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Found 588667 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:438448 (history)  Vaccinated:2011-10-16
Age:43.0  Onset:2011-10-16, Days after vaccination: 0
Gender:Male  Submitted:2011-10-16, Days after onset: 0
Location:Florida  Entered:2011-10-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: pt reports after he received vaccine and became itchy that 2 years ago he developed itching and did not feel well after influenza vaccine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1101301 IMRA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt returned to clinic approx 5 minutes after vaccine administered complaining of itching all over body, no rash, no hives, no SOB, given 25mg of Benadryl, pt kept in clinic for approx 30 minutes after itching improved. Pt awake, alert, talkative and laughing, stated itching improved prior to leaving the clinic.

VAERS ID:438666 (history)  Vaccinated:2011-10-16
Age:59.0  Onset:2011-10-16, Days after vaccination: 0
Gender:Male  Submitted:2011-10-17, Days after onset: 1
Location:Ohio  Entered:2011-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED13749111A0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dyspnoea, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Sore Throat 4:30 PM. Touble breathing shortly thereafter. Patient then went to the ER and received treatment.

VAERS ID:440059 (history)  Vaccinated:2011-10-16
Age:63.0  Onset:2011-10-18, Days after vaccination: 2
Gender:Female  Submitted:2011-10-25, Days after onset: 7
Location:Unknown  Entered:2011-10-26, 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: Intracranial hypertension; shunt malfunction; allergic reaction to antibiotics; penicillin allergy; sulfonamide allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1110USA02436
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Encephalitis, Injection site rash, Pain, Paraesthesia, Paraesthesia oral, Rash, Shunt malfunction, Skin warm, Upper extremity mass
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a 63 year old female consumer reporting on herself with intracranial hypertension, allergy to penicillin, sulpha, cephalexin and ciprofloxacin, who on 16-OCT-2011, was vaccinated with ZOSTAVAX (Merck) (lot number, route and dose not reported). Consumer reported that on 18-OCT-2011, a "big lump on her arm and it was hot after receiving the ZOSTAVAX (Merck)". It was spreading and doubled from the vaccination she had on Sunday (16-OCT-2011). On 18-OCT-2011, there was rash on her arm and at the injection site. She also had weird tingling sensations all over her body including her face and lips. She had body aches all over. "Consumer was concerned about encephalitis because she had intracranial hypertension or IH. She had a shunt but it was not working at the time of reporting". Patient did not receive any treatment for adverse reactions. The patient did not seek medical attention. At the time of reporting the patient had not recovered. Upon internal review "concerned about encephalitis" was considered to be other important medical event. Additional information has been requested.

VAERS ID:440733 (history)  Vaccinated:2011-10-16
Age:69.0  Onset:2011-10-17, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Missouri  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH468AC IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Arthralgia, Bursitis, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Arm and joint pain. Diagnosed as bursitis.

VAERS ID:438672 (history)  Vaccinated:2011-10-17
Age:3.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-17, Days after onset: 0
Location:Florida  Entered:2011-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported.
Preexisting Conditions: Hx of 2 seizures in the past, parent states related to oncoming illness--right before he gets a cold or the flu.
Diagnostic Lab Data: Father states child has been seen in the ER for seizures in the past; was given medication to use PRN (unknown what it is); has appointment in March with a neurologist. Staff here advised parents to notify neurologist of this additional seizure, and to try to get appointment sooner for child.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501103P1IN 
Administered by: Public     Purchased by: Public
Symptoms: Condition aggravated, Convulsion, Foaming at mouth, Muscle rigidity
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Approximately 20 minutes after receiving FluMist, child had a seizure. Was walking next to father, leaving office, and child grabbed/punched father to let him know something was happening, then grabbed father''s hand really hard. Father states he looked down at child who was having a seizure. Father held child during seizure, stating it lasted about 2 minutes and 20 seconds. Child''s eyes were open, a little bit of frothy saliva on his lips toward end of seizure. Father states child was a bit rigid, but seemed to fight the seizure. Afterward he slept for about 30 minutes.

VAERS ID:438674 (history)  Vaccinated:2011-10-17
Age:38.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-17, Days after onset: 0
Location:Connecticut  Entered:2011-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Environmental allergies - eggplant; similar reaction in 2007 after flu vaccine.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT426AA IMUN
Administered by: Public     Purchased by: Private
Symptoms: Chest discomfort, Dyspnoea, Paraesthesia, Pruritus generalised
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mild chest tightness & mild SOB, tingling in hands, & generalized itch. Symptoms improved with BENADRYL 25 mg 2 tabs PO at 9 am & CLARITIN 10 mg at 9:40 on 10/17/11.

VAERS ID:438687 (history)  Vaccinated:2011-10-17
Age:1.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-17, Days after onset: 0
Location:Pennsylvania  Entered:2011-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no reaction even 10 minutes after injection
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1452Z0IMLL
Administered by: Unknown     Purchased by: Other
Symptoms: No adverse event
SMQs:
Write-up: no symptoms of reaction seen child here for 10min after injection

VAERS ID:438693 (history)  Vaccinated:2011-10-17
Age:42.0  Onset:0000-00-00
Gender:Female  Submitted:2011-10-17
Location:California  Entered:2011-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known.
Preexisting Conditions: No.
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11063P IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1397Z1IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:, Medication errors (narrow)
Write-up: No noted adverse reaction. Vaccine booster given before Manufacturer recommendation.

VAERS ID:438699 (history)  Vaccinated:2011-10-17
Age:60.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-17, Days after onset: 0
Location:California  Entered:2011-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No acute illness.
Preexisting Conditions: allergies: sulfa, iodine, mesna, heparin conditions: cancer, hypertension, thyroid dz, seasonal allergies.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3921BA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Cough, Dysgeusia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)
Write-up: Pt experienced mild tightness of the throat, a metallic taste, and acute onset coughing (he said this was the same rxn he had had to previous doses of iodine and heparin). Coughing continued for about 20 minutes, at first wanted me to use the Epipen, but when I told him I would have to contact 911 once I used it, he declined injection. Waited in the immunization area for 15 minutes, then left the store with his wife once he felt he was ok. I called him at 7:48 pm and he now feels fine.

VAERS ID:438711 (history)  Vaccinated:2011-10-17
Age:11.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-17, Days after onset: 0
Location:Virginia  Entered:2011-10-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma; Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0405AA1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Dyspnoea, Heart rate increased, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives, difficulty breathing, increased pulse.

VAERS ID:438789 (history)  Vaccinated:2011-10-17
Age:31.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:Pennsylvania  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA; asthma
Diagnostic Lab Data: Bloodwork; CT scan
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA688AA0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0895AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Asthma, Blood test, Chest discomfort, Computerised tomogram, Condition aggravated, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Approximately an hour post vaccination the patient developed a tightness in her chest, a nonproductive cough, and became short of breath. She was taken to ER. Determined that pt. suffered an asthma attack. Given oxygen and nebulizer treatments.

VAERS ID:438812 (history)  Vaccinated:2011-10-17
Age:18.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:New York  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA634AA1IMLA
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: Patient was given Flu vaccine has a 3" x 1 1/2" reddened, hot, swollen, painful area on left deltoid.

VAERS ID:438821 (history)  Vaccinated:2011-10-17
Age:2.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:North Carolina  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness at time of visit.
Preexisting Conditions: Milk and soy intolerance at birth. Gross motor delay, language delay.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501117P0IN 
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Within 5 minutes of receiving the Flumist vaccine, the patient started breaking out in hives. Patient was immediately given Benadryl. Within 20 minutes the hives started to resolve. The nurse checked on the patient on 10/18/2011 and the mother reported the patient was doing fine but still had a few hives still.

VAERS ID:438822 (history)  Vaccinated:2011-10-17
Age:47.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:South Carolina  Entered:2011-10-18
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: None
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1100901 IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Cold sweat, Dizziness, Dyspnoea, Lethargy, Pallor
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: I gave patient the IM injection to her right deltoid. She was fine after the injection. She is a radiation therapist and her coworker called me about five minutes after she left the nurses station and said she needed some medical attention. When we got back to her she was very pale, lethargic and felt like she was going to pass out. We helped her into a wheelchair and she became so lethargic we had to physically hold her up while we were wheeling her into an exam room, then we had to lift her onto the exam table. She was clammy, pale and said she was having trouble breathing. Our physician came in and examined her. She was placed on 2L O2. Her BP was checked 112/54, HR 58, blood sugar was 84, oxygen saturation maintained at 99% or higher. After lying on the exam table for about 15 minutes she felt better and was urged to go home for the rest of the day but she insisted on staying on to work. She had no problems throughout the day today since this episode and continues to state that she feels fine now.

VAERS ID:438823 (history)  Vaccinated:2011-10-17
Age:0.3  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-18, Days after onset: 0
Location:Virginia  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4025AA1IMLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169711IMLL
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALSA41FB243A1PO 
Administered by: Unknown     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fever of 102.0

VAERS ID:438826 (history)  Vaccinated:2011-10-17
Age:60.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:New Jersey  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: None reported.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH454AB0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Headache, Heart rate increased, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Onset of rapid heart rate, headache, nausea, chills.

VAERS ID:438827 (history)  Vaccinated:2011-10-17
Age:23.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:Alabama  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No complaints or signs of illness at time of vaccination or today.
Preexisting Conditions: Takes levothyroxin for thyroid disorder, B12 and Vitamin D for deficiencies.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH455AA1IMLA
Administered by: Private     Purchased by: Other
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: Area at injection site, L deltoid, approximately 2 inches in diameter, red swollen and c/o painful to touch.

VAERS ID:438830 (history)  Vaccinated:2011-10-17
Age:28.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-18, Days after onset: 0
Location:Missouri  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Penicillin allergy
Diagnostic Lab Data: Ambulance came to home. Doctor''s office called in the morning.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH446AA1IMRA
Administered by: Other     Purchased by: Unknown
Symptoms: Chills, Lip swelling, Pyrexia, Swelling face, Swollen tongue, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vomiting, Fever and chills upon waking at 12:30 am and swelling of face, lips and tongue upon waking at approximately 9:00 am on 10/18/11.

VAERS ID:438837 (history)  Vaccinated:2011-10-17
Age:55.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:New Jersey  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: mva accident injuries 10/2000 slip and fall 08/2011 mild ms
Diagnostic Lab Data: hospital er doctor prescribed me ... Albuterol MDI mcg per actuation
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain upper, Dyspnoea, Influenza like illness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: difficulty breathing, shortness of breath, flu like aches, stomach pain

VAERS ID:438867 (history)  Vaccinated:2011-10-17
Age:63.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-18, Days after onset: 1
Location:Texas  Entered:2011-10-18
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: Blood and Urine
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH464AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Blood test, Hypoaesthesia, Oropharyngeal pain, Oxygen saturation decreased, Pyrexia, Tremor, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 6 hours after receiving vaccine, patient experienced numb hands, severe shaking, sore throat, fever, vomiting, drop in oxygen level. Went to ER via ambulance. Was released with these Rx''s: CIPRO, Prednisone, ZOFRAN.

VAERS ID:438874 (history)  Vaccinated:2011-10-17
Age:1.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-18, Days after onset: 0
Location:California  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Reactive airway disease
Diagnostic Lab Data: CBC, CXR, blood and urine cultures, BMP, lumbar puncture
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4119CR0IMLL
Administered by: Private     Purchased by: Other
Symptoms: Blood culture, Chest X-ray, Culture urine, Full blood count, Lumbar puncture, Metabolic function test, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever of 103.9, extremity shaking (?seizure), 911 activated, sent to E.R. After discharge from E.R., pt. came into doctor''s office, and admitted to Pediatrics unit for seizure work up.

VAERS ID:438880 (history)  Vaccinated:2011-10-17
Age:14.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-10-18, Days after onset: 0
Location:Florida  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Father denies
Preexisting Conditions: Father denies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB982BB2IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURE095021IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0608AA1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: LARGE WELTS (HIVES) OVER LARGE PORTIONS OF BODY: BACK, ARMS, ANKLES, ACCORDING TO FATHER

VAERS ID:438886 (history)  Vaccinated:2011-10-17
Age:30.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:Unknown  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJ 
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pain and soreness at the injection site that has persisted for nearly 36 hours.

VAERS ID:438926 (history)  Vaccinated:2011-10-17
Age:29.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 1
Location:Rhode Island  Entered:2011-10-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT499AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site haematoma, Mobility decreased, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Parkinson-like events (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient called pharmacy one hour from FLUZONE dose (IM) said she could not move her arm much at all, felt like it hurt if moved any direction. Not swollen but red. Next 24 hrs still hurt and hard to move and bruised at injection site. Patient told to try Ibuprofen and Ice. Helps somewhat. Patient will call their MD if not better by 10/19/11.

VAERS ID:438889 (history)  Vaccinated:2011-10-17
Age:0.6  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 2
Location:Michigan  Entered:2011-10-19
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: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1 LL
Administered by: Public     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives

VAERS ID:439013 (history)  Vaccinated:2011-10-17
Age:82.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 2
Location:Pennsylvania  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: "Sniffles"
Preexisting Conditions: Diabetes; Hypertension
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED13849121A0UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Insomnia, Musculoskeletal pain, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pain in right arm started Monday 10/17/11 evening at 7 or 8 PM had trouble sleeping. Tuesday 10/18/11 still moderate pain - could not sleep at all Wednesday 10/19/11 - severe pain arm, shoulder, neck.

VAERS ID:439017 (history)  Vaccinated:2011-10-17
Age:26.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-19, Days after onset: 1
Location:Alabama  Entered:2011-10-19
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: Aspirin; CIPRO; Levaquin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT491AB UNLA
Administered by: Other     Purchased by: Private
Symptoms: Blood pressure increased, Dizziness, Flushing, Injection site nodule, Injection site urticaria, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Flushing to face, neck, and chest; Rash to face, neck, and chest, dizziness, tingling to upper torso and face, elevated BP, red welp and knot at injection site. Give 40mg Prednisone and SQ injection of epinephrine sent home with prescriptions for prednisone 5 days, ranitidine and vistaril.

VAERS ID:439019 (history)  Vaccinated:2011-10-17
Age:67.0  Onset:0000-00-00
Gender:Female  Submitted:2011-10-19
Location:Pennsylvania  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUNREADABLE0IMRA
Administered by: Public     Purchased by: Other
Symptoms: Asthma, Condition aggravated, Crying, Ocular hyperaemia, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Within seven hours: asthma attack, very red eyes, copious weeping of eyes, and fever.

VAERS ID:439021 (history)  Vaccinated:2011-10-17
Age:40.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-19, Days after onset: 2
Location:Ohio  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergy to sulfa and iodine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal discomfort, Dizziness, Fatigue, Influenza like illness, Migraine, Nasopharyngitis, Pain, Pruritus, Rhinorrhoea, Sneezing, Visual field defect
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On the evening of the vaccination I started experiencing migraine symptoms. I experienced blind spots in my vision. The following morning I awoke with flu-like symptoms (upset stomach, dizziness, sneezing, aches and extreme fatigue). Now, the morning following the day after the vaccination, I have fatigue and mild cold symptoms (itchy, running nose, sneezing)

VAERS ID:439026 (history)  Vaccinated:2011-10-17
Age:51.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-19, Days after onset: 1
Location:Florida  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: none reported
Diagnostic Lab Data: Patient was sent to a local center for evaluation by a doctor.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA688AA1IMGM
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient received the flu vaccine lot #AFLLA688AA, exp. 6/2012 on 10/17/2011 in the left buttock. The following morning, she noted a reddened area approximately 9 cm in circumference around the injection site. The area is warm to touch and raised approximately 1 mm.

VAERS ID:439034 (history)  Vaccinated:2011-10-17
Age:55.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 2
Location:New Jersey  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Well teaching class that day.
Preexisting Conditions: None
Diagnostic Lab Data: none to date
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH454AB1IMLA
Administered by: Other     Purchased by: Private
Symptoms: Activities of daily living impaired, Body temperature increased, Chills, Cough, Dysgeusia, Dysphonia, Eye discharge, Eye pain, Eye swelling, Flushing, Headache, Ocular hyperaemia, Purulent discharge, Staring, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 1:30 PM developed a dry cough. Metal taste in mouth. Throat felt tightening and voice bacame hoarse. She could only whisper. At 3PM she reported her eyes became swollen hurting and sclera red with white pus draing from eyes. She had an increased headache at top of skull. Temperature noted of 101 at 4pm. Face flushed at that point. Patient reported chills at that time. She was advised by her MD to take Sudafed orally 2 nasal decongestant as per MD. Warm compresses on eyes. In the am when she woke up she called in sick. Her eyes continued to drain untill 2 pm on 10/18/2011. 10/19/2011 patient notes she is feeling improved, however her eyes are still looking reddened and glassy. Mild non productive cough continues.

VAERS ID:439045 (history)  Vaccinated:2011-10-17
Age:49.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-19, Days after onset: 2
Location:Vermont  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT491AA1IJLA
Administered by: Other     Purchased by: Public
Symptoms: Burning sensation, Chills, Disorientation, Dizziness, Headache, Heart rate increased, Influenza like illness, Nasal congestion, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: I became achy and feverish flu like sysmptoms. Apporx 9:30pm at my residents Ibegan to experince chills, Fever, soreness and dizziness. Approx. 11:30pm I was experincing an extremely high temp. (106*)severe chills, dizziness, disorientation, rapid heart beat and vomiting. Throughout time line I was drinking water and taking 800ml of Ibuprofen. Approx 1:30am on 10/18/11 my Fever and symptoms started to reside. Temp dropped (104*) chills started to subside and Vomiting stopped. Approx 3:00am body temp was down (101*) chills almost gone and hot burning sensation disappeared too. Approx. 5:45am awoke after a couple of hours of sound sleep. Except for light headedness and feeling of being tired all sysmptoms had gone. Approx 7:00am on 10/18/11 I had only a bad headache and nasal stuffiness type feeling left. Approx 9:00am I called my Doctor reported reaction event and was advised to continue Tylenol or Ibuprofen. Approx 5:30pm on 10/18/11 all symptoms gone. Felt fine.

VAERS ID:439099 (history)  Vaccinated:2011-10-17
Age:26.0  Onset:2011-10-19, Days after vaccination: 2
Gender:Female  Submitted:2011-10-19, Days after onset: 0
Location:Massachusetts  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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HPV4: HPV (GARDASIL)MERCK & CO. INC.1271Z1IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 48 hours s/p vaccine pt. reports swelling, redness and warmth at site of immunization. Hives on other body area.

VAERS ID:439132 (history)  Vaccinated:2011-10-17
Age:81.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-17, Days after onset: 0
Location:Montana  Entered:2011-10-19, 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: None
Diagnostic Lab Data: Pt. related she runs a low BP
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB991AB2UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0811AA1UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Cold sweat, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: About 9:00AM pt received Hep B & pneumonia shot. 1-2 minutes after shots pt. felt sick to her stomach, became pale and clammy. We put her head between legs, then laid down. BP 93/59, T=97.6, P=66.

VAERS ID:439153 (history)  Vaccinated:2011-10-17
Age:82.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-19, Days after onset: 2
Location:New York  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH436B1IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dyspepsia, Fatigue, Hypersomnia, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Depression (excl suicide and self injury) (broad)
Write-up: SORE THROAT, SEVERE INDIGESTION, EXTREME FATIGUE, SLEPT FOR 15 HOURS, STILL FATIGUED, TEMPERATURE 97.6 AND BLOOD PRESSURE 140 80 60 PHONED DOCTOR

VAERS ID:439157 (history)  Vaccinated:2011-10-17
Age:59.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-19, Days after onset: 2
Location:California  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: My joints began to ache within 5 minutes of getting vaccinated.
Preexisting Conditions: Non
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PER: PERTUSSIS (NO BRAND NAME)EMERGENT BIOSOLUTIONS    
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Other
Symptoms: Arthralgia, Chills, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Severe chills, fever, sweats and harsh joint pain.

VAERS ID:439161 (history)  Vaccinated:2011-10-17
Age:24.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 2
Location:Alabama  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma and seasonal allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR907151IMRA
Administered by: Public     Purchased by: Private
Symptoms: Diarrhoea, Fatigue, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Nausea, Diarrhea, Extreme muscle soreness, fatigue, muscle aches, etc. Symptoms were worse on 10/18/11 and are improving, although still not resolved on 10/19/11.

VAERS ID:439177 (history)  Vaccinated:2011-10-17
Age:6.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-10-19, Days after onset: 1
Location:Virginia  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dysphonia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Woke from being sound asleep being unable to breathe (inhale) and unable to speak more than one whispered word.

VAERS ID:439209 (history)  Vaccinated:2011-10-17
Age:48.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-19, Days after onset: 1
Location:Colorado  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None per VAR
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH477AD UNLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site induration, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Per pt - In middle of night awoke feeling nausea. Did not vomit. Arm is sore? Hard where vaccine was administered.

VAERS ID:439211 (history)  Vaccinated:2011-10-17
Age:18.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-10-19, Days after onset: 1
Location:Colorado  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None per VAR
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH477AD UNLA
Administered by: Other     Purchased by: Private
Symptoms: Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Per pt. Mom - had to leave school following day due n/v and diarrhea. Possible sore arm at injection site.

VAERS ID:439215 (history)  Vaccinated:2011-10-17
Age:14.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-10-19, Days after onset: 1
Location:Colorado  Entered:2011-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None per VAR
Preexisting Conditions: Per mom diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH477AD IJLA
Administered by: Other     Purchased by: Private
Symptoms: Diarrhoea, Injection site pain, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Per pt mom. Pt has n/v ? diarrhea. He does NOT have pain at injection site.

VAERS ID:439346 (history)  Vaccinated:2011-10-17
Age:50.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-20, Days after onset: 3
Location:Wisconsin  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies to antibiotics, birth control pill, nicorette gum, and Prozac
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AE  LA
Administered by: Unknown     Purchased by: Private
Symptoms: Erythema, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Had reddened area measured 82x42mm inferior to injection site. Caused numbness and tingling into hand.

VAERS ID:439361 (history)  Vaccinated:2011-10-17
Age:67.0  Onset:0000-00-00
Gender:Male  Submitted:2011-10-20
Location:California  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: PCN
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Lip swelling, Pruritus generalised, Rash generalised
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: One day later with some swelling of the lip and itchiness of the body. 2 days later with a rash on the body.

VAERS ID:439371 (history)  Vaccinated:2011-10-17
Age:44.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-20, Days after onset: 3
Location:Texas  Entered:2011-10-20
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
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNAR
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injected limb mobility decreased, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Two hours after the vaccine was given I felt my upper arm swollen and very warm. All through the night I was in extreme pain where I could not move my upper arm because of the pain. The next day my upper arm was still swollen and a huge red spot covered the area where the pain was. Two days later my arm is still in pain. The night of the vaccine I also had a fever.

VAERS ID:439374 (history)  Vaccinated:2011-10-17
Age:46.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-17, Days after onset: 0
Location:New York  Entered:2011-10-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Had MD appt. with primary on 10/18/11.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR 1IJAR
Administered by: Public     Purchased by: Unknown
Symptoms: Chills, Cough, Eye discharge, Eye infection, Eye swelling, Myalgia, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Ocular infections (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After receiving my flu shot 5 hours I became symptomatic. Cough, sore throat, body chills, muscle aches, pains, eyes swelled and leaked puss, fever 101.

VAERS ID:439379 (history)  Vaccinated:2011-10-17
Age:4.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-20, Days after onset: 2
Location:Missouri  Entered:2011-10-20
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
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B171FA UNRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0005AA1SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0469AA1SCRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red raised area to (R) leg.

VAERS ID:439382 (history)  Vaccinated:2011-10-17
Age:34.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-20, Days after onset: 3
Location:Texas  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Work comp injury - Lac. finger
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURERA049B UNLA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Headache, Irritability, Pain, 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), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever - 100.3; Body aches; Diarrhea; Headache; Irritability. Tx: fluids, ASA x3 days.

VAERS ID:439403 (history)  Vaccinated:2011-10-17
Age:55.0  Onset:2011-10-19, Days after vaccination: 2
Gender:Female  Submitted:2011-10-20, Days after onset: 1
Location:Pennsylvania  Entered:2011-10-20
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: Sulfa; Penicillin; PULMICORT; SEREVENT; Trimetoprim; Ketaconozole; Morphine
Diagnostic Lab Data: Influenza shot in same arm 2 weeks ago
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0619AA0SYRLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: ZOSTAVAX administered 10/17/11, 10/19 redness itching swelling at site of injection - softball size - doubled overnight in size - tender to touch & warm, able to use extremity with ease/no numbness. No difficulty breathing/systemic reaction.

VAERS ID:439417 (history)  Vaccinated:2011-10-17
Age:88.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-20, Days after onset: 2
Location:California  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH436AB IMLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Injection site swelling. Advised to ice & watch for signs of infection. If not resolved by next day, maybe check w/MD.

VAERS ID:439416 (history)  Vaccinated:2011-10-17
Age:45.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-20, Days after onset: 3
Location:Rhode Island  Entered:2011-10-21, 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 DIAGNOSTICS11132P5IMLA
Administered by: Public     Purchased by: Other
Symptoms: Feeling hot, Injection site haematoma, Local swelling, Pain
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 10/17 - 6pm - Started feeling soreness & warmth. Noticed bruising at site. Area of soreness, warmth & swelling continued to grow to 5 1/2" x 6". Tried to ice area. 10/21 - Area remains bruised. Not warm to touch. Remains swollen able to palpate edges.

VAERS ID:439477 (history)  Vaccinated:2011-10-17
Age:67.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-21, Days after onset: 4
Location:New York  Entered:2011-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Coronary artery disease (stent); allergies to sulfa & penicillin; scoliosis lower back; allergic to probably 90% of drugs
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH454AA0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Discomfort, Fatigue, Headache, Immediate post-injection reaction, Injection site pain, Malaise, Musculoskeletal pain, Pain, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Immediately hurt going in, immediate aching, got worse took ibuprofen did not help. Iced area. Pain extended to arm to shoulder blade, to back to chest. Switched to heat compresses also. Felt very uncomfortable, achy all over -$g aches continued to next day. Had headache. Feels fatigue/tired since then, general malaise. Pain has subsided. In the last couple of days also has some bumpy spots on back of neck to right ear. Called pharmacist who encouraged reporting.

VAERS ID:439485 (history)  Vaccinated:2011-10-17
Age:0.8  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-21, Days after onset: 4
Location:Florida  Entered:2011-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: CONSTIPATION
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169212IMLL
Administered by: Unknown     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: HIVES ON LOWER BACK.

VAERS ID:439496 (history)  Vaccinated:2011-10-17
Age:8.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-21, Days after onset: 4
Location:South Dakota  Entered:2011-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH478AB IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Dyspnoea, Oropharyngeal pain, Pallor, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Client was given a flu vaccination by this nurse in the left deltiod muscle at 1133 hrs. The vaccine is Sanofi brand, Lot # UH478AB, Expires 06/30/2012. The client went with her mom into the next room to look at the exhibits during the wait period. They returned to the vaccination room at 1141 and reported her symptoms. The client appeared pale. She complained of dizziness, sore throat, and labored breathing. This nurse had the client sit in a near by chair and instructed the client to take slow deep breaths, in the nose and out the mouth. Nurse administered oxygen via blow by mask while this nurse assessed vital signs at 1142 hrs: Blood Pressure 72/52, Pulse 80, Respirations 20. At 1144 hrs. the client stated she was feeling better and her skin color was improving. The oxygen was removed at 1149 hrs. The client then changed chiars so this nurse could continue with giving other''s their shots, but could still monitor the client. The client stated she then felt "shakey" and her mom allowed her to eat a piece of candy. She reported she felt better after having the candy. Client was released at 1205 hrs. This nurse gave the client''s mom her card and cell phone number to call if there are any concerns. This nurse left a message with the mom''s cell number to follow up on the client. The client''s father was at a different flu clinic the next day and stated the client had no further problems after leaving the flu clinic the day before.

VAERS ID:439501 (history)  Vaccinated:2011-10-17
Age:5.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-21, Days after onset: 3
Location:Washington  Entered:2011-10-21
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: History of congenital subluxation of hip, pyelonephritis, and congenital toe deformity.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3944AA4IMRL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH478AB5IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURG10833SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0398AA1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0398AA1SCLL
Administered by: Unknown     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site induration, Injection site swelling, Lymphangitis
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The patient developed redness, induration, and swelling of the left thigh at the site of the polio, varicella, and influenza immunizations, increasing over 36 hours, subsequently treated with cephalexin and TMP/SMZ for suspected cellulitis and lymphangitis, and much improved by 10/21/11. Immunizations given in the right thigh posed no problems.

VAERS ID:439604 (history)  Vaccinated:2011-10-17
Age:4.0  Onset:2011-10-19, Days after vaccination: 2
Gender:Female  Submitted:2011-10-20, Days after onset: 1
Location:Massachusetts  Entered:2011-10-21, 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: Albuterol sulfate 0.083% Neb soln
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA609BA UNUN
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen red area, hot to touch at site of injection and down deltoid area.

VAERS ID:439519 (history)  Vaccinated:2011-10-17
Age:10.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-22, Days after onset: 5
Location:Texas  Entered:2011-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Rapid strep test negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501086P4IN 
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Lymph node pain, Nasal congestion, Oropharyngeal pain, Petechiae, Sneezing, Streptococcus test, Streptococcus test negative
SMQs:, Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Nasal congestion, sneezing, sore throat. Palatal petechiae, erythematous tonsils, upper cervical tenderness of lymphnodes.

VAERS ID:439631 (history)  Vaccinated:2011-10-17
Age:30.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-24, Days after onset: 7
Location:Connecticut  Entered:2011-10-24
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURUT425AA9IMUN
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Paraesthesia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Vomited day of vaccine. Dizziness, tingling in hands & feet, SOB, sweating intermittently. 10/18-10/24/11.

VAERS ID:439637 (history)  Vaccinated:2011-10-17
Age:67.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-21, Days after onset: 3
Location:Virginia  Entered:2011-10-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Pt. had CBC & CMP done today.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1101901 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Full blood count, Headache, Metabolic function test, Pain, Pyrexia, Rash erythematous, Rash generalised
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever 102.1, rash all over body (red & raised), body aches & headache. Gave pt an injection of KENALOG & pres. MEDROL Dose pack. See attached Progress Note.

VAERS ID:439681 (history)  Vaccinated:2011-10-17
Age:35.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-24, Days after onset: 7
Location:Arizona  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 15 LA
Administered by: Unknown     Purchased by: Private
Symptoms: Chills, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever, chills, aches, full body hives.

VAERS ID:439715 (history)  Vaccinated:2011-10-17
Age:23.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-17, Days after onset: 0
Location:Michigan  Entered:2011-10-24, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA684AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Patient came to medical to report dizziness, lightheaded & weak at 12:22pm. Had flu vaccine this date (10-17-11) at 10:48AM. Given Ibuprofen 400mg & bed rest.

VAERS ID:439724 (history)  Vaccinated:2011-10-17
Age:1.2  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-17, Days after onset: 0
Location:Massachusetts  Entered:2011-10-24, 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 known
Preexisting Conditions: None
Diagnostic Lab Data: Will schedule EEG because no family hx of sz.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4176CA2UNLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0405AA0UNRL
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Febrile convulsion, Partial seizures, Pharyngitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 3-5 min (R) focal seizure 7 hrs. after vaccines. PE showed T 101.4 (was 102 at daycare), blistery pustular pharyngitis. Probable first febrile seizure.

VAERS ID:439747 (history)  Vaccinated:2011-10-17
Age:26.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-18, Days after onset: 1
Location:Massachusetts  Entered:2011-10-24, 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: Fish oil; WELLBUTRIN 75mg; PRILOSEC 20mg
Current Illness:
Preexisting Conditions: Penicillins; Amoxicillin; AUGMENTIN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0387AA1IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest discomfort, Dizziness, Flushing, Palpitations
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Dizziness, tightness in chest, facial flush, palpitations.

VAERS ID:439819 (history)  Vaccinated:2011-10-17
Age:37.0  Onset:2011-10-21, Days after vaccination: 4
Gender:Female  Submitted:2011-10-24, Days after onset: 3
Location:Pennsylvania  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Typical environmental allergies: cats, weeds, etc
Diagnostic Lab Data: No tests yet, plan to go to MD tomorrow if condition does not improve.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Fatigue, Oropharyngeal pain, Pain, Pyrexia, Upper-airway cough syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Post nasal drip sore throat, aches, chills in PM only. Next day same thing. By Sunday I had extreme sore throat, fatigue, aches, and chills but no fever. Monday aches all day worsening at evening to the point that 400mg ibuprofen does not alleviate chills or aches anymore. Still now fever. No stuffiness no runny nose.

VAERS ID:439820 (history)  Vaccinated:2011-10-17
Age:1.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-24, Days after onset: 7
Location:California  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4176AA1IM 
HEPA: HEP A (VAQTA)MERCK & CO. INC. 1IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1SC 
Administered by: Unknown     Purchased by: Private
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Febrile Seizure

VAERS ID:439832 (history)  Vaccinated:2011-10-17
Age:40.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-24, Days after onset: 7
Location:California  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT499AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Dyspnoea, Headache, Hyperhidrosis, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: Day of vaccination: muscle aches, dizziness. Next day headache, sweating, shortness of breath. Patient went to ER. She was given steroids and other medications. She recovered and left ER in 2 hours.

VAERS ID:439888 (history)  Vaccinated:2011-10-17
Age:49.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-25, Days after onset: 8
Location:Virginia  Entered:2011-10-25
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: Tests were taken CBC and others at Hospital.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Cough, Dizziness, Full blood count, Headache, Laboratory test, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever, dizziness, sore throat, headache, cough. I asked if I would get sick and was told "No". I had to go to emergency and Pay $150.00 co-pay.

VAERS ID:439905 (history)  Vaccinated:2011-10-17
Age:36.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-25, Days after onset: 8
Location:Oklahoma  Entered:2011-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: denies illnness
Preexisting Conditions: ?
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT451AA IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Feeling hot, Injection site pruritus, Injection site rash, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash/itching at site of injection and "hot" feeling systemically. Rash on back, right arm.

VAERS ID:439927 (history)  Vaccinated:2011-10-17
Age:46.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-25, Days after onset: 8
Location:Arkansas  Entered:2011-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Latex; Codeine; PCN; TALWIN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT425AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Immediate post-injection reaction, Injection site nodule, Injection site pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Immediate itching, knot @ injection site on day 2 & beyond area red & warm to touch.

VAERS ID:440044 (history)  Vaccinated:2011-10-17
Age:48.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-25, Days after onset: 7
Location:Illinois  Entered:2011-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AE UNLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Feeling hot, Headache, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)
Write-up: Approximately 6 hours after receiving vaccine patient felt chills & shaking from the chills about midnight. This lasted about one hour. Then patient felt she had a fever so she took 2 TYLENOL and went to sleep. She told me she felt ok in the morning except for having a headache.

VAERS ID:440089 (history)  Vaccinated:2011-10-17
Age:35.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 2
Location:Illinois  Entered:2011-10-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH469AB0IMRA
Administered by: Other     Purchased by: Private
Symptoms: Contusion, Skin warm
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)
Write-up: Bruising warm to touch. Bruise site: 7 " wide 2" high.

VAERS ID:440134 (history)  Vaccinated:2011-10-17
Age:16.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 2
Location:Pennsylvania  Entered:2011-10-26, 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
HPV4: HPV (GARDASIL)MERCK & CO. INC.1291AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4077BA1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Immediate post-injection reaction, Tonic clonic movements, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: GARDASIL injection was given. Pt immediately had a sudden onset of headache & tonic-clonic shaking of head and arms lasting 3-5 seconds. Pt was assisted to exam table. Observed for 40 minutes, she was given juice, crackers 2 tabs ALEVE, TYLENOL 325 mg 2 tabs, she was discharged to home with a severe headache which lasted 2 days.

VAERS ID:440154 (history)  Vaccinated:2011-10-17
Age:1.1  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-17, Days after onset: 0
Location:Minnesota  Entered:2011-10-26, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4197BA2IMRL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB492BA0IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0600AA0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0820AA0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Immediate post-injection reaction, Injection site erythema, Injection site reaction, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Raised welt at (R) thigh immediately following admin. of MMR vaccine. Also, localized redness at site of VZV vaccine (L) thigh (2.5 cm). (Redness on (R) thigh about 4 cm).

VAERS ID:440162 (history)  Vaccinated:2011-10-17
Age:52.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-10-26, Days after onset: 8
Location:Montana  Entered:2011-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: seeking mental health care
Preexisting Conditions: NKDA, depression, gout
Diagnostic Lab Data: medical physician consult sought by psychiatric providers, no leukocytosis or other infectious sources identified
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
Administered by: Private     Purchased by: Other
Symptoms: Laboratory test normal, Pain, Pain in extremity, Pyrexia, White blood cell count normal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever as high as 102.1, aches, arm pain.

VAERS ID:440197 (history)  Vaccinated:2011-10-17
Age:50.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 9
Location:West Virginia  Entered:2011-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE KNOWN
Preexisting Conditions: NO
Diagnostic Lab Data: Plans to follow up with facility to see if some other reason may be causing symptoms.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDN562065IMLA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: TEMPERATURE OF 101 AND BODY ACHES. CALLED TODAY 10/26/2011, THAT TEMPERATURE AND BODY ACHES HAVE BEEN REGULARLY RECURRING SINCE RECEIVING THE VACCINE.

VAERS ID:440226 (history)  Vaccinated:2011-10-17
Age:1.4  Onset:2011-10-19, Days after vaccination: 2
Gender:Male  Submitted:2011-10-26, Days after onset: 7
Location:Arizona  Entered:2011-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Multiple diagnostics tests done at verde valley medical center, inculding CBC, Cultures, chest xrays, etc.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEUR63896AB3IMLG
DTPIPV: DTP + IPV (NO BRAND NAME)SANOFI PASTEURC3755AA3IMLG
HEPA: HEP A (VAQTA)MERCK & CO. INC.0984AA0IMLG
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER 3IMLG
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0398AA0IMLG
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0603AA0IMLG
Administered by: Private     Purchased by: Public
Symptoms: Chest X-ray, Convulsion, Culture, Cyanosis, Febrile convulsion, Full blood count, Gaze palsy, Laboratory test, Moaning, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)
Write-up: Severe seizure, (including convulsions, gutteral moaning, eyes rolling into back of head, and eventually stopped breathing and turned blue) 911 was called, transported to ER by ambulance. Lab work, chest xrays done. Dr''s diagnosed as febrile seizure, though no instance of fever BEFORE seizure onset, no after release from ER. Max temp was 101.5 at ER.

VAERS ID:440243 (history)  Vaccinated:2011-10-17
Age:3.0  Onset:0000-00-00
Gender:Female  Submitted:2011-10-19
Location:New York  Entered:2011-10-26, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT472AB4IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4137AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Drug administered to patient of inappropriate age
SMQs:, Medication errors (narrow)
Write-up: None noted. She was given a vaccine in error by my staff.

VAERS ID:440255 (history)  Vaccinated:2011-10-17
Age:52.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-26, Days after onset: 8
Location:Texas  Entered:2011-10-26
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: Pt to have nerve conduction testing. Possible MRI.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH463AA0UNLA
Administered by: Public     Purchased by: Private
Symptoms: Axillary pain, Grip strength decreased, Hypoaesthesia, Injection site pain, Musculoskeletal pain, Nerve conduction studies, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Developed severe pain in left arm, shoulder, hand, & posterior shoulder blade & under arm in axillary area - day 2 post flu-shot; gradual increase in pain in arm (left) & numbness in hand, wrist, shoulder & up into (L) posterior latismus dorsi muscle-over next several days, TYLENOL & ibuprofen taken for pain with relief. Elevated arm (L) on pillows at night. Weak hand grip developed. Saw Dr on 10/24/11- awaiting referral to neurologist.

VAERS ID:440276 (history)  Vaccinated:2011-10-17
Age:64.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-26, Days after onset: 9
Location:California  Entered:2011-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA678AA UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Asthenia, Injection site pain, Injection site swelling
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (L) deltoid pain (L) arm with swelling weakness.

VAERS ID:440450 (history)  Vaccinated:2011-10-17
Age:4.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-10-26, Days after onset: 8
Location:Maine  Entered:2011-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Referral to ED.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT443AA1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site swelling, Injection site vesicles, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient developed red, swollen shoulder and upper arm. Edema three times normal size. Warm but nontender. Also a few blisters where band-aid adhesive was. Occurred 24 hrs after vaccine. See ER report. Fever to 101.

VAERS ID:440310 (history)  Vaccinated:2011-10-17
Age:1.1  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:2011-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Physical exam
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4119BA0IMRL
Administered by: Private     Purchased by: Unknown
Symptoms: Emotional distress, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt. developed fever and inconsolable x 3 days. Pt. seen on day 5. She still has symptoms but doing well. No fever. Consolable.

VAERS ID:440408 (history)  Vaccinated:2011-10-17
Age:1.2  Onset:0000-00-00
Gender:Male  Submitted:2011-10-27
Location:Georgia  Entered:2011-10-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever to 103. Rash on face, arms, trunk, and legs.

VAERS ID:440529 (history)  Vaccinated:2011-10-17
Age:57.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-10-28, Days after onset: 10
Location:Texas  Entered:2011-10-28
Life Threatening? Yes
Died? Yes
   Date died: 2011-10-27
   Days after onset: 9
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None.
Preexisting Conditions: Unknown.
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA685AA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Death, Intensive care, Multi-organ failure, Septic shock
SMQs:, Agranulocytosis (broad), Toxic-septic shock conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Reported to us that patient received Flu shot on 10/17/2011 and went to ER. Admitted to ICU with septic shock and multiple organ failure.

VAERS ID:440641 (history)  Vaccinated:2011-10-17
Age:39.0  Onset:2011-10-20, Days after vaccination: 3
Gender:Female  Submitted:2011-10-28, Days after onset: 8
Location:New York  Entered:2011-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lupus - diagnosed 3/2011
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1102501 UNRA
Administered by: Unknown     Purchased by: Private
Symptoms: Arthritis, Cardiac disorder, Condition aggravated, Nervous system disorder, Renal disorder, Systemic lupus erythematosus
SMQs:, Systemic lupus erythematosus (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt rec''d FLUVIRIN; 3-5 days later, all of LUPUS sx increased (to include renal cardiac, CNS & arthritis), sx remained x 5-7 days, then tapered; pt was in contact w/MD after 5-6 days after vaccine. MD directed pt to increase MTX - prednisone to control sx. Sx still present, but not as severe - worst flair since pt was on DM agent.

VAERS ID:440683 (history)  Vaccinated:2011-10-17
Age:29.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-28, Days after onset: 11
Location:Florida  Entered:2011-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject had previously received flu shots with no documented reactions.
Diagnostic Lab Data: UNK
CDC Split Type: A0949617A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA671AA0IJLA
Administered by: Private     Purchased by: Private
Symptoms: Burning sensation, Chest pain, Erythema, Immediate post-injection reaction, Injection site erythema, Injection site swelling, Non-cardiac chest pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of injection site redness in a 29-year-old female subject who was vaccinated with FLULAVAL (GlaxoSmithKline). There were no concurrent medications. On 17 October 2011 at 10:30 the subject received a dose of FLULAVAL at 0.5 ml in the left arm. On 17 October 2011, immediately after vaccination with FLULAVAL, the subject experienced injection site redness and swelling at the injection site. Her entire arm became red and burned. She also developed redness on her chest and non-cardiac chest burning. The healthcare professional considered the events were clinically significant (or requiring intervention). The subject was treated with BENADRYL. At the time of reporting the events were unresolved. The healthcare professional considered the events were probably related to vaccination with FLULAVAL. It was reported that 4 additional subjects experienced unspecified injection site reactions following administration of FLULAVAL. These events were not considered to be serious. Linked cases include A0950780A, A0950781A, A0950782A and A0950783A.

VAERS ID:440583 (history)  Vaccinated:2011-10-17
Age:43.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-29, Days after onset: 12
Location:Arizona  Entered:2011-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Had just recovered from pneumonia the week before
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 1IJLA
Administered by: Unknown     Purchased by: Private
Symptoms: Bone pain, Injection site pain, Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad)
Write-up: The injection itself was unusually painful and deeper than I''ve experienced before with flu shots. Left arm was predictably sore but the pain has continued well past a week and feels deep in my muscle and bone. Any range of motion of my left arm is painful. Pain radiates from left arm muscle to elbow. It does not radiate to the shoulder. Standard NSAID does help relieve pain, but pain persists if I don''t take this.

VAERS ID:440597 (history)  Vaccinated:2011-10-17
Age:53.0  Onset:2011-10-19, Days after vaccination: 2
Gender:Female  Submitted:2011-10-30, Days after onset: 11
Location:Wisconsin  Entered:2011-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Sulfa Drugs
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR   LA
Administered by: Unknown     Purchased by: Private
Symptoms: Migraine
SMQs:
Write-up: Migraine headache for 2 days and migraines increasing from usual pattern.

VAERS ID:440624 (history)  Vaccinated:2011-10-17
Age:64.0  Onset:2011-10-23, Days after vaccination: 6
Gender:Male  Submitted:2011-10-30, Days after onset: 7
Location:New York  Entered:2011-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to LEVAQUIN, KEFLEX; High Blood Pressure, Cholesterol
Diagnostic Lab Data: No tests
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITEDN573070IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chills, Malaise, Purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Purpuric rash on both legs below the knee, chills, malaise. Patient experienced same reaction 6 days after 2010 flu shot. No reaction previous to 2010.

VAERS ID:440652 (history)  Vaccinated:2011-10-17
Age:13.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-28, Days after onset: 11
Location:New Jersey  Entered:2011-10-31, 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: None
Diagnostic Lab Data: Body temp, 106
CDC Split Type: WAES1110USA02926
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1317AA1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: The information has been received from an office manager and a physician concerning a 13 years old male with no concurrent condition, no pertinent medical history or drug allergies who on 15-AUG-2011 was vaccinated with his first dose of GARDASIL (lot number 1009AA) and on 17-OCT-2011 was vaccinated with his second dose of GARDASIL (lot number 1317AA). No concomitant medications or vaccines. The reporter stated that after the first dose, the patient tolerated well. On 17-OCT-2011, the evening of the second dose, the patient experienced high fever/106 degree fever and seizure. The seizure was witnessed by the mother, a registered nurse. No treatment was needed. The patient did not go to emergency room. Mother simply called the physician the next day and related the incident. A list of neurologist names was given to the mother. The patient recovered from the fever and seizure. As the physician did not witness the seizure, she could not say if it was life threatening or disabling. The third dose would not be given. Upon internal review, seizure was considered to be an other important medical event. This is one of several reports receive from the same source about siblings. Additional information has been requested.

VAERS ID:440718 (history)  Vaccinated:2011-10-17
Age:4.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-19, Days after onset: 2
Location:Hawaii  Entered:2011-10-31, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Snoring; Tonsillar hypertrophy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4025AA0UNLL
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH476AB1UNLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB517CA0UNLL
Administered by: Private     Purchased by: Unknown
Symptoms: Gait disturbance, Injection site swelling, Local reaction
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)
Write-up: Limp, swelling (L) thigh from groin to knee large local reaction.

VAERS ID:440724 (history)  Vaccinated:2011-10-17
Age:53.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-24, Days after onset: 7
Location:Connecticut  Entered:2011-10-31, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURLTT462AC UNAR
Administered by: Other     Purchased by: Unknown
Symptoms: Chills, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Chills, body aches, headache, fever (101) approximately 4 hours after vaccine. Felt better next day, but took 1/2 of next day to feel "normal" again.

VAERS ID:440728 (history)  Vaccinated:2011-10-17
Age:35.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-24, Days after onset: 6
Location:Pennsylvania  Entered:2011-10-31, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3974AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythema at injection site. Advised cool compresses and TYLENOL.

VAERS ID:440736 (history)  Vaccinated:2011-10-17
Age:73.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Nevada  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Routine check up
Preexisting Conditions: Pancreatic cancer 6-13-03; essential thrombocytopenia 5-08; diabetes 1-11
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Military     Purchased by: Military
Symptoms: Cellulitis, Erythema, Injection site swelling, Oedema peripheral, Skin warm, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pneumonia shot in (R) arm. Swelling upper (R) arm medial aspect upper arm to crease of forearm. Axilla & spread to area of (R) chest. Appearance like cellulitis, skin red, swollen and warm to the touch. Treatment is cephalexin & BENADRYL every 6 hrs for 10 days.

VAERS ID:440884 (history)  Vaccinated:2011-10-17
Age:65.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 14
Location:Massachusetts  Entered:2011-11-01, 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: PCN; Perfume; Hx COPD; Hyperthyroid; DM 2; GERD; Dyslip
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA678AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Axillary pain, Immediate post-injection reaction, Injection site pain, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Flu vaccine given - immediate soreness at delt inj site followed by pain in ipsilateral axilla and swelling. Swelling gone now constant sting/throb in axilla persist.

VAERS ID:440940 (history)  Vaccinated:2011-10-17
Age:  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-27, Days after onset: 10
Location:Indiana  Entered:2011-11-01, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had no known allergies. Pre-existing conditions and illness at the time of vaccination were denied. The patient "never had a problem with flu shot".
Diagnostic Lab Data: Not reported
CDC Split Type: 201110255
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4163AA IDLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Erythema, Injection site erythema, Injection site nodule, Injection site pain, Injection site swelling, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report was received on 18 and 25 October 2011 from a health care professional, who is also the patient''s parent. A female patient (date of birth not reported) had received on 17 October 2011 a left arm injection of FLUZONE intradermal, lot number UT4163AA and five to ten minutes after injection, developed a red, painful knot that was approximately two inches. On 18 October 2011, the "knot was even larger approximately four to five inches and looks like cellulitis." According to the reporter, the patient''s arm was red, swollen and painful from the site to almost the elbow. Treatments included ADVIL and ice to the area. No further information was available at the time of the report. The patient recovered on 25 October 2011. Documents held by sender: none.

VAERS ID:441031 (history)  Vaccinated:2011-10-17
Age:71.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-23, Days after onset: 6
Location:Wisconsin  Entered:2011-11-01, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11025010IMLA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0661AA0SCLA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Inflammation, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: For 3+ days following vaccination arm is red, swollen, sore & inflamed.

VAERS ID:441083 (history)  Vaccinated:2011-10-17
Age:26.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-11-02, Days after onset: 16
Location:North Carolina  Entered:2011-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV2943UNUN
Administered by: Military     Purchased by: Military
Symptoms: Local reaction
SMQs:
Write-up: Pt developed large local reaction following receipt of AVA #4.

VAERS ID:441128 (history)  Vaccinated:2011-10-17
Age:35.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-02, Days after onset: 16
Location:Virginia  Entered:2011-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma, seasonal allergies, dairy allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11040115IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.9086AA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Dizziness, Injection site erythema, Injection site pain, Injection site reaction, Injection site urticaria, Injection site warmth, Joint swelling, Mobility decreased, Myalgia, Pain, Pain in extremity, Pyrexia, Skin infection, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Evening of 10/17/11 - Extreme pain at injection site and surrounding muscle. Morning of 10/18/11 - Extreme pain continued. Noon of 10/18/11 - Fever began, around 100 deg. Aches began. Evening of 10/18/11 - Extreme arm pain continued, fever up to 102.5 degrees. Muscle and joint pain, weakness, dizziness. Overnight 10/18-10/19/11 - Pain is so severe, sleep is disrupted. Fever continued, body pain continued. 10/19/11 morning - Fever continued at 102.5. Called dr and was instructed to do 800mg ibuprofen every 8 hrs. Ibuprofen brought fever down to around 100.7. Continued to have fever, feel weak, and achy throughout the day on 10/19. 10/20/11 morning - Woke up with large hives on right arm around injection site. Hives were large, red, raised, and very hot. Arm is so painful it is hard to move at all. Fever continued, but kept around 100 with ibuprofen. Evening of 10/20 - Hives have spread, but are no longer raised. Redness is deeper. Ibuprofen keeps fever down, but doesn''t help much with the arm pain. Morning of 10-21-11, hives now go from shoulder to elbow, elbow is swollen. Return to dr. He diagnoses a skin infection in addition to the vaccine reaction. Prescribed antibiotics, and 600mg ibuprofen every 6 hours. Evening of 10-21 - Hives spread more, and around to the under side of arm. 10-22 to 10-26 - Pain and hives continued, but slowly lessened as the days went on. 10-27 - Began to feel better overall... less tired, less weak. 10-30 - took final antibiotic. At present - Still have a faint pink mark on arm where hive began, and still have some light pain when pressure is applied, as well as some itching.

VAERS ID:441178 (history)  Vaccinated:2011-10-17
Age:55.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-11-02, Days after onset: 15
Location:Wisconsin  Entered:2011-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH486AE IMRA
Administered by: Other     Purchased by: Public
Symptoms: Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient husband said had shoulder pain & needed to see MD for pain meds after shot given on 10/17/11.

VAERS ID:441232 (history)  Vaccinated:2011-10-17
Age:1.2  Onset:0000-00-00
Gender:Male  Submitted:2011-11-01
Location:New Jersey  Entered:2011-11-03, Days after submission: 2
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: The patient was well at the time of vaccination. Pre-existing conditions and adverse events following prior vaccinations were reported as none.
Diagnostic Lab Data: Not reported
CDC Split Type: 201110403
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4159BB IMRA
Administered by: Private     Purchased by: Private
Symptoms: Encephalitis, Fall, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Initial report was received on 25 October 2011 from a health care professional. A one year-old patient who was well at the time of vaccination had received on 17 October 2011 an intramuscular right arm injection of FLUZONE, lot number U4159BB and an unspecified amount of later, experienced difficulty walking and would drop to the floor. The patient was diagnosed with cerebellitis, possibly from vaccination. Treatments and diagnostic tests were not reported. The patient had received on 13 September 2011 an intramuscular left arm injection of PREVNAR 13, Pfizer lot number 916973. The patient''s pre-existing conditions and adverse events following prior vaccinations were reported as none. No further information was available at the time of the report. The patient''s outcome was recovered. Documents held by sender: none.

VAERS ID:441319 (history)  Vaccinated:2011-10-17
Age:34.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 2
Location:Georgia  Entered:2011-11-03, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: GA11024
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH470AD IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site warmth, Pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Shot (Flu) admin. LA on 10/17/11. Client state injection was not painful at all - started having pain shoot down left arm. This A.M. 10-19-11 got up, could hardly move arm, is feverish at injection site.

VAERS ID:441397 (history)  Vaccinated:2011-10-17
Age:5.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-11-04, Days after onset: 17
Location:Wisconsin  Entered:2011-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Given Rocephin on 10/15/11 for otitis media
Preexisting Conditions: Recovering Otitis media No allergies. Nothing on his problem list
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (FOREIGN)GLAXOSMITHKLINE BIOLOGICALSAC20B171BA4IMRL
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501111P1IN 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0446AA1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0701AA1SCLL
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site pain, Injection site reaction, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Raised welt like spot warm to touch covering 3/4 of upper right thigh. Was painful to child. Reported to staff 11/04/2011 at office visit.

VAERS ID:441422 (history)  Vaccinated:2011-10-17
Age:7.0  Onset:2011-10-21, Days after vaccination: 4
Gender:Male  Submitted:2011-11-04, Days after onset: 14
Location:Texas  Entered:2011-11-04
Life Threatening? No
Died? Yes
   Date died: 2011-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: DENIED
Preexisting Conditions: PER REPORTS CHILD HAD UNDISCLOSED HEART CONDITION
Diagnostic Lab Data: UNKNOWN
CDC Split Type: TX20110081
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH455AD4IMRA
Administered by: Public     Purchased by: Other
Symptoms: Cardiac disorder, Condition aggravated, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: PT WAS VACCINATED ON 10/17. NO DISTRESS IMMEDIATELY FOLLOWING VACCINATION. PER REPORT FROM SCHOOL NURSE, PT COLLAPSED ON PLAYGROUND ON 10/21. REPORTEDLY, CHILD HAD UNDISCLOSED HEART CONDITION.

VAERS ID:441499 (history)  Vaccinated:2011-10-17
Age:68.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-04, Days after onset: 18
Location:Illinois  Entered:2011-11-04
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1101401 IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0453AA IMLA
Administered by: Other     Purchased by: Public
Symptoms: Cellulitis, Erythema, Myocardial infarction, Pyrexia, Trismus, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Dystonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The evening of vaccination - pt felt as if jaw was locking up. She was running 103 degree fever. She went to hospital - they suspected heart attack. Pt saw & felt redness in Rt arm. Went back to hosp 10/19/11 diagnosed with cellulitis from vaccine given antibiotics for tx.

VAERS ID:441452 (history)  Vaccinated:2011-10-17
Age:93.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-05, Days after onset: 19
Location:Oregon  Entered:2011-11-05
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
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED04549221A IMRA
Administered by: Other     Purchased by: Other
Symptoms: Influenza like illness, Injection site discolouration, Injection site erythema, Oropharyngeal pain, Sneezing
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Flu-like symptoms (sore throat, sneezing, big area of redness/purple color at injection site.

VAERS ID:441648 (history)  Vaccinated:2011-10-17
Age:65.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-11-07, Days after onset: 21
Location:Colorado  Entered:2011-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0630AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Hyperhidrosis, Nodule, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever chills sweats, nodule.

VAERS ID:441661 (history)  Vaccinated:2011-10-17
Age:37.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-11-07, Days after onset: 20
Location:New Mexico  Entered:2011-11-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Drug administered at inappropriate site, Incorrect drug administration duration, Injection site pain, Joint range of motion decreased
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)
Write-up: Arm has been extremely sore in the deltoid/shoulder region since the shot was administered 3 weeks ago, with no improvement (possibly worsening). Range of motion is limited. Shot was administered unusually high in the deltoid. Shot was administed at a shot clinic, and done very quickly and without much attention.

VAERS ID:441726 (history)  Vaccinated:2011-10-17
Age:26.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-08, Days after onset: 22
Location:Massachusetts  Entered:2011-11-08
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
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IJLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injected limb mobility decreased, Vaccination site pain
SMQs:
Write-up: Severe pain surrounding vaccine site, continuing at 1 month subsequent to vaccination and causing loss of range of motion of arm and shoulder in which vaccine was given.

VAERS ID:441736 (history)  Vaccinated:2011-10-17
Age:69.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-08, Days after onset: 22
Location:Maine  Entered:2011-11-08
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: Neurological testing in dr''s office - EKG, blood work and will have an MRI of head & lumbar area.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA6FEAA1IMLA
Administered by: Public     Purchased by: Other
Symptoms: Blood test, Cold sweat, Electrocardiogram, Fatigue, Neurological examination, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)
Write-up: Left arm tingling - 10/18/2011 continued left arm tingling down left leg tingling - cold sweat followed by fatigue. This has been ongoing since that date off & on different days. Have seen doctor twice, had an EKG, blood work, will also have an MRI. Everything is normal.

VAERS ID:441744 (history)  Vaccinated:2011-10-17
Age:4.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-10-19, Days after onset: 1
Location:Louisiana  Entered:2011-11-08, Days after submission: 20
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: CBC - ok
CDC Split Type: LA111022
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B178DA5IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB464AA1IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0008AA1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0419AA1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Full blood count normal, Injection site erythema, Injection site induration, Injection site swelling, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: (L) deltoid area, redness with hard swollen approx 19 cm x 11 cm started 10-18-11 approx 9:00 am. Seen at clinic by RN. Referred to dr. Seen at another clinic approx 10:00 am - was given rx for clindamycin, ATARAX, prednisone. Started rx at 1:0pm within 20 min rash & itching was gone.

VAERS ID:441870 (history)  Vaccinated:2011-10-17
Age:10.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 2
Location:Maryland  Entered:2011-11-09, Days after submission: 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: Osteochondrosis leg (juvenile)
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH471AA2IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1291AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0034AA1SCRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site urticaria, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Small red wheal 24 hrs after progressing to large 8x10 area of red induration at site. Tender & warm to touch.

VAERS ID:441971 (history)  Vaccinated:2011-10-17
Age:0.3  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-08, Days after onset: 22
Location:Virginia  Entered:2011-11-09, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Normal EEG; seen at clinic tx with ATIVAN, phenobarbital; seen by neurology
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B256BA1UNRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1263AA1UNRL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169751UNLL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.1557Z PO 
Administered by: Military     Purchased by: Unknown
Symptoms: Electroencephalogram normal, Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Child had complex febrile seizure after shots.

VAERS ID:442032 (history)  Vaccinated:2011-10-17
Age:50.0  Onset:2011-10-29, Days after vaccination: 12
Gender:Female  Submitted:2011-10-29, Days after onset: 0
Location:Pennsylvania  Entered:2011-11-09, Days after submission: 11
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: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT474AB IMAR
Administered by: Other     Purchased by: Private
Symptoms: Mobility decreased, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)
Write-up: Patient presented today (10/29/11) after receiving her flu shot (10/17/11) with shoulder pain. Patient reported not being able to raise her arm above her head. Patient is going to start naproxen and follow up with PCP.

VAERS ID:442080 (history)  Vaccinated:2011-10-17
Age:84.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Unknown  Submitted:0000-00-00
Location:Florida  Entered:2011-11-09
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 PASTEURVT450AA UNAR
Administered by: Unknown     Purchased by: Unknown
Symptoms: Mobility decreased, Musculoskeletal stiffness, Neck pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Woke up following morning with severe pain in neck - right side - neck stiff and movement limited - lasted four days went to orthopedic surgeon - steroid shot and 10 hr heat pack and daily ALEVE for 7 days.

VAERS ID:442021 (history)  Vaccinated:2011-10-17
Age:0.5  Onset:0000-00-00
Gender:Male  Submitted:2011-11-09
Location:Oklahoma  Entered:2011-11-10, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Premature birth
Preexisting Conditions:
Diagnostic Lab Data: Temperature measurement, 103 degr, elevated
CDC Split Type: WAES1111USA00055
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  PO 
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Condition aggravated, Eating disorder, Ileus, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician and a medical assistant (M.A) concerning a 6 months male patient with a history of premature birth who "two weeks ago", on approximately 17-OCT-2011 was vaccinated orally with a dose of ROTATEQ (Lot number and dose not reported). The physician reported that the patient''s mother had taken the patient to another pediatrician to receive ROTATEQ immunization on an unknown date. The physician reported that few days after the patient received ROTATEQ developed an elevated temperature of 103 degrees. The patient had episodes of vomiting and was not eating (previously reported as the baby was vomiting and eating issues prior to the immunization, the condition seemed to have gotten worse). The patient was admitted to the hospital with a diagnosis of an ileus. The patient was treated with intravenous fluids and PEDIALYTE. The patient recovered and was discharged from the hospital on 31-OCT-2011. The patient was scheduled for a follow-up visit with the physician. Ileus diagnosis was considered to be immediately life threatening by the reporter. Additional information has been requested.

VAERS ID:442054 (history)  Vaccinated:2011-10-17
Age:0.2  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-11-10, Days after onset: 23
Location:Missouri  Entered:2011-11-10
Life Threatening? No
Died? Yes
   Date died: 2011-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: No illness at the time. Patient was crying after his shots, that was the only reaction he showed. No fevers all day. He went to sleep at his normal time. Woke up around 0230 am and my husband rocked him back to sleep. When my husband went to wake patient up, patient wasn''t breathing, he was blue in the lips and cold and stiff. He was pronounced dead at 0604 am on 10/18/2011.
Preexisting Conditions: n/a
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B285EA0IJLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUH321AA0IJRL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169720IJRL
RV1: ROTAVIRUS (ROTARIX)GLAXOSMITHKLINE BIOLOGICALS41CB098A0PO 
Administered by: Military     Purchased by: Military
Symptoms: Crying, Cyanosis, Death, Musculoskeletal stiffness, Peripheral coldness, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow)
Write-up: Death

VAERS ID:442122 (history)  Vaccinated:2011-10-17
Age:46.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-11-10, Days after onset: 24
Location:Arkansas  Entered:2011-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: NIDDM HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT480AB10IMLA
Administered by: Military     Purchased by: Public
Symptoms: Injection site reaction, Muscle spasms, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Muscle soreness, muscle spasm in left deltoid extending up into left trapezius musculature.

VAERS ID:442124 (history)  Vaccinated:2011-10-17
Age:29.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-10, Days after onset: 24
Location:South Carolina  Entered:2011-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Plus vitamins.
Current Illness: No.
Preexisting Conditions: No.
Diagnostic Lab Data: None to date. Will see doctor as soon as patient can get an appointment, afraid the doctors won''t see a correlation between the shot and pain.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR 0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Injected limb mobility decreased, Injection site pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Injection site (left shoulder) sore to touch almost immediately after injection. Next few days pain increased, patient can barely lift arm to wash hair, put on clothes etc. At night arm falls asleep, and to date the pain has started to run down arm into fingers.

VAERS ID:442288 (history)  Vaccinated:2011-10-17
Age:74.0  Onset:2011-10-20, Days after vaccination: 3
Gender:Female  Submitted:2011-11-08, Days after onset: 19
Location:Florida  Entered:2011-11-11, 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: High BP
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Chills, Fatigue, Pain
SMQs:
Write-up: Tired - body aches - chills - lasted 4 days.

VAERS ID:442289 (history)  Vaccinated:2011-10-17
Age:28.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 14
Location:Florida  Entered:2011-11-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1100901 UNLA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Diarrhoea, Fatigue, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Nausea, vomiting, diarrhea, chills, fatigue.

VAERS ID:442290 (history)  Vaccinated:2011-10-17
Age:48.0  Onset:2011-10-20, Days after vaccination: 3
Gender:Female  Submitted:2011-10-31, Days after onset: 11
Location:Florida  Entered:2011-11-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Latex allergies; IBS; cervical & lumbar slipped discs
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal discomfort, Chills, Headache, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vomiting. Headache. Body aches. Chills. Stomach upset. Last for 5 days.

VAERS ID:442320 (history)  Vaccinated:2011-10-17
Age:69.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-11-12, Days after onset: 26
Location:Ohio  Entered:2011-11-12
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: Heart disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS111784P10UNLA
Administered by: Public     Purchased by: Public
Symptoms: Pharyngeal oedema
SMQs:, Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient came in 3 days after flu shot to let us know he had to go to ER due to his throat swelling after flu shot. ER administered epinephrine and pt was able to go home.

VAERS ID:442402 (history)  Vaccinated:2011-10-17
Age:15.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-11-14, Days after onset: 28
Location:Oregon  Entered:2011-11-14
Life Threatening? No
Died? Yes
   Date died: 2011-10-20
   Days after onset: 3
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote, Lyrica, Diazapam, Adderall
Current Illness: No
Preexisting Conditions: Seizure Disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1262AA IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4006AA IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B072EA IMRA
Administered by: Private     Purchased by: Public
Symptoms: Death, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Initial soreness and swelling. Death 10/20/2011.

VAERS ID:442466 (history)  Vaccinated:2011-10-17
Age:51.0  Onset:0000-00-00
Gender:Female  Submitted:2011-11-14
Location:Georgia  Entered:2011-11-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hypothyroid; allergies; lisinopril; sulfa
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA664AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Pt seen with complaints of arm pain since receiving flu vaccine 1 month ago.

VAERS ID:442500 (history)  Vaccinated:2011-10-17
Age:24.0  Onset:2011-10-24, Days after vaccination: 7
Gender:Female  Submitted:2011-10-31, Days after onset: 7
Location:New York  Entered:2011-11-14, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1332Y1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash erythematous, Rash macular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt. reports that on 10/24/11, 1 wk after receiving 2nd GARDASIL vaccine she broke out in red, blotchy rash that turned into hives torso, arms & legs. Pt. started BENADRYL 10/27/11 with relief.

VAERS ID:442646 (history)  Vaccinated:2011-10-17
Age:56.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-11-15, Days after onset: 28
Location:Florida  Entered:2011-11-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Mobility decreased, Musculoskeletal pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pharmacist administered flu shot into my shoulder. Pain started next day and increased. Received cortisone shot on Nov. 8. Still having pain and limited movement of arm/shoulder.

VAERS ID:442672 (history)  Vaccinated:2011-10-17
Age:52.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-16, Days after onset: 30
Location:Pennsylvania  Entered:2011-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: slight head cold, temp was 98.2 orally
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA69FAA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Local reaction, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm where shot administered became red and swollen, and painful to touch. Did not notify employee health at that time, because it seems like a normal local reaction, however didn''t feel well at about 12:30 PM and left work.

VAERS ID:442689 (history)  Vaccinated:2011-10-17
Age:60.0  Onset:2011-10-19, Days after vaccination: 2
Gender:Female  Submitted:2011-10-28, Days after onset: 9
Location:Missouri  Entered:2011-11-16, Days after submission: 19
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: Dust; Pollen (seasonal); Penicillin; Ibuprofen
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11025010UNLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Itching around injection site and down arm toward elbow. Patient says area that itched turn red and blotchy. Started itching 2 days after injection occurred and still itches (11 days later).

VAERS ID:443275 (history)  Vaccinated:2011-10-17
Age:4.0  Onset:2011-11-19, Days after vaccination: 33
Gender:Female  Submitted:2011-11-21, Days after onset: 2
Location:Texas  Entered:2011-11-21
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: NKDA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4027AA4IMLL
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.501117P IN 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0599AA1SCLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9169224IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0602AA1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Blister, Body temperature increased, Herpes zoster, Pain of skin, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Symptoms started 11/19 - painful rash to right forearm, c/o itching rash is blistering. Patient seen 11/20/11, diagnosed with shingles, seen by MD. 11/20/2011 - weight 36 lbs, temperature 99.7 degrees F (temporal).

VAERS ID:443329 (history)  Vaccinated:2011-10-17
Age:11.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-11-15, Days after onset: 28
Location:West Virginia  Entered:2011-11-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Seizures~Vaccine not specified (no brand name)~UN~1.30~Sibling
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB472BA1UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1437Z1UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0023A1SCUN
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: In on 10/17/11 for Varicella #2, Hep A #2, and HPV #2. Mother noticed that afternoon redness & swelling in (R) arm at injection sites. Called and was advised to use cool compresses and TYLENOL or MOTRIN. By the next am (10/18/11) swelling had increased, had fever, area was red & hot to touch, (+) pain. Sought tx at medical center. was started on ABX.

VAERS ID:443879 (history)  Vaccinated:2011-10-17
Age:51.0  Onset:2011-10-24, Days after vaccination: 7
Gender:Female  Submitted:2011-11-17, Days after onset: 24
Location:Ohio  Entered:2011-11-22, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: Had a CT done on 10/31/2011.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED04549221A IDUN
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Computerised tomogram, Decreased appetite, Faeces discoloured, Hemiparesis, Lymphadenopathy, Musculoskeletal stiffness
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Arthritis (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Severe weakness, stiff neck, swollen glands all over body, black stools, no appetite. (L) side weakness. No fever. Symptoms lasted 2 wks started after flu vac.

VAERS ID:443446 (history)  Vaccinated:2011-10-17
Age:80.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2011-11-23, Days after onset: 36
Location:Ohio  Entered:2011-11-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: FELDOPINE, RAMIPRIL, IMDAPAMIDE, METOPROLOL SUCCINATE, WARFARIN, DOXAZOSIN, SIMVASTATIN
Current Illness: DENIED
Preexisting Conditions: ALLERGY TO SULFA DRUGS
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT492AA IMRA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0756AA0SCLA
Administered by: Other     Purchased by: Public
Symptoms: Breast discomfort, Limb discomfort, Paraesthesia, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: RECEIVED SHINGLES VACCINE, NEXT PM DEVELOPED TINGLING & DISCOMFORT OVER RIGHT BREAST AND UNDER RIGHT ARM. DEVELOPED ITCHY RED BUMPS. TX WITH STEROIDS AND ANTIVIRAL.

VAERS ID:443918 (history)  Vaccinated:2011-10-17
Age:1.0  Onset:2011-11-15, Days after vaccination: 29
Gender:Male  Submitted:2011-11-21, Days after onset: 6
Location:Arizona  Entered:2011-11-28, 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 (well child check)
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4149CA0IMRL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB453AA0IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0155AA0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0137AA0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Impetigo, Rash, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: "Rash appeared on lower abdomen and upper buttocks appearing impetiginous. Lesions had a central grey fluid filled vesicle. Rash erupted 27 days post vaccination."

VAERS ID:443971 (history)  Vaccinated:2011-10-17
Age:36.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-10-17, Days after onset: 0
Location:Texas  Entered:2011-11-30, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH478AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling at injection site bigger than quarter size. Feels warm at injection site. Feels hard at injection site. No rash / no trouble breathing.

VAERS ID:444188 (history)  Vaccinated:2011-10-17
Age:49.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-12-01, Days after onset: 44
Location:North Dakota  Entered:2011-12-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type: ND1129
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH455AD IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0453AA2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Flushing, Headache, Mobility decreased, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: ARM "SO SORE COULD NOT LIFT IT UP" FEVER HEADACHE AND "FELT FLUISH".

VAERS ID:444826 (history)  Vaccinated:2011-10-17
Age:64.0  Onset:2011-10-20, Days after vaccination: 3
Gender:Female  Submitted:2011-11-25, Days after onset: 36
Location:Kentucky  Entered:2011-12-07, 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: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
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PER: PERTUSSIS (NO BRAND NAME)EMERGENT BIOSOLUTIONS 0UNUN
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNUN
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Bacterial infection, Chest X-ray, Computerised tomogram, Cough, Dizziness, Dysphonia, Dyspnoea, Increased upper airway secretion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Dry cough - wheezing - difficulty breathing - phlegm - weak - hoarseness - dizzy - started Oct 20-11. Went to Dr. office - treated for bacterial infection w/ antibiotic & cough syrup - 10 days later had to go to ER - got chest x-ray - CT scan - breath treatment meds - antibiotic - inhaler - prednisone - cough syrup.

VAERS ID:444830 (history)  Vaccinated:2011-10-17
Age:51.0  Onset:2011-11-09, Days after vaccination: 23
Gender:Female  Submitted:2011-12-06, Days after onset: 27
Location:Ohio  Entered:2011-12-07, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH462AB IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site atrophy, Muscle atrophy, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)
Write-up: C/O dull achy pain in left arm, noticed "divet" at this site 3-4 wks. after the vaccine was given. Saw MD on 12/2/11 Dr. measured the "divet" at 2 cm x 1.5 cm on client''s left arm - feels due to vaccine - recommends arm be monitored every 2 months for 1 yr. Avoid taking flu vaccine in future. May need plastic surgery to fill in "divet" in future. Diag. muscle atrophy due to flu vaccine.

VAERS ID:445826 (history)  Vaccinated:2011-10-17
Age:4.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-12-09, Days after onset: 52
Location:Pennsylvania  Entered:2011-12-19, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NASONEX nasal spray
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSAC20B171CA0IMLL
Administered by: Private     Purchased by: Other
Symptoms: Chills, Crying, Disorientation, Pyrexia, Speech disorder, Staring, Vomiting
SMQs:, Acute pancreatitis (broad), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: She had vomiting, low grade fever the night after vaccine. Approx 24 hours after vaccine, mom was alerted by unusual cry after nap and she appeared disoriented, then normal. Similar episode of staring/shivering/mumbling happened briefly that night again. Mom concerned about seizure, but did not seek medical attention because incident did not recur.

VAERS ID:446983 (history)  Vaccinated:2011-10-17
Age:55.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2012-01-06, Days after onset: 80
Location:Illinois  Entered:2012-01-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Musculoskeletal pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)
Write-up: Extreme soreness in arm and shoulder. Dizziness.

VAERS ID:447072 (history)  Vaccinated:2011-10-17
Age:70.0  Onset:2011-11-18, Days after vaccination: 32
Gender:Female  Submitted:2012-01-09, Days after onset: 52
Location:Georgia  Entered:2012-01-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vytorin, propranolol, lisinopril, paroxetine, and diclofenac.
Current Illness: None
Preexisting Conditions: HBP, hypercholesterolemia, depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUH439AA0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Fatigue, Headache, Musculoskeletal stiffness, Neck pain, Rhinorrhoea
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Headache in back of head and pain in neck. Stiffness in the neck. Fatigue. Runny nose. All symptoms are still continuing, but intermittent.

VAERS ID:447174 (history)  Vaccinated:2011-10-17
Age:12.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2012-01-05, Days after onset: 80
Location:Georgia  Entered:2012-01-11, 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: None
Current Illness: Well child check
Preexisting Conditions: No known drug allergy; asthma - seasonal
Diagnostic Lab Data: Negative MRI. Small arachnoid cyst - incidental finding. Seen by neurology placed on PERIACTIN.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0841AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Arachnoid cyst, Headache, Nuclear magnetic resonance imaging normal
SMQs:
Write-up: HPV #1 received 10-17-11 at well check. Headache within 24 hours. Seen 11-1-11 ? atypical migraine. No relief with ADVIL. Seen 11-4-11 continued headache pain 6-10 no relief with IMITREX negative MRI slight improvement with LORTAB. Placed on PERIACTIN. Headache -$g 12/1/11. 2nd HPV given 12-20-11 immediate onset headache.

VAERS ID:447490 (history)  Vaccinated:2011-10-17
Age:43.0  Onset:2011-10-31, Days after vaccination: 14
Gender:Female  Submitted:2012-01-17, Days after onset: 78
Location:Vermont  Entered:2012-01-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Spinal tap showing high protein level.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3539AAND0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Abasia, CSF protein increased, Guillain-Barre syndrome, Hypoaesthesia, Immunoglobulin therapy, Intensive care, Lumbar puncture abnormal, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Guillain-Barre Syndrome, pain, numbness, tingling in feet and legs, inability to walk, numbness in fingers. Hospitalized in ICU and rehab, treated with IVIG, pain medication, muscle relaxants.

VAERS ID:447726 (history)  Vaccinated:2011-10-17
Age:46.0  Onset:2011-12-09, Days after vaccination: 53
Gender:Female  Submitted:2012-01-20, Days after onset: 42
Location:California  Entered:2012-01-20
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not known which Sanofi vaccine patient received. Her clinic may know.
Current Illness: No.
Preexisting Conditions: None.
Diagnostic Lab Data: Enhancing high signal abnormalities in mid-thoracic spinal cord on MRI; pleocytosis on LP; no other abnormalities to suggest a specific diagnosis.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR182043 UN 
Administered by: Public     Purchased by: Private
Symptoms: Hypoaesthesia, Lumbar puncture abnormal, Muscular weakness, Myelitis transverse, Nuclear magnetic resonance imaging spinal cord abnormal, Pleocytosis, Spinal cord disorder, Urinary retention
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow)
Write-up: Progressive lower extremity weakness and numbness with urinary retention. Proven diagnosis of T6-7 transverse myelitis.

VAERS ID:448003 (history)  Vaccinated:2011-10-17
Age:38.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2011-10-21, Days after onset: 4
Location:Texas  Entered:2012-01-25, Days after submission: 96
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 PASTEURUH476AB1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Patient went to ER because the patient could not breath. His airway was closing and having trouble breathing. Patient brought in an ER rx the next day (10/18/11).

VAERS ID:448166 (history)  Vaccinated:2011-10-17
Age:53.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2012-01-10, Days after onset: 85
Location:Idaho  Entered:2012-01-26, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: AMBIEN 10 mg
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type: WA120001
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11135P0IMAR
Administered by: Other     Purchased by: Private
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)
Write-up: - Unpleasant (soap-like) taste in mouth.

VAERS ID:449139 (history)  Vaccinated:2011-10-17
Age:16.0  Onset:2011-11-23, Days after vaccination: 37
Gender:Female  Submitted:2012-02-08, Days after onset: 77
Location:New York  Entered:2012-02-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Migraine Headaches; Asthma; Nearsightedness
Diagnostic Lab Data: All labs (-) to date for acute etiology. EKG (-)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURAFLUA618BA UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1437Z0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Clumsiness, Electrocardiogram normal, Fatigue, Hypoaesthesia, Laboratory test normal, Loss of proprioception, Migraine, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: W/i 24 hours, migraine headache each GARDASIL since October. She has had body aches: pain, reports of clumsiness and tiredness. She started coming in for sick visit in early January due to nausea/vomiting. Now she reports periods of numbness and "not knowing where her legs are" and proprioception.

VAERS ID:451013 (history)  Vaccinated:2011-10-17
Age:58.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2012-03-04, Days after onset: 139
Location:New York  Entered:2012-03-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergic to ibuprofen
Diagnostic Lab Data: MRI 12/28/2011- edema of infraspinatus muscle and musculotendinous junction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA627CA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pain in same shoulder as vaccination, which was administered high on the deltoid. Pain increased daily. Steroid injection done on 11/09/2011. Physical therapy 11/23/2011 for 4 weeks. Pain continues to this day.

VAERS ID:451550 (history)  Vaccinated:2011-10-17
Age:0.2  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2012-03-12, Days after onset: 147
Location:Ohio  Entered:2012-03-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient screamed uncontrollable, non stop, for over 4 hours. She slept through the rest of the day and evening after the doctor advised us to give her Tylenol. Patient woke the next morning with a blank stare on her face. She did not make eye contact for over 4 days and just stared. She was "glazed" over for almost a week.
Preexisting Conditions: None
Diagnostic Lab Data: DTaP, IPV, Pnemococcal, HIB, Rotavirus
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
DTPIPV: DTP + IPV (NO BRAND NAME)UNKNOWN MANUFACTURER    
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER    
RVX: ROTAVIRUS (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Decreased eye contact, Screaming, Staring, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Patient screamed uncontrollably non stop for over 4 hours. The next day she did not make eye contact. Patient was staring blankly and "glazed" over. She was unresponsive to any noise or movement in front of her. This lasted for 4 days.

VAERS ID:451970 (history)  Vaccinated:2011-10-17
Age:67.0  Onset:2011-10-21, Days after vaccination: 4
Gender:Male  Submitted:2012-03-14, Days after onset: 145
Location:Pennsylvania  Entered:2012-03-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had a history of seasonal allergies. He took no concomitant medications and had no illnesses at the time of vaccination. The patient had a reaction of "very sick" to the influenza vaccine when he was in his teens.
Diagnostic Lab Data:
CDC Split Type: 201202777
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT474AB IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Deafness unilateral, Decreased appetite, Ear infection viral, Mobility decreased, Nerve injury, Nuclear magnetic resonance imaging brain normal, Pain
SMQs:, Dementia (broad), Parkinson-like events (broad), Accidents and injuries (narrow), Hearing impairment (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Initial report received from a health care professional on 12 March 2012. This reporter also reported another adverse event, which was captured in case number 2012-02847. A 68-year-old male patient received an intramuscular left deltoid injection of FLUZONE, sanofi pasteur Inc. lot number UT474AB, on 17 October 2011. On 21 October 2011, the patient started with symptoms of body aches and pain and could not get out of bed for five days. He could barely eat. The patient developed loss of hearing in the right ear. The patient had a magnetic resonance imaging (MRI) of the brain which was interpreted as "OK". He was seen by his physician who diagnosed him with a viral infection behind the ear drum which caused nerve damage. The patient''s hearing will not return. The outcome was reported as recovered. Documents held by sender: None.

VAERS ID:452475 (history)  Vaccinated:2011-10-17
Age:75.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2012-03-26, Days after onset: 161
Location:Maine  Entered:2012-03-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine; Propanolol; Simvastatin
Current Illness: No
Preexisting Conditions: Hypothyroid; High cholesterol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH462AC0IMAR
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Mobility decreased
SMQs:, Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Intense pain at time of shot, shooting pain down to elbow. Could not move arm for months (due to extreme pain). Pain eventually/slowly subsided. Immunization given in extreme upper deltoid per pt.

VAERS ID:453659 (history)  Vaccinated:2011-10-17
Age:0.2  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2012-03-29, Days after onset: 164
Location:Missouri  Entered:2012-04-10, 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: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1110USA02607
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 0PO 
Administered by: Private     Purchased by: Other
Symptoms: No adverse event, Oral administration complication, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Information has been received from a certified medical assistant concerning a 9 weeks old female patient with no pertinent medical history and no drug allergy or reaction who on 17-OCT-2011 was vaccinated with the first dose of ROTATEQ (Lot number not reported) orally. On 17-OCT-2011 the patient experienced vomited in the office after receiving her first dose of ROTATEQ. At the time of the report, the patient''s present status was unknown. Follow-up information has been received from a physician concerning the patient who on 17-OCT-2011 3:00 PM was vaccinated with the first dose of ROTATEQ (lot # 12011Z is an invalid lot number for ROTATEQ) orally. The physician reported that there was no adverse event. The patient spit out dose on 17-OCT-2011 3:00 PM. The physician checked to see if needed to be repeated. It was reported answer was no. Emergency room or doctor visit was not required. No further information is available.

VAERS ID:454426 (history)  Vaccinated:2011-10-17
Age:49.0  Onset:2011-10-19, Days after vaccination: 2
Gender:Female  Submitted:2012-04-26, Days after onset: 190
Location:Illinois  Entered:2012-04-26
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: X-rays, MRI, NCV, EMG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT425AA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Electromyogram, Injection site mass, Nerve conduction studies, Nuclear magnetic resonance imaging, Pain in extremity, X-ray
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Arm extremely sore with lump at injection site.

VAERS ID:456974 (history)  Vaccinated:2011-10-17
Age:59.0  Onset:0000-00-00
Gender:Female  Submitted:2012-06-07
Location:Ohio  Entered:2012-06-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR? IMRA
Administered by: Public     Purchased by: Private
Symptoms: Musculoskeletal stiffness, Neck pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Shortly after I received the flu shot, I began having a stiffness and soreness in my neck that will not go away - after many doctor consultations where no one can determine the cause, the only event that coincides with my pain is my flu shot.

VAERS ID:461502 (history)  Vaccinated:2011-10-17
Age:51.0  Onset:0000-00-00
Gender:Female  Submitted:2012-06-18
Location:California  Entered:2012-08-08, Days after submission: 51
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: There were no concomitant vaccinations or medications, and no relevant medical history. The subject had not experienced adverse events following previous vaccinations, including prior flu shots (including FLUARIX).
Diagnostic Lab Data: UNK
CDC Split Type: A0951580A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA609AA UNLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This case was reported by a pharmacist and described the occurrence of injection site soreness/tenderness in a 51-year-old female subject who was vaccinated with FLUARIX (GlaxoSmithKline). On 17 October 2011 the subject received a dose of FLUARIX (.5 ml, unknown route, left deltoid). Between 17 and 19 October 2011, less than one week after vaccination with FLUARIX, the subject experienced injection site soreness/tenderness and injection site warmth. The subject was treated with ibuprofen. At the time of reporting the events were unresolved. The pharmacist considered the events were possibly related to vaccination with FLUARIX.

VAERS ID:461526 (history)  Vaccinated:2011-10-17
Age:1.1  Onset:2011-10-17, Days after vaccination: 0
Gender:Male  Submitted:2012-08-09, Days after onset: 297
Location:Oregon  Entered:2012-08-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Dairy allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNRL
Administered by: Private     Purchased by: Private
Symptoms: Hypersensitivity, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed a large hive at injection site. Given Benadryl by nurse, waited at clinic for two hours to ensure no further allergic reaction. No further reaction happened.

VAERS ID:461905 (history)  Vaccinated:2011-10-17
Age:68.0  Onset:2011-12-01, Days after vaccination: 45
Gender:Male  Submitted:2012-01-10, Days after onset: 40
Location:Unknown  Entered:2012-08-13, Days after submission: 215
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: High cholesterol; Hypertension; IGT
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: VIIth nerve paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: 10/17/2011. ZOSTAVAX injection. Patient had Bells Palsy 12/1/2011. Patient convinced his immune system is not working as well as before ZOSTAVAX. ZOSTAVAX received via Pharmacy.

VAERS ID:463860 (history)  Vaccinated:2011-10-17
Age:24.0  Onset:0000-00-00
Gender:Female  Submitted:2012-08-13
Location:New York  Entered:2012-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Obesity; Depression; Abortion induced
Preexisting Conditions:
Diagnostic Lab Data: Ultrasound, normal
CDC Split Type: WAES1110USA02499
Vaccination
Manufacturer
Lot
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Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Delivery, Inappropriate schedule of drug administration, Laboratory test, Maternal exposure during pregnancy, Normal newborn, Ultrasound scan normal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Medication errors (narrow)
Write-up: Information has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning a 24 year old female with depression, gestation for 14 weeks and 5 days and no drug allergies who on 09-OCT-2010, 17-OCT-2011 were vaccinated with the first and second dose of GARDASIL, respectively. Concomitant therapy included prenatal vitamins (unspecified). On an unspecified date, routine lab blood work was performed with unspecified results. The patient contacted physician to seek medical attention. No treatment was given for the adverse event. The last menstrual period was on 07-JUL-2011, and estimated delivery date was on 12-APR-2012. At the time of the report, the patient''s outcome was unknown. Follow up information has been received from an outreach specialist who reported that the patient gave birth on 19-APR-2012 at 40 weeks, to a healthy baby boy via vaginal delivery. The infant weighted 8 lb 5 oz. There were no complications with delivery or infant congenital anomalies reported. Follow-up information has been received from a physician concerning a patient with obesity and depression and a history of two previous pregnancies and two elective abortions. Concomitant medication was reported as "prenatal vitamins". It was reported that the patient gave birth on 19-APR-2012 at 41 weeks (previously reported 40), to a male infant without congenital anomalies; it was also reported that the baby was not normal. Apgar scare 8/9. Diagnostic tests included ultrasound scan (Date:unknown, result: normal). There is no complication and infections or illness during pregnancy. No further information is available.

VAERS ID:463224 (history)  Vaccinated:2011-10-17
Age:0.9  Onset:2012-03-28, Days after vaccination: 163
Gender:Female  Submitted:2012-08-23, Days after onset: 148
Location:Wisconsin  Entered:2012-08-27, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject had previously received two doses of PENTACEL; lot number C3801AA received on 13 June 2011 and lot number C3930AA received on 15 August 2011.
Diagnostic Lab Data:
CDC Split Type: 201207606
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL)SANOFI PASTEURC4001AB2UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Apnoea, Chest X-ray normal, Cough, Laboratory test abnormal, Pertussis, Polymerase chain reaction, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Respiratory failure (narrow)
Write-up: Initial report received on 15 August 2012 from the Investigator participating in a post-marketing study under the reference number of M5A16. A case of pertussis disease in an 11-month-old female subject was identified by the investigator based on review of data from the Electronic Disease Surveillance (EDSS) electronic database. The subject had received 3 doses of PENTACEL; lot number C3801AA received on 13 June 2011, lot number C3930AA received on 15 August 2011 and lot number C4001AB received on 17 October 2011 (routes and sites of administration not reported). The subject developed a cough on 28 March 2012, approximately five months after the last dose. On 01 April 2012, the subject developed a paroxysmal cough without a whoop. The subject also experienced apnea and sleep disturbance. Laboratory testing included positive PCR on 09 April 2012. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of Azithromycin starting on 09 April 2012 for five days. The subject was not hospitalized. At the time of final contact on 17 April 2012, the subject''s cough was still persisting. The duration of the cough was reported at that time as 20 days. Investigator causality assessment is not required as per protocol. Documents held by sender: None.

VAERS ID:472467 (history)  Vaccinated:2011-10-17
Age:18.0  Onset:0000-00-00
Gender:Female  Submitted:2012-10-03
Location:Unknown  Entered:2012-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Seasonal allergy; Gastrooesophageal reflux disease; Attention deficit/hyperactivity disorder
Diagnostic Lab Data: Pregnancy test, 9 weeks pregnant
CDC Split Type: WAES1110USA03841
Vaccination
Manufacturer
Lot
Dose
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Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Live birth, Maternal exposure during pregnancy, No adverse event, Pregnancy test positive, Shortened cervix
SMQs:, Dementia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Information has been received from an 18 year old female patient with no pertinent medical history and no drug reactions or allergies, for GARDASIL, a Pregnancy Registry product, reporting on herself who on 17-OCT-2011 was vaccinated intramuscularly with the first dose of GARDASIL (dose and lot # not reported). The patient performed pregnancy test and had discovered that she was 9 weeks pregnant now. There were no adverse events to report. The patient did not seek medical attention. Her LMP was approximately on 23-AUG-2012 and EDD is on 29-MAY-2012. Follow-up information was received from the physician regarding a female patient with attention deficit disorder, seasonal allergies, GERD. Concomitant medications included SINGULAIR, ATROVENT and ZANTAC. On 28-MAY-2012, the patient gave birth to a male (8 lbs., 2 oz.; 20" in length). 40 weeks from LMP. The infant was reported as being normal with no reported congenital anomalies or any other complications. The patient had a shortened cervix during pregnancy and required bed rest during the pregnancy. There were no complications reported during labor or delivery. Additional information has been requested.

VAERS ID:472843 (history)  Vaccinated:2011-10-17
Age:48.0  Onset:2012-10-17, Days after vaccination: 366
Gender:Female  Submitted:2012-11-04, Days after onset: 18
Location:Missouri  Entered:2012-11-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None, doctor wasn''t concerned with seeing me, especially since I had the shot given to me at a pharmacy
CDC Split Type:
Vaccination
Manufacturer
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS6652101151012IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Extremely painful at time of injection and still cannot lift arm without extreme pain and arm and fingers go numb.

VAERS ID:474111 (history)  Vaccinated:2011-10-17
Age:37.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-11-30, Days after onset: 43
Location:Colorado  Entered:2012-11-09, Days after submission: 345
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 illness at the time of vaccination. Medical history included hypertension (HTN).
Diagnostic Lab Data: None
CDC Split Type: 201110153
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4164BA IDRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Injection site erythema, Injection site pain, Injection site swelling, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Initial report was received from a health care professional on 18 October 2011. A 37-year-old female patient had received an Intradermal (ID) injection of FLUZONE; lot number UT4164BA in right deltoid on 17 October 2011. On 18 October 2011, the patient developed a "2.5" inch diameter red, swollen, painful, sore and burning at the right deltoid. She also experienced headache and nausea. No further informational was available at the time of the report. The patient outcome was reported as not recovered/not resolved. Documents held by sender: none.

VAERS ID:475816 (history)  Vaccinated:2011-10-17
Age:51.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2012-02-23, Days after onset: 128
Location:Ohio  Entered:2012-11-09, Days after submission: 260
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: Illness at the time of vaccination, pre-existing medical conditions and concomitant medications were unknown. The patient had several doses of influenza vaccines in the past. The patient also had the same reactions (achiness, feverish for 2-3 days, joint pain and muscle aches) following an influenza vaccine in the past. Follow-up information received on 21 February 2012 reported that the patient had no illnesses at the time of vaccination.
Diagnostic Lab Data: Unknown
CDC Split Type: 201200774
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH467AB IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Arthralgia, Myalgia, Pain, Pyrexia, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report was received from a health care professional on 19 January 2012. This case is one of a cluster of seven patients reported by the same reporter who each experienced adverse events following administration of FLUZONE (lot number not reported). The events for the other patients were captured in case numbers 2012-00770, 2012-00771, 2012-00772, 2012-00773, 2012-00775 and 2012-00776. A female patient had received an injection of FLUZONE, sanofi pasteur Inc. (lot number, route, site and date of administration unknown) and an unspecified amount of time later experienced achiness, feverish for 2-3 days, joint pain and muscle aches. Illness at the time of vaccination, pre-existing medical conditions and concomitant medications were unknown. The patient had several doses of influenza vaccines in the past. The patient also had the same reactions (achiness, feverish for 2-3 days, joint pain and muscle aches) following an influenza vaccine in the past. No further information was available at the time of the report. The patient''s outcome was recovered. Documents held by sender: none. Follow-up information received from a healthcare professional on 21 February 2012 reported that the 51-year-old patient had no illnesses at the time of vaccination. The patient received an intramuscular left deltoid injection of FLUZONE, sanofi pasteur Inc. lot number UH467AB, on 17 October 2011 in the AM. On 18 October 2011, Tuesday morning, the patient felt achy and took MOTRIN every four hours (q4h) and hot baths. On Wednesday she became feverish and achier. She continued with MOTRIN and hot baths. Wednesday evening and Thursday, the fever continued and "felt like a semi truck kept driving over me and backing up and driving over me again". Every muscle and joint hurt and she continued with MOTRIN and hot baths. She had no respiratory symptoms. The outcome remained recovered. No additional information was available. Documents held by sender: Medical timeline.

VAERS ID:474093 (history)  Vaccinated:2011-10-17
Age:35.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2012-11-07, Days after onset: 387
Location:Ohio  Entered:2012-11-14, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None - multivitamin.
Current Illness: None prior to vaccination
Preexisting Conditions: None
Diagnostic Lab Data: Bloodwork urinalysis - I can send if you need it.
CDC Split Type:
Vaccination
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR64147BA0SYRRA
Administered by: Public     Purchased by: Other
Symptoms: Blood pressure increased, Blood test, Caesarean section, Fatigue, Immediate post-injection reaction, Malaise, Maternal exposure during pregnancy, Premature delivery, Protein urine present, Urine analysis
SMQs:, Acute renal failure (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Hypertension (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: I was pregnant. I became immediately very sick feeling & tired. My blood pressure went way up and stayed, I had 6 grams of protein in my urine by 4 days later. I was hospitalized. My son was born 13 days after the vaccine by C-section and was 30 days premature.

VAERS ID:489764 (history)  Vaccinated:2011-10-17
Age:11.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2013-04-15, Days after onset: 546
Location:Pennsylvania  Entered:2013-04-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA113AA2UNLA
Administered by: Private     Purchased by: Public
Symptoms: Rash erythematous, Skin exfoliation, Skin hypopigmentation, Skin lesion
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 1.5 cm diameter lesion, erythematous, scaly with clearing in center. There is also a hypopigmental patch.

VAERS ID:495856 (history)  Vaccinated:2011-10-17
Age:39.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2013-07-03, Days after onset: 625
Location:Connecticut  Entered:2013-07-03
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I was on no other prescriptions for anything and was healthy prior to receiving vaccine. No prior adverse reactions to any vaccine. The hospital would have all the flu shot vaccine lot information etc. as asked for above.
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: IV adminstered to counter act the effects caused Cellulitis and subsequent persistent blood clots from wrist to crease in forearm. Inability to diffuse blood clots with several rounds of daily injectable blood thinners caused permenent left arm nerve damage as verified by two doctors, one of them an independent doctor for the hospital.
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11074P1IMRA
Administered by: Public     Purchased by: Other
Symptoms: Cellulitis, Erythema, Immediate post-injection reaction, Nerve injury, Throat irritation, Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Immediate itchy throat and reddening of entire arm. Sent to employee health then immediately to Emergency Room where counter active IV''s where administered.

VAERS ID:650597 (history)  Vaccinated:2011-10-17
Age:  Onset:2011-10-17, Days after vaccination: 0
Gender:Unknown  Submitted:2016-08-29, Days after onset: 1778
Location:Oregon  Entered:2016-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1608USA013592
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0138AA0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect product storage, No adverse event
SMQs:, Medication errors (narrow)
Write-up: This spontaneous report was received from a nurse practitioner and refers to a patient of unknown age and gender. On 17-OCT-2011, the patient was vaccinated with improperly stored dose of VARIVAX lot # 669601/0138AA dose 1. On 22-NOV-2011, the patient was vaccinated with second improperly stored dose of VARIVAX, lot#: 669601/0138AA. No adverse effect reported. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:650677 (history)  Vaccinated:2011-10-17
Age:  Onset:2011-10-17, Days after vaccination: 0
Gender:Unknown  Submitted:2016-08-29, Days after onset: 1778
Location:Oregon  Entered:2016-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1608USA013591
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0138AA0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect product storage, No adverse event
SMQs:, Medication errors (narrow)
Write-up: This spontaneous report was received from a nurse practitioner and refers to a patient of unknown age and gender. On 17-OCT-2011 the patient was vaccinated with improperly stored dose VARIVAX lot # 669601/0138AA dose 1. On 07-DEC-2011, the patient was vaccinated with the second improperly stored dose of VARIVAX lot # 669601/0138AA. No adverse effect reported. This is one of several reports received from the same source. Additional information has been requested.

VAERS ID:439928 (history)  Vaccinated:2011-10-17
Age:57.0  Onset:2011-10-19, Days after vaccination: 2
Gender:Female  Submitted:2011-10-25, Days after onset: 6
Location:Foreign  Entered:2011-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: B0757904A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA643CA IMAR
Administered by: Other     Purchased by: Other
Symptoms: Pain, Pain in extremity, Rash, Skin warm, Vasculitis
SMQs:, Anaphylactic reaction (broad), Vasculitis (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a pharmacist and described the occurrence of vasculitis in a 57-year-old female subject who was vaccinated with FLUARIX (GlaxoSmithKline). No concomitant medications or relevant medical history were reported. On 17 October 2011, the subject received unspecified dose of FLUARIX (intramuscular, unknown arm). On 19 October 2011, 2 days after vaccination with FLUARIX, the subject experienced vasculitis with a rash on arm which was 1-2 inches below and to the right of the site of injection. The rash was not painful but was hot. The subject also experienced throbbing pain on arm. On 20 October 2011, the subject went to the pharmacy. This case was assessed as medically serious by GSK. The subject was treated with paracetamol. At the time of reporting, throbbing pain and hot sensation on arm improved on arm, whereas vasculitis and rash on arm were unresolved. No further information was available.

VAERS ID:440686 (history)  Vaccinated:2011-10-17
Age:5.0  Onset:0000-00-00
Gender:Unknown  Submitted:2011-10-28
Location:Foreign  Entered:2011-10-28
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: B0757346A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (FOREIGN)GLAXOSMITHKLINE BIOLOGICALSAC20B199AB UNUN
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis, Erysipelas, Product quality issue
SMQs:
Write-up: This case was reported by a physician and described the occurrence of cellulitis in a 5-year-old subject of unspecified gender who was vaccinated with INFANRIX-IPV (GlaxoSmithKline). On 17 October 2011, the subject received an unspecified dose of INFANRIX-IPV (administration site and route unknown). The reporter had a doubt regarding the lot number. In October 2011, less than one week after vaccination with INFANRIX-IPV, the subject experienced cellulitis and erysipelas on upper arm. The subject was hospitalised. The subject was treated with antibiotics. At the time of reporting, the events were improved. This case was associated to a pharmaceutical product complaint. This case has been linked to B0757344A: same reporter. Further information has been expected.

VAERS ID:441678 (history)  Vaccinated:2011-10-17
Age:12.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-11-04, Days after onset: 18
Location:Foreign  Entered:2011-11-04
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: Elastoplast allergy
Diagnostic Lab Data: UNK
CDC Split Type: B0758072A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA087AE IMUN
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Lip swelling, Oedema mouth, Photosensitivity reaction, Rash, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a regulatory authority (# GB-MHRA-EYC 00073392) and described the occurrence of rash in a 12-year-old female subject who was vaccinated with CERVARIX. The subject''s medical history included elastoplast allergy. On 17 October 2011 the subject received unspecified dose of CERVARIX (0.5 ml, intramuscular). On 17 October 2011, within minutes after vaccination with CERVARIX, the subject experienced rash, acute back pain, photosensitivity, swollen lips, mouth swollen and swollen tongue. Initially symptoms mild, then increased in severity and adrenaline given intramuscularly for this. The regulatory authority reported that the events were clinically significant (or requiring intervention). At the time of reporting the events were unresolved. Verbatim Text: Started to have symptoms as above within minutes of receiving HPV 1 vaccine. Initially symptoms mild, then increased in severity and adrenaline given intramuscularly for this. Rash on trunk, neck chest and back of ears.

VAERS ID:443815 (history)  Vaccinated:2011-10-17
Age:13.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-11-28, Days after onset: 41
Location:Foreign  Entered:2011-11-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Body temperature, 18Oct2011, 39.2deg.C
CDC Split Type: B0759496A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA146BA1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Eczema, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of fever in a female subject of unspecified age who was vaccinated with CERVARIX (GlaxoSmithKline). On 17 October 2011, the subject received unspecified dose of CERVARIX (intramuscular, unknown site of injection, batch number not provided). On 18 October 2011, 1 day after vaccination with CERVARIX, the subject experienced fever. At the time of reporting the outcome of the event was unspecified. Additional information received on 27 October 2011: Concomitant vaccination included 1st dose of CERVARIS, received on 16 September 2011. On 17 October 2011, the subject received the second dose of CERVARIX (0.5 ml, intramuscular, unknown site of injection, batch number was provided). On 18 October 2011, 1 day after vaccination with CERVARIX, the subject experienced fever and arthralgia. On 19 October 2011, the event fever resolved. On 25 October 2011, 8 days after vaccination with CERVARIX, the subject experienced eczema. At time of reporting, the outcome of the events arthralgia and eczema was unknown. Additional information received on 11 November 2011: On 18 October 2011, in the morning, the subject experienced arthralgia. On 18 October 2011, in the afternoon, the subject presented with pyrexia of 39.2 degrees Centigrade. She took CALONAL at 300 mg (3 tablets x1/day, which was discontinued in 1 day because defervescence was obtained) and CLARITH at 200 mg each in the afternoon and the night. On 19 October 2011, defervescence was obtained and headache and arthralgia had resolved. On 25 October 2011, the subject visited the reporting physician''s hospital. She presented with eczema on the cheeks and inner sides of the knees. CLARITIN was prescribed. Because the subject did not visit the reporting physician''s hospital after 25 October 2011, the clinical course of the eczema was unknown. The reporter considered the events pyrexia, headache and arthralgia as related to CERVARIX. Additional information received on 18 November 2011: This case was upgraded from non serious to serious adverse event. On 17 October 2011, the subject received the second dose of CERVARIX in the left shoulder. The reporting physician considered the event as clinically significant/requiring intervention.

VAERS ID:444276 (history)  Vaccinated:2011-10-17
Age:1.5  Onset:2011-10-19, Days after vaccination: 2
Gender:Unknown  Submitted:2011-12-02, Days after onset: 44
Location:Foreign  Entered:2011-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Body temperature, 19Oct2011, 39.5Deg. C; C-reactive protein, Oct2011, high
CDC Split Type: B0766081A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (FOREIGN)GLAXOSMITHKLINE BIOLOGICALSA20CA706A IMUN
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, C-reactive protein increased, Crying, Laboratory test normal, Pyrexia, Restlessness, Tearfulness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: This case was reported by a physician via a regulatory authority (# PL-URPL-OCR-20111116001) and described the occurrence of possible infection in a 18-month-old subject of unspecified gender who was vaccinated with INFANRIX-POLIO-HIB (GlaxoSmithKline). On 17 October 2011, the subject received unspecified dose of INFANRIX-POLIO-HIB (intramuscular, unknown injection site). On 19 October 2011 in the evening, 2 days after vaccination with INFANRIX-POLIO-HIB, the subject experienced possible acute infection, restlessness, crying, anxiety, tearful and fever (39.5 Deg. C). The subject was hospitalised for 5 days (from 20 October 2011 until 24 October 2011) and the regulatory authority reported that the events were clinically significant (or requiring intervention). Relevant test results included high level of C-reactive protein and a negative test for pneumonia. The subject was treated with antibiotics. On 21 October 2011, fever was resolved. At the time of reporting restlessness and crying were resolved. The outcome of the other events was unspecified.

VAERS ID:444533 (history)  Vaccinated:2011-10-17
Age:11.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2011-12-05, Days after onset: 49
Location:Foreign  Entered:2011-12-05
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: UNK
CDC Split Type: B0767053A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA159AA0SYRUN
Administered by: Other     Purchased by: Other
Symptoms: Fall, Malaise, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: This case was reported by a healthcare professional (ministry of health) and described the occurrence of fainting in a 11-year-old female subject who was vaccinated with CERVARIX (GlaxoSmithKline). On 17 October 2011, the subject received 1st dose of CERVARIX (unknown route of administration, unknown site of injection). On 17 October 2011, less than one day after vaccination with CERVARIX, the subject experienced fainting, fall and malaise. This case was assessed as medically serious by GSK. At the time of reporting, the events were resolved without treatment. No further information was available at the time of reporting. The case is considered as closed.

VAERS ID:446593 (history)  Vaccinated:2011-10-17
Age:16.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2011-12-30, Days after onset: 73
Location:Foreign  Entered:2012-01-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1112USA03308
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.NM10090 IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abortion spontaneous, Maternal exposure during pregnancy, Uterine dilation and curettage
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)
Write-up: This case was received from a Health Authority on 22-DEC-2011 under the reference number 2011008704. This case was medically confirmed. A 16 year old female patient with no medical history, no concurrent conditions and who was not receiving any concomitant medication, received a dose of GARDASIL (lot # NM10090, batch # NN40800, dose in series unspecified) 0.5 ml intramuscularly, site not reported on 17-OCT-2011. On 18-OCT-11, within 24 hours of vaccination, the patient experienced a miscarriage followed by a dilation and curettage in hospital . At the time of reporting, the patient has recovered. Upon internal review, the event of vaccine exposure during pregnancy was added. Miscarriage was considered to be an other important medical event by the Health Authority. Other business partner numbers include E2011-08429. No further information is available.

VAERS ID:446962 (history)  Vaccinated:2011-10-17
Age:48.0  Onset:2011-10-18, Days after vaccination: 1
Gender:Male  Submitted:2012-01-06, Days after onset: 80
Location:Foreign  Entered:2012-01-06
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fluticasone+salmeterol; Salbutamol sulphate; Prednisolone; Amoxicillin trihydrate; Clarithromycin
Current Illness: Unknown
Preexisting Conditions: Allergic reaction to wasp sting; Asthma; Cluster Headache; Duodenal Ulcer; Dyspepsia; Lumbar Discectomy; Periodontal Abscess; Sciatica; Usually well prior to last illness
Diagnostic Lab Data: UNK
CDC Split Type: B0771783A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA660AB IMUN
Administered by: Other     Purchased by: Other
Symptoms: Bacterial sepsis, Disseminated intravascular coagulation, Gangrene, Intensive care, Malaise
SMQs:, Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)
Write-up: This case was reported by the MHRA (GB-MHRA-ADR 21405011) and described the occurrence of septicemia in a 48-year-old male subject who was vaccinated with FLUARIX. The subject''s medical history included allergic reaction to wasp sting, asthma, cluster headache, duodenal ulcer, dyspepsia, lumbar discectomy, periodontal abscess and sciatica. Concurrent medications included SERETIDE, VENTOLIN, Prednisolone, Amoxicillin and Clarithromycin. On 17 October 2011 the subject received unspecified dose of FLUARIX (0.5 ml, intramuscular). On 18 October 2011, 1 day after vaccination with FLUARIX, the subject experienced septicemia, disseminated intravascular coagulation, gangrene of toe and unwell. The subject was hospitalised and the regulatory authority reported that the events were disabling and life threatening. At the time of reporting the events were unresolved. MHRA Verbatim Text: Admitted to hospital 4 days after having had FLUARIX. Very unwell with septicemia and Disseminated Intravascular Coagulation (DIC). Patient in Intensive Treatment Unit (ITU) for 3 days. No infective cause found. Presumed gram negative septicaemia. Gangrenous toes continue to be a problem.

VAERS ID:449746 (history)  Vaccinated:2011-10-17
Age:0.1  Onset:2011-10-18, Days after vaccination: 1
Gender:Female  Submitted:2012-02-16, Days after onset: 121
Location:Foreign  Entered:2012-02-17, Days after submission: 1
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: Unknown
CDC Split Type: WAES1202USA02013
Vaccination
Manufacturer
Lot
Dose
Route
Site
6VAX-F: DTAP+IPV+HEPB+HIB (FOREIGN)GLAXOSMITHKLINE BIOLOGICALSA21FB154A0IMLA
PNC: PNEUMO (PREVNAR)PFIZER/WYETHF362260IMRA
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.0497AA0PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Decreased immune responsiveness, Hypophagia, Lethargy, Listless, Vomiting
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)
Write-up: Information was obtained on a request by the Company from the agency via a Public Case Detail form, concerning a 41 day old female who on 17-OCT-2011 was vaccinated with the first dose of ROTATEQ (Lot# 670015/0497AA), orally, dose not reported. On the same day the patient was given the first dose of PREVENAR (Batch# F36266), intramuscularly in the right arm, dose not reported and the first dose of INFANRIX HEXA (Batch# A21FB154A), intramuscularly in the left arm, dose not reported which were the secondary suspected therapies. On 18-OCT-2011 the patient experienced severe vomiting, poor oral intake, listless and anergia. The patient was taken to emergency department (ED) for treatment. The adverse events caused or prolonged inpatient hospitalisation. The agency considered that vomiting, decreased immune responsiveness, listless and hypophagia were possibly related to therapy with ROTATEQ. On an unspecified date, the patient recovered. No further information is available.

VAERS ID:449771 (history)  Vaccinated:2011-10-17
Age:38.0  Onset:0000-00-00
Gender:Male  Submitted:2012-02-16
Location:Foreign  Entered:2012-02-17, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: D0074471A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA641AA UNUN
Administered by: Other     Purchased by: Other
Symptoms: Type 1 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)
Write-up: This case was reported by a nurse on behalf of a physician via a sales representative and described the occurrence of diabetes mellitus type 1 in a 38-year-old male subject who was vaccinated with INFLUSPLIT SSW (GlaxoSmithKline). On 17 October 2011 the subject received a dose of INFLUSPLIT SSW (0.5 ml, unknown) during annual vaccination of employees. Approximately two weeks post vaccination with INFLUSPLIT SSW, on an unknown date end of October 2011 or early in November 2011, the subject was diagnosed by the family physician for the first time with diabetes mellitus type 1. This case was assessed as medically serious by GSK criteria. At the time of reporting the outcome of the event was unspecified.

VAERS ID:462793 (history)  Vaccinated:2011-10-17
Age:  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2012-08-21, Days after onset: 309
Location:Foreign  Entered:2012-08-22, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Heart rate (date unknown): 130 (units not specified)
CDC Split Type: 2012183722
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPVHIB: DTAP + IPV + HIB (NO BRAND NAME)SANOFI PASTEURC3560AA IMUN
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER386011 IMUN
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF19055 IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anaphylactic reaction, Choking, Crying, Pallor, Salivary hypersecretion, Staring, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This is a spontaneous report obtained from 3 Healthcare professionals reported agency (GB-CHIRONMA-PHFR2011GB06121) via the contactable Regulatory Agency; regulatory authority report number: GB-MHRA-ADR 21306495. A female baby of unknown age, received PREVENAR 13, batch/lot number F19055, 0.5 ml single dose, intramuscularly on 17Oct2011 for immunisation; MENJUGATE batch/lot number 386011, 0.5 ml single dose, intramuscularly on 17Oct2011 for immunisation; and PEDIACEL batch/lot number C3560AA, 0.5 ml single dose, intramuscularly on 17Oct2011 for vaccination. The baby normally well - was breast fed and of good weight. The baby had no known reactions in the past. The baby also had two older siblings that had not experienced side effects from immunisations. The baby''s concomitant therapy was unknown. On 17Oct2011, the baby experienced acute anaphylaxis. Two and a half hours post routine immunisation, the mother heard the baby making choking sounds and found the baby pale, dribbling and with staring eyes. The mother ran to the surgery from her home across the road. The baby was seen by a GP. The baby was crying, without angioedema but widespread urticaria which resolved spontaneously after 10 minutes. The baby was given intramuscular chlorphenamine and EFCORTESOL. The baby was happy and alert not distressed but remained pale and was sent to accident and emergency as a precaution. Lab data included heart rate on unknown date at 130 (units not specified). At the time of reporting, the baby was recovering from acute anaphylaxis. The outcome of choking, pale, staring, hypersalivation, and crying was not known. Urticaria, choking, pale, staring, hypersalivation, and crying were reported as serious adverse events. The reporter considered the case to be serious, meeting, the criteria of medically significant and the considered the case to be serious for an unspecified reason. No follow-up attempts possible. No further information expected. Follow-up (16Aug2012): New information reported from the agency includes: new adverse events (added "urticaria, choking, pale, staring, hypersalivation, and crying", seriousness criteria and outcome of new adverse events. No follow-up attempts possible. No further information expected.

VAERS ID:479084 (history)  Vaccinated:2011-10-17
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2012-12-21
Location:Foreign  Entered:2012-12-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PHHY2012DE115126
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABIPUR)NOVARTIS VACCINES AND DIAGNOSTICS490011A UNUN
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Depression, Fatigue, Headache, Musculoskeletal discomfort, Nausea, Nervous system disorder, Performance status decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (narrow)
Write-up: Case number PHHY2012DE115126, is a combined initial and follow up spontaneous report from the Health Authority (DE-PEI-PEI20120584) received on 12 Dec 2012, 13 Dec 2012 and 15 Dec 2012. This report refers to a 33-year-old male patient. Past medical history and concomitant medication were not provided. His vaccination history included TBE vaccine INN on 12 Jul 2007; TWINRIX adults on 18 May 2000 and on 14 Sep 2000 were tolerated well. On 20 Sep 2011, the patient was vaccinated with FSME immune adults (batch number: VNRIK09A, other manufacturer), and TWINRIX adults (batch number: AHABBR05B6, other manufacturer). On 22 Sep 2011, the patient received INFLUSPLIT SSW (batch number: AFLUA601AD other manufacturer) and PRIORIX (batch number: A69CC563A, other manufacturer). The patient received TYPHIM VI (batch number: H0047-1, other manufacturer) on 26 Sep 2011, Rabies vaccine (HDC) inactivated (batch number: E0896-1, other manufacturer) on 29 Sep 2011, Rabies vaccine (HDC) inactivated (batch number: E0896-1, other manufacturer) on 04 Oct 2011, MENVEO (batch number: X10137) on 06 Oct 2011 and RABIPUR (batch number: 4900 11A) on 17 Oct 2011. All vaccines were intramuscularly. At an undetermined date after vaccinations, the patient presented with depression, discomfort in joints, headache, muscle discomfort, nausea, neurological disorder NOS, tiredness, weakness and had performance status decreased. Outcome was unknown at time of reporting (03 Dec 2012). The case was assessed serious due to medically significance by the reporter. Causal relationship to the vaccines was not reported.

VAERS ID:520837 (history)  Vaccinated:2011-10-17
Age:6.0  Onset:2011-10-17, Days after vaccination: 0
Gender:Female  Submitted:2014-01-27, Days after onset: 833
Location:Foreign  Entered:2014-01-27
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: UNK
CDC Split Type: B0963700A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Extensive swelling of vaccinated limb, Incorrect route of drug administration, Injection site vesicles, Vaccination site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)
Write-up: This case was reported by a physician via a regulatory authority (# ES-AGEMED-51068337) and described the occurrence of vaccination site erythema in a 6-year-old female subject who was vaccinated with INFANRIX (GlaxoSmithKline). On 17 October 2011, the subject received unspecified dose of INFANRIX (.5 ml, unknown injection site; lot number not provided). The vaccine was administered subcutaneous instead of intramuscularly as requested by the product''s global datasheet. On 17 October 2011, 2 days after vaccination with INFANRIX, the subject experienced vaccination site erythema, extensive swelling of vaccinated limb, both with a diameter of 10x10 centimetres and injection site vesicles with a diameter of 0.5x0.5 centimetres. The regulatory authority reported that the events were clinically significant (or requiring intervention). At the time of reporting the events were improved. The regulatory authority reported that the events were probably related to vaccination with INFANRIX.

VAERS ID:439248 (history)  Vaccinated:2011-10-18
Age:73.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-20, Days after onset: 1
Location:Michigan  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension, Syncope, Hyperlipidemia
Preexisting Conditions: Allergies: Aspirin, Codeine, Sulfa
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0813AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness and pain to injection site with warmth

VAERS ID:439376 (history)  Vaccinated:2011-10-18
Age:12.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Male  Submitted:2011-10-20, Days after onset: 1
Location:Wisconsin  Entered:2011-10-20
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: Tx for depression, ADD & pre-diabetic.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS11131P IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Diarrhoea, Injection site erythema, Injection site swelling, Injection site warmth, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 10/19 Noted bump on vaccinated arm. 10/20 9 pm Noted 3" reddened area where vaccinated. After showering noted area hot to the touch, remains red & swollen has diarrhea, nauseated & felt like vomiting.

VAERS ID:439386 (history)  Vaccinated:2011-10-18
Age:3.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-20, Days after onset: 1
Location:North Carolina  Entered:2011-10-20
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: Subluxable hip at birth.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.YK20130IN 
Administered by: Private     Purchased by: Public
Symptoms: Erythema multiforme, Rash, Urticaria
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash - wheal - appears like a mix of hives and erythema multiforme - all over body.

VAERS ID:439391 (history)  Vaccinated:2011-10-18
Age:37.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-20, Days after onset: 1
Location:Colorado  Entered:2011-10-20
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
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0005AA0SCRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B065AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1060AA0SCLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Large (approximately 3 inches) reddened, raised area at site of varicella injection, tender, no fever.

VAERS ID:439405 (history)  Vaccinated:2011-10-18
Age:58.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-20, Days after onset: 2
Location:Wisconsin  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH475AB3IMRA
Administered by: Public     Purchased by: Public
Symptoms: Flushing, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Itching and flushing of upper chest noted 30 minutes after flu vaccine. Within 1 hour of vaccine had red, raised rash on chest, back of neck. Saw nurse practitioner in work area and NP told her to take CLARITIN. Itching resolved in 30 minutes. Following morning rash resolved.

VAERS ID:439419 (history)  Vaccinated:2011-10-18
Age:61.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-20, Days after onset: 2
Location:Washington  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH477AB IMUN
Administered by: Other     Purchased by: Public
Symptoms: Cyanosis, Injection site haematoma, Injection site reaction
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Large bruise blue (ish) at site a couple days later. At time of injection "dollar bill" size long developed after 1-2 minutes.

VAERS ID:439425 (history)  Vaccinated:2011-10-18
Age:79.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-20, Days after onset: 2
Location:Illinois  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT427AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Generalised erythema, Pruritus, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient reported severe itching. Red from head to toes. Said felt like tongue may have swelled a little. Took BENADRYL & doing fine. 10-20-11.

VAERS ID:439426 (history)  Vaccinated:2011-10-18
Age:46.0  Onset:2011-10-20, Days after vaccination: 2
Gender:Female  Submitted:2011-10-20, Days after onset: 0
Location:Delaware  Entered:2011-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH438AA UNRA
Administered by: Other     Purchased by: Private
Symptoms: Lip swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received FLUZONE vaccine on 10/18/11. She then returned home and awoke on 10/20/11 with swollen face/lips. Pt advised to take BENADRYL, call doctor/go to hospital.

VAERS ID:439395 (history)  Vaccinated:2011-10-18
Age:8.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Male  Submitted:2011-10-21, Days after onset: 2
Location:Virginia  Entered:2011-10-21
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: IBS, PCN allergy, Cephalosporin allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH469AA9IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Swelling/rash at injection site; gave Benadryl and Zyrtec.

VAERS ID:439397 (history)  Vaccinated:2011-10-18
Age:60.0  Onset:2011-10-20, Days after vaccination: 2
Gender:Female  Submitted:2011-10-21, Days after onset: 1
Location:Wisconsin  Entered:2011-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: Allergic to: antibiotics.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Local swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local area in the shape of a two inch pink heart with swelling over a slightly larger area. Twenty four hours later area remains pink with a total four inch area slightly swollen.

VAERS ID:439512 (history)  Vaccinated:2011-10-18
Age:63.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-21, Days after onset: 3
Location:Texas  Entered:2011-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Severe Flu Symptons Chills, Severe Aches & Pain Weakness, Sleeplessness
Preexisting Conditions: Penicillin, Sulfa Drugs, Aloxi, Darvocet, Depakote, Lithium, Tegretol, Tylenol is limited
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Bone pain, Chills, Influenza, Insomnia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Severe Flu Symptoms Chills, Aches, Pain, Hurt all over Bones Muscles, Weakness, Sleeplessness

VAERS ID:439560 (history)  Vaccinated:2011-10-18
Age:58.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-20, Days after onset: 1
Location:Connecticut  Entered:2011-10-21, 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: penicillin
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1100901 IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Quarter sized raised red area left deltoid area.

VAERS ID:439562 (history)  Vaccinated:2011-10-18
Age:37.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-21, Days after onset: 3
Location:Wisconsin  Entered:2011-10-21
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: None - Medical conditions; Penicillin allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH475AB IMRA
Administered by: Public     Purchased by: Public
Symptoms: Muscle twitching, Paraesthesia, Sensation of heaviness
SMQs:, Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad)
Write-up: Received FLUZONE vaccine at 1100 hours 10/18/11. When needle inserted by R.N. felt muscle twitch/jump. Patient stated "It felt like a pop, like when inserting an IV & you feel vein pop". 23 gauge 1" needle used. (No blood on aspiration noted). 2-3 pm on 10/18/11 started feeling "zingers", tingling into neck, shoulder, wrist, elbow (R) arm. Arm feels heavy. Saw M.D. Given Tramadol.

VAERS ID:439588 (history)  Vaccinated:2011-10-18
Age:2.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Male  Submitted:2011-10-21, Days after onset: 2
Location:Connecticut  Entered:2011-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: 1 previous febrile seizure due to illness on 2/11/11.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT4176BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Condition aggravated, Febrile convulsion
SMQs:, Neuroleptic malignant syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received flu vaccine 10/18/11. Had febrile seizure 2 AM 10/19/11. Seizure lasted 45 seconds per mother, EMTs called. Evaluated, not transported to hosp. Temp 10 mins. after seizure was 100.3; fell asleep and was usual self next AM, no fever.

VAERS ID:439595 (history)  Vaccinated:2011-10-18
Age:26.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-21, Days after onset: 2
Location:Texas  Entered:2011-10-21
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 Known
Diagnostic Lab Data: Unknown - Antibiotic prescribed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL)SANOFI PASTEURUT4164AA0IDRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Received vaccine 10/18/11 at 1800. Arm at injection site red, swollen & warm to touch in a.m. on 10/19/11. Redness increased & patient saw primary care physician on 10/21/11.

VAERS ID:439596 (history)  Vaccinated:2011-10-18
Age:53.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-21, Days after onset: 2
Location:Texas  Entered:2011-10-21
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 PASTEURUH460AA1IJLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness and warm below the injection site.

VAERS ID:439611 (history)  Vaccinated:2011-10-18
Age:67.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-18, Days after onset: 0
Location:Oregon  Entered:2011-10-22, 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 HIGH-DOSE)SANOFI PASTEURUH488AB IMAR
Administered by: Other     Purchased by: Unknown
Symptoms: Chest discomfort, Headache, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Severe headache commencing about 4 hrs after shot. Worsened & tightness in chest occured at about 6 hours. Wheezing resulted. Condition resolved itself after several hours without intervention.

VAERS ID:439666 (history)  Vaccinated:2011-10-18
Age:29.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-24, Days after onset: 6
Location:Massachusetts  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLLA673AA1IMRA
Administered by: Other     Purchased by: Private
Symptoms: Cough, Dizziness, Dyspnoea, Eye irritation, Headache, Lacrimation increased, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (broad)
Write-up: Burning, watery eyes; headache; cough; Dizziness; Shortness of Breath; Wheezing; All occurred until 4:00am 10/19/2011 except burning eyes, which lasted until 1:00 PM 10/19/2011.

VAERS ID:439673 (history)  Vaccinated:2011-10-18
Age:8.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Male  Submitted:2011-10-24, Days after onset: 5
Location:Kansas  Entered:2011-10-24
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: PCN allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU4777AB  RA
Administered by: Private     Purchased by: Other
Symptoms: Injection site reaction, Rash maculo-papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pruritic rash to injection site. Saw for rash 10/24/2011. Measures 10 cm papular, macular rash surrounding injection site.

VAERS ID:439674 (history)  Vaccinated:2011-10-18
Age:25.0  Onset:2011-10-21, Days after vaccination: 3
Gender:Male  Submitted:2011-10-24, Days after onset: 3
Location:Texas  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Cough, Oropharyngeal pain, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Around noon I started getting an irritating sensation in my throat. After coughing it felt much worse. My throat is still sore, but I have no need for a cough supressant as I don''t have to cough very often.

VAERS ID:439755 (history)  Vaccinated:2011-10-18
Age:59.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-24, Days after onset: 6
Location:Nevada  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSAFLUA628BA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Headache, Pharyngeal oedema, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Low grade fever and headache for 48 hours progressing to urticaria (full body) throat swelling, facial edema, difficulty breathing.

VAERS ID:439836 (history)  Vaccinated:2011-10-18
Age:54.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-24, Days after onset: 5
Location:Mississippi  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B074CA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Extensive swelling/redness at site. Antibiotic p.o. prescribed.

VAERS ID:439852 (history)  Vaccinated:2011-10-18
Age:76.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 1
Location:Washington  Entered:2011-10-24, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0813AA1IMRA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Induration, Injection site erythema, Injection site oedema, Injection site streaking, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: RUE firm edema & redness starting PM 10/18/11 with red line traveling near elbow to shoulder. Massive soft edema and redness (R) upper arm to elbow - especially back of arm.

VAERS ID:439869 (history)  Vaccinated:2011-10-18
Age:71.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Male  Submitted:2011-10-24, Days after onset: 6
Location:California  Entered:2011-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Blood & urine cultures were taken.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUH459AB0IMUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0630AA0IMUN
Administered by: Other     Purchased by: Private
Symptoms: Blood culture, Body temperature increased, Culture urine, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: (1) Increased temperature 103 f. (2) Low blood pressure.

VAERS ID:439834 (history)  Vaccinated:2011-10-18
Age:62.0  Onset:2011-10-21, Days after vaccination: 3
Gender:Female  Submitted:2011-10-25, Days after onset: 4
Location:Pennsylvania  Entered:2011-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0356AA0SCUN
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Site reaction - red rash - 1 inch diameter - itchy rash.

VAERS ID:439886 (history)  Vaccinated:2011-10-18
Age:55.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-21, Days after onset: 3
Location:New Mexico  Entered:2011-10-25, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS1102501 UNRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0595AA0UNLA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pain, redness, swelling in the arm. Fever lasting several days.

VAERS ID:439887 (history)  Vaccinated:2011-10-18
Age:46.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-19, Days after onset: 1
Location:Minnesota  Entered:2011-10-25, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None given
Current Illness: None
Preexisting Conditions: Diabetes mellitus; HTN; Hyperlipidemia
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0631AA0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Oedema peripheral, Pain, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pain within 30 min, became red and hard within a few hours of administration. Clinical observation by RN: arm is red, warm to touch, redness and swelling extend from upper arm over elbow onto forearm.

VAERS ID:439892 (history)  Vaccinated:2011-10-18
Age:35.0  Onset:2011-10-21, Days after vaccination: 3
Gender:Male  Submitted:2011-10-25, Days after onset: 4
Location:Georgia  Entered:2011-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Allergic to shellfish, tree nuts, grasses, trees, pollen.
Diagnostic Lab Data: Blood work showed elevated levels of muscle enzymes in blood. Normal range is 170 mine was at 649. I am going to doctor on Saturday 10/29 for further bloodwork. Was told by family physician that if numbers were a little higher would have been hospitalized.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IJLA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Blood test abnormal, Muscle enzyme increased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Sore joints and muscles. On 10/23 went to ER at hospital due to pain in muscles. Had blood work taken and urine specimin collected. Taking Tylenol and Loritab as prescribed by ER doctor with follow up with family physician. Still sore one week later after receiving flu shot.

VAERS ID:440157 (history)  Vaccinated:2011-10-18
Age:66.0  Onset:2011-10-19, Days after vaccination: 1
Gender:Female  Submitted:2011-10-26, Days after onset: 7
Location:Utah  Entered:2011-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: She reported an allergy to eggs and a previous Vaccination 20 years ago. There wasn''t any physician documentaion of the allergy and her employer required her to recieve the vaccine because she didn''t have documentation.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUH488AC0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash

VAERS ID:440792 (history)  Vaccinated:2011-10-18
Age:50.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 13
Location:Illinois  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Codeine. Arthritis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Public
Symptoms: Activities of daily living impaired, Chest discomfort, Cough, Dyspnoea, Headache, Obstructive airways disorder, Pain
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Cough and tightness in chest. General achiness and very bad headache increased throughout the evening and next day. As evening progress ability to breathe became more difficult. Approximately at 6:30 p.m. a inhaler was used to open airways. Inhaler was used that night again before bedtime and the following day. Missed one day of work due to headache and breathing issues. Returned to work the second day.

VAERS ID:440800 (history)  Vaccinated:2011-10-18
Age:50.0  Onset:2011-10-18, Days after vaccination: 0
Gender:Female  Submitted:2011-10-31, Days after onset: 13
Location:Pennsylvania  Entered:2011-10-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALSAFLUA631BA0IMUN
Administered by: Public     Purchased by: Private
Symptoms: Eye swelling, Malaise,