN) but refused Benadryl IM and took her own Benadryl 25 mg tab po @ approx. 3:30 pm; at approx 5:30pm, noticed one hive on upper right chest; the following day, woke with red warm rash on both upper arms, upper chest, entire neck and face, and with orbital edema and called off work.

VAERS ID:467482 (history)  Vaccinated:2012-09-27
Age:17.0  Onset:2012-10-02, Days after vaccination: 5
Gender:Male  Submitted:2012-10-03, Days after onset: 1
Location:Massachusetts  Entered:2012-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH716AD1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4258AA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Urticaria.

VAERS ID:467547 (history)  Vaccinated:2012-09-27
Age:77.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Male  Submitted:2012-09-27, Days after onset: 0
Location:New York  Entered:2012-10-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Uncertain
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206701 IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dysgeusia, Paraesthesia oral
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: After vaccination patient complained of "a tingling sensation in the left side of tongue and like he could taste medication". Monitored for 25 minutes at which point symptoms had resolved.

VAERS ID:467605 (history)  Vaccinated:2012-09-27
Age:20.0  Onset:2012-10-01, Days after vaccination: 4
Gender:Female  Submitted:2012-10-04, Days after onset: 3
Location:New York  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Amoxicillin, penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEUR  IDRA
Administered by: Other     Purchased by: Other
Symptoms: Fatigue, Nausea, Pain, Pyrexia, Respiratory tract congestion, Sinus headache
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Congestion, Aches, Fatigue, low fever, sinus headache, Nausea.

VAERS ID:467711 (history)  Vaccinated:2012-09-27
Age:46.0  Onset:2012-09-29, Days after vaccination: 2
Gender:Female  Submitted:2012-10-05, Days after onset: 6
Location:North Carolina  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Admitted for gastric bypass surgery, got routine vaccination.
Preexisting Conditions: IDDM, HYPERLIPIDEMIA, OSA, SOB, JOINT PAIN, FOOT/ANKLE PAIN, S/P SINUS SURGERY, TONSILLECTOMY, C SECTION, TOTAL HYSTERECTOMY, CTR
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H010916 SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Left upper arm pink warm around injection site-5 inches diameter. Pt c/o itching.

VAERS ID:467747 (history)  Vaccinated:2012-09-27
Age:3.0  Onset:0000-00-00
Gender:Male  Submitted:2012-10-04
Location:Maryland  Entered:2012-10-05, 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: Nephrotic syndrome
Preexisting Conditions: Hypertension; Asthma; Eczema; Allergy to penicillin; Ampicillin; Sulfadoxine and CELEPIN
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (PRIORIX)GLAXOSMITHKLINE BIOLOGICALS0129AE0IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0495AE0IMLL
Administered by: Public     Purchased by: Other
Symptoms: Contraindication to vaccination
SMQs:
Write-up: Live vaccines (MMR and varicella) were administered to a patient on PROGRAF, an immunosuppressive drug. This is a contraindication.

VAERS ID:468063 (history)  Vaccinated:2012-09-27
Age:2.0  Onset:0000-00-00
Gender:Male  Submitted:2012-09-27
Location:Michigan  Entered:2012-10-05, 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: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH712AB UNUN
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None.

VAERS ID:468079 (history)  Vaccinated:2012-09-27
Age:51.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 6
Location:Connecticut  Entered:2012-10-05, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: High blood pressure
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12049010UNRA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: 20 min post injection, patient returned to administration site with with general itching and 1 inch red area on her (L) arm and 3-4 inch red area on back of neck. BP was 138/88. Patient decided to take a BENADRYL which she had at her desk. Within 10 min of original symptoms itching & redness gone. Telephone call 3 hrs later patient had no symptoms & had reported to her MD.

VAERS ID:468225 (history)  Vaccinated:2012-09-27
Age:38.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 11
Location:New York  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None. No previous issues ever with the flu shot, either.
Preexisting Conditions: Shellfish, Lactose, Latex sensitivities
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH711AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Activities of daily living impaired, Impaired driving ability, Joint range of motion decreased, Mobility decreased, Musculoskeletal pain, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Within a few hours of receiving the flu shot in my upper left arm, I experienced a massive, acute pain in my back shoulder. That pain spread across my upper shoulder down my left arm. I have had the flu shot every year for almost two decades and have never experienced anything like this. There was no redness or swelling on my outer skin. But I cannot move my shoulder in any direction. The pain is worse when I sleep. I cannot lift my arm in any direction without pain in the muscles. Lifting and driving have also become difficult. Taking Tylenol or Aleve nor applying tiger balm help. I''ve also applied heating pad regularly. The pain is lessened, but mobility has never been restored. This is now day 12 and I am very concerned.

VAERS ID:468416 (history)  Vaccinated:2012-09-27
Age:69.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Male  Submitted:2012-10-09, Days after onset: 12
Location:West Virginia  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204801 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Site red, warm to the touch, slight pain.

VAERS ID:468541 (history)  Vaccinated:2012-09-27
Age:31.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-09, Days after onset: 12
Location:California  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No known
Diagnostic Lab Data: No diagnostic tests. Medications only--Benadryl, Solumedrol, Epinephrine
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED0674921 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Patient complained of pressure in the throat.

VAERS ID:472861 (history)  Vaccinated:2012-09-27
Age:76.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Male  Submitted:2012-10-09, Days after onset: 12
Location:Unknown  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA000382
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  SYRUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Information has been received from a pharmacist concerning a 76 years old male patient, who on 27-SEP-2012 was vaccinated with a dose of ZOSTAVAX (dose, route and lot # not reported). No other co-suspects were reported. No concomitant medications were reported. The pharmacist reported that on 27-SEP-2012 the patient bled little along with some of the solution from ZOSTAVAX at the injection site. At the time of reporting the outcome of the event was unknown. Additional information has been requested.

VAERS ID:472865 (history)  Vaccinated:2012-09-27
Age:14.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-09, Days after onset: 12
Location:Unknown  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA000416
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0105150IMLA
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event, Wrong drug administered
SMQs:
Write-up: This spontaneous report was received from a licensed Practical Nurse concerned to a 14 years old patient of unknown gender. Nurse reported that the patient received an unintended 0.5 ml dose intramuscular of PNEUMOVAX 23 (lot not reported). No concomitant medications were reported. No adverse effect reported. Additional information has been requested.

VAERS ID:472885 (history)  Vaccinated:2012-09-27
Age:  Onset:2012-09-27, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-09, Days after onset: 12
Location:Texas  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA000499
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC. 1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report as received from a pharmacist refers to a patient of unknown age who on 27-AUG-2012, was vaccinated with first dose of VAQTA 1 ml intramuscular (lot number not reported). No other co-suspects were reported. No concomitant medications were reported. The pharmacist reported that the patient received the second dose of VAQTA early on 27-SEP-2012, 1 ml intramuscular (lot number not reported), the patient was not experiencing any known symptoms. No treatment information was reported. At the time of the report, the patient''s outcome for the adverse events was unknown. Additional information has been requested.

VAERS ID:469221 (history)  Vaccinated:2012-09-27
Age:  Onset:2012-09-30, Days after vaccination: 3
Gender:Female  Submitted:2012-09-30, Days after onset: 0
Location:New Hampshire  Entered:2012-10-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEUR04490AA0IMUN
Administered by: Other     Purchased by: Public
Symptoms: Infection
SMQs:
Write-up: Infection in muscle.

VAERS ID:473127 (history)  Vaccinated:2012-09-27
Age:70.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-11, Days after onset: 14
Location:Unknown  Entered:2012-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug hypersensitivity
Preexisting Conditions: Codeine, Hypersensitivity
Diagnostic Lab Data:
CDC Split Type: WAES1210USA000771
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1206701 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0098260IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injected limb mobility decreased, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This spontaneous report as received from a pharmacist refers to a 70 years old female patient with codeine allergy. On 27-SEP-2012, the patient was vaccinated with, 0.5 ml PNEUMOVAX23 Lot # H009826 Exp date: 11-FEB-2014. Pharmacist reported that on 27-SEP-2012, the patient experienced very swollen arm after receiving PNEUMOVAX23 and complained of difficulty moving the arm. The patient did not received any treatment for the event. The patient sought medical attention by spoke to pharmacist. The outcome of adverse events was unknown. The relatedness for adverse events was unknown for PNEUMOVAX23. Additional information has been requested.

VAERS ID:473383 (history)  Vaccinated:2012-09-27
Age:69.0  Onset:2012-09-28, Days after vaccination: 1
Gender:Female  Submitted:2012-10-12, Days after onset: 14
Location:Unknown  Entered:2012-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure; Drug hypersensitivity, allergy to codeine
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA001449
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC. 0UNLA
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Paraesthesia, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a 69 year old female consumer with allergy to codeine. Concomitant medications included blood pressure medication (unspecified), calcium, vitamins and vitamin D. On Thursday, 27-SEP-2012 the consumer was vaccinated with a dose of ZOSTAVAX in her left arm. A day later on 28-SEP-2012 the consumer had a high fever and a tingling sensation on her stomach. By Monday, 01-OCT-2012 she had red spots on her stomach. The consumer sought medical attention. Her doctor advised her it was a minor case of the "virus that causes the chicken pox." Treatments was not given. No further information was provided. Additional information is not expected.

VAERS ID:470152 (history)  Vaccinated:2012-09-27
Age:66.0  Onset:2012-10-12, Days after vaccination: 15
Gender:Male  Submitted:2012-10-17, Days after onset: 5
Location:Nebraska  Entered:2012-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: HCM
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1SYRRA
Administered by: Public     Purchased by: Private
Symptoms: Cough, Fatigue, Hyperhidrosis, Influenza, Nasopharyngitis, Night sweats, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: All cold flu symptoms - fever (99.5), cough and sense, excessive sweating while sleeping (had to change clothing), fatigue, not much improvement (except for fever).

VAERS ID:470378 (history)  Vaccinated:2012-09-27
Age:65.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-17, Days after onset: 20
Location:Colorado  Entered:2012-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis; Sinus Infection
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4489AA1SYRLA
Administered by: Public     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injection site erythema, Injection site pain, Injection site swelling, Pain in extremity, Sinusitis
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Patient said right after the shot, the area was swollen and solid red circle (about 2") and pain down to her whole arm. When patient came in and report on 10/10/12, not red anymore, but still swollen. She started LEVAQUIN for sinus infection 2 days after the shot. Nurse think patient got infection from shot. Recommend to check with her Dr. Dr. couldn''t conclude what caused it.

VAERS ID:470386 (history)  Vaccinated:2012-09-27
Age:47.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-19, Days after onset: 22
Location:Michigan  Entered:2012-10-19
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: XANAX prn sleep
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: 2 EKGs; Chest x-ray; IV sodium; Potassium pills; IV TORADOL x2; Blood work; Steroid injection + MEDROL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH716AA1IMUN
Administered by: Other     Purchased by: Unknown
Symptoms: Aphonia, Blood test, Chest X-ray, Chest discomfort, Dysphonia, Dyspnoea, Electrocardiogram, Eye swelling, Eyelid margin crusting, Headache, Heart rate abnormal, Hypoaesthesia oral, Muscle spasms, Musculoskeletal stiffness, Ocular hyperaemia, Photophobia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: ER 9-27-2012 SOB, with chest heaviness, abnormal HR, eyes bloodshot red with heavy crusting, numb lips, tongue, severe headache, swollen eyes. Raspy voice-to point of not being able to talk. Neck stiffness. Lately, leg spasms going into feet light sensitivity.

VAERS ID:470770 (history)  Vaccinated:2012-09-27
Age:78.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-19, Days after onset: 22
Location:Georgia  Entered:2012-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Penicillin allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4494AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Sensation of foreign body, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Patient reported that a lump formed in her throat about one hour after receiving the vaccination, which progressed to vomiting about 2 hours later. Patient reports about 3-4 episodes of emesis along with diarrhea.

VAERS ID:471053 (history)  Vaccinated:2012-09-27
Age:84.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-23, Days after onset: 26
Location:Arizona  Entered:2012-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4489AA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injection site pain, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Pt had pain when receiving vaccination in deltoid muscle. She said within 15 minutes she had pain in shoulder. Three weeks later she still has pain in shoulder but she said it is getting a little better.

VAERS ID:474679 (history)  Vaccinated:2012-09-27
Age:0.2  Onset:0000-00-00
Gender:Female  Submitted:2012-10-29
Location:Unknown  Entered:2012-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA003683
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEUR  UNUN
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH  UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 0PO 
Administered by: Other     Purchased by: Other
Symptoms: Tongue discolouration
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: This spontaneous report as received from a physician refers to a 2 months old female patient. The patient was vaccinated with dose 1, 2 ml ROTATEQ on 27-SEP-2012 (Lot # not reported). No other co-suspects were reported. Concomitant medications included PENTACEL, PREVNAR 13 and vitamin D (unspecified). No allergies were reported. On an unknown date in 2012 the patient experienced black tongue. The physician stated that he knows that pink colored liquids can sometimes cause a black tongue. No treatment information was reported. The outcome of black tongue was reported as not recovered/not resolved. The relatedness for black tongue was unknown for ROTATEQ. Additional information has been requested.

VAERS ID:472229 (history)  Vaccinated:2012-09-27
Age:3.0  Onset:2012-09-30, Days after vaccination: 3
Gender:Female  Submitted:2012-10-30, Days after onset: 30
Location:Virginia  Entered:2012-10-30
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: CMTC left arm
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0011AE0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Enuresis, Fungal infection, Hyperphagia, Irritability, Lethargy, Polydipsia, Polyuria
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Patient quickly began exhibiting symptoms of type 1 diabetes... polyuria, polydypsia, polyphagia, yeast infection, irritability, lethargy, bed wetting.

VAERS ID:472316 (history)  Vaccinated:2012-09-27
Age:44.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 11
Location:Colorado  Entered:2012-10-30, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies = seasonal = grass, mold, dust
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP503080IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, 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: Itchy at site of injection on 9/29/12. Noticed 2" x 2" round, red, swollen, warm to touch area on arm at site. Took BENADRYL 50mg PO that night gone after 24 hours.

VAERS ID:472323 (history)  Vaccinated:2012-09-27
Age:77.0  Onset:2012-10-06, Days after vaccination: 9
Gender:Female  Submitted:2012-10-31, Days after onset: 25
Location:Massachusetts  Entered:2012-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Pruritus generalised, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Overall body itch and rash. Benadryl not helping. Atarax 2 10mg/day not helping. Eucerin Calming Creme not helping.

VAERS ID:473055 (history)  Vaccinated:2012-09-27
Age:16.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-09-27, Days after onset: 0
Location:Rhode Island  Entered:2012-11-01, Days after submission: 35
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; NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1745AA0UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt had pain at the left deltoid at site of HPV vaccine. Mother is nervous about such a new vaccine MSM didn''t really want this due to it not out in the community long enough. But we sent this anyway due to the pain at same muscle group.

VAERS ID:472848 (history)  Vaccinated:2012-09-27
Age:23.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-11-03, Days after onset: 37
Location:Maryland  Entered:2012-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug hypersensitivity; Asthma
Preexisting Conditions: Attention deficit/hyperactivity disorder; Anxiety disorder; Depression; SUPREX
Diagnostic Lab Data: White blood cell count, elevated
CDC Split Type: WAES1210USA001903
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED  IDLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1850AA IMRA
Administered by: Other     Purchased by: Other
Symptoms: Headache, Injection site swelling, Nausea, Pyrexia, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This spontaneous report was received from a healthcare worker refers to a 23 years old female patient. Patient''s current conditions included asthma and SUPREX allergy. The patient''s medical history included depression, anxiety disorder and attention deficit-hyperactivity disorder (ADHD). On 27-SEP-2012, the patient was vaccinated intramuscularly with 0.5 ml dose of PNEUMOVAX23 (lot # 672369/1850AA, expiry:28-JUL-2013) and was also vaccinated intradermally in the left arm with a dose of Influenza Virus Vaccine (manufacturer unknown)(lot # not reported). Concomitant medications included WELLBUTRIN, TOPAMAX, oral hormonal contraceptives (unspecified) and budesonide, SYMBICORT. On 27-SEP-2012, the patient experienced headache, vomiting, nausea, fever and extreme swelling of her right arm at the injection site after receiving PNEUMOVAX23. The patient went to the emergency room, where she was treated with unspecified pain medication and released after about 3 hours. On an unspecified date an unspecified white blood cell count test was performed with elevated result. The patient was recovering from headache, fever, nausea, vomiting and injection site swelling. The outcome of elevated white blood cell count was unknown. Additional information has been requested.

VAERS ID:473340 (history)  Vaccinated:2012-09-27
Age:89.0  Onset:2012-10-02, Days after vaccination: 5
Gender:Female  Submitted:2012-10-11, Days after onset: 9
Location:Texas  Entered:2012-11-07, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Syncope
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204101 IMRA
Administered by: Other     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Provider reports pt. developed numerous brief seizures after administration.

VAERS ID:474640 (history)  Vaccinated:2012-09-27
Age:58.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-11-04, Days after onset: 38
Location:Illinois  Entered:2012-11-07, 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: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH712AA0UNLA
Administered by: Public     Purchased by: Other
Symptoms: Immediate post-injection reaction, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Patient states she had pain immediately while receiving the injection in her left deltoid. Denies numbness or tingling. No redness, edema, or bruising at injection site. Patient contacted me 3 weeks after the vaccine, stating her deltoid still hurts.

VAERS ID:474954 (history)  Vaccinated:2012-09-27
Age:39.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-11-12, Days after onset: 46
Location:Kentucky  Entered:2012-11-20, Days after submission: 8
Life Threatening? No
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: Crest disease
Preexisting Conditions: "Hx anaphylactic reactions secondary to crest disease"
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH745AA1IMLA
Administered by: Public     Purchased by: Other
Symptoms: Anaphylactic reaction, Erythema, Flushing, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Face, arms, trunk, legs - red, flushed - anaphylactic reaction - airway tight - used EPI-PEN - treated in ED.

VAERS ID:475210 (history)  Vaccinated:2012-09-27
Age:37.0  Onset:2012-09-28, Days after vaccination: 1
Gender:Male  Submitted:2012-11-14, Days after onset: 47
Location:New York  Entered:2012-11-20, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH721AB0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Muscle fatigue, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Muscle weakness and fatigue, more on left extremities than right.

VAERS ID:475254 (history)  Vaccinated:2012-09-27
Age:52.0  Onset:2012-10-03, Days after vaccination: 6
Gender:Male  Submitted:2012-11-26, Days after onset: 54
Location:Maryland  Entered:2012-11-26
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: Arachnoiditis, ciguitera poisioning
Diagnostic Lab Data: EMG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Electromyogram, Inflammatory pain, Polyneuropathy chronic
SMQs:, Peripheral neuropathy (narrow)
Write-up: Diffuse post vaccine inflammatory painful chronic polyneuropathy.

VAERS ID:476156 (history)  Vaccinated:2012-09-27
Age:30.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Male  Submitted:2012-12-03, Days after onset: 67
Location:Missouri  Entered:2012-12-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Went to doctor on 11-24-12, pain still persisted, doctor prescribed a steroid shot and then ibuprofen twice a day and constantly to wear an elbow brace to restrict use for two weeks.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRAR
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Diarrhoea, Fatigue, Headache, Orthosis user, Pain
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: Headache, diarrhea, tired, body aches, pain and soreness in elbow of arm shot was administered.

VAERS ID:476218 (history)  Vaccinated:2012-09-27
Age:72.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-11-01, Days after onset: 35
Location:Massachusetts  Entered:2012-12-03, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4491AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Bursitis
SMQs:
Write-up: Had severe "bursitis" type reaction in shoulder. Resolved after 1 mo.

VAERS ID:476220 (history)  Vaccinated:2012-09-27
Age:68.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2012-11-29, Days after onset: 63
Location:Massachusetts  Entered:2012-12-03, Days after submission: 4
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: Unk.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4491AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Pain in extremity
SMQs:
Write-up: Soreness in arm x approximately 2 months post injection. Denies fever, swelling. Did not seek medical attention. Sx resolved on their own without tx.

VAERS ID:476981 (history)  Vaccinated:2012-09-27
Age:67.0  Onset:2012-10-05, Days after vaccination: 8
Gender:Female  Submitted:2012-11-25, Days after onset: 51
Location:Unknown  Entered:2012-12-07, 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:
Preexisting Conditions: Female, non smoker, 2 wine glasses/d. PMH: HTN, OA, seasonal allergies. Allergic to NSAIDS, IVP Dye, BACTRIM, Amoxicillin, E-mycin, LEVAQUIN, MACROBID.
Diagnostic Lab Data: Seen at urgent care. Tx with Pred-Pak.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4247AA UNUN
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0598AE SCUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Rash erythematous, Rash generalised, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Seven days after receiving the shingles vaccine I developed a rash from head to ankles! Despite a Prednisone Pak the rash & severe itching lasted 3 wks, I still have small red dots on my abdomen & some scaly red patches on my back, arm & thigh.

VAERS ID:485356 (history)  Vaccinated:2012-09-27
Age:43.0  Onset:2012-10-12, Days after vaccination: 15
Gender:Female  Submitted:2013-02-22, Days after onset: 133
Location:North Carolina  Entered:2013-02-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cambia, Cyclobenzapril, Premarin, Tramadol, Nexium, Miralax, Propranolol, Celebrex, Toprol XL, Humira, Fioricet, Diazepam, and Botox
Current Illness:
Preexisting Conditions: Rheumatoid Arthritis, Fibromyalgia, Migraines, Lower Back Pain
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4463BA ID 
Administered by: Other     Purchased by: Public
Symptoms: Injection site atrophy, Injection site discolouration, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Injection site reaction: skin discoloration, redness, tenderness, and indentation that has been present for 4 months and is still present.

VAERS ID:485452 (history)  Vaccinated:2012-09-27
Age:44.0  Onset:2012-10-02, Days after vaccination: 5
Gender:Female  Submitted:2013-02-25, Days after onset: 146
Location:Washington  Entered:2013-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron, vitamin C, multivitamin, metformin, pantoprazole, levothyroxine, allergy shots
Current Illness: No
Preexisting Conditions: Hay, cats, guinnea pigs, trees; PCOS, thyroid
Diagnostic Lab Data: EKG, Liver enzymes
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Private
Symptoms: Asthenia, Body temperature increased, Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Hepatic enzyme, Muscular weakness, Neuralgia, Pain in extremity, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: 103 temperature, weakness, trouble breathing, dizzy, tiredness, chest palpatations, weakness with standing, nerve pain in hands/arms.

VAERS ID:490050 (history)  Vaccinated:2012-09-27
Age:29.0  Onset:0000-00-00
Gender:Female  Submitted:2013-04-25
Location:Pennsylvania  Entered:2013-04-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: No
Preexisting Conditions: History of migraines
Diagnostic Lab Data: MRI indicated a subcutaneous fat defect.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4475AA IDLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site atrophy, Injection site discomfort, Injection site reaction, Nuclear magnetic resonance imaging abnormal, Skin disorder
SMQs:
Write-up: Pt. developed a dimpling/indent of the skin where the intradermal flu vaccine was administered. There was some discomfort noted. The indent worsened over the next few months, but has since stopped. Indent remains to left upper arm.

VAERS ID:492325 (history)  Vaccinated:2012-09-27
Age:41.0  Onset:2013-03-13, Days after vaccination: 167
Gender:Female  Submitted:2013-05-22, Days after onset: 70
Location:Nebraska  Entered:2013-05-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN 500MG BID, LOSARTAN WITH POTASSIUM 50MG QD.
Current Illness: NOT ILL.
Preexisting Conditions: PCN AND CODEINE, NO BIRTH DEFECTS, DIABETES.
Diagnostic Lab Data: FOLLOW UP APPOINTMENT WITH PCP ON JUNE 13, 2013.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)SANOFI PASTEUR33919BVA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Joint injection, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: LEFT ARM PAIN IS EXCRUTIATING, SAW PCP 03/13/13 OR 03/14/13. PER MD IT WAS A SORE BACK MUSCLE AND HAD "ABSOLUTELY NOTHING TO DO WITH HER TETANUS SHOT." RESOLVED WITH IBUPROFEN AND FINE NOW. RECENTLY HAD STEROID INJECTION TO LT SHOULDER, HAS HX OF 2 PREVIOUS INJURIES IN 1990 AND 2010, CURRENTLY NOT IN ANY PAIN.

VAERS ID:496231 (history)  Vaccinated:2012-09-27
Age:1.1  Onset:2013-04-24, Days after vaccination: 209
Gender:Male  Submitted:2013-07-09, Days after onset: 76
Location:Pennsylvania  Entered:2013-07-09
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:
Diagnostic Lab Data: LabTest: VZV DNA PCR; Specimen Date: 04/25/2013; Source: vesicle; Result: positive
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4049AA2UNUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1874AA0UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHF636662UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0306AE0UNUN
Administered by: Private     Purchased by: Other
Symptoms: Herpes zoster, Polymerase chain reaction, Varicella virus test positive
SMQs:
Write-up: Herpes zoster in very young 1 dose varicella vaccine recipient.

VAERS ID:498834 (history)  Vaccinated:2012-09-27
Age:21.0  Onset:2012-10-10, Days after vaccination: 13
Gender:Male  Submitted:2013-08-01, Days after onset: 295
Location:California  Entered:2013-08-08, 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:
Preexisting Conditions: Subject had not been taking any concomitant medications and denied any history of allergies to medications. Subject had no cardiac surgical history.
Diagnostic Lab Data:
CDC Split Type: 201308147
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
SMALL: SMALLPOX (ACAM2000)SANOFI PASTEUR  OTUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Echocardiogram normal, Electrocardiogram normal, Lymphadenopathy, Myocarditis, Troponin I increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad)
Write-up: Initial report was received 26 July 2013 from the investigator for the trial. A 21-year-old male subject had received the following vaccinations on 27 September 2012: ACAM2000 in the right arm, FLUMIST and anthrax vaccines (lot numbers not reported; routes and sites of administration for FLUMIST and anthrax vaccines were not reported). From 05-09 October 2012, the subject experienced a swollen a right axillary lymph node of mild intensity. On 10 October 2012, testing revealed positive rapid Troponin I, elevated Troponin I (3.06 ng/mL - high critical) and an EKG showed normal sinus rhythm with sinus arrhythmia. Subject denied chest pain, chest pressure, shortness of breath and chest discomfort. He was evaluated by cardiology on 11-12 October 2012; ECHO was normal. He was diagnosed with asymptomatic myocarditis, placed on activity restriction and made non-deployable. The subject had no new symptoms and no evidence of NSAID Rx. On 15 October 2012, Troponin I was "O.K." and the subject recovered. According to the investigator, the event of subclinical myocarditis was probably related to the study vaccine. Documents held by sender: Visit notes, EKG, lab report.

VAERS ID:505904 (history)  Vaccinated:2012-09-27
Age:  Onset:0000-00-00
Gender:Male  Submitted:2013-10-04
Location:Unknown  Entered:2013-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1310USA000202
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This spontaneous report was received from a male consumer of an unknown age referring to himself. On 27-SEP-2012, approximately (also reported as one year ago), the patient was vaccinated with ZOSTAVAX, (lot number not reported). The patient reported that he had a reaction at the injection site from the ZOSTAVAX vaccine. He had a small patch of redness at the injection site. The outcome of he had a reaction at the injections site from the ZOSTAVAX vaccine and he had a small patch of redness at the injections site was unknown. Additional information is not expected.

VAERS ID:522241 (history)  Vaccinated:2012-09-27
Age:14.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2014-02-09, Days after onset: 500
Location:Unknown  Entered:2014-02-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA003021
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Interchange of vaccine products, No adverse event
SMQs:
Write-up: This spontaneous report was received from a healthcare worker refers to a patient of unknown demography. On an unknown date in July 2012, the patient was vaccinated with series consisting of 1 dose of CERVARIX and 2 doses of GARDASIL. No adverse effects reported. No further information was available. Additional information has been requested.

VAERS ID:467518 (history)  Vaccinated:2012-09-27
Age:  Onset:2012-09-28, Days after vaccination: 1
Gender:Male  Submitted:2012-10-03, Days after onset: 5
Location:Foreign  Entered:2012-10-03
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:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210COL001614
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  PO 
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea haemorrhagic, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)
Write-up: This spontaneous report as received from a nurse (local reference number 2012PVCL0178) refers to a male patient of unknown age. The patient was vaccinated with a dose of ROTATEQ, oral on 27-SEP-2012. No other co-suspects were reported. No concomitant medications were reported. On 28-SEP-2012 the patient developed bloody diarrhea (hospitalization) and vomiting (hospitalization). No treatment information was reported. The outcome of bloody diarrhea and vomiting was unknown. The relatedness for bloody diarrhea and vomiting was unknown for ROTATEQ, oral. Additional information has been requested.

VAERS ID:468913 (history)  Vaccinated:2012-09-27
Age:2.7  Onset:2012-09-27, Days after vaccination: 0
Gender:Male  Submitted:2012-10-10, Days after onset: 13
Location:Foreign  Entered:2012-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210AUT004608
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURERH008355 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: Case received from the Health Authority on 09-Oct-2012 under the reference number AT-BASGAGES-122427. Case reported as serious (due to other medically important condition). Case medically confirmed. Initial source was a physician. A 32-month-old male patient (weight 13.9 kg, height 90 cm) with no relevant medical history reported, had received a dose of M-M-RVAXPRO (batch number H008355) via intramuscular route and not reported site of administration on 27-Sep-2012. No concomitant medication was reported. On the same day, right after vaccination at 11:30 am, the male patient experienced severe acute pain. The patient was treated with cooling and analgesics. The patient recovered within an unspecified timeframe.

VAERS ID:469738 (history)  Vaccinated:2012-09-27
Age:0.3  Onset:2012-10-05, Days after vaccination: 8
Gender:Male  Submitted:2012-10-14, Days after onset: 9
Location:Foreign  Entered:2012-10-16, Days after submission: 2
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: Unknown
Diagnostic Lab Data:
CDC Split Type: 2012252035
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)SANOFI PASTEUR 0SCUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH 0SCUN
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALS 1PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Idiopathic thrombocytopenic purpura, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow)
Write-up: This is a spontaneous report from a contactable physician received via a Pfizer sales representative. A 4-month-old male patient received the first dose of PREVENAR subcutaneously on 27Sep2012, the first dose of ACT-HIB subcutaneously on 2/Sep2012, and the second dose of rotavirus vaccine orally on 27Sep2012. The patient medical history was not reported. The patient''s concomitant medications were not reported. On 05Oct2012, the patient presented to the hospital due to looking ill. The patient was diagnosed with idiopathic thrombocytopenic purpura (ITP) and was hospitalized on 05Oct2012. Relevant lab test included a platelet value of 0 from a test at consultation. Therapeutic measures were taken as a result of the event and included unspecified standard treatment. On 10Oct2012, the platelet value normalized, and the patient was discharged. The outcome of the event was recovered on 10Oct2012. The reporting pediatrician commented that in view of the past medical history, the event was unlikely to be from a latent infection. In consideration of the temporal relationship between vaccination and onset of ITP, the event was considered to be equally attributable to one of the three vaccinations. The reporting pediatrician classified the event as serious and assessed it as probably related to the pneumococcal 7-valent conjugate vaccine.

VAERS ID:470168 (history)  Vaccinated:2012-09-27
Age:  Onset:2012-10-05, Days after vaccination: 8
Gender:Male  Submitted:2012-10-17, Days after onset: 12
Location:Foreign  Entered:2012-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data: 10/05/2012, Platelet count, decreased to 0; 10/--/2012, Platelet count, recovered to 200,000
CDC Split Type: WAES1210JPN005823
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  PO 
Administered by: Other     Purchased by: Other
Symptoms: Immunoglobulin therapy, Platelet count decreased, Red blood cell morphology normal, White blood cell morphology normal
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad)
Write-up: Initial and follow-up information was received from a physician concerning an infant male patient who on 27-SEP-2012 was vaccinated with live, oral ROTATEQ, two ml (dose and lot number not reported). There were no underlying disease/complications and medical history. Other concomitant vaccines included hib conj vaccine (unspecified carrier) and PREVENAR. On 05-OCT-2012, the patient developed platelets decreased, and was hospitalized for treatment. The number of platelets decreased to 0. There was no change of white blood cell shape and red blood cell shape. Gamma globulin was prescribed for the patient for five days. On an unspecified date, after treatment, the number of platelets was recovered to 200, 000. On 10-OCT-2012, platelets decreased were improved. The treatment was completed, and the patient was discharged. On an unspecified date, the action of live attenuated pentavalent rotavirus vaccine was not applicable. The reporter''s comment: chronologically, it might link between vaccines and platelets decreased. The reporting physician considered that the platelets decreased were serious due to hospitalization. The reporting physician did not assess the relationship of platelets decreased to ROTATEQ. Additional information is not expected.

VAERS ID:471809 (history)  Vaccinated:2012-09-27
Age:  Onset:0000-00-00
Gender:Male  Submitted:2012-10-26
Location:Foreign  Entered:2012-10-26
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: D0077421A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Pericardial effusion
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This case was reported by a hospital physician and described the occurrence of pericardial effusion in an adult male subject of unspecified age who was vaccinated with INFLUSPLIT SSW (GlaxoSmithKline). In September 2012 the subject received a dose of INFLUSPLIT SSW (0.5 ml, unknown). Less than one month post vaccination with INFLUSPLIT SSW, in September 2012, the subject experienced pericardial effusion. The subject was hospitalised for an unknown period of time for this event. At the time of reporting the outcome of the event was unspecified. Please note that the reported date of vaccination (27 September 2012) and the reported date of hospitalisation for pericardial effusion (21 September 2012) were not consistent with the reported course of the events. Follow-up information has been requested.

VAERS ID:471839 (history)  Vaccinated:2012-09-27
Age:0.2  Onset:2012-09-29, Days after vaccination: 2
Gender:Female  Submitted:2012-10-23, Days after onset: 24
Location:Foreign  Entered:2012-10-26, Days after submission: 3
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:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: 2012258695
Vaccination
Manufacturer
Lot
Dose
Route
Site
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN)GLAXOSMITHKLINE BIOLOGICALS  SCUN
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF95838 SCUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Cyanosis, Hypersomnia, Hypotonia, Malaise, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: This is a spontaneous report received from agency, regulatory authority report number SE20120493. An 8-week-old female patient received the following suspect vaccines on 27Sep2012 by subcutaneous route: PREVENAR 13 (lot n. F95838) at 0.5 ml, single and INFANRIX HEXA at 1 dose dorm (DF), single. No relevant medical history and no concomitant treatment were reported. On 29Sep2012, 48 hours after vaccination, the patient experienced malaise with cyanosis and hypotonia. It was noted that the infant was lying under a blanket. The patient was hospitalized due to the events. Then she has experienced transient febricula for 24 hours. It was also noted that the infant has been transitory slightly asthenic and has slept more than usual during the night following vaccination. The infant recovered soon without sequelae from malaise with cyanosis and hypotonia. The outcome of the other events was unknown at the time of this report. Based on the Official Foreign Method of Causality Assessment, both vaccines were rated by the agency as doubtful. No Follow Up attempts needed. No further information expected.

VAERS ID:473731 (history)  Vaccinated:2012-09-27
Age:0.9  Onset:2012-09-28, Days after vaccination: 1
Gender:Female  Submitted:2012-11-08, Days after onset: 41
Location:Foreign  Entered:2012-11-09, Days after submission: 1
Life Threatening? Yes
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 personal medical history. It was not reported if the patient had an history of adverse event to previous administration of vaccine or drug. Family medical history of convulsions.
Diagnostic Lab Data: MRI and electroencephalography were performed. No clear abnormalities were observed.
CDC Split Type: 201210385
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURH05190SCUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Crying, Electroencephalogram normal, Nuclear magnetic resonance imaging normal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Case received from the Health Authorities in a foreign country under reference number i12102141 on 02 November 2012. A 09-month-old female patient (height 72.1 cm and weight 8.6kg), with no personal medical history and family medical history of convulsions, had received her 1st primary dose of IMOVAX POLIO (batch number H0519, site of administration not reported) subcutaneously on 27 September 2012 at a clinic. The patient did not receive concomitant therapies. It was not reported if the patient had an history of adverse event to previous administration of vaccine or drug. On 28 September 2012 in the morning, the patient experienced crying and she had a generalised convulsion for one to two minutes. She recovered spontaneously. When she visited the reporting physician''s hospital as an urgent patient, she had already recovered. Diazepam 4 mg was rectally administered for prevention of convulsion. Eighteen hours later Diazepam was rectally administered additionally at home. The patient was recovered. On 01 October 2012, the patient revisited the hospital and was hospitalized for a complete physical examination. Since then the patient had developed no convulsion. MRI and electroencephalography were performed. No clear abnormalities were observed. On 04 October 2012, the patient was discharged. The case was considered as serious due to hospitalization and life threatening.

VAERS ID:473961 (history)  Vaccinated:2012-09-27
Age:2.0  Onset:2012-09-29, Days after vaccination: 2
Gender:Female  Submitted:2012-11-08, Days after onset: 40
Location:Foreign  Entered:2012-11-13, 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:
Preexisting Conditions: Unknown
Diagnostic Lab Data: 29-SEP-2012, Alanine aminotransferase, 11 IU/l; 26-OCT-2012, Alanine aminotransferase, 6 IU/l; 29-SEP-2012, Aspartate aminotransferase, 32 IU/l; 26-OCT-2012, Aspartate aminotransferase, 23 IU/l; 29-SEP-2012, Basophil percentage, 1.1%; 26-OCT-2012, Basophil percentage, 2.4%; 29-SEP-2012, Blood alkaline phosphatase, 704 IU/l; 26-OCT-2012, Blood alkaline phosphatase, 495 IU/l; 29-SEP-2012, Blood creatinine, 0.31 mg/dl; 26-OCT-2012, Blood creatinine, 0.23 mg/dl; 26-OCT-2012, Blood immunoglobulin A, 100 mg/dl; 26-OCT-2012, Blood immunoglobulin G, 841 mg/dl; 26-OCT-2012, Blood immunoglobulin M, 216 mg/dl; 29-SEP-2012, Blood lactate dehydrogenase, 313 IU/l; 26-OCT-2012, Blood lactate dehydrogenase, 289 IU/l; 29-SEP-2012, Blood urea, 9.8 mg/dl; 26-
CDC Split Type: 2012275094
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)PFIZER/WYETH12802A SCUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Adenovirus test, Alanine aminotransferase normal, Anti-complement antibody, Antinuclear antibody negative, Aspartate aminotransferase normal, Basophil percentage increased, Blood alkaline phosphatase increased, Blood creatinine normal, Blood immunoglobulin A normal, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactate dehydrogenase increased, Blood urea normal, C-reactive protein normal, Complement factor C3 increased, Complement factor C4, Complement factor normal, Encephalitis, Eosinophil percentage, Gait disturbance, Haemoglobin normal, Immunology test abnormal, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Lymphocyte percentage decreased, Monocyte percentage, Mycoplasma test positive, Neutrophil percentage increased, Nuclear magnetic resonance imaging brain abnormal, Platelet count normal, Protein total increased, Pyrexia, Red blood cells urine positive, Respiratory syncytial virus test negative, Serum ferritin normal, Streptococcus test positive, Urine leukocyte esterase positive, Vaccination site erythema, Vaccination site swelling, White blood cell count increased, White blood cells urine positive
SMQs:, Liver related investigations, signs and symptoms (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Demyelination (narrow), Chronic kidney disease (broad), Hypersensitivity (broad)
Write-up: This is a spontaneous report from a contactable pediatrician via a Pfizer sales representative. A 34-month-old patient of unknown and gender received PREVENAR (Lot Number 12802A) subcutaneously on 27Sep2012. The patient had no underlying diseases, concurrent disease, past medical history, idiosyncrasy such as allergy, or past drug event. Concomitant medications were not reported. The patient experienced acute disseminated encephalomyelitis on 31Oct2012 and pyrexia, vaccination site erythema and vaccination site swelling on 29Sep2012. The clinical course was as follows: The patient received pneumococcal 7-valent conjugate vaccine at a hospital different from the reporter''s on 27Sep2012. She presented with pyrexia, vaccination site erythema, and vaccination site swelling on 29Sep2012. Then, she was admitted to the reporter''s hospital on 29Sep2012. The pyrexia continued after the admission. Since the possibility of some kind of infection was considered, antibiotic treatment was provided. However, the symptoms persisted. The antibiotic drug was discontinued and the clinical course was observed. The pyrexia gradually attenuated. She was well and follow-up was selected. However, she wobbled when she was walking after turning out of bed on 31Oct2012. Head MRI was performed regarding the wobbling, which demonstrated encephalitis. Based on the clinical course and findings from images, a diagnosis of acute disseminated encephalomyelitis following the injection of pneumococcal 7-valent conjugate vaccine was made on 01Nov2012. Lab data included the following: alanine aminotransferase (ALT) of 11 IU/l on 29Sep2012 and 6 IU/l on 26Oct2012; aspartate aminotransferase (AST) of 32 IU/l on 29Sep2012 and 23 IU/l on 26Oct2012; basophils of 1.1% on 29Sep2012 and 2.4% on 26Oct2012; blood alkaline phosphatase (ALP) of 704 IU/l on 29Sep2012 and 495 IU/l on 26Oct2012 (normal range 112-334 IU/l); blood creatinine of 0.31 mg/dl on 29Sep2012 and 0.23 on 26Oct2012; blood immunoglobulin A of 100 mg/dl on 26Oct2012 (normal range of 110 to 410 mg/dl); blood immunoglobulin G of 841 mg/dl on 26Oct2012; blood immunoglobulin M of 216 mg/dl on 26Oct2012 (normal range of 33 to 190 mg/dl); blood lactate dehydrogenase of 313 IU/l on 29Sep2012 and 289 IU/l on 26Oct2012 (normal range of 121 to 226 IU/l); blood urea of 9.8 mg/dl on 29Sep2012 and 5.3 mg/dl on 26Oct2012 (normal range of 8 to 20 mg/dl); body temperature of 40.4 degrees Centigrade (C) on 29Sep2012, 37.0 degrees C on 26Oct2012, and 37.2 degrees C on 01Nov2012; complement factor C3 of 140 mg/dl on 26Oct2012 (normal range of 86 to 160 mg/dl); complement factor C4 of 36 mg/dl on 26Oct2012 (normal range of 17 to 45 mg/dl); C-reactive protein of 0.19 mg/dl on 29Sep2012 and <0.07 mg/dl on 26Oct2012; eosinophils of 1.4% on 29Sep2012 and 3.3% on 26oct2012; haemoglobin of 13.0 g/dl on 29Sep2012 and 12.1 g/dl on 26Oct2012; lymphocytes of 16.1% on 29Sep2012 and 22.3% on 26Oct2012 (normal range of 18.0% to 59.0%); monocytes of 7.0% on 29Sep2012 and 6.1% on 26oct2012; neutrophils of 73.4% on 29Sep2012 and 65.9% on 26oct2012 (normal range of 32.0% to 80.0%); platelet count of 21.7 x 10 4/mm3 on 29Sep2012 and 45.5 x 10 4/mm3 on 26Oct2012 (normal range of 13.0 x 10 4/mm3 to 34.0 x 10 4/mm3); protein total of 7.0 g/dl on 26Oct2012 (normal range of 6.5 g/dl to 8.0 g/dl); serum ferritin of 73.7 ng/ml on 26Oct2012 (range of 4.6 ng/ml to 204.0 ng/ml); white blood cell count of 85.5 x 10 2/mm3 on 29Sep2012 and 173.1 x 10 2/mm3 on 26oct2012 (normal range of 40.0 x 10 2/mm3 and 90.0 x 10 2/mm3); Urine qualitative test (20Sep2012): Urine leukocytes reaction (+) (Reference: (-)), RBC 5-9/HPF (visually counted only), WBC 5-9/ HPF (visually counted); mycoplasma by enzyme immunoassay (29Sep2012): (+) Hemolytic streptococcus group A (29Sep2012): (-) (Reference: Negative); influenza antibody (29Sep2012): Negative for influenza A and influenza B (Reference: Negative); adeno antigen (pharynx) (29Sep2012): (-)(Reference: Negative); and head

VAERS ID:476727 (history)  Vaccinated:2012-09-27
Age:12.0  Onset:2012-09-28, Days after vaccination: 1
Gender:Female  Submitted:2012-11-15, Days after onset: 48
Location:Foreign  Entered:2012-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1211GBR006308
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMAR
Administered by: Other     Purchased by: Other
Symptoms: Blister, Malaise
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: This case was received from the health authority on 13-Nov-2012. GB-MHRA-ADR 21909752. This case is medically confirmed. A 12-years-old female patient, with no reported medical history or concomitant medication, received an injection of GARDASIL (batch no. and dose not reported) intramuscularly on her arm on 27-Sep-2012. One day post-vaccination, on 28-Sep-2012, she experienced blisters. The reporter stated that it was a "possible Steven Johnson syndrome", however the patient was not unwell enough to seek medical attention for 2 weeks. The appointment was for something else and blisters came up in conversation. The patient and her mother said that blisters were all over the body and after 2 weeks most of them were healing. The worse blisters were on the arm that was injected. At the time of reporting the patient was recovering. Upon internal review, the company decided to code "possible Steven Johnson syndrome" which was mentioned in the narrative but not coded by the health authority. The reporter stated that he was unsure of the seriousness of the reaction. The agency considered this case to be serious as an other medically important condition.

VAERS ID:474439 (history)  Vaccinated:2012-09-27
Age:5.0  Onset:0000-00-00
Gender:Female  Submitted:2012-11-16
Location:Foreign  Entered:2012-11-16
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: B0844944A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Extensive swelling of vaccinated limb, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This case was reported by a physician via regulatory authority (# CZ-CZSUKL-12001885) and described the occurrence of muscle weakness lower limb in a female subject aged between 0 and 9 years old who was vaccinated with INFANRIX (GlaxoSmithKline). On 27 September 2012, the subject received unspecified dose of INFANRIX (unknown route and injection site; lot number not provided). At an unspecified time after vaccination with INFANRIX, the subject experienced muscle weakness lower limb body temperature increased and extensive swelling of vaccinated limb (oedema of femur). The regulatory authority reported that the events were clinically significant (or requiring intervention). The events resolved 3 days after onset.

VAERS ID:476288 (history)  Vaccinated:2012-09-27
Age:14.0  Onset:2012-10-30, Days after vaccination: 33
Gender:Female  Submitted:2012-12-04, Days after onset: 35
Location:Foreign  Entered:2012-12-04
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:
Current Illness: Unknown
Preexisting Conditions: GARDASIL, No adverse event; GARDASIL, No adverse event; Previous doses of GARDASIL, administered on 26-Jan-2012 (D1) and on 10-May-2012 (D2) were tolerated well.
Diagnostic Lab Data: CK (7976 IU/l), C-reactive protein (0.1 mg/dl), GOT increased (118 IU/l), GPT (56 IU/l). Alanine aminotransferase, 56; Aspartate aminotransferase increased 118; Blood creatine phosphokinase, 7976; C-reactive protein, 0.1
CDC Split Type: WAES1212DEU000337
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNLA
Administered by: Other     Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood creatine phosphokinase increased, C-reactive protein normal, Myositis
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad)
Write-up: Case was received from the Health Authorities on 28-Nov-2012 (reference number PEI2012060256). Case is medically confirmed. A 14-year-old female patient received a third dose of GARDASIL (lot-no. H013132) into the left upper arm on 27-Sep-2012. 33 days later, on 30-Oct-2012, she presented with myositis of the left arm. She was hospitalised on an unspecified date. Diagnosis was confirmed by MRI, CK (7976 iU/), C-reactive protein (0.1 mg/dl), GOT increased (118 IU/l), GPT (56 IU/l). Duration was reported to be 7 days, however the final outcome was unknown by the reporter. Previous doses of GARDASIL, administered on 26-Jan-2012 (D1) and on 10-May-2012 (D2) were tolerated well.

VAERS ID:483260 (history)  Vaccinated:2012-09-27
Age:12.0  Onset:2012-09-27, Days after vaccination: 0
Gender:Female  Submitted:2013-02-01, Days after onset: 127
Location:Foreign  Entered:2013-02-01
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1302GBR000201
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  SYRUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Activities of daily living impaired, Anxiety, Constipation, Diarrhoea, Dizziness, Dyspepsia, Dyspnoea, Headache, Nausea, Neck pain, Oropharyngeal pain, Palpitations, Rash
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: This case was received from the health authority on 25-Jan-2013. GB-MHRA-ADR 21990010. This case is not medically confirmed as it was reported by a consumer. A 12 year old female patient (weight: 35.83 kg), with no medical history reported, received injections of GARDASIL (batch number, dose, route and site of administration not reported) on 27-Sep-2012. On 27-Sep-2012, the patient experienced severe abdominal pains and cramping, severe nausea, severe headaches, dizziness, palpitations, breathlessness, rash, sore neck and throat. Several attendances so far with general practitioner and general practitioner out of hours, 3 attendances as an emergency to causality at hospital. She was currently under care of ambulance paediatrics, awaiting scans and 2 further referrals to gastroenterology and gynaecology consultants, which have been severely delayed for no apparent reason. The patient continued absence from school since a month after reaction started. Since the reaction occurred, she presently took various medicines to counteract the varied symptoms: NUROFEN, CALPOL or paracetamol, GAVISCON (E401), sodium bicarbonate (E550i), codeine or alternatively CO-CODAMOL and initially a prescribed laxative. The agency also reported the patient experienced on 27-Sep-2012 alteration between constipation and diarrhoea, anxiety, bloating and indigestion. At the time of reporting, the patient was not recovered. The agency considered that case serious due to be disability and medically significant.

VAERS ID:499466 (history)  Vaccinated:2012-09-27
Age:  Onset:2013-06-06, Days after vaccination: 252
Gender:Male  Submitted:2013-08-13, Days after onset: 68
Location:Foreign  Entered:2013-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Diagnostic ultrasound, 23Oct2012, pregnancy
CDC Split Type: B0913656A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Foetal exposure during pregnancy, Renal aplasia
SMQs:, Congenital, familial and genetic disorders (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: This retrospective pregnancy case was reported by a regulatory authority (2013-03410) and described the occurrence of congenital renal agenesis in a male neonate whose mother was vaccinated with BOOSTRIX (GlaxoSmithKline) during pregnancy. The mother was healthy and didn''t consume alcohol or tobacco. She had irregular menstruation. The neonate was also exposed transplacentally to Folic acid treatment started 2 months before conception. On 27 September 2012, the 28-year old mother of the subject received unspecified dose of BOOSTRIX (unknown route, injection site and batch number). The mother''s last menstrual period was on 31 August 2013. The neonate was exposed to the vaccine during the 1st trimester. Ultrasound performed on 23 October 2012 revealed a foetal cardiac activity. On 27 September 2012, at 38 weeks gestation, the neonate was delivered by normal vaginal delivery in sitting position and weighted 2.8 Kg. Birth defects were noted. The neonate was born with a congenital renal agenesis. He only had the right kidney. The regulatory authority reported that the event was a congenital anomaly and clinically significant (or requiring intervention). The regulatory authority reported that the event was possibly related to the mother''s vaccination with BOOSTRIX.

VAERS ID:502536 (history)  Vaccinated:2012-09-27
Age:1.5  Onset:2013-08-01, Days after vaccination: 308
Gender:Female  Submitted:2013-09-13, Days after onset: 43
Location:Foreign  Entered:2013-09-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1309LBN005201
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 2PO 
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Gastroenteritis rotavirus, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: This spontaneous report as received from a physician via a medical representative, refers to a 18 month old female patient. On 04-APR-202, on 16-JUL-2012 and on 27-SEP-2012 the patient was vaccinated with her first, second and third doses respectively of oral ROTATEQ (doses, route and lot numbers not provided). In August 2013 the patient was admitted for severe rotavirus gastroenteritis with diarrhea, vomiting and fever and spent 6 days in the hospital. The outcome the event was unknown. The causal relationship was not reported. Additional information has been requested.

VAERS ID:504377 (history)  Vaccinated:2012-09-27
Age:24.0  Onset:2012-09-28, Days after vaccination: 1
Gender:Female  Submitted:2013-09-26, Days after onset: 363
Location:Foreign  Entered:2013-09-26
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: B0925422A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB988AD IMUN
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Influenza like illness
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: This case was reported by a nurse via a regulatory authority (# 2013-018230) and described the occurrence of acute asthmatic attack in a 24-year-old female subject who was vaccinated with ENGERIX B adult (GlaxoSmithKline). The subject''s medical history and concurrent medical condition were not reported. On 27 September 2012, the subject received unspecified dose of ENGERIX B adult (20 mcg/ml, intramuscular, unknown site of injection). On 28 September 2012, 24 hours after vaccination with ENGERIX B adult, the subject experienced flu like illness. On 29 September 2012, 48 hours after vaccination with ENGERIX B adult, the subject experienced acute asthmatic attack. The regulatory authority reported that the events were clinically significant (or requiring intervention). The subject was treated with prednisolone. The events lasted for 4 days. The subject had recovered.

VAERS ID:466906 (history)  Vaccinated:2012-09-28
Age:26.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-28, Days after onset: 0
Location:Texas  Entered:2012-09-28
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
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC111AA0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Condition aggravated, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Employee states that she had shortness of breath, asked employee when it started she stated she has been under alot of stress and has had shortness of breath this pass week. Instructed employee to have seat in the breakroom until she was better.

VAERS ID:466908 (history)  Vaccinated:2012-09-28
Age:46.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-28, Days after onset: 0
Location:Texas  Entered:2012-09-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: not known
Preexisting Conditions: not known
Diagnostic Lab Data: unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4468BA IDLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Hypersensitivity
SMQs:, Angioedema (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Patient felt lightheaded a few minutes after the flushot. Over a few hours, it progressed into an allergic reaction and the patient went to an emergency room for treatment.

VAERS ID:466909 (history)  Vaccinated:2012-09-28
Age:0.6  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-09-29, Days after onset: 1
Location:Maryland  Entered:2012-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: Intussusception.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4298AA UNUN
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4488EA UNUN
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF95942 UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.H011810 UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Intussusception, Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal obstruction (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vomiting, lethargy.

VAERS ID:466912 (history)  Vaccinated:2012-09-28
Age:32.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-29, Days after onset: 1
Location:New York  Entered:2012-09-29
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: Ehlers Danlos Syndrome, hypothyroidism, chronic muscle pain & fatigue, anxiety, depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 5IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Axillary pain, Fatigue, Injection site induration, Injection site pain, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pain at injection site (upper right arm), hardness and swelling at and around injection site in 3" diameter (similar to size and shape of smallpox vaccine scar), pain in right armpit and inside of upper right arm, profound fatigue.

VAERS ID:466922 (history)  Vaccinated:2012-09-28
Age:32.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-09-29, Days after onset: 0
Location:Missouri  Entered:2012-09-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Potential Uterine infection. I notified Pharmacist who administered the shot. I was picking up a prescription for that when I was talked into the flu shot.
Preexisting Conditions: Wheat, Gluten, Eggs, Dairy, Beef, and Shellfish. Penicillin Hives at time of vaccination. Pharmacist was also aware.
Diagnostic Lab Data: Blood work at hospital. Waiting on results.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4468BA0IDLA
Administered by: Other     Purchased by: Other
Symptoms: Blood test, Chills, Cyanosis, Feeling cold, Headache, Pain, Pallor, Pyrexia, Visual impairment
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Extremely cold with chills, face lost color, lips purple, extreme body aches. Headache. Went to doctor at 11:15. 103 fever, change in vision, chills, aches, cold. Sent to outpatient for blood work.

VAERS ID:466929 (history)  Vaccinated:2012-09-28
Age:74.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-09-29, Days after onset: 1
Location:Nevada  Entered:2012-09-29
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: Diabetic DVT
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Arthralgia, Body temperature increased, Headache, Hyperhidrosis, Myalgia, Rhinorrhoea, Sneezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Temp 103. Profuse sweating. Severe Headache. Achy joints, muscles. Runny nose, sneezing.

VAERS ID:467075 (history)  Vaccinated:2012-09-28
Age:74.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-28, Days after onset: 0
Location:Oregon  Entered:2012-09-29, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS120501 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Burning sensation, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad)
Write-up: Complained vaccine was burning - even after needle was pulled out. Stated strange sensation can down arm to neck & jaw - couldn''t differentiate pain vs strange sensation. No treatment administered. Pt said she was ok. I called her an hour later - she was running errands but still had a slight off sensation.

VAERS ID:466930 (history)  Vaccinated:2012-09-28
Age:30.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-30, Days after onset: 2
Location:Indiana  Entered:2012-09-30
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: Hashimoto''s Disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRAR
Administered by: Private     Purchased by: Other
Symptoms: Chest discomfort, Fatigue, Oropharyngeal pain, Pain, Productive cough, Pyrexia, Syringe issue
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Vaccination is required by employer. If you decline vaccination they make you wear a mask for months so you basically have no choice but to receive the vaccine. Vaccine was administered with a safety syringe which malfunctioned, causing the needle be retracted from my arm during injection. I felt the vaccine run down my arm and the nurse said that I had to have it again so I was injected a second time. Don''t know how much I actually received during the first injection. Within the next 3 hours I developed a productive cough with chest tightness, sore throat and fever, had general body aches and fatigue that lasted about 24 hours.

VAERS ID:466943 (history)  Vaccinated:2012-09-28
Age:57.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-09-30, Days after onset: 1
Location:Indiana  Entered:2012-09-30
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: HEART, BLOOD PRESSURE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDPS84061IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Fatigue, Injection site erythema
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: REDNESS AT SITE, PATIENT FEELING WEAK AND TIRED.

VAERS ID:467040 (history)  Vaccinated:2012-09-28
Age:12.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-09-29, Days after onset: 0
Location:Georgia  Entered:2012-09-30, 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: The child was well
Preexisting Conditions: None; JRA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH715AA SYRLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAV13667CB SYRRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURH1305 SCLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM11082 IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Marked erythema/edema (about 5x/5 cm) starting 24 hrs after injection extending down arm (R). Pt started on po Clindamycin x 10 days. Pt afebrile.

VAERS ID:467043 (history)  Vaccinated:2012-09-28
Age:26.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-09-30, Days after onset: 1
Location:Kentucky  Entered:2012-09-30
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.G0068630SCRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient reported heat and pain at injection site patient taking ibuprofen.

VAERS ID:466948 (history)  Vaccinated:2012-09-28
Age:42.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-01, Days after onset: 1
Location:North Carolina  Entered:2012-10-01
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: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Abdominal discomfort, Chills, Diarrhoea, Headache, Myalgia, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow)
Write-up: Severe nausea, vomiting, severe headache, sick in stomach, sensation of diarrhea but no actual diarrhea happen, chills, shoulder muscle ache. Had an acupuncture treatment.

VAERS ID:466949 (history)  Vaccinated:2012-09-28
Age:39.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:North Carolina  Entered:2012-10-01
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: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Chills, Fatigue, Headache, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: Muscle aches, headache, fever (up to 100.8), nausea, vomiting, chills, and fatigue. Lasted 48 hours. Called physician, who prescribed Promethazine to control symptoms. Tylenol, also recommended by physician, was used to address symptoms.

VAERS ID:466982 (history)  Vaccinated:2012-09-28
Age:34.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-01, Days after onset: 2
Location:D.C.  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Asthma
Diagnostic Lab Data: CBC, CMP
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Feeling abnormal, Full blood count, Metabolic function test, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad)
Write-up: Fri night I already felt the body soreness, and by Sat midnight fever started that progress the whole day, can''t even get up from bed, feels so bad. Tylenol taken for fever, and went to the nearest urgent care center.

VAERS ID:466990 (history)  Vaccinated:2012-09-28
Age:55.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:North Dakota  Entered:2012-10-01
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: some environmental allergies: dust, ragweed,
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDPS02081IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Choking sensation, Headache, Nausea, Oropharyngeal pain, Pyrexia, Retching, Rhinorrhoea, Vomiting
SMQs:, Anaphylactic reaction (broad), 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), Hypersensitivity (broad)
Write-up: Sore throat, intense, choking feeling. Fever and severe chills. Runny Nose, all these sypmtoms lasted for approximately 8 to 10 hours. Headache. Nausea, Vomiting, Dry Heaves, all these lasted 24 to 36 hours.

VAERS ID:466993 (history)  Vaccinated:2012-09-28
Age:19.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Unknown  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: asthma, seasonal allergies, type I diabetes, hypothyroidism, ADHD
Preexisting Conditions: Allergies: Amoxil, azithromycin, barium sulfate, contrast dye, influenza vaccine, iodine, latex, oxycodone, PCNs
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Hypersensitivity, Respiratory disorder
SMQs:, Angioedema (broad), Acute central respiratory depression (broad), Hypersensitivity (narrow)
Write-up: 19 y.o. female reported to ED after having an allergic reaction to flu shot. Patient has a known allergy to flu vaccine but received vaccine after premedicated with Benadryl and prednisone. Medical records do not list exactly when nor where the flu shot was given. Patient was unable to speak in while in ED due to her respiratory issues but answered via texting and had already given herself epi pen x2. Pt received Benadryl 25mg iv, epinephrine 0.3mg im, Pepcid 20mg iv, Solumedrol 125mg iv in the ED 14:05. RT treatment. By 17:44 pt has no s/s of distress. Respirations were even and unlabored. Patient was not admitted to hospital. She was d/c home in stable condition.

VAERS ID:466995 (history)  Vaccinated:2012-09-28
Age:52.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-01, Days after onset: 2
Location:Virginia  Entered:2012-10-01
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
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Body temperature increased, Chills, Pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad)
Write-up: Horrible aching up and down right arm, especially under armpit, down arm, side of breast and 1/2 way across back. Sunday, temp of 100.3 with chills.

VAERS ID:467011 (history)  Vaccinated:2012-09-28
Age:55.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-01, Days after onset: 2
Location:Missouri  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Asthma, hypertension, hyperlipidemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH733AD10IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Erythema, Induration, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Induration, redness, itching, pain. Maximal pain, redness, and induration: 9/30/12, 3:00PM, approx 3.5 cm diameter.

VAERS ID:467012 (history)  Vaccinated:2012-09-28
Age:62.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Minnesota  Entered:2012-10-01
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0117800SCLA
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: Redness, swelling, warmth and pain at the site of injection.

VAERS ID:467086 (history)  Vaccinated:2012-09-28
Age:60.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-01, Days after onset: 2
Location:Florida  Entered:2012-10-01
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUH732AB IDRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0491AE0IDRA
Administered by: Unknown     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: Swelling, redness, pain at injection site.

VAERS ID:467087 (history)  Vaccinated:2012-09-28
Age:72.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-01, Days after onset: 1
Location:Texas  Entered:2012-10-01
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: HTN, osteoporosis, hypercoagulation
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1600AA0SCRA
Administered by: Military     Purchased by: Military
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: Erythema, painful, swelling about 2 cm x 5 cm in diameter area at injection site. Emerged about 48 hours after injection. Denies fever, other skin lesions or rashes, or any other symptoms.

VAERS ID:467094 (history)  Vaccinated:2012-09-28
Age:65.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Florida  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Mobility decreased, Pain
SMQs:, Parkinson-like events (broad)
Write-up: Severe pain; could not move arm for 4 days; did not respond to Tylenol.

VAERS ID:467097 (history)  Vaccinated:2012-09-28
Age:55.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-01, Days after onset: 1
Location:Oklahoma  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported.
Preexisting Conditions: The patient takes "allergy injections" each week. She is unsure of the contents of this injection, but has been taking it for 4 years.
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH734AA IMRA
Administered by: Public     Purchased by: Private
Symptoms: Rash erythematous, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Patient states she has raised red hive-like rash on her trunk area (stomach, back, arm pits, breasts). The rash itches. She asked if rash could be related to the flu vaccine, as she has had flu vaccines many years previously. She also had one of her "allergy injections" the day following the flu vaccine. She reported to me on 10/01/2012 around 3:00 PM, and had not treated the rash. She will take Benadryl. I told her to have the doctor look at the rash in case it is not an allergy.

VAERS ID:467100 (history)  Vaccinated:2012-09-28
Age:57.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-01, Days after onset: 1
Location:New York  Entered:2012-10-01
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 DIAGNOSTICS1203801 IMRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site warmth, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Rt arm tender, area around injection site firm to touch, hot to touch, and itchy. Area of redness approximately the size of a half-dollar around injection site.

VAERS ID:467108 (history)  Vaccinated:2012-09-28
Age:60.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Texas  Entered:2012-10-01
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: history of shingles twice
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0567AE0SCLA
Administered by: Other     Purchased by: Private
Symptoms: Abdominal discomfort, Feeling abnormal, Injection site erythema, Injection site mass, Injection site vesicles, Vaccination site warmth
SMQs:, Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Head felt "tight" 30 min after shot, patient felt like she was coming down with something, felt like she did before she came down with the shingles, vaccine site is red, lumpy and hot to the touch. Feels like a blister. Red around site the size of her palm. Stomach is upset.

VAERS ID:467119 (history)  Vaccinated:2012-09-28
Age:66.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Ohio  Entered:2012-10-01
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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4497AA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site vesicles, Injection site warmth, Pruritus, Skin tightness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: 1-2 hrs after High Dose flu shot tight hot redness -$g proceeded to vesicles around area - decreased symptoms increased itch by 10/2/12.

VAERS ID:467120 (history)  Vaccinated:2012-09-28
Age:53.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-29, Days after onset: 1
Location:Rhode Island  Entered:2012-10-01, 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: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AD IMAR
Administered by: Other     Purchased by: Other
Symptoms: Eye discharge, Fatigue, Pharyngeal oedema
SMQs:, Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: Patient received a flu shot on 9/28/12. She called the pharmacy 9/29 around 10 am. She said her throat started swelling 9/28 & her eyes were running green mucous, very tired. She took BENADRYL and is feeling better.

VAERS ID:467126 (history)  Vaccinated:2012-09-28
Age:77.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-01, Days after onset: 2
Location:New York  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Penicillin; Cephalosporins
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4493AA UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H010515 UNLA
Administered by: Other     Purchased by: Private
Symptoms: Condition aggravated, Convulsion, Loss of consciousness, Pruritus, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Patient reported waking up the day after both vaccinations with hives and itchy hands. Later that day patient passed out and was taken to hospital. Later that evening, patient had a seizure. Pt has past history of hives, but this was first seizure.

VAERS ID:467131 (history)  Vaccinated:2012-09-28
Age:46.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Texas  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No medications
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4247AA IMRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site swelling, Joint swelling, Lip swelling, Nausea, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Nauseated shortly after the shot, lips started swelling after about 30 minutes. Tongue swelling on (R) side, went to sleep about 6-7 pm woke up around tongue still swollen, increased swelling of tongue, around inj. site and left wrist. To ED around 11 pm.

VAERS ID:467275 (history)  Vaccinated:2012-09-28
Age:76.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-01, Days after onset: 2
Location:California  Entered:2012-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4491AA IMUN
Administered by: Unknown     Purchased by: Public
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Develop severe rash all over the body.

VAERS ID:467113 (history)  Vaccinated:2012-09-28
Age:27.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 4
Location:Maine  Entered:2012-10-02
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: My chest had cleared after a few hours, was given an inhaler and some Zyrtec to take over the next several Days.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Unknown     Purchased by: Public
Symptoms: Dysphonia, Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Hoarseness, wheezing and trouble breathing. Called my doctor and was told to go to the emergency room. Treatment was an inhaler and Zyrtec over the next few days.

VAERS ID:467154 (history)  Vaccinated:2012-09-28
Age:1.5  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-02, Days after onset: 3
Location:Washington  Entered:2012-10-02
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: no
Preexisting Conditions: mild speech delay
Diagnostic Lab Data: normal EEG, EKG, head CT
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC4154BA3IMRL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4483BA2IMLL
Administered by: Private     Purchased by: Public
Symptoms: Computerised tomogram head normal, Cyanosis, Electrocardiogram normal, Electroencephalogram normal, Oxygen saturation decreased, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt sitting in highchair, then went unresponsive x 30 sec and turned blue, then self resolved. Pt had 4 additional similar episodes that same day. One was witnessed by an ER nurse and one was witnessed by a hospital resident after the child was admitted to Hospital. One of the episodes was documented with a desaturation to 15%. All spontaneously resolved. The patient was admitted until 10/1/12 for observation. The last episode was 9/29/12 mid afternoon. The patient had normal EEG, normal EKG, and normal head CT. Neurology consult felt this was unlikely to be seizures, but no explanation was found. The patient was perfectly well inbetween the episodes. No labs were done. No history of trauma, illness, or ingestion. He was discharged home on an oximeter and will follow up in the office tomorrow.

VAERS ID:467242 (history)  Vaccinated:2012-09-28
Age:11.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-02, Days after onset: 4
Location:California  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H010123 IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Headache, Myalgia, Photophobia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad)
Write-up: Fever, myalgia, headache, photophobia with in 12 hours of vaccine administration.

VAERS ID:467260 (history)  Vaccinated:2012-09-28
Age:65.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 4
Location:D.C.  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: MULTIPLE SCLEROSIS
Diagnostic Lab Data: NONE CANNOT ENTER CORRECT INFO ON NEXT PAGE - THE VACCINE WAS INFLUENZA ZONE HIGH, MANUFACTURED BY SANOFI
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4499AA IMLA
Administered by: Other     Purchased by: Public
Symptoms: Chills, Headache, Insomnia, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: HEADACHE, NAUSEA, CHILLS, INSOMNIA UNTIL 10/01/2012. TOOK ADVIL (6 PILLS DAILY).

VAERS ID:467269 (history)  Vaccinated:2012-09-28
Age:7.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:California  Entered:2012-10-02, Days after submission: 1
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: None
Preexisting Conditions: Parent reports illness related asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ21060IN 
Administered by: Other     Purchased by: Public
Symptoms: Cough, Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: FLUMIST administered 9/28/12. That evening student began coughing. Throughout Sat. and Sun student was coughing, had wheezing and SOB. Admitted to hospital with SpO2 89-90. Released from hospital 10/1/12.

VAERS ID:467292 (history)  Vaccinated:2012-09-28
Age:10.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-01, Days after onset: 3
Location:Illinois  Entered:2012-10-02, 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: Environmental allergies; Tree nuts; Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH711AA8IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.H0126421IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Rash - area blotchy, redness around vaccine site, swollen, warm to touch, soreness.

VAERS ID:467313 (history)  Vaccinated:2012-09-28
Age:61.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-02, Days after onset: 3
Location:Florida  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICSP505082IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4170AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, Local swelling
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt. experienced localized swelling, redness and heat (R) side at injection site 15-24 hours after injection. After 4 doses of BENADRYL 25mg pt. no better and was seen by Dr. for eval and treat.

VAERS ID:467323 (history)  Vaccinated:2012-09-28
Age:67.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-02, Days after onset: 4
Location:Delaware  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H0125770SCUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site rash, Injection site swelling, Mass, Pain, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 9/28 pt developed a slight ache. Swollen and red spots (not raised) at injection site. 9/29 began to itch and pt noticed a lump. 9/30 sx''s disappeared but still warm to touch.

VAERS ID:467328 (history)  Vaccinated:2012-09-28
Age:5.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-02, Days after onset: 2
Location:California  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC4211AA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURH13403SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0686A1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Erythema, Tenderness
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Within 48 hours after receiving DTaP/IPV in (R) deltoid pt developed redness / tenderness & multiple large fluid filled blisters.

VAERS ID:467332 (history)  Vaccinated:2012-09-28
Age:79.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 4
Location:California  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204701 IMRA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Haemorrhage, Oedema peripheral, Pain in extremity, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, tenderness, pain, swelling & internal bleeding in upper arm.

VAERS ID:467341 (history)  Vaccinated:2012-09-28
Age:52.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-02, Days after onset: 2
Location:Tennessee  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: MIDDM; Hypertension; Hypercholesterol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0138470IMRA
Administered by: Private     Purchased by: Other
Symptoms: Headache, Oedema peripheral, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Low grade fever, headache, body aches. Swollen arm.

VAERS ID:467354 (history)  Vaccinated:2012-09-28
Age:48.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Washington  Entered:2012-10-02, 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:
Preexisting Conditions: Asthma; HTN; GERD; Fibromyalgia; Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH716AC IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H010515 IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4152AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Lymphadenopathy
SMQs:
Write-up: (L) axillary lymphadenopathy. Had Tdap and Flu shots given 9/28/12.

VAERS ID:467370 (history)  Vaccinated:2012-09-28
Age:31.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 4
Location:Pennsylvania  Entered:2012-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AD SYRAR
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia oral, Injection site warmth, Paraesthesia, Rash macular, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Red blotches on both arms. Hot injection site. Swollen tongue/numbness. Pins & needles in (L) gums & ear & throat. Signs after about 10 min BENADRYL after 20 minutes.

VAERS ID:467373 (history)  Vaccinated:2012-09-28
Age:72.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-02, Days after onset: 3
Location:Texas  Entered:2012-10-03, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies: PCN and Sulfa
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0135811IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site nodule, Injection site pain, Injection site swelling, Injection site warmth, Joint effusion, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: (R) deltoid pain, fever, swelling and a knot at injection site. Parasthesia in (R) hand. Erythema extended down arm from deltoid to elbow with soft fluid sac at elbow.

VAERS ID:467398 (history)  Vaccinated:2012-09-28
Age:29.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-02, Days after onset: 3
Location:California  Entered:2012-10-03, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: Patient sent to primary care provider.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12731P UNLA
Administered by: Public     Purchased by: Other
Symptoms: Lymphadenopathy
SMQs:
Write-up: Right side enlarged supraclavicular lymph node.

VAERS ID:467462 (history)  Vaccinated:2012-09-28
Age:41.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-03, Days after onset: 4
Location:Missouri  Entered:2012-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergies: Nuts Asthma Graves Disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11016010IMLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Induration, Injection site pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Intense itching at injection site. Induration of 3x3 area very red, hot and hard.

VAERS ID:467484 (history)  Vaccinated:2012-09-28
Age:24.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 5
Location:Maryland  Entered:2012-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER120452114IMRA
Administered by: Other     Purchased by: Private
Symptoms: Hypoaesthesia, Paraesthesia, Peripheral coldness
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Started with the hand of the injected arm going numb and feeling cool and tingly. This ascended up past the shoulder (at 4pm), up the neck(5:30 pm), and further to the level of nose (6pm). PCP instructed me to go the ER. ER had never seen this reaction before, but was unconcerned about it. Sent home with nothing. Overnight the symptoms started to recede. The next morning, approximately 21 hours post onset, only parts of the arm were still having the tingling numbness. Symptoms were fully resolved at 3pm on 9/29/12, approx. 25 hours post administration of influenza vaccine.

VAERS ID:467556 (history)  Vaccinated:2012-09-28
Age:39.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-28, Days after onset: 0
Location:Indiana  Entered:2012-10-04, 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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH759AB IMRA
Administered by: Private     Purchased by: Private
Symptoms: Dysphagia, Dysphonia, Feeling hot, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (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 (broad), Hypersensitivity (broad)
Write-up: Previous questionable reaction (itching, rash). 0935 - Premedicated with BENADRYL 25mg PO. 1010 - Vaccine administered. 1020 - Flushed/hot, difficulty swallowing. 1025 - Hoarse voice.

VAERS ID:467564 (history)  Vaccinated:2012-09-28
Age:25.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-04, Days after onset: 6
Location:Missouri  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4474AA0IDRA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Immediate post-injection reaction, Injection site erythema, Injection site induration, Injection site swelling, Maculopathy, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Retinal disorders (narrow), Hypersensitivity (narrow)
Write-up: Immediate redness, itchiness. After an hour arm became swollen at site. The next morning it continued to be red, with $g 7cm induration. On the 2nd day post vaccination arm had "bullseye" look as well. Symptoms were gone by day 6 post vaccination.

VAERS ID:467598 (history)  Vaccinated:2012-09-28
Age:70.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-04, Days after onset: 5
Location:Virginia  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:
Preexisting Conditions: Codeine Allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4489AA0IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0098260IMUN
Administered by: Other     Purchased by: Military
Symptoms: Chills, Freezing phenomenon, Headache, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Hypersensitivity (narrow)
Write-up: Fever of 103, feeling chills & freezing, severe pounding headache & rash covered the entire back of the arm. Patient visited doctor & got an injection (not sure which one) & felt better.

VAERS ID:467607 (history)  Vaccinated:2012-09-28
Age:39.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-04, Days after onset: 5
Location:California  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: HX MIGRAINE, LUPUS, HIP BURSITIS. NOT ACUTELY ILL
Preexisting Conditions: BACTRIM, BEXTRA, CIPRO, UNKNOWN IF MD DIAGNOSED
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA691BA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Injection site nodule, Migraine, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: FEVER CHILLS, BODY ACHES. KNOT TO LEFT DELTOID AT INJECTION SITE. PERSISTENT MIGRAINE HA THAT LASTED FOR 5 DAYS.

VAERS ID:467627 (history)  Vaccinated:2012-09-28
Age:5.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-04, Days after onset: 5
Location:Vermont  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B187AA IMUN
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4483AA7IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0497AE1SCUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0108531SCUN
Administered by: Private     Purchased by: Public
Symptoms: Injection site swelling, Lethargy, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: High fever & lethargy 24 hrs after. Urticaria 5 days after. Swollen IZ site.

VAERS ID:467699 (history)  Vaccinated:2012-09-28
Age:83.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-04, Days after onset: 5
Location:Colorado  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4491AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling of shoulder.

VAERS ID:467702 (history)  Vaccinated:2012-09-28
Age:52.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-04, Days after onset: 5
Location:California  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR    
Administered by: Unknown     Purchased by: Other
Symptoms: Erythema, Erythema of eyelid, Eyelid oedema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow)
Write-up: REDNESS, SWELLING LOWER EYELIDS, ITCHING, REDNESS, RASH AROUND NECK, MOSTLY ON LT SIDE OF THE NECK.

VAERS ID:467730 (history)  Vaccinated:2012-09-28
Age:6.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 5
Location:Wisconsin  Entered:2012-10-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B154BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURH13543SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0184AE1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Eye swelling, Injection site cellulitis, Injection site erythema, Injection site pain, Injection site swelling, Lacrimation increased, Nasal discomfort, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow)
Write-up: 9/28/12 Pt developed facial swelling, runny eyes, swollen eyes, and a "funny sensation" to her nose after received Dtap, IPOL, MMR vaccines. Went to ER. 10/1/12 Later in day - mom reports (L) upper arm swelling, redness, pain 2" x 2" = cellulitis per walk in MD.

VAERS ID:467766 (history)  Vaccinated:2012-09-28
Age:32.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 4
Location:Unknown  Entered:2012-10-04, 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:
Preexisting Conditions: No Known Drug Allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12261P SYRUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site discolouration, Injection site erythema, Injection site haematoma, Injection site swelling, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt given flu shot 9-28-12, lot number: Company: Novartis NDC 66521-0115-02 had temp at site of injection with contusion, skin discoloration, redness, soft tissue swelling Lt deltoid at site of injection on evening of 9/28/12. Tx with ice and warm packs until seen 10/1/12. Pt with hx of brain tumor, surgery, chemotherapy that was completed <1 yr ago.

VAERS ID:467772 (history)  Vaccinated:2012-09-28
Age:43.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-04, Days after onset: 4
Location:North Carolina  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to PCN & codeine
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B093BA0UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site pain, Pain in extremity, Poor quality sleep
SMQs:, Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad)
Write-up: 2 days after vaccine given - whole (L) arm was painful from shoulder to fingers 8 (1-10). TYLENOL X-strength muscle cream. Heating - helped some. Did not sleep well x 4 nights. Pain continued for 4 days.

VAERS ID:472693 (history)  Vaccinated:2012-09-28
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2012-10-04
Location:Unknown  Entered:2012-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA001772
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: This spontaneous report as received from a other health professional refers to a patient of unknown age. The patient was vaccinated with dose 2, 1 DF PNEUMOVAX 23 on 28-SEP-2012. No other co-suspects were reported. No concomitant medications were reported. On an unknown date the patient experienced inappropriate schedule of drug administration. No treatment information was reported. The outcome of inappropriate schedule of drug administration was reported as not recovered/not resolved. Inappropriate schedule of drug administration is not related to PNEUMOVAX 23. {Additional information has been requested. Additional information is not expected.}

VAERS ID:467784 (history)  Vaccinated:2012-09-28
Age:58.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-05, Days after onset: 7
Location:Minnesota  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA695BA1IMAR
Administered by: Other     Purchased by: Private
Symptoms: Oedema peripheral, Pain in extremity, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Arm was sore 9/28/12, on the evening. Noticed on 10/1/12, after he woke up, that his arm was swollen. Had itching on top of head & below ears on 10/1/12. Right hand swollen. He used iced pack & that reduced swelling.

VAERS ID:467787 (history)  Vaccinated:2012-09-28
Age:12.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 7
Location:Ohio  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.J2025 IN 
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSHAVB515BA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0840AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSC52B088AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient received Tdap, HPV, Hep A, and Flu Mist. Patient experienced a syncopal episode. Duration 2-3 minutes. No injury occurred.

VAERS ID:467817 (history)  Vaccinated:2012-09-28
Age:78.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-05, Days after onset: 7
Location:Texas  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0069AE SCLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site joint pain, Myalgia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Joint pain in arm where injection was given. Generalized muscle aches and pains. Generalized tremors.

VAERS ID:467842 (history)  Vaccinated:2012-09-28
Age:42.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-05, Days after onset: 7
Location:Illinois  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Cheilitis, Cough, Dry throat, Hypoaesthesia oral, Ocular hyperaemia, Rash, Rash erythematous, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Throat became dry and irritated lips became numb started to cough was wheezing eyes became very very red the next day had a red rash over my neck and trunk.

VAERS ID:467847 (history)  Vaccinated:2012-09-28
Age:66.0  Onset:2012-10-01, Days after vaccination: 3
Gender:Male  Submitted:2012-10-05, Days after onset: 4
Location:New Jersey  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4493AA0IMAR
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Diarrhea.

VAERS ID:467851 (history)  Vaccinated:2012-09-28
Age:73.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-28, Days after onset: 0
Location:Colorado  Entered:2012-10-05, 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: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4489AA UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.C556AE UNRA
Administered by: Other     Purchased by: Private
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (broad)
Write-up: Sharp pain bilaterally to lower back pain lasting 5-10 minutes. Gave 50g BENADRYL.

VAERS ID:467852 (history)  Vaccinated:2012-09-28
Age:27.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-09-28, Days after onset: 0
Location:Florida  Entered:2012-10-05, 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: None
Diagnostic Lab Data: 2 X-rays left arm - no needle seen
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH734AB0SYRLA
Administered by: Other     Purchased by: Other
Symptoms: Needle issue, X-ray limb normal
SMQs:
Write-up: Gave pt. flu injection, removed needle from lt. arm. No needle on end of syringe, looked on floor, near vicinity - no needle seen. Marked site on arm, sent pt. to Urgent Care for x-ray.

VAERS ID:467857 (history)  Vaccinated:2012-09-28
Age:47.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Minnesota  Entered:2012-10-05, Days after submission: 4
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 PASTEURUH719AA4IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Feeling hot, Flushing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Patient got the flu shot in her right arm. About an hour later, she felt "warm, flush" all over her body. Her face was very red. She took TYLENOL, she eventually felt better.

VAERS ID:468005 (history)  Vaccinated:2012-09-28
Age:60.0  Onset:2012-10-01, Days after vaccination: 3
Gender:Female  Submitted:2012-10-05, Days after onset: 4
Location:North Carolina  Entered:2012-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pt c/o increase redness, itching, edema at injection site that lasted several days that increased to 3"
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4467AA0IDRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site pruritus, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Increase redness, itching, edema, warm to touch.

VAERS ID:468023 (history)  Vaccinated:2012-09-28
Age:48.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-06, Days after onset: 6
Location:New Jersey  Entered:2012-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: nka
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT446BA IDRA
Administered by: Other     Purchased by: Private
Symptoms: Contusion, Erythema, Local reaction, Skin warm, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Exaggerated localized reaction. 6x6 inch bruise that was hot, red, swollen, and tender.

VAERS ID:468037 (history)  Vaccinated:2012-09-28
Age:64.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-06, Days after onset: 8
Location:Colorado  Entered:2012-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204521 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vomiting and H/A at pain level of 8. Lasted until 9/30. Treated with Midrin and APAP.

VAERS ID:468286 (history)  Vaccinated:2012-09-28
Age:4.0  Onset:2012-10-05, Days after vaccination: 7
Gender:Female  Submitted:2012-10-06, Days after onset: 1
Location:Minnesota  Entered:2012-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CBC - WBC 6,800 (47%, PMN, 37% Lym); Hgb 10/6; Platelet 220,000
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ20240IN 
Administered by: Private     Purchased by: Private
Symptoms: Haemoglobin normal, Lymphocyte percentage, Neutrophil percentage decreased, Pain, Platelet count normal, Rash, Vasculitic rash, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Vasculitis (narrow), Hypersensitivity (narrow)
Write-up: Mother noted aches and pain on 10/5/12 and vasculitis rash lower extremities 10/6/12 where clothes bind, ankle, knee, inner thighs.

VAERS ID:468048 (history)  Vaccinated:2012-09-28
Age:11.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-07, Days after onset: 7
Location:Illinois  Entered:2012-10-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Other
Symptoms: Diarrhoea, Headache, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Diarrhea, headache, fever (101.7), severe lethargy. This lasted for 2 days and then she started experiencing headaches and fever again on 10/05/2012.

VAERS ID:468265 (history)  Vaccinated:2012-09-28
Age:68.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 5
Location:New York  Entered:2012-10-08, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA739AA UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Acne, Erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 4 puffy red welts about 1 inch each across upper chest and neck as well as whiteheaded small pimples. Extremely itchy. Also in b/of right arm near elbow.

VAERS ID:470026 (history)  Vaccinated:2012-09-28
Age:1.6  Onset:2012-09-28, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-08, Days after onset: 10
Location:Unknown  Entered:2012-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA002160
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0051AE0PO 
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: This spontaneous report as received from a registered nurse refers to an 18 months old patient. The patient was vaccinated with the first and only dose of live, oral, ROTATEQ (lot number not provided) oral on 28-SEP-2012 when the patient was "one year and six months old". No other co-suspects were reported. No concomitant medications were reported. No adverse effect reported. It was unspecified if the patient had sought medical attention. Additional information has been requested.

VAERS ID:468417 (history)  Vaccinated:2012-09-28
Age:5.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-09, Days after onset: 11
Location:Minnesota  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Angelman Syndrome; Developmental delay; Central precocious puberty
Diagnostic Lab Data: xray of leg normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH746AC6IMLL
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0843AA0IMLL
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Pyrexia, X-ray limb normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left thigh redness, swelling and pain increasing over 2 days, fever, treated with antibiotics for possible cellulitis.

VAERS ID:468418 (history)  Vaccinated:2012-09-28
Age:1.0  Onset:2012-10-07, Days after vaccination: 9
Gender:Female  Submitted:2012-10-09, Days after onset: 2
Location:New York  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNLL
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNRL
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site rash, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Swollen, warm bumpy rash on her thigh.

VAERS ID:468470 (history)  Vaccinated:2012-09-28
Age:69.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Sed rate, 33; CRP, 17
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Arthralgia, C-reactive protein increased, Erythema, Joint swelling, Pain in extremity, Red blood cell sedimentation rate increased
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad)
Write-up: Pain started in left arm & moved to right arm on 9/30/12 joints in hands, wrist were swollen, achy & red. Gradually dissipated was completely resolved by 10/3/12.

VAERS ID:468504 (history)  Vaccinated:2012-09-28
Age:41.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-09, Days after onset: 10
Location:Illinois  Entered:2012-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0115530SCRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site pain, Injection site swelling, Injection site urticaria, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt. received Varicella vaccine 9/28/12 at 830 AM. On 9/29/12 at 1 PM her (R) upper arm developed large (30 mm) hive with heat, swelling and tenderness that lasted approximately 24 hours and resolved w/ BENADRYL and ice pack. H/O varicella as child but no documented proof from MD.

VAERS ID:468729 (history)  Vaccinated:2012-09-28
Age:47.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-10, Days after onset: 12
Location:Indiana  Entered:2012-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1221030UNRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pain, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Rash, red hives, itching. Took CLARITIN & BENADRYL. Body ached.

VAERS ID:468762 (history)  Vaccinated:2012-09-28
Age:1.9  Onset:0000-00-00
Gender:Female  Submitted:2012-10-10
Location:Kansas  Entered:2012-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ2106 IN 
Administered by: Private     Purchased by: Unknown
Symptoms: Incorrect dose administered
SMQs:
Write-up: Patient received a flu vaccine at the County Health Dept 9-24-12. While with father and stepmother, she received another flu vaccine from Dr.''s office on 9-28-12.

VAERS ID:468764 (history)  Vaccinated:2012-09-28
Age:5.0  Onset:0000-00-00
Gender:Male  Submitted:2012-10-10
Location:Kansas  Entered:2012-10-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  SYRUN
Administered by: Private     Purchased by: Unknown
Symptoms: Incorrect dose administered
SMQs:
Write-up: Patient was given a FLUMIST at the County Health Dept on 9-24-12. While with his father & stepmother, he received a flu vaccine injection on 9-28-12.

VAERS ID:468994 (history)  Vaccinated:2012-09-28
Age:16.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-09-28, Days after onset: 0
Location:Utah  Entered:2012-10-10, 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: Pt felt well prior to
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12050011UNRA
Administered by: Other     Purchased by: Public
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: After receiving immunization, pt temporarily lost consciousness upon standing.

VAERS ID:469033 (history)  Vaccinated:2012-09-28
Age:63.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-02, Days after onset: 4
Location:New York  Entered:2012-10-10, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy - sulfa; High cholesterol; Osteopenia; Jaw pain
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)SANOFI PASTEURH10914IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Oxygen saturation decreased, Pallor
SMQs:, Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: I felt lightheaded. Nurse said I turned pale. Asked me to take a juice box, eat crackers. Meanwhile a nurse took my blood pressure: Started at 170/90, 5 min later 150/80 & when I left. 120/60. My oxygen had dropped to 75 - back to 93 ", pulse 88 to 80. Took about 45 min to feel ok.

VAERS ID:469045 (history)  Vaccinated:2012-09-28
Age:82.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-03, Days after onset: 5
Location:Idaho  Entered:2012-10-10, 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 knowledge of any
Diagnostic Lab Data: Specifics unknown - vital signs and EKG normal per ER MD.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4492BA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Bronchospasm, Dyspnoea, Electrocardiogram normal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Patient was given FLUZONE-HD at 2:21 PM on 9/28/12, appeared normal after 20 minutes, and was sent home. The patient entered the Emergency Dept. around 7:30 that evening experiencing shortness of breath and subjective bronchospasms. The patient then experienced syncope. EKG and vital signs appeared normal and patient was discharged after a couple of hours.

VAERS ID:469116 (history)  Vaccinated:2012-09-28
Age:11.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-28, Days after onset: 0
Location:Florida  Entered:2012-10-10, Days after submission: 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH715AB4UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0113500UNRA
Administered by: Private     Purchased by: Private
Symptoms: Face injury, Loss of consciousness, Suture insertion
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt. passed out while checking out. When she passed out she hit her chin on the counter. Pt. had to go to the ER for stitches.

VAERS ID:468971 (history)  Vaccinated:2012-09-28
Age:92.0  Onset:2012-10-10, Days after vaccination: 12
Gender:Female  Submitted:2012-10-11, Days after onset: 1
Location:Maine  Entered:2012-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Biaxin, Bactrim, Tetanus, Penicillin, Zithromax, Ceftin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH715AB IM 
Administered by: Private     Purchased by: Other
Symptoms: Pain, Pain in extremity
SMQs:
Write-up: Body aches, legs are achy.

VAERS ID:469214 (history)  Vaccinated:2012-09-28
Age:5.0  Onset:2012-10-10, Days after vaccination: 12
Gender:Male  Submitted:2012-10-11, Days after onset: 1
Location:Nevada  Entered:2012-10-11
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
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B157BA SYRRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H011087 SYRRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Patient developed what appears to be localized untreated rash with some mild induration about 12 days after vaccines. Exactly around injection site.

VAERS ID:469307 (history)  Vaccinated:2012-09-28
Age:83.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-12, Days after onset: 14
Location:Georgia  Entered:2012-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: injured knee
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4493AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: FEVER AND CHILLS. ADMITTED TO HOSPITAL 10/3/2012.

VAERS ID:469496 (history)  Vaccinated:2012-09-28
Age:30.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-09, Days after onset: 10
Location:Colorado  Entered:2012-10-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH733AC0SYRRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: - Warm & redness at injection site x 1 day post injection. - Soreness at injection site x 3 days post injection.

VAERS ID:469501 (history)  Vaccinated:2012-09-28
Age:26.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 10
Location:New York  Entered:2012-10-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hypertension - taking ramipril
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP583060IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Sensation of heaviness, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: C/o heaviness to both legs. Scratchy throat, tightening up. Escorted to Emergency Dept. Started on prednisone by mouth.

VAERS ID:469502 (history)  Vaccinated:2012-09-28
Age:56.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 10
Location:New York  Entered:2012-10-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hypertension - taking Ramipril
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12231P0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Upper lip swelling. Treatment in ER: Prednisone 20mg Tab BENADRYL Allergy 25mg capsule. Recovered.

VAERS ID:469757 (history)  Vaccinated:2012-09-28
Age:53.0  Onset:2012-10-01, Days after vaccination: 3
Gender:Female  Submitted:2012-10-12, Days after onset: 11
Location:Ohio  Entered:2012-10-12
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
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0598AE0SCLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Patient developed a headache and a shingles-like rash on forehead.

VAERS ID:469406 (history)  Vaccinated:2012-09-28
Age:2.0  Onset:2012-10-07, Days after vaccination: 9
Gender:Male  Submitted:2012-10-13, Days after onset: 6
Location:Connecticut  Entered:2012-10-13
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Vitiligo
Diagnostic Lab Data: EEG normal. Electrolytes, hemoglobin, hematocrit, BUN and creat normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ21080IN 
Administered by: Private     Purchased by: Other
Symptoms: Blood creatinine normal, Blood electrolytes normal, Blood urea normal, Body temperature increased, Convulsion, Cough, Electroencephalogram normal, Haematocrit normal, Haemoglobin normal, Throat irritation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: On 10/3 patient had temp 100.6 and started cough for 24 hours then back to normal. Daughter had first seizure on 10/7, unresponsive for 10 seconds. No fever and no prior history of seizures, seen in emergency room and sent home with no treatment. On 10/9 experienced another seizure and was seen in ED, labs normal and EEG normal, sent home with a follow up neuro appt. 10/11 cough worsening, scratchy throat. 10/12 temp 99.9.

VAERS ID:469425 (history)  Vaccinated:2012-09-28
Age:63.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-13, Days after onset: 14
Location:Minnesota  Entered:2012-10-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH716AA0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Pruritus generalised, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Systemic rash on scalp, upper thigh, and inside of upper arms. General itchiness on entire body. On 10/06/12 went to pharmacy and pharmacist recommended oral Diphenhydramine HCL 25 mg tablets, Benadryl (2% w/v diphenhydramine hydrochloride 1% w/v xinc acetate) topical spray, and .5% hydrocortisone cream applied to affected areas. On 10/12/2012 visited doctor and he prescribed Betamethasone Valerate Cream .1% as a stronger med. Symptoms are still present today.

VAERS ID:469658 (history)  Vaccinated:2012-09-28
Age:52.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-13, Days after onset: 15
Location:Utah  Entered:2012-10-13
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: Osteoporosis; Acid reflux; Sleep disorder; Hyperlipidemia; Hernia in disc
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA708AB0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad)
Write-up: The night of injection her left arm hurt. It has hurt constantly since that day. Pt says she tries not to move her arm because it hurts. She states she cannot lie directly on the arm since it hurts.

VAERS ID:469746 (history)  Vaccinated:2012-09-28
Age:26.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-11, Days after onset: 12
Location:Michigan  Entered:2012-10-13, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; PCOS
Diagnostic Lab Data: Lab/Tests N/A; Per patient per doctor - allergy to suspension from shot.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH713AB8IMLA
Administered by: Other     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Patient developed rash on torso. Patient contacted her personal physician and took BENADRYL according to doctors instructions with follow up appt on 10/7/12. Dr. provided steroid shot. Patient took ALLEGRA then BENADRYL with no relief.

VAERS ID:469446 (history)  Vaccinated:2012-09-28
Age:62.0  Onset:2012-10-06, Days after vaccination: 8
Gender:Male  Submitted:2012-10-14, Days after onset: 8
Location:Oregon  Entered:2012-10-14
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: prior allergic reactions to sulfa-based drugs and doxycycline
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Headache, Myalgia, Pyrexia, Rash pruritic, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Headache, muscle pains, and fever for 2-3 days, treated with aspirin. A few days later, itchy rash and hives on chest and back, treated with antihistamines.

VAERS ID:469848 (history)  Vaccinated:2012-09-28
Age:64.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-02, Days after onset: 3
Location:Massachusetts  Entered:2012-10-15, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H0121380SCUN
Administered by: Other     Purchased by: Unknown
Symptoms: Photopsia
SMQs:, Retinal disorders (narrow)
Write-up: Patient reported seeing flashes of light in their peripheral vision the next day.

VAERS ID:469850 (history)  Vaccinated:2012-09-28
Age:62.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-08, Days after onset: 10
Location:Alabama  Entered:2012-10-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12067010IMRA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H0114270SCLA
Administered by: Other     Purchased by: Private
Symptoms: Headache, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient developed soreness, swelling, and itching at site of injection. Also had headache every day for 10 days.

VAERS ID:469919 (history)  Vaccinated:2012-09-28
Age:68.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-12, Days after onset: 14
Location:California  Entered:2012-10-15, Days after submission: 3
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: Penicillin and Codeine; S/P Stroke (2002); Depression; S/P Breast CA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4489AA UNRA
Administered by: Other     Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Onset 3-4 after vaccine administration: developed fever and chills (after shower). Pt began having trouble breathing (slight heavier breathing than normal) for about 1 hour, pt possibly anxious. Fine next morning.

VAERS ID:470051 (history)  Vaccinated:2012-09-28
Age:54.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-13, Days after onset: 14
Location:Florida  Entered:2012-10-15, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1204901 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Monoplegia, Musculoskeletal pain, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Extravasation events (injections, infusions and implants) (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad)
Write-up: Shot administered in left arm 9-28-12. Day after shot, patient reported arm become painful and sore and red at injection site. Pain extended down arm to finger tips and up to neck/shoulder area. Arm felt paralyzed. Recovered after 2-3 days.

VAERS ID:473327 (history)  Vaccinated:2012-09-28
Age:62.0  Onset:2012-10-04, Days after vaccination: 6
Gender:Male  Submitted:2012-10-15, Days after onset: 11
Location:Pennsylvania  Entered:2012-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA005393
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H011427 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: This spontaneous report as received from a 62 years old male consumer with "Donatell" allergy reporting on himself. The patient was vaccinated with a dose of ZOSTAVAX (dose, route and lot # not reported) on 28-SEP-2012. No other co-suspects were reported. No concomitant medications were reported. On 04-OCT-2012, the patient experienced joint pain in his upper shoulders, knees and upper arms, and red raised rash 3/4 in length and half inch in width on the same arm, however it was the opposite side of the injection site. No treatment information was reported. The patient did not seek medical attention. No labs/diagnostic studies were performed. The outcome of the events was not reported. The consumer stated he did not associated his joint pain at first with taking the ZOSTAVAX, but now after reading the add, the consumer felt his joint pain was a side effect of the vaccine. The relationship between red raised rash 3/4 in length and half inch in width on the same arm and ZOSTAVAX was not reported. Additional information has been requested.

VAERS ID:469787 (history)  Vaccinated:2012-09-28
Age:51.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-16, Days after onset: 18
Location:North Dakota  Entered:2012-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: IV contrast
Diagnostic Lab Data: Thus far only exam and x-rays. Scheduling an MRI.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED  SYRLA
Administered by: Other     Purchased by: Other
Symptoms: Injected limb mobility decreased, Injection site pain, Insomnia, X-ray
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Received injection of flu vaccine in left shoulder. Have pain in that shoulder since that time. Restricted movement in left arm. Seems to be getting progressively worse. Unable to sleep at night due to pain.

VAERS ID:469883 (history)  Vaccinated:2012-09-28
Age:77.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-03, Days after onset: 5
Location:Colorado  Entered:2012-10-16, Days after submission: 13
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: Pregabalin; Tetracycline; Neomycin (mild)
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4498BA UNLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pruritus, Injection site swelling, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 10/2/12 patient reported that shortly after receiving her vaccination on 9/28/12 she developed a local reaction at the site some swelling, itching, skin warmth. Over the course from 9/28 to 10/2 the swelling remained constant but the itching worsened. I instructed her to take some OTC diphenhydramine prn and put ice on the area and asked her to report back in 1-2 days with her condition.

VAERS ID:469926 (history)  Vaccinated:2012-09-28
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-16
Location:Washington  Entered:2012-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Unknown
Diagnostic Lab Data: Dr Visit has not occurred, but has been scheduled.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH729AA IM 
Administered by: Private     Purchased by: Other
Symptoms: Activities of daily living impaired, Hypoaesthesia, Mobility decreased, Pain
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad)
Write-up: Stated I got my flu shot during the flu clinic about 2 weeks ago and ever since then I have had very limited range of motion in my arm. I gave it a couple days, since I usually have a sore arm for a couple days after getting vaccines, but it seems like the problem is getting worse rather than better. It really hurts to lift my left arm over my head or towards my midline. At times, my little/ring finger goes to sleep. I''ve tried icing/heating my shoulder and have been taking Ibuprofen and Tylenol as needed for the pain. It didn''t hurt terribly when I got the shot, but progressively has gotten worse. My only concern is that I had a hard time doing simple things at work, i.e. helping move someone up in bed, reaching for pillows on the top shelf, moving beds around.

VAERS ID:469927 (history)  Vaccinated:2012-09-28
Age:50.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-16
Location:Washington  Entered:2012-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH729AA IM 
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash. Being treated by provider with predinsone.

VAERS ID:470393 (history)  Vaccinated:2012-09-28
Age:1.3  Onset:2012-10-01, Days after vaccination: 3
Gender:Female  Submitted:2012-10-17, Days after onset: 16
Location:Pennsylvania  Entered:2012-10-17
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: Epidermal nevus
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4275AA3IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHG107843IMRL
Administered by: Private     Purchased by: Private
Symptoms: Febrile convulsion, Otitis media
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Patient experienced a brief simple febrile seizure 48 hrs after immunization. Seen in ER diagnosed with feb. seizure & OM.

VAERS ID:470306 (history)  Vaccinated:2012-09-28
Age:3.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-18, Days after onset: 20
Location:Alabama  Entered:2012-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE AT THE TIME
Preexisting Conditions: NONE
Diagnostic Lab Data: BLOOD ALLERGY TEST DONE ON 10/17/2012; CHEST XRAY ON 10/15/2012; EPI PEN INJECTION DONE ON 10/15/2012
CDC Split Type:
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC. 1IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Allergy test, Chest X-ray, Cough, Pyrexia, Rhinorrhoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: HIVES, COUGHING, RUNNY NOSE, FEVER LASTING FOR 3 WEEKS NOW AND STILL GOING.

VAERS ID:470512 (history)  Vaccinated:2012-09-28
Age:57.0  Onset:2012-10-01, Days after vaccination: 3
Gender:Female  Submitted:2012-10-10, Days after onset: 9
Location:California  Entered:2012-10-18, 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:
Preexisting Conditions: None known allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBV0C046CA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 3 days after injection developed headache x 4 d. followed by erythematous rash of upper body x 2 after headache.

VAERS ID:470577 (history)  Vaccinated:2012-09-28
Age:63.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-19, Days after onset: 20
Location:Hawaii  Entered:2012-10-19
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: Allergic to cats, peanuts, bermuda grass
Diagnostic Lab Data: Optometrist determined allergic reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR03901IMLA
Administered by: Other     Purchased by: Private
Symptoms: Eye pruritus, Eye swelling, Hypersensitivity, Ocular hyperaemia, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Hypersensitivity (narrow)
Write-up: Itching red swollen eye, pain in arm.

VAERS ID:470592 (history)  Vaccinated:2012-09-28
Age:42.0  Onset:2012-10-05, Days after vaccination: 7
Gender:Female  Submitted:2012-10-19, Days after onset: 14
Location:Indiana  Entered:2012-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough/upper respiratory illness, mold
Preexisting Conditions: None
Diagnostic Lab Data: Biopsy pending to confirm psoriasis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEUR  IDRA
Administered by: Public     Purchased by: Private
Symptoms: Psoriasis, Rash erythematous, Rash pruritic, Skin plaque
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash. Erythematous, plaques, pruritic, on extensor surfaces of elbows, anterior ankles, extensor knees, wrists, and medial fingers, suspect psoriasis. No previous hx.

VAERS ID:475633 (history)  Vaccinated:2012-09-28
Age:  Onset:2012-09-28, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-19, Days after onset: 21
Location:Pennsylvania  Entered:2012-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA008713
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1522AA IMUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report was received from an office manager refers to a patient of unknown age who on 28-SEP-2012, was vaccinated with a dose of RECOMBIVAX HB (lot number 671326/1522AA) (dose and route not reported) that was improperly stored. No symptoms reported. This is one of several reports from the same source. Additional information has been requested.

VAERS ID:470620 (history)  Vaccinated:2012-09-28
Age:70.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-10-20, Days after onset: 21
Location:Georgia  Entered:2012-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None mentioned
Preexisting Conditions: None mentioned
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4493AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Asthenia, Disorientation, Dizziness, Fall, Malaise, Thinking abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Vestibular disorders (broad)
Write-up: Patient got very dizzy and disoriented and fell into bathtub. Could not get out without assistance because he could not think straight. This resolved after a few hours. He felt very weak and ill for a week.

VAERS ID:470974 (history)  Vaccinated:2012-09-28
Age:59.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-22
Location:California  Entered:2012-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4466BA IDRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This patient is one of a cluster of 15 patients that had an injection site reaction characterized by erythema, pruritus and nodule at the injection site. Lasted 24 hrs to 1 week. No treatment given.

VAERS ID:470976 (history)  Vaccinated:2012-09-28
Age:42.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-22
Location:California  Entered:2012-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4466BA IDRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This patient is one of a cluster of 15 patients that had an injection site reaction characterized by erythema, pruritus & nodule at the injection site. Lasted 14 hrs to 1 week. No treatment given.

VAERS ID:470980 (history)  Vaccinated:2012-09-28
Age:30.0  Onset:0000-00-00
Gender:Male  Submitted:2012-10-22
Location:California  Entered:2012-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4466BA IDLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site nodule, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This patient is one of a cluster of 15 patients that had an injection site reaction characterized by erythema, pruritus & nodule at the injection site. Lasted 24 hrs to 1 week. No treatment given.

VAERS ID:471049 (history)  Vaccinated:2012-09-28
Age:72.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-23, Days after onset: 24
Location:South Carolina  Entered:2012-10-23
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
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H0114310SCLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: SORENESS & ACHING OF LEFT UPPER ARM WHERE VACCINE WAS GIVEN.

VAERS ID:471072 (history)  Vaccinated:2012-09-28
Age:51.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-23, Days after onset: 25
Location:California  Entered:2012-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH747 IMLA
Administered by: Public     Purchased by: Other
Symptoms: Drug administered at inappropriate site, Feeling abnormal, Mobility decreased, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Parkinson-like events (broad)
Write-up: Shoulder aches, hard to lift arm, going on 4th week now. I get the flu shot every year (I work in the hospital) and never had a reaction, but this year, I felt it was strange the minute she gave it to me, I felt it was too high. I think better education needs to be given for administrators.

VAERS ID:471274 (history)  Vaccinated:2012-09-28
Age:46.0  Onset:2012-10-14, Days after vaccination: 16
Gender:Female  Submitted:2012-10-24, Days after onset: 10
Location:Illinois  Entered:2012-10-24
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Upper respiratory complaints (bronchitis), diarrhea
Preexisting Conditions: History of Bell''s Palsy
Diagnostic Lab Data: Neutrophils 79; Eosinophils 10
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12265P IMUN
Administered by: Other     Purchased by: Other
Symptoms: Abasia, Blood pressure increased, Endotracheal intubation, Eosinophil percentage increased, Muscular weakness, Neutrophil percentage increased, Paraesthesia, Paralysis, Plasmapheresis
SMQs:, Rhabdomyolysis/myopathy (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad)
Write-up: Tingling in lower legs, weakness in lower extremities, unable to walk, elevated blood pressure, paralaysis, patient intubated and received plasmapheresis.

VAERS ID:471285 (history)  Vaccinated:2012-09-28
Age:34.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-24, Days after onset: 24
Location:Arizona  Entered:2012-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDU3840 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Patient came to RPh to let him know that she had a reaction to flu shot. Her arm was red and itched. She felt it was warm as well. She was given Benadryl cream to apply to it and it went away in less that 24 hours.

VAERS ID:471444 (history)  Vaccinated:2012-09-28
Age:59.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-01, Days after onset: 3
Location:Michigan  Entered:2012-10-24, Days after submission: 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSFLUA706BA IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4247AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: (R) deltoid area red, and sore. Had low grade temp of 99 degrees during the weekend. Rx KEFLEX 500 mg 1 po QID x 7d. Dx: cellulitis.

VAERS ID:471603 (history)  Vaccinated:2012-09-28
Age:66.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-10-24, Days after onset: 25
Location:Washington  Entered:2012-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None contributing to symptoms
Diagnostic Lab Data: EKG was within normal limits.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H010515 UNRA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0069AE UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Electrocardiogram normal, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient has significant pain in (R) deltoid. She reports pneumonia vaccine and ZOSTAVAX were given there Sept 28, 2012 at health center.

VAERS ID:471606 (history)  Vaccinated:2012-09-28
Age:7.0  Onset:0000-00-00
Gender:Male  Submitted:2012-10-24
Location:Washington  Entered:2012-10-24
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC4050AA4IMLL
Administered by: Private     Purchased by: Unknown
Symptoms: Drug administered to patient of inappropriate age
SMQs:
Write-up: None stated.

VAERS ID:472427 (history)  Vaccinated:2012-09-28
Age:18.0  Onset:2012-10-02, Days after vaccination: 4
Gender:Male  Submitted:2012-10-24, Days after onset: 22
Location:Florida  Entered:2012-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug hypersensitivity
Preexisting Conditions: Wisdom teeth removal
Diagnostic Lab Data:
CDC Split Type: WAES1210USA003661
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, No adverse event, Throat irritation
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This spontaneous report as received from a consumer refers to her son, a 18 years old male patient with allergy for sulfa drugs. The patient''s medical history included wisdom teeth removal. The patient was vaccinated with dose 1, 0.5 ml GARDASIL intramuscularly (IM) in March 2012, as part of a 3 dose series of injections. Lot number was not reported. The patient used no concomitant medications. After the first 2 injections the patient did not experience any adverse event. On 28-SEP-2012 the patient received the third and final dose of GARDASIL 0.5 ml IM (lot # not reported). On 02-OCT-2012, after the third injection, the patient developed pain in his upper right abdomen. He also mentioned his throat was bothering him and he did not want to eat because of the irritation. The reporter had not spoken to the patient''s doctor yet, but planned to do so. No treatment was provided for the events. At the time of report the patient had not recovered. The relatedness for the events was not reported for GARDASIL. Additional information has been requested.

VAERS ID:471653 (history)  Vaccinated:2012-09-28
Age:76.0  Onset:2012-10-10, Days after vaccination: 12
Gender:Female  Submitted:2012-10-25, Days after onset: 15
Location:Kansas  Entered:2012-10-25
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: Unknown - none listed
Diagnostic Lab Data: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH717AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Abdominal discomfort, Chills, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Upset stomach, chills, body aches, queasy "felt it go through her after she got it."

VAERS ID:472127 (history)  Vaccinated:2012-09-28
Age:13.0  Onset:2012-10-15, Days after vaccination: 17
Gender:Female  Submitted:2012-10-25, Days after onset: 10
Location:Tennessee  Entered:2012-10-29, 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: None
Diagnostic Lab Data: To see Neurologist 11/29/2012
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH747AB IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0628AE1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0636AE1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Ear pain, Urinary tract infection, VIIth nerve paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: 2 week hx right facial paralysis. Preceded by URI symptoms and mild right ear pain. Flu, Hep A & HPV shots 1-2 weeks prior to symptoms. Previous flu shots, Hep A & HPV without problems. Wears glasses. Bell''s Palsy handout given. Eye care/protection discussed, VAERS given. F/U no improvement referral - Neurology.

VAERS ID:474670 (history)  Vaccinated:2012-09-28
Age:  Onset:2012-09-28, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-29, Days after onset: 31
Location:Unknown  Entered:2012-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA000290
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report was received from a physician refers to a patient of unknown age (gender unspecified). On 14-SEP-2012, the patient was vaccinated with dose 1 ROTATEQ (Lot# and route not reported). No concomitant medications were reported. On 28-SEP-2012, the patient was vaccinated with second dose of ROTATEQ (Lot# and route not reported). No adverse symptoms were reported. Additional information has been requested.

VAERS ID:474680 (history)  Vaccinated:2012-09-28
Age:  Onset:2012-09-28, Days after vaccination: 0
Gender:Unknown  Submitted:2012-10-29, Days after onset: 31
Location:Unknown  Entered:2012-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA000560
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1778Y1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:
Write-up: This spontaneous report was received from a registered nurse refers to a patient of unknown age and gender. The patient was vaccinated with expired dose 2 GARDASIL (lot # 666121/1778Y) expiration date 19-AUG-2012) (dose and route not reported) on 28-SEP-2012. No concomitant medications were reported. The patient was not experiencing any known symptoms. No further information is available. Additional information has been requested.

VAERS ID:476678 (history)  Vaccinated:2012-09-28
Age:73.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2012-10-29, Days after onset: 31
Location:Unknown  Entered:2012-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA000146
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0595AA IMUN
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:
Write-up: This spontaneous report was received from a pharmacist refers to a 73 year old patient of unknown gender. On 28-SEP-2012, the patient was vaccinated with a dose of PNEUMOVAX 23 (lot number was reported as 0595AA expiration date 30-AUG-2012). Concomitant medications were not reported. The reporter stated that the patient received PNEUMOVAX 23 on 28-SEP-2012 that had expired on 30-AUG-2012. The patient did not have a prior history of vaccination with PNEUMOVAX 23. No adverse event was reported. This is one of the several reports received from the same reporter. Additional information has been requested.

VAERS ID:472000 (history)  Vaccinated:2012-09-28
Age:38.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-30, Days after onset: 32
Location:California  Entered:2012-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 2IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Musculoskeletal pain, Neck pain, Oedema peripheral, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Swollen upper arm, pain in arm radiating to neck, shoulder, arm and forearm.

VAERS ID:472360 (history)  Vaccinated:2012-09-28
Age:52.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-12, Days after onset: 14
Location:Colorado  Entered:2012-10-30, 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: No
Preexisting Conditions: Allergies = none; Hay fever
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP503082IMLA
Administered by: Public     Purchased by: Private
Symptoms: Contusion, Erythema, Induration, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Red induration 4-5cm for 48 hours. Wheezing, bruising. Wheezing 2 days.

VAERS ID:476821 (history)  Vaccinated:2012-09-28
Age:75.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-10-30, Days after onset: 32
Location:Unknown  Entered:2012-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA008870
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0595AA IMUN
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:
Write-up: This spontaneous report was received from a pharmacist refers to a 75 year old patient of unknown gender. On 28-SEP-2012, the patient was vaccinated with a dose of PNEUMOVAX 23 (lot number was reported as 0595AA expiration date 30-AUG-2012). Concomitant medications were not reported. The reporter stated that the patient received PNEUMOVAX 23 on 28-SEP-2012 that had expired on 30-AUG-2012. The patient did not have a prior history of vaccination with PNEUMOVAX 23. No adverse event was reported. This is a report received from the same reporter. Additional information has been requested.

VAERS ID:472422 (history)  Vaccinated:2012-09-28
Age:60.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-10-31, Days after onset: 31
Location:New Mexico  Entered:2012-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Heart Disease
Diagnostic Lab Data: PCP did an exam and a hearing test.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Acoustic stimulation tests, Tinnitus
SMQs:, Hearing impairment (narrow)
Write-up: Ringing in ear over 2 hours on 9/30 at 3AM. Ringing in ear over 1 1/2 hours on 10/3 at 9:40pm. Ringing multiple times a day, lasting only seconds now.

VAERS ID:472686 (history)  Vaccinated:2012-09-28
Age:42.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-09-29, Days after onset: 0
Location:Missouri  Entered:2012-10-31, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS12054011UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0135811UNLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site nodule, 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: Both shots administered in (L) deltoid 9/28/12 pt. has pain, swelling, erythema at injection site "hard knot, hot to the touch" will try ice pack, BENADRYL / NSAIDS first. May seek further treatment. Pt went to urgent care and received antibiotic.

VAERS ID:472969 (history)  Vaccinated:2012-09-28
Age:35.0  Onset:2012-10-02, Days after vaccination: 4
Gender:Female  Submitted:2012-10-04, Days after onset: 2
Location:Colorado  Entered:2012-11-01, Days after submission: 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP503082IMLA
Administered by: Public     Purchased by: Private
Symptoms: Exposure during breast feeding, Lactation disorder
SMQs:, Functional lactation disorders (narrow), Neonatal exposures via breast milk (narrow)
Write-up: She is nursing her baby states her breast milk dried up after she received her flu vaccine baby is 2 months old.

VAERS ID:473456 (history)  Vaccinated:2012-09-28
Age:0.7  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-11-02, Days after onset: 34
Location:Ohio  Entered:2012-11-05, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4483BA0IMLL
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives onset $g 24 hours after receiving .25 pediatric pre-filled flu vaccine. Instructed to take BENADRYL and hives resolved in 1 1/2 days after administration.

VAERS ID:477262 (history)  Vaccinated:2012-09-28
Age:  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-11-05, Days after onset: 38
Location:New York  Entered:2012-11-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA004298
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: This spontaneous report was received from a female patient of unknown age regarding herself. Approximately on 28-SEP-2012 (reported as last Friday) the patient was vaccinated with VARIVAX (lot # not reported) single vial dose. The patient stated that instead of receiving the ZOSTAVAX (Merck) her physician had accidentally given her the VARIVAX (merck). The physician may have ordered the incorrect product for the patient. No adverse reactions. No further adverse event (AE) information was reported. Additional information has been requested.

VAERS ID:477960 (history)  Vaccinated:2012-09-28
Age:0.2  Onset:2012-11-05, Days after vaccination: 38
Gender:Female  Submitted:2012-11-09, Days after onset: 4
Location:Unknown  Entered:2012-11-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1211USA002484
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0128AE SCUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H006538 SCUN
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, Nasopharyngitis, Rhinorrhoea, Upper respiratory tract infection
SMQs:
Write-up: This spontaneous report as received from a medical assistant refers to an 83 days old female patient with no drug or food allergies or pertinent medical history. The patient was vaccinated with a dose of 0.5 ml VARIVAX (Merck) (Lot# reported as H006538 and Exp date reported as 09-MAR-2014) and M-M-R II (Lot# 0128AE and Exp date: 10-JAN-2014) subcutaneously on 28-SEP-2012. Concomitant medications included selenium sulfide and EUCERIN creme. The medical assistant stated that the patient received M-M-R II and VARIVAX (Merck) too early on 28-SEP-2012. The patient was seen in office on 05-NOV-2012 for an upper respiratory infection, runny nose and cold. The patient presented smiling and happy. The patient did not seek medical attention. No lab diagnostics studies were performed. Additional information has been requested.

VAERS ID:474474 (history)  Vaccinated:2012-09-28
Age:47.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-01
Location:California  Entered:2012-11-14, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: COPD
Diagnostic Lab Data: None
CDC Split Type: CA12006
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AA1IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3922AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Incorrect dose administered
SMQs:
Write-up: Patient had been prescreened by volunteer. Patient had answered not to have received any vaccines in the last 4 weeks. Nurse (I) asked patient if she was ok and reason for her oxygen tank. Pt says she is ok but has COPD and not tired. I ask if she is here for the flu & Tdap vaccines as to what pt said: "Yes". Pt realized she had received flu 9/17/12. Pt was observed for 20 minutes and she was AAO x 4 and a nurse business card was provided.

VAERS ID:474454 (history)  Vaccinated:2012-09-28
Age:0.2  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-11-16, Days after onset: 49
Location:North Carolina  Entered:2012-11-16
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:
Preexisting Conditions:
Diagnostic Lab Data: CBC; CRP; Flu test; CXR; Lumbar puncture; Urinalysis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B344CA0IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.H0113260IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETHF657320IMRL
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALSA41CB289A0PO 
Administered by: Private     Purchased by: Public
Symptoms: C-reactive protein, Chest X-ray, Full blood count, Influenza virus test, Irritability, Lumbar puncture, Pyrexia, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Pt received vaccines on 9/28/12, later that evening pt was very irritable and had temp. of 102 degrees. Gave TYLENOL, pt had return of fever on 9/29/12. Went to ER, was admitted.

VAERS ID:475105 (history)  Vaccinated:2012-09-28
Age:59.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-11-21, Days after onset: 54
Location:Maryland  Entered:2012-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes, arthritis
Diagnostic Lab Data: Called doctor''s office to report pain and ask if this was normal, nurse contacted me back after several days, was told it was probably just a cold. Colds do not manifest in me as debilitating muscle pain and fever.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Activities of daily living impaired, Fatigue, Influenza like illness, Muscle spasms, Myalgia, Nasopharyngitis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Eosinophilic pneumonia (broad)
Write-up: Initially high temperature, muscle aches, flu-like feeling. By 11 PM severe back spasms from shot site to spine. By 4 AM considered going to ER. Fever and extreme muscle pain continued for 2 days, then fatigue and lesser aches for 2 more days. Missed 1 1/2 days of work after weekend. Have never reacted this way to vaccine before. Not allergic to eggs.

VAERS ID:475403 (history)  Vaccinated:2012-09-28
Age:60.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2012-11-27, Days after onset: 59
Location:California  Entered:2012-11-27
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: Chronic pain in legs from earlier MVA in 2001
Diagnostic Lab Data: Clinical exam is normal. No diagnostic tests done at this time.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERUNKNOWN IMLA
Administered by: Other     Purchased by: Public
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Strong tingling sensation along the left flank (vaccine given in left deltoid) that increased in intensity to the point of cannot touch it or use muscles underlying the skin. Skin appears normal.

VAERS ID:475651 (history)  Vaccinated:2012-09-28
Age:70.0  Onset:2012-10-10, Days after vaccination: 12
Gender:Male  Submitted:2012-11-18, Days after onset: 39
Location:Massachusetts  Entered:2012-11-28, 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: None
Preexisting Conditions: No known allergies; Coronary disease; Atrial Fib; sequelae of stroke
Diagnostic Lab Data: Evaluated by Dr. in neurologic consultation Brachial plexitis MR negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURU4491AA UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Brachial plexopathy, Nuclear magnetic resonance imaging normal
SMQs:
Write-up: Right brachial plexitis.

VAERS ID:475919 (history)  Vaccinated:2012-09-28
Age:39.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-12-01, Days after onset: 63
Location:Texas  Entered:2012-12-01
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: Lupus- went to rheumatologist and no anti DNA noted.
Diagnostic Lab Data: May receive from Hosp. MRI of the head negative. Only abnormality was elevated liver enzymes which returned to normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Dysstasia, Gait disturbance, Hepatic enzyme increased, Muscle twitching, Myalgia, Myoclonus, Nuclear magnetic resonance imaging brain normal, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: On not sure of the exact date of the vaccine but the Hosp. I work for will have the exact date. That night I went to the ER with severe muscle and joint pain and abd pain. The day after the vaccine I started having twitching to my left side-arm and leg. Vaccine was administed in left deltoids. Sunday the twitching slowed down. Monday I went to my PCP dr with myoclonic jerks on the left side. He referred me to a neurologist and the myoclonic jerks have become worse and are now affecting my right side. Its difficult to walk stand or do anything and they are painful. All work up is normal so they are. Calling psychogenic because it does not fit any diagnostic criteria. I have had no recent trauma or stressor that could cause this.

VAERS ID:480892 (history)  Vaccinated:2012-09-28
Age:48.0  Onset:2012-11-01, Days after vaccination: 34
Gender:Female  Submitted:2013-01-10, Days after onset: 70
Location:Texas  Entered:2013-01-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH747AA IMRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site atrophy, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: About one month after receiving the flu vaccine, I noticed a dimpling in the area of the injection. Over a period of about 1 month, the dimpling had worsened and there is an area directly below the dimpling that looks swollen.

VAERS ID:480902 (history)  Vaccinated:2012-09-28
Age:29.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Male  Submitted:2013-01-10, Days after onset: 103
Location:Delaware  Entered:2013-01-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEUR 0IDAR
Administered by: Other     Purchased by: Other
Symptoms: Burning sensation, Discomfort, Muscle spasms, Pain
SMQs:, Peripheral neuropathy (broad), Dystonia (broad)
Write-up: Discomfort / pain / cramping in ankles and knees. Progressed throughout out the day to intense pain / burning sensation in both legs to lower back. Subsided by 09/30/12.

VAERS ID:480975 (history)  Vaccinated:2012-09-28
Age:34.0  Onset:2012-09-30, Days after vaccination: 2
Gender:Female  Submitted:2012-11-30, Days after onset: 61
Location:Unknown  Entered:2013-01-10, Days after submission: 41
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: Ankles ulcers; Unspecified diffuse connective tissue disease; Penicillin allergy; Sulfa allergy; Pregnant: No
Diagnostic Lab Data:
CDC Split Type: 2012033548
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDP58507 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: This medically confirmed spontaneous report (initial receipt: 03-Oct-2012) concerns a 34-year-old female patient, who had a pertinent medical history of ankle ulcers and unspecified diffuse connective tissue disease and was allergic to penicillin and sulfa drugs. Concomitant medications included methylprednisolone acetate, hydroxychloroquine phosphate, oxycocet, hydrocodone; paracetamol combination, calcium carbonate, folic acid, nifedipine and prednisone. On 28-Sep-2012 the patient received AFLURIA (batch number: P58507) injection at a dose of 0.5 mL intramuscularly in left arm. On 30-Sep-2012, after receiving AFLURIA, the patient developed blisters on both legs, below the knees. The patient sought medical attention by calling to office. No treatment was given for the event. No lab diagnostics study was performed. The event outcome was not reported.

VAERS ID:483516 (history)  Vaccinated:2012-09-28
Age:67.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Male  Submitted:2013-02-05, Days after onset: 130
Location:California  Entered:2013-02-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 1) Enbrel 50mg weekly 2) Zetia 10mg daily 3) Mobic 15mg daily 4) Metrogel 1% gel BID PRN 5) Timolol 0.5% gel
Current Illness: None
Preexisting Conditions: Seronegative spondyloarthropathy.
Diagnostic Lab Data: He was seen by Neurology with abnormal NCV of the right Ulnar nerve and MRI of the brachial plexus demonstrated neuropathic signal changes of the inferior root of the right brachial plexus.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0105151IMRA
Administered by: Military     Purchased by: Military
Symptoms: Brachial plexopathy, Hypoaesthesia, Injection site pain, Muscular weakness, Musculoskeletal pain, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging abnormal, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: On 21 September 2012 patient received Influenza vaccine (Sanofi Pasteur, preservative free) in his left deltoid. On 28 September 2012 he received Pneumovax in his right deltoid. He relates that approximately 1-2 weeks after receiving the Influenza vaccine he awakened with a sharp pain at the base of his right shoulder blade that progressively worsened and radiated into the right shoulder and right arm. As the pain resolved over the next several weeks he noted numbness over his right fourth and fifth fingers as well as weakness of his right arm and hand. The weakness has since improved but he still notes numbness of his fingers. He was seen by Neurology with abnormal NCV of the right Ulnar nerve and MRI of the brachial plexus demonstrated neuropathic signal changes of the inferior root of the right brachial plexus. He was diagnosed with idiopathic brachial plexopathy. In the week prior to the onset of symptoms he denies any rhinoconjunctival, cutaneous, pulmonary, GI or cardiovascular symptoms. Denies constitutional symptoms. Denies antecedent surgery/procedure, known injury or infection/illness.

VAERS ID:485030 (history)  Vaccinated:2012-09-28
Age:15.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2012-11-02, Days after onset: 34
Location:Wisconsin  Entered:2013-02-20, Days after submission: 110
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; MOTRIN
Current Illness:
Preexisting Conditions: Acne
Diagnostic Lab Data:
CDC Split Type: 2012SE76084
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AH2139 IN 
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Cough, Fatigue, Influenza like illness, Oropharyngeal pain, Pain, Pharyngitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: A report has been received from a health professional. The report concerns a 15 year old female patient. The patient''s medical history included acne. Concomitant medications included salbutamol and ibuprofen. The patient received nasal FLUMIST on 28-Sep-2012. The patient started experiencing flu like symptoms on 29-Sep-2012. The patient''s symptoms were sore throat, body aches, fatigue, and trouble getting out of bed. It was reported that physicians notes stated cough, acute pharyngitis, possibly strep. It was reported that patient was not given antibiotics, but she was given albuterol nebulizer Q4H and was told to take MUCINEX or MUCINEX D. It was further reported that the patient has sore throat and cough. The reporter also reported that the patient was not allergic to eggs or egg proteins, had no long term aspirin therapy, no previous Guillain-Barre Syndrome, no reactive airways disorder or asthma, not taking TAMIFLU or other related medications, not pregnant or lactating, no heart, kidney or lung disease, no seizure disorder, no cerebral palsy, and would not be in contact with anyone with a weakened immune system. The outcome of the events was unknown. The report was considered to be non-serious by the reporter. Summary of follow-up information received by AstraZeneca/MedImmune 01-Nov-2012 from health professional: Non-serious event of cough acute pharyngitis possibly strep was added. Reporter information was added. Suspect Vaccine Information was added. Concomitant medication and medical history was added. Narrative was updated. Summary of follow-up information received by AstraZeneca/MedImmune 02-Nov-2012 from health professional: Events were added as sore throat and cough. Reporter''s details were updated.

VAERS ID:485032 (history)  Vaccinated:2012-09-28
Age:11.0  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2012-09-28, Days after onset: 0
Location:Unknown  Entered:2013-02-20, Days after submission: 145
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: 2012SE76119
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.AJ2025 IN 
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug
SMQs:
Write-up: A report has been received from a health professional concerning an 11 year old, female patient. The patient''s medical history and concomitant medications were not reported. On 28-Sep-2012, received nasal FLUMIST after a power outage on 25-Sep-12 when storage unit reached 50 degrees F. FLUMIST was administered to the patient after six hours after the cut-off time and experienced cold chain break. The patient recovered from the events. The report was considered to be non-serious by reporter. Summary of follow-up information received by AstraZeneca/MedImmune from HCP on 23-Oct-2012: new adverse event, patient''s sex, age, reporter''s phone number, duration of the events added, outcome changed to recovered.

VAERS ID:486009 (history)  Vaccinated:2012-09-28
Age:52.0  Onset:2012-09-29, Days after vaccination: 1
Gender:Female  Submitted:2013-03-04, Days after onset: 156
Location:Arizona  Entered:2013-03-04
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Severe swelling & pain
Preexisting Conditions: The following information was obtained through follow-up and/or provided by the government. 3/19/13. Consultant records. PMH: insomnia. NKDA.
Diagnostic Lab Data: MRI''s show tendonitis, arthritis The following information was obtained through follow-up and/or provided by the government. 3/19/13. Consultant records. EMG: neg. MRI L shoulder: rotator cuff tendinosis; focal oedema in superior distal aspect of infraspinatus muscle; osteoarthritis of acromioclavicular joint; bicipital tenosynovitis; shoulder joint effusion.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA735BA UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Anxiety, Arthritis, Bursitis, Contusion, Fatigue, Haematoma, Hypoaesthesia, Immediate post-injection reaction, Increased tendency to bruise, Joint crepitation, Musculoskeletal discomfort, Musculoskeletal pain, Neck pain, Nuclear magnetic resonance imaging abnormal, Oedema peripheral, Pain, Pain in extremity, Paraesthesia, Rotator cuff syndrome, Tendonitis, Tremor, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (narrow)
Write-up: Hematoma, bruising. Severe pain in left arm by following morning. Chronic pain in arms, shoulders and neck still (5 months later). Naproxen, tramadol. MRI''s & x-rays. The following information was obtained through follow-up and/or provided by the government. 3/19/13. Consultant records (neurology) DOS 10/24/12. DX: haematoma LUE, resolved; swelling LUE. CC: vax was administered higher than usual immediate discomfort; L arm pain/bruising/swelling; pain increases c movement; neck discomfort; numbness to L wrist; tingling to L hand; LUE weakness; fatigue; easy bruising; anxiety. MRI scheduled. RTC 11/2/12 for EMG. RTC 11/20/13. DX: LUE pain; paraesthesias; neck pain. CC: f/u. Steroid taper improved pain, but after completion pain has returned. Rxed medically et referred to PT. 3/28/13. Consultant records DOS 12/26/12. DX: subacromial bursitis c tendinitis; rotator cuff tendinitis L shoulder c impingement. CC: persistent LUE pain. PE: painful impingement signs to LUE. Medically managed. RTC 3/21/13. DX: --. CC: painful L shoulder crepitus; persistent symptoms of impingement; tremors. Arthroscopic decompression recommended.

VAERS ID:487256 (history)  Vaccinated:2012-09-28
Age:82.0  Onset:2012-10-25, Days after vaccination: 27
Gender:Male  Submitted:2013-03-19, Days after onset: 145
Location:Wisconsin  Entered:2013-03-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, lovastatin, mirtazepine, furosemide, multivitamin, aspirin, calcium with vitamin D, omega 3 fish oil
Current Illness: NO
Preexisting Conditions: Hypertension, hypercholesterolemia, plantar fasciitis, adenocarcinoma of prostate, mild renal insufficiency, basal cell carcinoma The following information was obtained through follow-up and/or provided by the government. PMH: hypercholesterolemia, HTN. Former smoker.
Diagnostic Lab Data: US venous duplex-no acute changes The following information was obtained through follow-up and/or provided by the government. 3/25/2013 lab/diagnostic records received for DOS 10/25/2012. US venous duplex LLE WNL. Blood: BUN 21 mg/dL (H), creatinine 1.5 mg/dL (H), GFR 45 (L), Ca 8.5 mg/dL (L), Cl 109 mmol/L (H).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH719AC15IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood urea increased, Gait disturbance, Glomerular filtration rate decreased, Muscular weakness, Myalgia, Oedema peripheral, Pain in extremity, Ultrasound scan normal, Weight bearing difficulty
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow)
Write-up: Pain and weakness in legs, L$gR, starting in feet going to knees. Seen in ER on 10/25/2012. US venous duplex-no acute changes. On 3/12/2013 pt still has a little residual pain in muscle/cords in his legs. Question possible Guillain-Barre Syndrome. The following information was obtained through follow-up and/or provided by the government. 3/25/2013 ER records received for DOS 10/25/2012. D/c Dx: LE pain. Pt c/o lt calf pain/swelling, able to partially bear weight, difficulty ambulating. PE unremarkable. Pt d/c''d home in stable condition w/ care & f/u instructions.

VAERS ID:487511 (history)  Vaccinated:2012-09-28
Age:0.2  Onset:2012-09-28, Days after vaccination: 0
Gender:Female  Submitted:2013-03-21, Days after onset: 174
Location:Pennsylvania  Entered:2013-03-21
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: We did not take her back to the doctor, as they said this reaction was normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4298AA0SCRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0384AE1SCLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF959420SCLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.H012759 PO 
Administered by: Private     Purchased by: Private
Symptoms: Crying, Immediate post-injection reaction, Injection site pain,