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Found 547698 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:156043 (history)  Vaccinated:2000-06-26
Age:16.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-06-27, Days after onset: 0
Location:New Jersey  Entered:2000-07-05, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0072AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Back pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: 8 hours post vax pt developed a temperature of 101; severe abdominal pain; back pain; shoulder pain; and nausea.

VAERS ID:156078 (history)  Vaccinated:2000-06-26
Age:1.8  Onset:2000-06-26, Days after vaccination: 0
Gender:Female  Submitted:2000-06-27, Days after onset: 1
Location:California  Entered:2000-07-06, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725421IMLL
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The pt experienced hives which developed 14 hours post 2nd Prevnar vax. No reaction on 1st. Treated with Benadryl only.

VAERS ID:156087 (history)  Vaccinated:2000-06-26
Age:1.5  Onset:2000-06-27, Days after vaccination: 1
Gender:Male  Submitted:2000-06-28, Days after onset: 1
Location:Ohio  Entered:2000-07-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4705273IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS591313A3IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt experienced redness and swelling to the size of a half dollar. Area was hard to touch. Treated with ice compressed and Motrin.

VAERS ID:156091 (history)  Vaccinated:2000-06-26
Age:57.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-06-28, Days after onset: 1
Location:Kansas  Entered:2000-07-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: pseudoepinephrine, dura vent, tomatoes/antibiotics
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0193AA IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: One day post vax pt developed a swollen area 2 in across, with itching and warm to touch. Pt experienced some erythema.

VAERS ID:156092 (history)  Vaccinated:2000-06-26
Age:38.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Male  Submitted:2000-06-28, Days after onset: 1
Location:Alabama  Entered:2000-07-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: laceration left hand
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES468408 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt experienced fever and swelling at injection site.

VAERS ID:156097 (history)  Vaccinated:2000-06-26
Age:2.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-06-28, Days after onset: 1
Location:Colorado  Entered:2000-07-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4705263IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0291K3IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R05063IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0653K0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt developed a dark red, 2 cm diameter area surrounding injection site with 7 cm diameter area of lighter redness, warm to touch, on left leg. Dark red 4 cm diameter area surrounding injection site with 15 cm area of lighter redness surrounding injection site on right leg, also warm to touch.

VAERS ID:156100 (history)  Vaccinated:2000-06-26
Age:1.3  Onset:2000-06-26, Days after vaccination: 0
Gender:Female  Submitted:2000-06-27, Days after onset: 1
Location:Tennessee  Entered:2000-07-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic to egg whites
Diagnostic Lab Data: CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS622363A3IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0257K0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt developed a temperature of up to 103.6, was taken to the ER with a temperature of 105.8. Pt was treated with Tylenol, Phenergen, and acetaminophen

VAERS ID:156107 (history)  Vaccinated:2000-06-26
Age:49.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-06-27, Days after onset: 0
Location:Michigan  Entered:2000-07-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: Demerol, asthma, allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM654A40IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.P09980IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0147AA IMLA
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA279AA0SCRA
Administered by: Public     Purchased by: Private
Symptoms: Blood pressure increased, Dyspnoea, Face oedema, Feeling hot, 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), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Approximately 2 hours post vax pt developed hives, face began to swell, and pt had difficulty breathing. BP increased and heart rate increased, skin felt like it was on fire. Pt was treated in ER with Benadryl and epinephrine.

VAERS ID:156139 (history)  Vaccinated:2000-06-26
Age:64.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Virginia  Entered:2000-07-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: seasonal allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1441H0IMLA
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4998114 IMRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site inflammation, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Approximately 24 hours, post vax, pt experienced swelling and inflammation involving 3/4''s of deltoid area extending down right arm.

VAERS ID:156337 (history)  Vaccinated:2000-06-26
Age:1.0  Onset:2000-07-04, Days after vaccination: 8
Gender:Female  Submitted:2000-07-05, Days after onset: 1
Location:New Jersey  Entered:2000-07-11, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0174R0SCRA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712130IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0441K0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: The pt experienced a rash at the site of injection.

VAERS ID:156511 (history)  Vaccinated:2000-06-26
Age:1.0  Onset:2000-06-26, Days after vaccination: 0
Gender:Female  Submitted:2000-07-03, Days after onset: 7
Location:Oregon  Entered:2000-07-13, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4693963IMRA
Administered by: Private     Purchased by: Private
Symptoms: Skin reaction
SMQs:, Hypersensitivity (narrow)
Write-up: Pt developed a large cutaneous reaction to DtaP.

VAERS ID:157155 (history)  Vaccinated:2000-06-26
Age:1.0  Onset:2000-07-04, Days after vaccination: 8
Gender:Female  Submitted:2000-07-12, Days after onset: 8
Location:Florida  Entered:2000-07-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM921A23IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS560753A3IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P12322SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1285J0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 7/6 office visit had varicella vax 6/26/00 few red spots on 7/3/00-7/4/00, more 7/6/00. Some fever 100.9 -102.0 no signs or symptoms URI, no vomiting few reddened papular 1-3 scattered over trunk and legs. 1-2 vesicular with red base. Given EES for possible bacterial infection. RTC 7/10/2000 rash came down, a few with reddened marks. Dx side effect from chickenpox vax.

VAERS ID:157379 (history)  Vaccinated:2000-06-26
Age:1.3  Onset:2000-07-03, Days after vaccination: 7
Gender:Female  Submitted:2000-07-05, Days after onset: 2
Location:New York  Entered:2000-07-19, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0163K0SC 
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: 7 days post vax pt experienced a fever of 102F axillary. Pt was treated with Tylenol and fever decreased somewhat. Pt remained feverish for 5 days.

VAERS ID:157383 (history)  Vaccinated:2000-06-26
Age:0.3  Onset:2000-06-27, Days after vaccination: 1
Gender:Male  Submitted:2000-06-28, Days after onset: 1
Location:Georgia  Entered:2000-07-19, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: WBC = 29000
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM922A21IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0295K1IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.10311IMRL
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Crying, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: Pt experienced persistent uncontrollable crying accompanied by fever of 100.8F. ????

VAERS ID:157396 (history)  Vaccinated:2000-06-26
Age:4.0  Onset:2000-06-28, Days after vaccination: 2
Gender:Female  Submitted:2000-07-13, Days after onset: 15
Location:New Jersey  Entered:2000-07-19, 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: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7172DA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0125J1SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4664073PO 
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Subsequent to receiving vax pt developed swelling, pain, warmth and erythema at injection site.

VAERS ID:157406 (history)  Vaccinated:2000-06-26
Age:43.0  Onset:2000-06-29, Days after vaccination: 3
Gender:Female  Submitted:2000-07-12, Days after onset: 13
Location:Mississippi  Entered:2000-07-19, 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: UNK
Diagnostic Lab Data:
CDC Split Type: MS00029
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0106K0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia
SMQs:, Arthritis (broad)
Write-up: Post vax, the pt complained of general aching in all joints which started 3 days after vax was given.

VAERS ID:157923 (history)  Vaccinated:2000-06-26
Age:0.4  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-07-18, Days after onset: 21
Location:Massachusetts  Entered:2000-07-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Blood work, EEG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0039CA1IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS560903A1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P02391 LL
Administered by: Private     Purchased by: Public
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: One day post vax, parent reported that the pt shook from head to foot and the eyes were not focusing. Condition lasted seconds.

VAERS ID:157954 (history)  Vaccinated:2000-06-26
Age:3.0  Onset:2000-07-02, Days after vaccination: 6
Gender:Male  Submitted:2000-07-20, Days after onset: 18
Location:Unknown  Entered:2000-07-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: cat bite
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MA20000345
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABIVAC)NOVARTIS VACCINES AND DIAGNOSTICS215011A3IMGM
Administered by: Other     Purchased by: Other
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: A three year old boy was vaccinated with Rabipur (rabies vaccine) after a cat bite per post exposure. The first vax was carried out after the cat bite in the middle of June (possible June 12, 2000). Further vax on June 15, June 19, June 26. The boy suffered from focal convulsions on July 2 and 3. No rabies specific immunoglobulin had been given. The child has not had any convulsions before. This is considered Medically significant. Causality is pending.

VAERS ID:158303 (history)  Vaccinated:2000-06-26
Age:52.0  Onset:2000-06-26, Days after vaccination: 0
Gender:Female  Submitted:2000-07-10, Days after onset: 14
Location:Florida  Entered:2000-08-02, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness:
Preexisting Conditions: allergy to PCN
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3212A4 IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0163K SCLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: The pt stated, she experienced nausea, weakness, rash on legs. Seen at a clinic and was told the reaction due to Hep b vaccine.

VAERS ID:158314 (history)  Vaccinated:2000-06-26
Age:49.0  Onset:2000-06-26, Days after vaccination: 0
Gender:Female  Submitted:2000-06-28, Days after onset: 2
Location:Washington  Entered:2000-08-02, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: rash;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;;.00;In Patient
Other Medications: PPD / Connaught
Current Illness:
Preexisting Conditions: allergy to multiple medications
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0162AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Chest discomfort, Hypoaesthesia, Pain, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Within 2 minutes, the pt had blotting and itching of upper body. 1/2 hour post vax, the pt had a slight tightness in the chest. The pt received Benadryl and was observed for 2 hours. Returned 2 days later with soreness and numbness in left arm.

VAERS ID:158597 (history)  Vaccinated:2000-06-26
Age:37.0  Onset:2000-06-28, Days after vaccination: 2
Gender:Female  Submitted:2000-06-28, Days after onset: 0
Location:Idaho  Entered:2000-08-08, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ID00033
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM639A40IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0010AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever of 101F, headache and chills, post vax.

VAERS ID:158605 (history)  Vaccinated:2000-06-26
Age:6.0  Onset:2000-07-04, Days after vaccination: 8
Gender:Female  Submitted:2000-07-05, Days after onset: 1
Location:Georgia  Entered:2000-08-08, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: environmental allergies
Diagnostic Lab Data: NONE
CDC Split Type: GA00078
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.00720SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: On 7/4/00, the pt''s arm started itching after swimming in the ocean at the injection site. It was an area the size of a dime. It is red, swollen and the size of a 1/2 dollar. Treatment was cold compresses and Benadryl.

VAERS ID:158647 (history)  Vaccinated:2000-06-26
Age:58.0  Onset:2000-06-26, Days after vaccination: 0
Gender:Male  Submitted:2000-08-08, Days after onset: 43
Location:New Jersey  Entered:2000-08-09, 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: Lotensin, HCTZ
Current Illness:
Preexisting Conditions: hypertension
Diagnostic Lab Data:
CDC Split Type: 20000236241
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Bursitis, Hypokinesia, Joint swelling, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: On 6/26/00, the pt received his first IM - left deltoid dose of Lymerix. Within one week post vax, he experienced severe left shoulder pain and swelling. During the first few days, the pt "could not move" his shoulder. He can move his shoulder now but has constant pain. He thought it was more muscle pain than joint pain. An MD visit was required and the pt was treated with an analgesic/anti-inflammatory combination. The pt had difficulty identifying whether his pain was in the shoulder joint or in the deltoid area of his left arm. He was unable to determine whether the pain was myalgia or arthralgia. He reported that on a scale of 1-10, his pain was a "9" in the mid-day to evening and a "3" in the morning. He reported that his pain was worse if the weather changed to rain. He reported that the pain is primarily "in his shoulder". He was seen by a physician about 5-7 days after the pain started. He reported that his physician noted redness and swelling and the diagnosis of bursitis was given. His joint complaints have been evaluation by a physician. A swollen left shoulder joint has been documented on physical exam. Joint fluid was not obtained. On FU pt states within 2 hours post-vaccination he experienced severe left shoulder pain and swelling. He was "almost totally immobilized for about a week or two thereafter. The pt reported that the physician wanted to treat the pt with cortisone injection, but the pt declined. The pt took the meds for one week but discontinued it as it caused drowsiness and nausea. As of 8/02/00, the pt reported that there had been slow and gradual improvement and he can extend his left arm "up to shoulder level" but it continued to be painful. He was unsure if there was redness or swelling now. The events of left shoulder pain, left shoulder swelling, bursitis, and shoulder stiffness do not meet ICH serious criteria, but are being submitted expeditiously for information purposes.

VAERS ID:158851 (history)  Vaccinated:2000-06-26
Age:1.2  Onset:2000-06-30, Days after vaccination: 4
Gender:Male  Submitted:2000-07-03, Days after onset: 3
Location:Tennessee  Entered:2000-08-15, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: frequent URI''s
Diagnostic Lab Data: NONE
CDC Split Type: TN00025
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM956A23IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0291K2IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R06172SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1713J0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1770J0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Nausea, Pyrexia, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Mother called clinic stating child has had temperature of 103, nausea, vomiting, and hives since 06/30/2000. Instructed mother to take child in for treatment and notify clinic when she has returned from doctors office.

VAERS ID:158934 (history)  Vaccinated:2000-06-26
Age:58.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Male  Submitted:2000-08-08, Days after onset: 42
Location:New York  Entered:2000-08-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: Historical Condition contact with or exposed to rabies. Previously vax, with pre exposure series of rabies vax, 1984 received post exposure rabies treatment with state licensed vax.
Diagnostic Lab Data:
CDC Split Type: EM20000292
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)CHIRON CORPORATION2330110IM 
Administered by: Other     Purchased by: Other
Symptoms: Lymphadenopathy, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt developed bilateral lymphadenopathy post vax, for post exposure prophylaxis. Following day he complained of itchiness of the right and left axillary areas left more than right, as well as swelling unilaterally in axilla. On June 30, 2000 the pt received Benadryl and Solu-Medrol prior to 2nd dose. No reaction, reporter assessed the event as related to RabAvert.

VAERS ID:159385 (history)  Vaccinated:2000-06-26
Age:1.7  Onset:2000-06-27, Days after vaccination: 1
Gender:Male  Submitted:2000-08-23, Days after onset: 57
Location:Iowa  Entered:2000-09-06, 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: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4693973IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712210IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site mass, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The pt experienced a severe localized reaction with redness, edema, tenderness at site. Onset began one day post vax. A painful nodule lasted for 1 1/2 weeks.

VAERS ID:159522 (history)  Vaccinated:2000-06-26
Age:1.9  Onset:2000-06-26, Days after vaccination: 0
Gender:Female  Submitted:2000-08-28, Days after onset: 63
Location:Texas  Entered:2000-09-11, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER919A23IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER581313A3IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.P123132  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1082J0SC 
Administered by: Public     Purchased by: Public
Symptoms: Irritability, Rash
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: Pt developed red rash to face, neck, abdomen, hands, feet and on the back. Pt was very irritable and was crying a lot. No respiratory distress noted.

VAERS ID:159757 (history)  Vaccinated:2000-06-26
Age:24.0  Onset:2000-06-26, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2000-09-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV048B2SC 
Administered by: Other     Purchased by: Other
Symptoms: Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The pt received the vax and developed a raised, erythematous area that covered a 5 x 5 cm area.

VAERS ID:159759 (history)  Vaccinated:2000-06-26
Age:36.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Male  Submitted:2000-06-28, Days after onset: 1
Location:Unknown  Entered:2000-09-15, Days after submission: 79
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV048B2SCLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site urticaria, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The pt developed urticaria over left arm and lower legs following the 3rd dose of Anthrax.

VAERS ID:159761 (history)  Vaccinated:2000-06-26
Age:19.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-06-28, Days after onset: 1
Location:Unknown  Entered:2000-09-15, Days after submission: 79
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV048B2SCLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: The pt developed pain, edema and erythema.

VAERS ID:159762 (history)  Vaccinated:2000-06-26
Age:22.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-06-28, Days after onset: 1
Location:Unknown  Entered:2000-09-15, Days after submission: 79
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV048B2SCLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site oedema, Injection site reaction, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: The pt experienced itchiness, warmth and swelling to the left arm.

VAERS ID:159763 (history)  Vaccinated:2000-06-26
Age:29.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Male  Submitted:2000-06-28, Days after onset: 1
Location:Unknown  Entered:2000-09-15, Days after submission: 79
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV048B2SCLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The pt experienced continued pain in left upper and lower arm.

VAERS ID:159765 (history)  Vaccinated:2000-06-26
Age:46.0  Onset:2000-06-26, Days after vaccination: 0
Gender:Male  Submitted:2000-06-28, Days after onset: 2
Location:Unknown  Entered:2000-09-15, Days after submission: 79
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: allergy to PCN
Diagnostic Lab Data: CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV048B2SC 
Administered by: Military     Purchased by: Unknown
Symptoms: Injection site oedema, Injection site pain, Injection site warmth, Malaise, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Within 1-2 hours post vax, the pt experienced malaise and sleepiness which has persisted. He also complained of local swelling, warmth, pain and itching at site. No other symptoms were experienced.

VAERS ID:159766 (history)  Vaccinated:2000-06-26
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2000-09-15
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV048B2SCLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site mass, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: The pt experienced a large circle of redness and itching from 3rd dose. A hard lump the size of a dime was experienced from 1st dose.

VAERS ID:159875 (history)  Vaccinated:2000-06-26
Age:6.2  Onset:0000-00-00
Gender:Male  Submitted:2001-07-17
Location:Nevada  Entered:2000-09-19, Days after submission: 301
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00090390
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1713J0  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0065K0  
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Coordination abnormal, Delirium, Nervous system disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: The pt developed a "brain reaction", ataxia, collapsed and was hospitalized. The pt sought unspecified medical attention. Additional information has been requested. Follow-up info received on 09/10/2001 states the pt has chronic seizure disorder, neurological disorder, and partial brain damage. The follow-up info from a registered nurse indicated that the pt was vaccinated on 06/26/2000 with one dose of varicella virus vaccine live. Concomitant therapy included MMR, DTP, polio vaccines. she reported that she did not have any info on an adverse event post vaccination on this pt. She stated that their office only does immunizations and well baby care. She noted that it is possible that the mother may have taken the pt to another pediatrician for care, but their office was never notified of any adverse event post vaccination. She reported that she did not have the lot numbers of the vaccines that the child had received; she would need to put in a request for that day of immunizations to be pulled from the warehouse for the lot number info. Additional info has been requested.

VAERS ID:160131 (history)  Vaccinated:2000-06-26
Age:40.0  Onset:2000-06-30, Days after vaccination: 4
Gender:Female  Submitted:2000-09-18, Days after onset: 80
Location:New York  Entered:2000-09-26, Days after submission: 8
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: Liver enzymes elevated; IGG and Igm-all positive; all other blood work was normal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG31939A21IM 
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Arthritis, Carpal tunnel syndrome, Hepatic enzyme abnormal, Joint swelling, Nausea, Paraesthesia, Pyrexia, Raynaud's phenomenon
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: 1st dose of Hep-B was on 5/26/00. 2nd dose of Hep-B was on 6/26/00 and within a few days, developed nausea, slight fever, then knee pain and swelling, tingling and pain and numbness of both hands. Severe joint pain. Was dx''d with acute arthritis, Reynaud''s syndrome and carpal tunnel (severe).

VAERS ID:160326 (history)  Vaccinated:2000-06-26
Age:12.0  Onset:2000-06-26, Days after vaccination: 0
Gender:Male  Submitted:2000-06-26, Days after onset: 0
Location:Missouri  Entered:2000-10-04, Days after submission: 100
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: dust and mold allergy
Diagnostic Lab Data:
CDC Split Type: MO2000067
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3200B91IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Post vax, the pt complained of feeling dizzy and nauseated. No fainting or vomiting; blood pressure and pulse were stable.

VAERS ID:161313 (history)  Vaccinated:2000-06-26
Age:1.0  Onset:2000-07-05, Days after vaccination: 9
Gender:Female  Submitted:2000-07-12, Days after onset: 7
Location:Pennsylvania  Entered:2000-11-03, Days after submission: 114
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: PA2036
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.171170SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.4679670SCRA
Administered by: Private     Purchased by: 0
Symptoms: Lethargy, Photophobia, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: On 7/5/00, the pt developed fever and lethargy. On 7/8/00, the pt developed a rash and photophobia. .

VAERS ID:161315 (history)  Vaccinated:2000-06-26
Age:1.0  Onset:2000-07-04, Days after vaccination: 8
Gender:Female  Submitted:2000-07-11, Days after onset: 7
Location:Pennsylvania  Entered:2000-11-03, Days after submission: 115
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: PA2034
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0102K0SC 
Administered by: Private     Purchased by: Other
Symptoms: Infection, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: On 7/4/00, the pt developed a temperature of 102. Rash started on face, neck, chest, and extremities on 7/6/00. Dx with measles.

VAERS ID:170799 (history)  Vaccinated:2000-06-26
Age:1.1  Onset:2000-07-05, Days after vaccination: 9
Gender:Female  Submitted:2001-05-30, Days after onset: 329
Location:Pennsylvania  Entered:2001-06-01, 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: UNK
Diagnostic Lab Data: diagnostic laboratory 07/17/00 comment- differential --69% lymphocytes, Immunoglobulin G index 07/17/2000 comment- positive, serum immunoglobulin N 07/17/00 comment - negative for IgM antibodies to the measles virus, NBC count 07/17/00 valu
CDC Split Type: WAES00071712
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES 0  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Emotional distress, Infection, Lethargy, Photophobia, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow)
Write-up: Asthenia / fatigue; Mental status change, photophobia, roseola - Information has been received from a physician concerning a 1 year old female who on 26 June 2000 was vaccinated with the first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation). Concomitant therapy included the first dose of Haemophilum S conjugate vaccine (Hib Titer). On 05 Jul 2000 the patient experienced a fever and lethargy. The patient then developed a macular papular rash which began on her face and descended to the rest of the body. On 08- July 2000 the patient experienced photophobia and had a questionable mental change. The patient sought medical treatment. Lab work from 17 Jul 2000 revealed a positive IgG and Igm was negative for antibodies to the measles virus. A white count was 6000 with a differential that included 69% lymphocytes. The reporting physician thought it was roseola. On 12 Jul 2000 the patient recovered from all of her symptoms. Additional information has been requested.

VAERS ID:171526 (history)  Vaccinated:2000-06-26
Age:36.0  Onset:2000-07-02, Days after vaccination: 6
Gender:Female  Submitted:2001-05-15, Days after onset: 317
Location:Oregon  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;Measles;Measles + Mumps + Rubella (MMR II);;15;In Patient;;Measles + Mumps + Rubella (MMR II);;0;In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: seasonal allergy
Diagnostic Lab Data:
CDC Split Type: WAES00070374
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Headache, Nausea, Pain, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Information has been received concerning a pt who on 6/26/00 was vaccinated with the first dose of varicella vaccine. On 07/02/00 the pt experienced two puruitic, erythematous, macular lesion on the right posterior shoulder. The pt also developed a lesion on the upper lip and on chin, nose, left knee, and right inguinal fold, all of which were reported to be puruitic. The physician saw the pt on 07/06/00 and as of that date, she had four lesions remaining. These lesions were throbbing with pain. The pt reported that the lesion on her nose was draining slightly serous fluid. As of 07/06/00 the pt did not have any vesicular lesions. All the lesions left were macular papular. These 2 lesions resolved within 48 hours. In July 2000, the pt experienced headache and mild nausea. The physician discussed the case with another physician and they both felt that the rash was not a typical varicella rash, though neither know exactly what the rash was. F/U 6/17/02 revealed there was no record of this pt. However, it was noted "to date all pts experiencing adverse reactions to varicella virus vaccine live, through this clinic, have recovered fully". No further info is available.

VAERS ID:171598 (history)  Vaccinated:2000-06-26
Age:23.0  Onset:2000-07-17, Days after vaccination: 21
Gender:Male  Submitted:2001-05-15, Days after onset: 302
Location:Pennsylvania  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Keflex; Flonase; ibuprofen;
Current Illness: onychomycosis;
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00071616
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6348421867J0SCLA
Administered by: 0     Purchased by: 0
Symptoms: Dermatitis bullous, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Twenty-two days post vaccination, the patient developed a chicken pox-like rash with less than 50 pox. The rash resolved spontaneously. The rash was associated with a low grade fever and myalgia. The patient was also resolving a case of onychomycosis.

VAERS ID:180227 (history)  Vaccinated:2000-06-26
Age:8.0  Onset:2000-06-28, Days after vaccination: 2
Gender:Female  Submitted:2000-10-13, Days after onset: 107
Location:Virginia  Entered:2002-01-22, Days after submission: 466
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: viral rashes.
Diagnostic Lab Data:
CDC Split Type: 20000301551
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3207A20IMRA
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Report 20000301551 describes viral looking rash in an eight year old female who received Engerix-B for prophylaxis of hepatitis B. Allergies are not specified. The vaccinee''s medical history includes several viral rashes. She takes no concomitant medications. On 06/26/2000, the vaccinee received her first IM right deltoid dose of Engerix-B. 24-72 hours later, she developed a "viral looking rash" and fever. Her symptoms resolved. On 08/01/2000, the vaccinee received her second IM right deltoid dose of Engerix-B. 24-72 hours later, she again developed a "viral looking rash" and fever. Her symptoms resolved. No treatment was given. As of 09/29/2000, the outcome of the events is resolved.

VAERS ID:209370 (history)  Vaccinated:2000-06-26
Age:30.0  Onset:2001-06-01, Days after vaccination: 340
Gender:Female  Submitted:2003-08-05, Days after onset: 795
Location:New Jersey  Entered:2003-09-17, Days after submission: 43
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
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALSLY128A2   
Administered by: Private     Purchased by: Other
Symptoms: Rheumatoid arthritis
SMQs:, Arthritis (narrow)
Write-up: Rheumatoid arthritis. I am currently taking Naproxen 500 mg tablet and see a rheumatologist regularly.

VAERS ID:239503 (history)  Vaccinated:2000-06-26
Age:1.0  Onset:2000-09-01, Days after vaccination: 67
Gender:Male  Submitted:2005-05-27, Days after onset: 1729
Location:Unknown  Entered:2005-06-03, 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: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0409USA01701
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.632459/0163K SC 
Administered by: Other     Purchased by: Other
Symptoms: Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Information has been received from a physician who is the parent of a 12 month old male patient who on 06/26/200 was vaccinated subcutaneously with a 0.5ml dose of measles virus vaccine live, mumps virus vaccine live, rubella virus vaccine live. There was no concomitant medication. Within 3 months of receiving measles virus vaccine live, mumps virus vaccine live, rubella virus vaccine live, in approximately September 2000, the patient developed significant speech delays. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested.

VAERS ID:244882 (history)  Vaccinated:2000-06-26
Age:1.1  Onset:2005-10-01, Days after vaccination: 1923
Gender:Female  Submitted:2005-10-04, Days after onset: 3
Location:Indiana  Entered:2005-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 0  
Administered by: Other     Purchased by: Other
Symptoms: Headache, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Headache for 1 day, less than 50 spots, treated with Zovirax 200 2tsp QID for 5 days, Benadryl, Calamine.

VAERS ID:258106 (history)  Vaccinated:2000-06-26
Age:1.0  Onset:2006-05-05, Days after vaccination: 2139
Gender:Female  Submitted:2006-06-07, Days after onset: 33
Location:Indiana  Entered:2006-06-07
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
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0175K0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712170IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.866J0SCRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash erythematous, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Patient presented to the office with <20 erythematous vesicular lesions on torso. No fever or any other sx at this time.

VAERS ID:271527 (history)  Vaccinated:2000-06-26
Age:1.1  Onset:2007-01-25, Days after vaccination: 2404
Gender:Female  Submitted:2007-01-26, Days after onset: 1
Location:New Hampshire  Entered:2007-01-30, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0073K0 LL
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Skin lesion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: About 20 lesions with low grade fever.

VAERS ID:281314 (history)  Vaccinated:2000-06-26
Age:1.0  Onset:2006-09-05, Days after vaccination: 2262
Gender:Female  Submitted:2007-05-16, Days after onset: 253
Location:Florida  Entered:2007-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0609USA01322
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0075K0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Exposure to communicable disease, Rash erythematous, Rash papular, Varicella
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 7 year old female, with no medical history and no allergies, who on 26-JUN-2007 was vaccinated once with a 0.5 ml dose of Varivax (Lot# 635207/0075K). There was no concomitant medication. It was noted that the patient had a possible exposure in school to varicella. on 05-SEP-2006 the patient experienced greater than 50 lesions initially appearing on her abdomen which had then spread to her body. The appearance of the rash was an erythematous papular rash progressing to pustules in various stages. No other systemic symptoms were noted. The patient was diagnosed clinically with breakthrough varicella, but was not laboratory confirmed. There were no laboratory or diagnostic tests performed. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. The reporter expressed concern about the lot. A lot check was requested. The records of testing prior to release of the lot in question have been rechecked and found to be satisfactory. The lot let the requirements and was released. Additional information has been requested.

VAERS ID:281316 (history)  Vaccinated:2000-06-26
Age:2.0  Onset:2006-09-05, Days after vaccination: 2262
Gender:Female  Submitted:2007-05-16, Days after onset: 253
Location:Florida  Entered:2007-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0609USA01520
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0075K0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning an 8 year old female, with no medical history and no allergies, who on 26-JUN-2000 was vaccinated once with a 0.5 ml dose of Varivax (Lot# 635207/0075K). There was no concomitant medication. On 05-SEP-2006 the patient presented with breakthrough rash with more than 50 lesions. It was noted that the patient was still developing more. At the time of the report the patient had not recovered. There were no laboratory or diagnostic tests performed. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. The reporter expressed concern about the lot. A lot check was requested. The records of testing prior to release of the lot in question have been rechecked and found to be satisfactory. The lot met the requirements and was released by the regulatory agency. Additional information has been requested.

VAERS ID:306389 (history)  Vaccinated:2000-06-26
Age:29.0  Onset:2002-05-01, Days after vaccination: 674
Gender:Female  Submitted:2008-03-04, Days after onset: 2134
Location:New Jersey  Entered:2008-03-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Allergic rhinitis; cervical dysplasia; degenerative disc disease; discectomy; laminectomy; loop electrosurgical excision proce; low back injury; lumbar radiculopathy; miscarriage; motor vehicle accident; seasonal allergy; sinusitis; smoking; social alcohol consumption. The subject developed buttock/leg/low back/foot pain, headaches, and neck/shoulder/hand/arm pain in approximately
Diagnostic Lab Data: Antinuclear antibody 21Jun2003 negative; Erythrocyte sedimentation rate 21Jun2003 normal; Diagnostic results: 20 May 2000: With the exception of a low white blood cell count, results of a complete blood count and comprehensive metabolic pan
CDC Split Type: A0713268A
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Antibody test negative, Antibody test positive, Antinuclear antibody negative, Arthralgia, Aura, Back pain, Borrelia burgdorferi serology negative, Borrelia burgdorferi serology positive, Brachial plexopathy, Burning sensation, Carpal tunnel syndrome, Cervicobrachial syndrome, Cluster headache, Drug dependence, Electroencephalogram normal, Electromyogram abnormal, Fatigue, Full blood count normal, Headache, Hypoaesthesia, Immunology test, Inflammation, Malaise, Metabolic function test normal, Migraine, Muscle spasms, Myalgia, Nausea, Neck injury, Neck pain, Nerve conduction studies abnormal, Osteoarthritis, Pain, Pain in extremity, Paraesthesia, Phonophobia, Photophobia, Radiculopathy, Red blood cell sedimentation rate normal, Visual disturbance, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Convulsions (broad), Dystonia (broad), Drug abuse and dependence (narrow), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Vasculitis (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: This case was reported via medical record that were forwarded by a lawyer and described the occurrence of arthralgias in a female subject who was vaccinated with LYMErix for prophylaxis. The subject was 29 years old at the time of vaccination with LYMErix, and was in her thirties at the approximate time of adverse event onset. The subject''s medical history included a motor vehicle accident in 1992 with a low back injury, laminectomy/discectomy (L5 to S1), left lumbar radiculopathy, buttock/leg/low back/foot brain, headaches, and neck/shoulder/hand/arm pain. According to information obtained from medical records, the subject received her first and second doses of LYMErix on 17 May 2000 and on 26 June 2000 (unknown). Approximately two years after vaccination withy LYMErix, on 08 May 2002, the subject reported feeling "sick a lot" and headaches approximately three times per week. Assessment on that date included migraine headaches, arthralgias, myalgias, fatigue, and generalized joint pain. Physician''s progress notes dated 06 May 2003 indicated that the subject carried a diagnosis of degenerative joint disease. On 22 May 2003, she was seen for an initial evaluation with a neurologist due to headaches, neck/shoulder/arm/hand pain, and low back/leg/foot pain. The event had been ongoing for approximately five years but had worsened in the three months preceding evaluation. She also complained of headaches/migraine pain with associated visual disturbances, photophobia, and phonophobia. Neurologist''s impression on that date was of "triggered wave syndrome" with low back pain ongoing into the neck and head, causing headaches; bilateral low back pain with burning, numbness, and tingling and diffuse pain in the low back, legs, and feet; cervical pain and strain with bilateral brachial plexus irritation and inflammation involving the bilateral upper extremities, forearms, and hands sometimes associated with numbness and tingling; mixed migraine headaches with migraine features with and without aura, cluster, catamenial, and

VAERS ID:160335 (history)  Vaccinated:2000-06-26
Age:0.3  Onset:2000-06-28, Days after vaccination: 2
Gender:Male  Submitted:2000-09-28, Days after onset: 92
Location:Foreign  Entered:2000-10-05, Days after submission: 7
Life Threatening? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Labs on hospitalization: leukocytes 19300, 64% lymphocytes, hemoglobin 12g/100ml, platelets 431000, CRP <9, midstream urine specimen normal. After death labs: viral serologies were negative for parainfluenza, enteroviru, adenovirus, and RSV
CDC Split Type: WAES00091814
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPIHI: DT+IPV+HIB+HEPB (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: On 6/28/00, it was reported that the pt presented with viral infection. The pt developed a moderate fever 48 to 72 hours after vax and he was seen by the pediatrician who prescribed antipyretics. He was discharged to home but the fever, 100.4 F, persisted. Three to four days after discharge, sometime in the beginning of July 2000, the pt''s grandmother found him dead in his bed. Pediatrician concluded to a sudden death without specific origin.

VAERS ID:160597 (history)  Vaccinated:2000-06-26
Age:1.3  Onset:2000-06-27, Days after vaccination: 1
Gender:Female  Submitted:2000-10-10, Days after onset: 105
Location:Foreign  Entered:2000-10-17, Days after submission: 7
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: bronchiolitis
Diagnostic Lab Data: UNK
CDC Split Type: WAES00092389
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURERBN43079 IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.HJ63900 IM 
Administered by: Other     Purchased by: Other
Symptoms: Bronchospasm, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow)
Write-up: Information has been received from a health authority concerning a 15 month old female pt who on 6/26/00 was vaccinated with 1 dose of MMR and Meningococcal vaccines. On 6/27/00, the pt experienced bronchospasm (wheeze) and respiratory distress and was admitted to ICU in the hospital. Subsequently, the pt recovered.

VAERS ID:162461 (history)  Vaccinated:2000-06-26
Age:42.0  Onset:2000-06-27, Days after vaccination: 1
Gender:Male  Submitted:2000-11-17, Days after onset: 143
Location:Foreign  Entered:2000-11-22, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hx of extrasystole and psoriasis
Diagnostic Lab Data:
CDC Split Type: U2000008220
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.  IM 
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH  IM 
Administered by: Other     Purchased by: Other
Symptoms: Cardiac disorder, Fatigue, Ventricular extrasystoles
SMQs:, Ventricular tachyarrhythmias (narrow)
Write-up: One day post vax, the pt experienced ventricular extrasystole and he felt tired. He was admitted to the hospital. Technical exam showed no abnormalities. The hospital MD''s stated that "an unspecified myocardial reaction on the vaccinations can''t be excluded". Further information is not expected.

VAERS ID:205841 (history)  Vaccinated:2000-06-26
Age:19.0  Onset:0000-00-00
Gender:Female  Submitted:2003-07-03
Location:Foreign  Entered:2003-07-07, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: D0041298A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS169A4  LA
Administered by: Other     Purchased by: Other
Symptoms: Haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: A physician reported the occurrence of hematoma in a 19 year old female who was vaccinated with hepatitis A-B vaccine for prophylaxis. No current medical conditions and no concurrent medications were reported. The subject never had hematoma, which were over the normal extent. Former vaccinations were well tolerated. The first hepatitis A-B vaccine was administered on 5/25/00. On 6/26/00, the subject received the second dose of hepatitis A-B vaccine, lot number HAB169A4, in the left deltoid. On an unknown date after the second vaccination, the subject developed hematoma of the left upper arm. The subject twice consulted a dermatological hospital as outpatient and was examined. There was no evidence for blood-clotting disorder. The event was not resolved. Permanent disabling was reported. The subject received a third hepatitis A-B vaccination on 1/4/01. A 15-day follow up report received 7/14/2003 adds no new info.

VAERS ID:155853 (history)  Vaccinated:2000-06-27
Age:1.9  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-06-28, Days after onset: 1
Location:Missouri  Entered:2000-06-30, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712060IMRL
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Same day post vax, the pt developed a rash. Child has classical target lesions on his abdomen, back, and torso. Mom states rash is worse today. Rash also noted sparsely on arms and legs. Being treated with Benadryl.

VAERS ID:156041 (history)  Vaccinated:2000-06-27
Age:3.3  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-07-03, Days after onset: 6
Location:Texas  Entered:2000-07-05, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4682680IMLL
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt experienced fever, emesis and decreased energy.

VAERS ID:156086 (history)  Vaccinated:2000-06-27
Age:1.8  Onset:2000-06-28, Days after vaccination: 1
Gender:Female  Submitted:2000-06-29, Days after onset: 1
Location:Illinois  Entered:2000-07-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7389AA3IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.P099722 RA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt experienced redness and swelling in upper arm.

VAERS ID:156303 (history)  Vaccinated:2000-06-27
Age:13.0  Onset:2000-06-28, Days after vaccination: 1
Gender:Male  Submitted:2000-06-29, Days after onset: 1
Location:Louisiana  Entered:2000-07-11, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PCN allergy
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3199A21IMRA
Administered by: Other     Purchased by: Other
Symptoms: Feeling hot, Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt experienced an injection site reaction (right deltoid) characterized by redness, edematous, extremely warm to touch from distal tip of right clavical spreading to area just above right antecubital fossa.

VAERS ID:156372 (history)  Vaccinated:2000-06-27
Age:0.3  Onset:2000-06-29, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Pennsylvania  Entered:2000-07-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4693951IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC. 1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R066841 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712170IM 
Administered by: Private     Purchased by: Other
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Temperature up to 102.9 two days post vax. Physical exam was negative.

VAERS ID:156374 (history)  Vaccinated:2000-06-27
Age:0.8  Onset:2000-07-01, Days after vaccination: 4
Gender:Male  Submitted:2000-07-05, Days after onset: 4
Location:Georgia  Entered:2000-07-12, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NA
Current Illness: Otitis
Preexisting Conditions: Recurrent Otitis
Diagnostic Lab Data: MRI, viral cultures, spinal tap
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712030IMLL
Administered by: Private     Purchased by: Private
Symptoms: Dehydration, Demyelination, Encephalitis, Mouth ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Optic nerve disorders (broad), Demyelination (narrow), Hypersensitivity (broad)
Write-up: Within 48 hours post vax, pt was hospitalized, mouth ulcers and dehydration, maybe not related but progressed to acute demyelination cerebellar encephalitis.

VAERS ID:156854 (history)  Vaccinated:2000-06-27
Age:1.3  Onset:2000-07-05, Days after vaccination: 8
Gender:Female  Submitted:2000-07-11, Days after onset: 6
Location:Massachusetts  Entered:2000-07-17, 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: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS441003A3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1543H0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: The pt experienced a fever of 102 and a rash that lasted approximately 5 days.

VAERS ID:157165 (history)  Vaccinated:2000-06-27
Age:38.0  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-07-11, Days after onset: 14
Location:Illinois  Entered:2000-07-18, 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
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3140D60IMLA
Administered by: Other     Purchased by: Other
Symptoms: Eye irritation, Keratitis
SMQs:, Corneal disorders (narrow), Conjunctival disorders (narrow), Ocular infections (broad)
Write-up: Irritated eyes, conjunctivitis and Keratitis ruined left contact lens.

VAERS ID:157193 (history)  Vaccinated:2000-06-27
Age:3.0  Onset:2000-06-28, Days after vaccination: 1
Gender:Male  Submitted:2000-06-29, Days after onset: 1
Location:North Carolina  Entered:2000-07-18, 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: Augmentin
Current Illness: Inner ear infection
Preexisting Conditions: Bronchial Asthma
Diagnostic Lab Data: NONE
CDC Split Type: NC00041
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4705252IMLA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.P08242SCLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Redness noted 6/28/2000 with swelling and warm to touch at 4 pm by mom. Cool cloths placed over site and Benadryl. Mom spoke to MD 6/28/2000. On 6/29/2000 left arm 91/2 inches with redness, warm and swelling today. Mom states it has gone down a lot.

VAERS ID:157906 (history)  Vaccinated:2000-06-27
Age:13.0  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-06-28, Days after onset: 1
Location:Texas  Entered:2000-07-25, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: asthma; allergic to dairy products, wheat, soy, chocolate, apples, eggs, onions, kiwi and grasses.
Diagnostic Lab Data:
CDC Split Type: TX00087
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3199E90IMRA
Administered by: Public     Purchased by: Public
Symptoms: Chest discomfort, Tongue disorder, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Pt experienced wheezing, tightness of chest and tongue jerking. Parent initiated two breathing treatments with some relief of tightness of chest. Tongue continued jerking. Pt taken to ER and Decadron injection was administered, breathing treatment given. Pt given a prescription for Prednisone and discharged.

VAERS ID:157921 (history)  Vaccinated:2000-06-27
Age:21.0  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-07-10, Days after onset: 13
Location:South Carolina  Entered:2000-07-25, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD-lot #C0147AA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: SC00035
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0011AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cold sweat, Coma, Eye movement disorder, Flushing, Hypotonia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), 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 (broad), Hypersensitivity (broad)
Write-up: Subsequent to receiving vax, pt rolled his head back with a moaning sound, dropped eyes forward, then rolled eyes backward, body went limp. Pt was unresponsive for about 30 seconds. Face was flushed, color changed pale, skin clammy, pt alert and stated he felt like he was dreaming. Pt was advised to see physician.

VAERS ID:157987 (history)  Vaccinated:2000-06-27
Age:0.7  Onset:2000-07-05, Days after vaccination: 8
Gender:Female  Submitted:2000-07-18, Days after onset: 13
Location:Tennessee  Entered:2000-07-27, Days after submission: 9
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI and viral cultures (pending)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712021IMLL
Administered by: Private     Purchased by: Private
Symptoms: Musculoskeletal stiffness, Myelitis transverse
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Demyelination (narrow), Arthritis (broad)
Write-up: Post vax, the pt developed stiffening of lower extremities 1-2 weeks before dx of transverse myelitis was made. 60 Day FU states the last letter from the neurologist stated she has almost completely recovered by still has some residual decreased muscle tone.

VAERS ID:158105 (history)  Vaccinated:2000-06-27
Age:4.0  Onset:2000-07-16, Days after vaccination: 19
Gender:Female  Submitted:2000-07-18, Days after onset: 2
Location:New York  Entered:2000-07-28, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NY520011
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM917A20IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R02360SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0347J1SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Ear pain, Feeling hot, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Woke up early Sunday very hot to touch, not feeling good, complaining of muscle aches, tired and ears painful. Gave Tylenol on 7/16, FNP. No ear infection found and instructed to continue Tylenol or Advil. On 7/18, mom states child is acting fine.

VAERS ID:159032 (history)  Vaccinated:2000-06-27
Age:30.0  Onset:2000-07-09, Days after vaccination: 12
Gender:Female  Submitted:2000-07-25, Days after onset: 16
Location:Wisconsin  Entered:2000-08-22, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diluent Merk Lot number 1654E
Current Illness: NONE
Preexisting Conditions: allergy to flagyl, strawberries
Diagnostic Lab Data:
CDC Split Type: WI0015
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1510J1SC 
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Approximately 12 days post vax, the pt developed a fever and then a rash appeared the following morning.

VAERS ID:159833 (history)  Vaccinated:2000-06-27
Age:0.4  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-07-19, Days after onset: 22
Location:Utah  Entered:2000-09-15, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: E3 oil, children''s xanthium formula
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: UT000615
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM941A21IM 
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES4701401IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R05171  
Administered by: Private     Purchased by: Other
Symptoms: Agitation, Crying, Injection site oedema
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad)
Write-up: Post vax, the pt developed swelling at injection site. He also had shrill crying, high-pitched crying for 2 hours. Normally a easy baby. Now continues high-pitched screaming with any upset.

VAERS ID:159864 (history)  Vaccinated:2000-06-27
Age:2.2  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-08-18, Days after onset: 52
Location:Ohio  Entered:2000-09-18, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergies
Diagnostic Lab Data: blood work, and visit to infectious disease specialist
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1857J SC 
Administered by: Private     Purchased by: Private
Symptoms: Abnormal behaviour, Aggression, Agitation, Crying, Dermatitis bullous, Diarrhoea, Immune system disorder, Lethargy, Pruritus, Pyrexia, Rash, Vomiting, Wheezing
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Within hours post vas pt experienced very volatile behavior, aggressive, mean, extremely strong, tantrums, wheezing, excessive crying, fever, dots and rash. Within days pt developed chickenpox blisters, itching, weakened immune system and has been ill for over a 4 week period including vomiting, diarrhea and lethargy for long 4 hour periods of time.

VAERS ID:160097 (history)  Vaccinated:2000-06-27
Age:1.5  Onset:2000-06-28, Days after vaccination: 1
Gender:Male  Submitted:2000-06-28, Days after onset: 0
Location:Oregon  Entered:2000-09-26, Days after submission: 90
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: OR200029
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4623173IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS582953A3IMRL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.P04732SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1720J1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1851J0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: When mother put child in bathtub this AM (6:28), she noted puffiness of hand and feet and redness of feet. There was a rash on legs and arms.

VAERS ID:160137 (history)  Vaccinated:2000-06-27
Age:57.0  Onset:2000-07-01, Days after vaccination: 4
Gender:Female  Submitted:2000-09-20, Days after onset: 81
Location:California  Entered:2000-09-26, 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: Fosamax, Premarin
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R0518 SC 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0194AA IM 
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA232AA0SC 
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 4 days, post vax, pt developed rash on legs, very itchy.

VAERS ID:161486 (history)  Vaccinated:2000-06-27
Age:0.3  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-08-07, Days after onset: 41
Location:Pennsylvania  Entered:2000-10-05, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ8006429JUN2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU027CA IM 
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0299K IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R12512   
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712170IMLL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: A nurse reported that a 3 month old male received Prevnar, IPV (Aventis Pasteur SA), Comvax (Merck) and Tripedia (Aventis Pasteur, Inc) vaccines on 6/27/00 and subsequently, developed a fever.

VAERS ID:161488 (history)  Vaccinated:2000-06-27
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2000-07-06
Location:Michigan  Entered:2000-10-05, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ8121805JUL2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712160IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: A physician reported that a child received the 1st dose of Prevnar on 6/27/00. The child subsequently, developed swelling at the injection site, the swelling extended to involve the entire arm into which the vaccinee was administered. The child was treated with diphenhydramine.

VAERS ID:160772 (history)  Vaccinated:2000-06-27
Age:18.0  Onset:2000-06-30, Days after vaccination: 3
Gender:Male  Submitted:2000-10-12, Days after onset: 104
Location:Virginia  Entered:2000-10-20, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIESUA230AA0SCLA
Administered by: Private     Purchased by: Other
Symptoms: Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: The pt received vaccine on 6/27/00. Pt calls on 7/5/00 to report that on 6/30/00 he began feeling "really draggy", tired, various muscle aching, and headache. He denied nausea, vomiting, fever or chills. He also denied cough or rash. The pt states he started feeling better as of today.

VAERS ID:166469 (history)  Vaccinated:2000-06-27
Age:43.0  Onset:2000-06-29, Days after vaccination: 2
Gender:Female  Submitted:2000-10-06, Days after onset: 99
Location:Illinois  Entered:2001-03-05, Days after submission: 150
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nedocromil
Current Illness: UNK
Preexisting Conditions: Asthma NOS
Diagnostic Lab Data: UNK
CDC Split Type: 8492513
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4998169   
Administered by: Other     Purchased by: Other
Symptoms: Influenza like illness, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: a pharmacist reported that a pt received a vaccine on 6/27/2000. Two days post vaccine she developed fever and flu like symptoms, which lasted more than 36 hours. Pt also developed a 15 cm area of soreness at injection site. On 7/1/2000 pt was treated by physician.

VAERS ID:167017 (history)  Vaccinated:2000-06-27
Age:5.0  Onset:2000-06-28, Days after vaccination: 1
Gender:Female  Submitted:2000-07-06, Days after onset: 8
Location:Florida  Entered:2001-03-13, Days after submission: 250
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:
CDC Split Type: FL00024
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4693973IMRA
Administered by: Public     Purchased by: 0
Symptoms: Erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: A nurse stated that this child presented in there office on 06/29/00, with severe large red welts on her upper right arm. Had also gone to the hospital ER on 06/28/00.

VAERS ID:167544 (history)  Vaccinated:2000-06-27
Age:17.0  Onset:2000-07-03, Days after vaccination: 6
Gender:Female  Submitted:2001-03-07, Days after onset: 247
Location:Pennsylvania  Entered:2001-03-15, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Idiopathic scoliosis
Diagnostic Lab Data: Repeat films today reveal a progression of her scoliosis. The curve from T5 to T11 is unchanged at 25 degrees. The lumbar curve from T11 to L3 measures 19 degrees. There has been a slight progression. Neurological exam on 7/3/00-normal.
CDC Split Type: WAES00072277
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0829J1IM 
Administered by: 0     Purchased by: 0
Symptoms: Back pain, Fatigue, Spine malformation, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Congenital, familial and genetic disorders (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Information has been received from a physician concerning a 17 year old Caucasian female pt with idiopathic scoliosis who was vaccinated with a 1st and 2nd pediatric/adolescent dose of Hep-B on 5/24/00 and 6/27/00. Subsequently, following the 2nd dose the pt developed tremors of both hands. It was indicated that the 1st dose was administered with no problems. Conflicting follow-up from the physician indicated that the pt has been experiencing tremors since 7/5/00, after her 2nd Hep-B injection. However, on 7/3/00, the pt was seen in the scoliosis clinic by her pediatric orthopedic physician for her normal 6 mo. scoliosis checkup and the pt''s mom indicated that the pt was having tremors in her hands. She was last seen in 10/98 and at that time her curves measured 25 degrees and 35 degrees. She is not having any problems. She has no pain with range of motion of her lumber spine with excellent range of motion of the spine. She has no pain with extension. She is having some lower back pain predominantly on the left side of her lower back in the region of her lumbar curve, most likely secondary to a fatigue type symptom. Her mom reported that she is having some tremors in her hands. An upper extremity neurologic exam was performed to evaluate her tremors and it was reported that her exam is entirely normal with full motor strength, sensation and reflexes. It was recommended that she come back in 6 mo. for follow-up care, repeat xrays and possibly consider MRI if there is progression of her scoliosis as well as to evaluate or rule out a spinal cord etiology of her tremors. On 7/6/00, the pt was seen by her family physician and it was reported that the tremors become worse when playing volleyball. The pt was referred to a neurologist for further evaluation. Follow-up information received from the neurologist''s office on 10/24/00, indicated that the pt was scheduled for an appointment on 9/11/00 but "never showed up". No further information is expected.

VAERS ID:169738 (history)  Vaccinated:2000-06-27
Age:18.0  Onset:2000-06-28, Days after vaccination: 1
Gender:Male  Submitted:2001-01-10, Days after onset: 196
Location:Maine  Entered:2001-05-09, Days after submission: 118
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD-Tubersol 5 TU/Aventis Pasteur LTD/251811
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U2000005360
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIESUA231AA SC 
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: It was reported that an 18 year old male pt received a Menomune A/C/Y/W-135 vaccination and a PPD-Tubersol skin test on 6/27/00. Reportedly, on 6/28/00, the pt developed a temperature of 100F and dizziness. A physician did not evaluate the pt. Further information requested. From correspondence received on 8/8/00, it was reported that the pt recovered from this experience. No further information is expected, this case is closed.

VAERS ID:170783 (history)  Vaccinated:2000-06-27
Age:5.0  Onset:2000-06-27, Days after vaccination: 0
Gender:Female  Submitted:2001-05-30, Days after onset: 337
Location:Michigan  Entered:2001-06-01, 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: NONE
Preexisting Conditions: Medical History: asthenia/fatigue; fever
Diagnostic Lab Data:
CDC Split Type: WAES00064662
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES 4IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD. 3SC 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0173K1SC 
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Feeling hot, Infection, Injection site erythema, Injection site swelling, Joint swelling, Skin discolouration
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a registered nurse concerning a 5 year old female patient with no past medical history who on 27 June 2000 at 15:00 was vaccinated SC in the left upper arm with a second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (lot #632456/0173K). Concomitant vaccinations on 27 June 2000 included a fifth dose IM in the right thigh of alum, potassium (+) diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid (tripedia) and a fourth dose SC in the right arm of poliovirus vaccine (ipol). There were no illnesses at the time of vaccination. On 27 June 200 at 22:00 the patient experienced a fever of 100-101 degrees fahrenheit, accompained by fatigue for 5-6 days. The patient''s skin has noted to be hot to the touch with the upper arm, from the shoulder to below the elbow, to be swollen to twice the normal size. The upper are was blood red looking for 5 days. Subsequently a band of tissue 1 1/2 inches around the site appeared. The skin around this area was black (bruised) for 10 days. Unspecified medical attention was sought and the patient was treated with ice, diphenhydramine hydrachloride (benadryl) and ibuprofen (Motrin). On an unspecified date the patient recovered from her experiences. It was noted that the patient always has fever and 1-2 days of fatigue following vaccines. No further information is expected.

VAERS ID:171510 (history)  Vaccinated:2000-06-27
Age:38.0  Onset:2000-06-29, Days after vaccination: 2
Gender:Female  Submitted:2001-06-15, Days after onset: 351
Location:Unknown  Entered:2001-06-01, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00064635
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0412K0SC 
Administered by: Private     Purchased by: Private
Symptoms: Blister, Injection site erythema, Injection site swelling, Pruritus, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received concerning a pt who 06/27/00 was vaccinated with one dose of varicella vaccine. On 06/29/00 the pt developed lesions. The lesions were on both arms and the left side of her neck. The pt later developed vesicles on the right thigh and chest. the pt sought unspecified medical attention and was treated with Atarax. On 07/08/00 the pt developed redness, itching and swelling of approximately 5 cm at the injection site. On 07/14/00 the pt recovered from her symptoms.

VAERS ID:171519 (history)  Vaccinated:2000-06-27
Age:  Onset:2000-06-30, Days after vaccination: 3
Gender:Unknown  Submitted:2001-05-15, Days after onset: 319
Location:Unknown  Entered:2001-06-01, Days after submission: 17
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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00070045
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Information has been received concerning a pt who on 06/27/00 was vaccinated with one dose of varicella vaccine. On 06/30/00, the pt experienced difficulty breathing and sought medical attention at the physician office.

VAERS ID:172070 (history)  Vaccinated:2000-06-27
Age:1.6  Onset:2001-01-16, Days after vaccination: 203
Gender:Female  Submitted:2001-05-15, Days after onset: 118
Location:Texas  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Varicella exposure
Diagnostic Lab Data:
CDC Split Type: WAES01011345
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Blister, Rash erythematous, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: On 01/16/2001 the patient developed approximately 20 to 25 lesions, mostly erythematous papules with 2 to 3 clear vesicles and one excavated, throughout the body especially on her trunk with 2 to 3 on her labia with 1 spot scabbed over. The patient was treated with Benadryl as needed for the itch. It was noted that the patient was exposed to chicken pox on 01/02/2001 through 01/05/2001. Additional information has been requested.

VAERS ID:178576 (history)  Vaccinated:2000-06-27
Age:1.1  Onset:2001-11-19, Days after vaccination: 510
Gender:Female  Submitted:2001-11-27, Days after onset: 8
Location:Colorado  Entered:2001-12-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0373L0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Herpes zoster, Infection
SMQs:
Write-up: Pt recvd chicken pox vax at 13 mos of age. She was diagnosed with shingles on 11/19/2001.

VAERS ID:187742 (history)  Vaccinated:2000-06-27
Age:43.0  Onset:2001-04-01, Days after vaccination: 278
Gender:Female  Submitted:2002-07-14, Days after onset: 468
Location:Pennsylvania  Entered:2002-07-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Back pain intermittent s/p auto accident ''99
Diagnostic Lab Data: All kinds of blood tests for RA, Hepatitis, Lyme; MMR and scan of brain, back, legs (body); tests were negative. 10/1/02 Per review of medical records an MRI of the cervical spine noted a disc bulging at C5-6. The HLA-DR4 was negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS 1  
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Fatigue, Joint swelling, Musculoskeletal stiffness, Neck pain, Pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Joint pain/swelling, fatigue, pain in arms, legs, shoulder, feet, knees, hands, hip pain, pain all over arms, neck, stiffness in hands, neck, ankles and feet; symptoms are similar to rheumatoid arthritis and Lyme. 10/1/02 Per review of medical records a thyroid nodule was found on exam in 4/2002 and later determined by fine needle biopsy to be benign. The opinion of one specialist was that the patient had a reactive arthritis syndrome secondary to Lymerix vaccine in spite of the lack of genetic or inflammatory markers.

VAERS ID:192639 (history)  Vaccinated:2000-06-27
Age:5.0  Onset:2002-10-14, Days after vaccination: 839
Gender:Male  Submitted:2002-10-29, Days after onset: 15
Location:Indiana  Entered:2002-11-05, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Other
Symptoms: Decreased appetite, Headache, Pharyngolaryngeal pain, Pyrexia, Skin ulcer
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Temp 100-101, sore throat, decreased appetite, headache, multiple lesions.

VAERS ID:237710 (history)  Vaccinated:2000-06-27
Age:1.1  Onset:2004-03-16, Days after vaccination: 1358
Gender:Male  Submitted:2005-05-16, Days after onset: 425
Location:Virginia  Entered:2005-05-20, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0403USA02023
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.645267/0101N1  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.632724/0087K   
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from office staff concerning a 4 year old caucasion male with no relevant medical history who on 06/27/2000 was vaccinated on the left side with a first dose of varicella virus vaccine live (Oka/Merck) (Lot # 632724/0087K). Concomitant therapy on 06/27/2000 included a second dose on the right side of measles virus vaccine, live mumps virus vaccine, live rubella virus vaccine. There was no illness at the time of vaccination. On 03/16/2004, at 14:40, the patient developed a rash that erupted on the trunk area, hand and face with approximately 40 lesions. It was noted that during the office visit at 14:40 some lesions had vesicular tops with fluid filled tops and itched. Unspecified medical attention was sought. Subsequently, the patient recovered. No further information has been requested.

VAERS ID:256786 (history)  Vaccinated:2000-06-27
Age:1.1  Onset:2005-10-10, Days after vaccination: 1931
Gender:Female  Submitted:2006-05-12, Days after onset: 214
Location:New Jersey  Entered:2006-05-17, 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: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: WAES0510USA07008
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Info has been received from an RN concerning a 6 year old female with no known drug allergies who on 6/27/00 was vaccinated with a dose of varicella virus vaccine live. There was no illness at the time of vaccination. The RN reported that on 10/10/05, developed itchy white bumps on different areas of her body X 2-3 days. The pt was noted to be afebrile. The pt subsequently, developed 14 isolated papules on her neck, chest and right underarm. A diagnosis of mild breakthrough was made. Unspecified medical attention was sought and the pt was treated with calamine lotion. No lab/diagnostic tests were performed. In 2005, the pt''s breakthrough subsequently, resolved. Additional info is not expected.

VAERS ID:261948 (history)  Vaccinated:2000-06-27
Age:55.0  Onset:0000-00-00
Gender:Male  Submitted:2006-08-22
Location:Unknown  Entered:2006-08-22
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: A0602324A
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Cardiac disorder, Cognitive disorder, Fatigue, Headache, Influenza like illness, Joint swelling, Muscle spasms, Nervous system disorder, Pain, Rheumatoid arthritis, Sleep disorder
SMQs:, Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: This case was reported by a lawyer and described the occurrence of joint pain and swelling in a male subject of unspecified age who was vaccinated with Lyme disease vaccine recombinant (Lymerix) for prophylaxis. A physician or other health care professional has not verified this report. On an unspecified date the subject received unspecified dose of Lymerix (unk). On an unspecified date after vaccination with Lymerix, the subject experienced joint pain and swelling, flu like symptoms, fatigue, cardiac problems, charley horse type pain in calves, headaches, sleep disorder, cognitive problems, decreased activities of daily life, rheumatologic, neurologic and/or cognitive impairment of an autoimmune, immune mediated, or other mechanism. At the time of reporting the outcome of the events was unspecified. This information was received via a statement of injuries. Follow up information was received on 18Aug06 via the attorney, who reported that the pt was a 55 yr old male who was vaccinated with Lyme disease vaccine recombinant (Lymerix) on 24May99, 01Jul99, and 27Jun00. Approx one and a half months after vaccination (unspecified which vaccination of the series), the pt developed symptoms including severe rheumatologic and neurological injuries, fatigue, and cognitive impairment. Treatment included intravenous immunoglobulin. According to the attorney, the pt''s symptoms were debilitating to the point that he has been forced to go on private disability and subsequently apply for social security disability. The attorney also reported that the events had gotten progressively worse.

VAERS ID:273595 (history)  Vaccinated:2000-06-27
Age:7.0  Onset:2007-02-16, Days after vaccination: 2425
Gender:Male  Submitted:2007-02-23, Days after onset: 7
Location:Pennsylvania  Entered:2007-03-07, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Reactive airway disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4696920IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1869J0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Varicella
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Varicella vaccine breakthrough. Diagnosed with varicella 2-17-07. Approximately 30 lesions afebrile.

VAERS ID:157869 (history)  Vaccinated:2000-06-27
Age:42.0  Onset:2000-06-29, Days after vaccination: 2
Gender:Female  Submitted:2000-07-21, Days after onset: 22
Location:Foreign  Entered:2000-07-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: 20000199711
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM  IM 
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Fatigue, Lymphadenopathy, Musculoskeletal stiffness, Pyrexia, Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: On 6/27/2000, the pt received a dose of ''Hepatyrix'' (Hep-A and Typhoid) vaccine. On 6/28/2000, the pt experienced painful joints, fatigue, swollen neck glands, stiff neck, swollen base of tongue and was pyrexial. The events were noted to be severe in intensity and incapacitating. The nurse did not confirm the nausea as initially reported. No further doses of the vaccine will be given. The most recent information received on 7/17/2000, reports the outcome of the events as recovered. The reporting nurse considers the events to be "definitely" related to ''Hepatyrix''. The nurse indicated that the events had been reported to the regulatory authority.

VAERS ID:160140 (history)  Vaccinated:2000-06-27
Age:1.3  Onset:2000-07-07, Days after vaccination: 10
Gender:Female  Submitted:2000-09-21, Days after onset: 76
Location:Foreign  Entered:2000-09-27, Days after submission: 6
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: NONE
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES00091343
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Coordination abnormal, Grand mal convulsion
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: This pt received first vax on 06/27. On 07/07, the pt was hospitalized due to ataxia and convulsions grand mal. Upon internal review, convulsions and grand mal was considered to be an Other Medical Event. The reporter felt that ataxia and convulsions grand mal were possibly related to therapy with MMR.

VAERS ID:161166 (history)  Vaccinated:2000-06-27
Age:2.0  Onset:2000-06-27, Days after vaccination: 0
Gender:Male  Submitted:2000-10-26, Days after onset: 121
Location:Foreign  Entered:2000-11-01, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES00079653
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis, Hypersensitivity, Injection site swelling, Pyrexia
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Information has been received concerning a 2 year old male who on 6/27/00 was vaccinated with pneumococcal vaccine-23. On 6/27/00, the pt experienced fever and swelling at the injection site. The pt was treated with diclofenac sodium (Voren) and 12.5 mg supp., acetaminophen (Panadol), Anti-phen syrup and bacitracin ointment. Since the fever and swelling can not be well controlled after the above treatment, the pt was hospitalized on 6/29/00. After some antibiotic treatment, the pt was transferred to another hospital on 6/30/00. The pt was dx''d with cellulitis and was hospitalized. The pt was provided with vancomycin for 12 days. Subsequently, the pt recovered from swelling at the injection site and fever and cellulitis. The reporting physicians felt that swelling at the injection site was related to therapy with pneumococcal vaccine-23 and that the fever and cellulitis were not. No further information about this case.

VAERS ID:436155 (history)  Vaccinated:2000-06-27
Age:6.0  Onset:2003-05-01, Days after vaccination: 1038
Gender:Female  Submitted:2011-09-28, Days after onset: 3072
Location:Foreign  Entered:2011-09-29, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: magnetic resonance imaging, In favour with the diagnosis
CDC Split Type: WAES1109USA02686
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTIPV: DT + IPV (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Blindness unilateral, Condition aggravated, Dysgraphia, Multiple sclerosis, Nuclear magnetic resonance imaging abnormal, Optic neuritis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Retinal disorders (broad), Ocular infections (broad)
Write-up: Case received from the Health Authorities through a line listing on 13-SEP-2011 under the reference number B0650890A. Case medically confirmed. A 6-year-old female patient had received a booster dose of DT POLIO (batch number not reported) on 27-JUN-2000, a dose of MMR II (batch # not reported) on 02-FEB-2000 and a booster dose of ENGERIX-B (batch # not reported) on 08-FEB-1996. The patient had received injections of ENGERIX-B (batch number not reported) on 08-FEB-1996, 11-JUL-1995 and 16-AUG-1995. In May 2003 (also reported 01-May-2003), writing disorders were observed. MRI results were in favour with the diagnosis. In September 2003, left eye vision loss was founded. A retrobulbar optic neuritis was diagnosed in January 2004. A corticotherapy was instaured. The multiple sclerosis was diagnosed on an unspecified date. A treatment with interferon was administered. An aggravation of the disease was observed. In 2006, asthenia was reported. In 2007, a treatment with Tysabri was instaured. In December 2009, writing difficulties were observed. The patient had not recovered. The patient had received booster doses of ENGERIX (batch # not reported) on 11-JUL-1995 and 16-AUG-1995. The patient had received booster doses of DT POLIO (batch number not reported) on 07-JUN-1995 and on 27-JUL-2005. The Health Authorities assessed the causal relationship between the reported reaction and vaccinations as "doubtful" (C1 S1) according to the Foreign method of assessment. Multiple sclerosis was considered to be serious due to the other important medical event. Sender''s comments: Current scientific knowledge and epidemiological studies have not shown an association between multiple sclerosis and vaccination. Other business partner numbers included: E2011-05646. No further information is available.

VAERS ID:156072 (history)  Vaccinated:2000-06-28
Age:0.3  Onset:2000-06-29, Days after vaccination: 1
Gender:Male  Submitted:2000-06-30, Days after onset: 1
Location:Minnesota  Entered:2000-07-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: EEG, LP, CT scan of brain, CBC, BMP
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM941A21 RL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0290K1 LL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R12501 LL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712210 RL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Nystagmus, Strabismus
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt had focal seizures on left lower extremity then on left upper extremity getting to be generalized which lasted for about one hour. He was given Ativan and Dilantin. He continued to have brief eye deviation both downward gaze and nystagmus, about 5 seconds for a few hours. He has not had any seizures after that.

VAERS ID:156089 (history)  Vaccinated:2000-06-28
Age:36.0  Onset:2000-06-28, Days after vaccination: 0
Gender:Female  Submitted:2000-06-28, Days after onset: 0
Location:Florida  Entered:2000-07-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1715J SCRA
Administered by: Other     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt experienced a seizure after vaccine. 911 responded to the call.

VAERS ID:156296 (history)  Vaccinated:2000-06-28
Age:4.0  Onset:2000-06-29, Days after vaccination: 1
Gender:Male  Submitted:2000-06-29, Days after onset: 0
Location:Washington  Entered:2000-07-11, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic to feathers; reactive airway disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM919A24IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P04740SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0125J1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, Feeling hot, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Left leg swollen to below the knee, very warm, mild erythema. Pt treated with Keflex for early cellulitis.

VAERS ID:156473 (history)  Vaccinated:2000-06-28
Age:1.3  Onset:2000-07-01, Days after vaccination: 3
Gender:Male  Submitted:2000-07-03, Days after onset: 2
Location:Indiana  Entered:2000-07-13, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM916A23IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R044422IM 
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Pt developed a low temperature and broke out in flat red rash on chest and abdomen. Pt not itching or irritable.

VAERS ID:156731 (history)  Vaccinated:2000-06-28
Age:4.0  Onset:2000-06-29, Days after vaccination: 1
Gender:Female  Submitted:2000-06-30, Days after onset: 1
Location:Texas  Entered:2000-07-14, 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: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (CERTIVA)NORTH AMERICAN VACCINESD005R4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P032843SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0915J1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Mother noticed redness and swelling at the injection site. Redness and induration measure 60 X 70 mm.

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