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Case Details (Sorted by Vaccination Date)

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VAERS ID:165556 (history)  Vaccinated:2001-01-30
Age:0.3  Onset:2001-01-30, Days after vaccination: 0
Gender:Male  Submitted:2001-01-31, Days after onset: 1
Location:Kentucky  Entered:2001-02-02, 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: NONE
Diagnostic Lab Data:
CDC Split Type: KY2001006
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0056FA1IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.U706K IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01871SCLA
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Crying, Injection site erythema, Injection site oedema, Rash maculo-papular
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), Hypersensitivity (narrow)
Write-up: Within minutes of receiving vax, the DTaP injection site became red and swollen. Pt became splotchy on face, neck, behind ears and down to chest area. Pt was treated with Benadryl and ice packs at site of DTaP and Hib. Pt would continuously cry.

VAERS ID:165838 (history)  Vaccinated:2001-01-30
Age:4.6  Onset:2001-01-31, Days after vaccination: 1
Gender:Female  Submitted:2001-02-01, Days after onset: 1
Location:California  Entered:2001-02-13, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4669254IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R050623 LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site induration, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen, indurated area on left arm and tender to touch.

VAERS ID:165964 (history)  Vaccinated:2001-01-30
Age:4.0  Onset:2001-01-31, Days after vaccination: 1
Gender:Female  Submitted:2001-02-02, Days after onset: 2
Location:New Jersey  Entered:2001-02-16, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0356BA4IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Pyrexia, Upper respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm from just above the elbow to the top of her shoulder, became red, swollen, indurated but not tender within 24 hours, post vax. Had a fever, 3 days, post vax, and an URI.

VAERS ID:165987 (history)  Vaccinated:2001-01-30
Age:0.5  Onset:2001-01-30, Days after vaccination: 0
Gender:Female  Submitted:2001-01-31, Days after onset: 1
Location:Georgia  Entered:2001-02-20, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM972A22IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1288K2IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747340IMLL
Administered by: Private     Purchased by: Public
Symptoms: Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Fever of 104F and fussiness.

VAERS ID:166147 (history)  Vaccinated:2001-01-30
Age:29.0  Onset:2001-02-01, Days after vaccination: 2
Gender:Male  Submitted:2001-02-15, Days after onset: 14
Location:Ohio  Entered:2001-02-26, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Migraines
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0476SCLA
Administered by: Private     Purchased by: Military
Symptoms: Fatigue, Injection site erythema, Injection site swelling, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling at injection site, raised, reddened area measuring 70mm X 70mm at injection site of left deltoid. Pt experienced some malaise and fatigue. Seen by our MD. Treated with ibuprofen prn.

VAERS ID:166163 (history)  Vaccinated:2001-01-30
Age:10.0  Onset:2001-01-30, Days after vaccination: 0
Gender:Female  Submitted:2001-01-30, Days after onset: 0
Location:South Carolina  Entered:2001-02-26, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: SC0104
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5155892IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0929K0SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt started to develop itching within 5 min of injections. Small welts developed on LT arm. Large welts developed on Rt arm. one welt developed on side of neck. Vital signs taken at 9:30, BP 102/88, pulse 62, resp 24. Benadryl 25mg given IM RA deltoid. Vital signs re-checked 5-10 min times 30 min. Dr notified. Follow-up Q 4-6 hrs at home if welts re-occur, ER if breathing difficulty. Pt to be at home with Mom. Left at 10:00am BP 100/60, pulse 114.

VAERS ID:166171 (history)  Vaccinated:2001-01-30
Age:1.2  Onset:2001-01-30, Days after vaccination: 0
Gender:Female  Submitted:2001-02-12, Days after onset: 13
Location:Georgia  Entered:2001-02-27, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: All kinds of tests; EKG''s; Ultrasounds of heart; Blood tests-all tests wnl
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM973A20IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1291K0IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT01870IMRA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747340IMLL
Administered by: Private     Purchased by: Unknown
Symptoms: Cardiac disorder, Crying, Eye movement disorder, Insomnia, Respiratory disorder, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow)
Write-up: The doctor came in to check my daughter and said she was perfect, 10 minutes before the shots. Then 10 minutes after she received the shots she was dead. The doctor does not tell you to wait so I had already started home. I had to stop the car and ask for help. Thank God there was a lady that Stopped to help and she did CPR on my daughter. The ambulance came and she was taken to the ER. The doctor in the ER said she was sorry, but my daughters doctor, had refused to come to the hospital and see her. She was admitted to pediatrics and the doctors on call there had to take care of her. The doctors ran several tests on her, they checked her heart with EKG, Heart ultrasounds, checked her blood, gave her an IV and all the test came back perfect. Nothing was wrong with her blood or her heart or lungs so it had to be the shots. Later on that night of 01/30/01, the family pediatrician came to the nurses station. My daughter was right across from the nurses station, he stayed for over an hour and still never came in my daughters room. When he started to leave my mother stopped him and asked what had happened to My baby, he stated he did not know but it could not have been the shots. My mother told him, he said 10 minutes before the shots she was perfect( she weighed 14 1/2 lbs, 25 1/2 '''' long). Then 10 minutes after the shots she was dead. She also asked him why don''t you tell people to wait but, he stated nothing has ever happened and we see no reason to tell people to wait. He still never came into to check on her. The doctors on call said they would check her to see which shot she was allergic to but they came in the next day and dismissed her without a care in the world. For a few days after the shots she would scream and cry for 10-20 minutes non stop. This child never did this before, she only cried when she was hungry or wet. Some days she sits like she is in a daze. She goes to sleep and it is really hard to wake her up and if she does wake up, she only opens her eyes a little and back to sleep she goes. It hurts

VAERS ID:166189 (history)  Vaccinated:2001-01-30
Age:71.0  Onset:2001-01-31, Days after vaccination: 1
Gender:Female  Submitted:2001-02-09, Days after onset: 9
Location:Ohio  Entered:2001-02-27, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: arm was swollen, hot red with extreme itching and a huge hive;Influenza (unknown mfr);;60;In Patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: allergy to eggs
Diagnostic Lab Data:
CDC Split Type: OH0003
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM658A40IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R03940IMRA
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU034AA IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESR03840IMLA
Administered by: Public     Purchased by: Other
Symptoms: Angioneurotic oedema, Injection site erythema, Injection site oedema, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: The pt reports that within 24 hours the left arm was swollen, hot and red from the elbow to the shoulder, "one huge hive" and extreme itching. The family MD was not available and the Pt went to the ER. Treated with Prednisone and Atarax for itching.

VAERS ID:166275 (history)  Vaccinated:2001-01-30
Age:17.0  Onset:2001-01-30, Days after vaccination: 0
Gender:Male  Submitted:2001-01-31, Days after onset: 1
Location:Oklahoma  Entered:2001-03-01, Days after submission: 29
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: OK0105
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS622BG0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Migraine, Myalgia, Pharyngolaryngeal pain, Photosensitivity reaction
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Pt reports 30 minutes after injection, severe migraine - like headache. 1/31/01 headache continues, back of neck sore/stiff, sore throat, sensitive to light, left side of body sore. 2/1/01 headache continues, other symptoms resolved. Pt went to school today.

VAERS ID:166308 (history)  Vaccinated:2001-01-30
Age:1.1  Onset:2001-02-08, Days after vaccination: 9
Gender:Female  Submitted:2001-02-09, Days after onset: 1
Location:Oregon  Entered:2001-03-02, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5159A22IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0947J0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1241K0SCLL
Administered by: Private     Purchased by: Other
Symptoms: Blister, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Broke out in rash last night on back and mouth, turning over course of day to blisters. Advised to use aveeno bath, benadyl cream and tylenol if fever.

VAERS ID:166431 (history)  Vaccinated:2001-01-30
Age:2.0  Onset:2001-01-30, Days after vaccination: 0
Gender:Female  Submitted:2001-02-05, Days after onset: 6
Location:Texas  Entered:2001-03-05, Days after submission: 28
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 (INFANRIX)SMITHKLINE BEECHAM961A23IMRL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES560753A4IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1277J0IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712280IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1149K0IMLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site haemorrhage, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)
Write-up: At time of injection, the site of PCV, bled real bad. Was able to apply pressure and a bandaid. Child was seen on 1/31/01 for rash reaction. Mom states left thigh was worse. Child had complete body rash and was instructed to use OTC.

VAERS ID:166559 (history)  Vaccinated:2001-01-30
Age:15.0  Onset:2001-01-30, Days after vaccination: 0
Gender:Male  Submitted:2001-02-05, Days after onset: 6
Location:Minnesota  Entered:2001-03-06, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;Pertussis;2;2;In Sibling
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM655A21 RA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Dizziness, Hallucination, Hyperhidrosis, Insomnia, Myalgia, Restlessness
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad)
Write-up: Legs and muscles ached, mind racing, couldn''t sleep, restless, not & sweaty,damp, dizziness back ached. Hallucinations at school next day.

VAERS ID:166619 (history)  Vaccinated:2001-01-30
Age:4.0  Onset:2001-01-31, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Michigan  Entered:2001-03-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, Singulair, Nasonex
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712310IM 
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: On 1/31/01 at 05:30, pt awoke with a fever of 104F and vomiting which continued. We went back to the doctor at 11:00 and he gave a prescription for Phenergan suppository. Vomiting stopped, controlled temperature with Tylenol and Motrin. On 2/1/01, diarrhea started and continued until the late evening of 2/4/01. Fever and diarrhea stopped on 2/5/01.

VAERS ID:166677 (history)  Vaccinated:2001-01-30
Age:46.0  Onset:2001-01-31, Days after vaccination: 1
Gender:Female  Submitted:2001-02-02, Days after onset: 2
Location:New York  Entered:2001-03-07, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergies to Sulfa, ASA, PON.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0193AA1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: This patient remained home on 01/31/2001 after receiving vaccine on 01/30/2001. Complained of left deltoid pain, feverish / chills. Treatment was Tylenol, Ice, and ROM. No SOB, no chest pain, no rash, no headache.

VAERS ID:166687 (history)  Vaccinated:2001-01-30
Age:1.0  Onset:2001-01-30, Days after vaccination: 0
Gender:Male  Submitted:2001-02-07, Days after onset: 8
Location:Illinois  Entered:2001-03-07, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;DTP (unknown mfr);2;0;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM65168A22IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0448K0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Disorientation, Pyrexia, Rash, Viral infection, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: At 6 PM this infant had a spike fever of 102.5 F then it went to 104.5, he vomited, and became disoriented. His fever went down with Motrin. He had a fever on and off for a total of 5 days, then he had a viral rash. Doing well now.

VAERS ID:166711 (history)  Vaccinated:2001-01-30
Age:11.0  Onset:2001-01-30, Days after vaccination: 0
Gender:Male  Submitted:2001-02-01, Days after onset: 2
Location:Connecticut  Entered:2001-03-07, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Hives;Varicella (Varivax);1;8;In Patient
Other Medications: Dextrostat
Current Illness: NONE
Preexisting Conditions: ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5167A20 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0781K1 RA
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Dyspnoea, Erythema, Eye swelling, Ocular hyperaemia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: This child had red, swollen eyes, weakness, erythematous skin, questionable difficulty breathing, and a rash.

VAERS ID:167404 (history)  Vaccinated:2001-01-30
Age:53.0  Onset:2001-02-01, Days after vaccination: 2
Gender:Female  Submitted:2001-03-01, Days after onset: 28
Location:Oregon  Entered:2001-03-20, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: OR200107
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.4419K1IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Myalgia, Nasopharyngitis
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad)
Write-up: Muscle in left upper arm ached for about 1 week and then had a bad cold which settled in same location and ached severely for 2 nights; responded to hot cloth application but still minimal aching on 3/1/01.

VAERS ID:167603 (history)  Vaccinated:2001-01-30
Age:7.0  Onset:2001-02-01, Days after vaccination: 2
Gender:Male  Submitted:2001-03-14, Days after onset: 41
Location:Wisconsin  Entered:2001-03-21, 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: Medicated for ADD
Current Illness:
Preexisting Conditions: History of Autism, ADD, Tics
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0301AA3IM 
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1028K1IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T04852SC 
Administered by: Private     Purchased by: Private
Symptoms: Tic
SMQs:, Dyskinesia (broad), Dystonia (broad)
Write-up: Pt''s mother stated he displayed marked increase in tics, post vax. He had tics prior to vaccines. Affect of increased tics more noticeable after environmental stimulation. In clinic only minimal evidence of tics activity on 3/13/01. Note: mother believes older sibling had permanent (neurologic) changes following immunizations.

VAERS ID:168030 (history)  Vaccinated:2001-01-30
Age:38.0  Onset:2001-01-30, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Illinois  Entered:2001-04-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TB test
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0193AA   
Administered by: Public     Purchased by: Private
Symptoms: Joint stiffness, Pain
SMQs:, Arthritis (broad)
Write-up: Within 6 hours of the injection, this patient''s left TMJ became stiff, and extremely painful. The pain lasted 48 hours then resolved.

VAERS ID:168658 (history)  Vaccinated:2001-01-30
Age:4.0  Onset:2001-02-01, Days after vaccination: 2
Gender:Male  Submitted:2001-02-08, Days after onset: 7
Location:Texas  Entered:2001-04-13, Days after submission: 63
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: TX01016
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM914A24IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R129423SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725430IMLL
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left thigh was swollen, red and warm to touch. Had no other symptoms. Child''s mother states when he woke up the morning of 2/1/01, his left thigh was red and swollen. Referred to MD and they instructed mother to put an ice pack to his thigh. I did a follow-up call on 2/5/01 and mother states child''s symptoms went away on 2/3/01 and he is fine.

VAERS ID:168685 (history)  Vaccinated:2001-01-30
Age:0.9  Onset:2001-01-30, Days after vaccination: 0
Gender:Male  Submitted:2001-01-31, Days after onset: 1
Location:Texas  Entered:2001-04-13, Days after submission: 71
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: TX01015
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM919A22IMLL
HIBV: HIB (HIBTITER)PFIZER/WYETH560753A2IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R12502 RL
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Clinic called to report pt was taken to ER and was diagnosed with generalized urticaria post vaccine. Was treated with Benadryl 10.9 mg PO now and q 4-6 hrs prn hives. Pt to follow up per Dr.

VAERS ID:168982 (history)  Vaccinated:2001-01-30
Age:1.1  Onset:2001-01-30, Days after vaccination: 0
Gender:Female  Submitted:2001-03-26, Days after onset: 55
Location:Rhode Island  Entered:2001-04-24, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0299AB0IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0555K0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01170SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725450IMLL
Administered by: Public     Purchased by: Public
Symptoms: Cyanosis, Hypotonia, Rash papular, Skin discolouration, Somnolence
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt cried, turned blue, developed cyanotic colored rash on thighs and then turned limp. Afterwards, had vesicular papular rash and was very dazed and sleepy. Symptoms resolved in 24-36 hours.

VAERS ID:170319 (history)  Vaccinated:2001-01-30
Age:0.6  Onset:2001-01-30, Days after vaccination: 0
Gender:Female  Submitted:2001-05-01, Days after onset: 90
Location:Florida  Entered:2001-05-29, Days after submission: 28
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
Diagnostic Lab Data:
CDC Split Type: FL01011
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM960A21IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1888J1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R14371SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4753821IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Crying, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Spoke with Mom of child, child had seizures with unconsolable crying and elevated temp for 3 days following administration of second DTAP.

VAERS ID:172183 (history)  Vaccinated:2001-01-30
Age:33.0  Onset:2001-02-15, Days after vaccination: 16
Gender:Male  Submitted:2001-05-15, Days after onset: 88
Location:New Jersey  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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01021283
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.692614/1687J0SC 
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: on 02/15/2001 the patient developed a generalized rash. The patient sought unspecified medical attention. It was reported that the patient recovered from the rash. Additional information has been requested.

VAERS ID:173433 (history)  Vaccinated:2001-01-30
Age:69.0  Onset:2001-02-01, Days after vaccination: 2
Gender:Female  Submitted:2001-05-22, Days after onset: 109
Location:Unknown  Entered:2001-07-19, Days after submission: 58
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: Bayer aspirin; Atenolol, Embrel, Levothyroxine, Omeprazole, Pamidronate Disodium, Prednisone,Simvastatin
Current Illness: UNK
Preexisting Conditions: Osteoporosis NOS; Rheumatoid arthritis
Diagnostic Lab Data: on 02/01/2001 body temperature for pt was 106 degrees F
CDC Split Type: HQ1063318MAY2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad)
Write-up: On 02/01/2001, the pt developed a fever of 106 with joint paints. She was hospitalized and treated with amoxicillin and Clavulanic acid for two days. Therapy was discontinued when the possibility of an infection was ruled out by her Dr. The pt recovered. The reported noted that the treating rheumatologist considered the events to be temporally related to the Pamidronate infusion or the influenza virus vaccine.

VAERS ID:173860 (history)  Vaccinated:2001-01-30
Age:10.0  Onset:2001-02-06, Days after vaccination: 7
Gender:Male  Submitted:2002-09-03, Days after onset: 573
Location:Illinois  Entered:2001-08-03, Days after submission: 396
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: Hay fever; rhinitis allergic NOS
Diagnostic Lab Data: UNK
CDC Split Type: WAES01072223
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1985J0  
Administered by: Private     Purchased by: Private
Symptoms: Abnormal behaviour, Agitation, Convulsion, Hallucination, Headache, Insomnia, Phobia
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a physician concerning a 10 year old male with allergic rhinitis who on 1/30/01, 2/27/01 and 6/19/01 was vaccinated with first (lot# 632556/1985J, in the right arm), second (lot #632556/1985J, in the right arm), and third (lot# not provided, in the left arm) doses of Hep B, respectively. This does not comply with the recommended dose schedule. there was no illness at the time of vaccination. On 2/27/01 the patient experienced a "bizarre" reaction. He began to hallucinate, became fearful, phobic and did not know what was going on around him. He also experienced insomnia, stiffness, and personality change. It was noted that this reaction lasted 6 weeks. ON 7/2/01 the patient, again experienced a "bizarre reaction", hallucinations, insomnia, stiffness, and personality change. Unspecified medical attention was sought. It was reported that the patient recovered from the second reaction on 8/15/01. There were no laboratory tests done. Additional follow-up information was received from the child''s parents, on 08/15/02. According to them, the child received the first dose Hep B vaccine recombinant on 1/30/01. Seven to ten days post vaccination, the child began having trouble sleeping at night. He bacame "clingy" about an hour before bedtime and wanted his paretns to sit with him until he fell asleep. He would lay awake for hours waiting for his parents to go to bed and then would go to their room "begging" them to let him sleep in their room. They reported that they did not know what the problem was and that the child had always been a good sleeper. They tried "everything" including reading to him, rubbing his back, and lying with him until he relaxed, but nothing worked. He became more agitated each night. He began to have panic attacks about going to bed. His parents reported that they tried to be firm and force hiim to stay in his own room, but he kept getting more upset. They spoke to the physician, who "pressed" them to keep working on getting the child to sleep in his own bed. He

VAERS ID:175037 (history)  Vaccinated:2001-01-30
Age:70.0  Onset:2001-01-30, Days after vaccination: 0
Gender:Female  Submitted:2001-06-06, Days after onset: 126
Location:Kentucky  Entered:2001-09-05, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lotrel, Premarin
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ6930807FEB2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES469132 IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: A pharmacist reported that a 70 year old female received an injection of Pnu-Imune 23 on 01/30/01. Within 1 day of vaccine administration,the patient developed an injection site reaction characterized by redness, swelling, warmth, and tenderness. She was treated "symptomatically". This is 1 of 2 patients from this facility who experienced this event following receipt of Pnu-Imune 23 lot 469-132. Follow-up info received on 06/06/01 indicated that the patient recovered.

VAERS ID:179552 (history)  Vaccinated:2001-01-30
Age:56.0  Onset:2001-01-31, Days after vaccination: 1
Gender:Male  Submitted:2001-12-03, Days after onset: 306
Location:Florida  Entered:2001-12-28, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: Contact with or exposure to Rabies.
Diagnostic Lab Data:
CDC Split Type: EM20010238
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (RABAVERT)CHIRON CORPORATION 0  
Administered by: Public     Purchased by: Other
Symptoms: Chills, Disturbance in attention, Encephalitis, Encephalopathy, Meningism, Pyrexia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (narrow), Depression (excl suicide and self injury) (broad), Chronic kidney disease (broad)
Write-up: A 54 year old male pt experienced encephalopathy following treatment with RabAvert for post exposure prophylaxis. the pt was bitten and scratched by a stray cat. He had previously received two full courses of human rabies immune globulin and 5 injections of post exposure rabies vaccine in the US about 9 to 10 years ago. He had not received any rabies booster shots since that time. The pt received one dose of post exposure RabAvert without human rabies immune globulin on 30-JAN-01 after stray cat bite. He did not receive his second dose because he experienced "encephalopathy" after the first RabAvert dose and the pt was hesitant to obtain either RabAvert or Imovax for the second dose. No titer was taken prior to the first dose and at the time of this report, it had been 7 days since the first dose. Follow up information is pending. ADDITIONAL INFORMATION: Follow up information was received on 27-FEB-01. The pt was 56 years of age (correction). Twenty-four hours after his last dose of RabAvert on 30-JAN-01 at 1600, he experienced tachycardia, a fever 100 degrees F, and chills which lasted 24 hours; menigismus which lasted 2 to 3 days; and difficulty concentrating which lasted 5 days. His diagnosis was mild encephalitis and he recovered on 21-FEB-01.

VAERS ID:252490 (history)  Vaccinated:2001-01-30
Age:  Onset:2006-03-01, Days after vaccination: 1856
Gender:Male  Submitted:2006-03-06, Days after onset: 5
Location:Georgia  Entered:2006-03-09, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Varicella (unknown mfr)~~6~In Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Clinical Dx
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0998K0 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES472549  LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0541K  LL
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: 03/01/2006 appeared with lesions that were Dx varicella $g 50 pox.

VAERS ID:253474 (history)  Vaccinated:2001-01-30
Age:1.1  Onset:2006-03-01, Days after vaccination: 1856
Gender:Male  Submitted:2006-03-06, Days after onset: 5
Location:Georgia  Entered:2006-03-30, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Varicella (Varivax)~~1~In Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Clinical Dx
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0998K0 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES472549  LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0541K  LL
Administered by: Private     Purchased by: Private
Symptoms: Skin ulcer
SMQs:
Write-up: 03/01/2006 Appeared with lesions that were dx varicella $g 50 pox

VAERS ID:302330 (history)  Vaccinated:2001-01-30
Age:7.0  Onset:2007-08-02, Days after vaccination: 2375
Gender:Male  Submitted:2008-01-07, Days after onset: 158
Location:California  Entered:2008-01-10, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
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.1093L1 RA
Administered by: Private     Purchased by: Private
Symptoms: Varicella
SMQs:
Write-up: Varicella despite vaccination 1/30/01, 2/13/07.

VAERS ID:165760 (history)  Vaccinated:2001-01-31
Age:54.0  Onset:2001-02-01, Days after vaccination: 1
Gender:Female  Submitted:2001-02-08, Days after onset: 7
Location:Texas  Entered:2001-02-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plaquenil; Prednisone; Medrol; Prilosec; Synthroid; Vioxx
Current Illness: UNK
Preexisting Conditions: Rheumatoid arthritis; Celiac disease; Hypothyroidism; Myasthenia gravis
Diagnostic Lab Data: UNK
CDC Split Type: HQ6826305FEB2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4630150IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: A nurse reported that a pt received an injection of Pnu-Imune-23 on 1/31/2001. The following day, the pt developed a fever of 102F and an injection site reaction characterized by redness and soreness. The pt was hospitalized and treated with unspecified antibiotics and steroids. As of the date of this report, the pt''s symptoms were improving. Follow-up info received from the physician on 3/7/01, indicated that the pt was a 54 year old female. She recovered.

VAERS ID:165766 (history)  Vaccinated:2001-01-31
Age:24.0  Onset:2001-02-01, Days after vaccination: 1
Gender:Male  Submitted:2001-02-01, Days after onset: 0
Location:Michigan  Entered:2001-02-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, Flonase
Current Illness: NONE
Preexisting Conditions: Environmental allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (NO BRAND NAME)MICHIGAN DEPT PUB HLTHRV1622IMRA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Feeling abnormal, Hypoaesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: After 3rd Rabies vaccine injection, pt''s right upper arm experienced numbness and tingling in hand with loss of feeling in right hand for 5 hours duration. Complained of dizziness and feeling "just not right". Stated temperature was 103F-101F, during the night. No breathing or swallowing difficulties. Temperature is now 98.9F. Treated with Benadryl.

VAERS ID:165820 (history)  Vaccinated:2001-01-31
Age:5.0  Onset:2001-02-01, Days after vaccination: 1
Gender:Male  Submitted:2001-02-01, Days after onset: 0
Location:North Carolina  Entered:2001-02-13, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergy to PCN, Amoxicillin, Cefzil, Latex
Diagnostic Lab Data:
CDC Split Type: NC00015
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.T01213 LL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747310IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site inflammation, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 5 X 7 raised, edematous, inflammed area of dorsal right thigh, warm to touch, 12 hours, post vax. Treatment: ice pack, Motrin and Benadryl PRN and return if needed.

VAERS ID:165841 (history)  Vaccinated:2001-01-31
Age:1.3  Onset:2001-02-01, Days after vaccination: 1
Gender:Female  Submitted:2001-02-02, Days after onset: 1
Location:Montana  Entered:2001-02-13, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: MT0106
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM968A23IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1149K0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site inflammation, Injection site swelling, 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: 24 hours, post vax, injection site became inflamed, swollen and hot into joint area and to knee (left VL). Child did not run a fever. Local reaction only. Seems to be itching. 48 hours, post vax, much improved.

VAERS ID:165848 (history)  Vaccinated:2001-01-31
Age:4.5  Onset:2001-02-02, Days after vaccination: 2
Gender:Female  Submitted:2001-02-02, Days after onset: 0
Location:Michigan  Entered:2001-02-13, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt also had 1st PPD/Connaught/C0152AA/RFA on 1/31/01.
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4670084IMGM
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1284J1SCGM
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Redness, sore, itchy and warm to touch at injection site on right buttocks. Was told to use Benadryl cream.

VAERS ID:165859 (history)  Vaccinated:2001-01-31
Age:67.0  Onset:2001-02-02, Days after vaccination: 2
Gender:Female  Submitted:2001-02-06, Days after onset: 4
Location:Wisconsin  Entered:2001-02-13, 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: Amoxicillin (1 week earlier)
Current Illness: Resolved stomach problem (1 week earlier)
Preexisting Conditions: Bad back.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LTD.UO342AA2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Infection, Injection site hypersensitivity, Injection site oedema, Injection site pain, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: On 02/02/01, this patient felt tenderness in her left arm. ON 02/03/01 , the patient''s left upper arm was tender, swollen, with 1 quarter size spot (red) at the site of the injection. Another smaller red spot closer to the body. On 02/04/01, the spots got larger , area swollen, itching, and painful. She called the ER and was advised to use Benadryl, Ibuprofen and warm pads. On 02/04/01, the patient''s sickness increased so the patient went in to the ER. The MD suspected an infection but he was not sure it wasn''t a reaction to the vaccine. The patient received a prescription for Keflex, and she was advised to continue the Benadryl and Ibuprofen. On 02/06/01, the patient saw her own MD and she was advised to not have another TD vaccination and to continue the Keflex until gone. The swelling and inflammation are down but she can still feel a soreness in the upper arm.

VAERS ID:165917 (history)  Vaccinated:2001-01-31
Age:22.0  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2001-02-10, Days after onset: 10
Location:Michigan  Entered:2001-02-15, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (NO BRAND NAME)MICHIGAN DEPT PUB HLTHRV1622IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Injection site swelling, Shoulder pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt reports left shoulder pain and swelling after 3rd Rabies vaccine injection. Did experience mild reaction to 1st and 2nd doses, temp of 97.4- pt denies breathing or swallowing difficulties. Localized reaction.

VAERS ID:166107 (history)  Vaccinated:2001-01-31
Age:16.0  Onset:2001-02-05, Days after vaccination: 5
Gender:Female  Submitted:2001-02-07, Days after onset: 2
Location:Virginia  Entered:2001-02-22, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Screaming Syndrome;Vaccine not specified;1;0;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: VA01007
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM941A23IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0784K2IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R050622SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1659J0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Injection site erythema, Injection site mass, Otitis media, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: "Pt developed a knot and redness at injection site on right leg (larger than a 50 cent piece) that lasted through 2/4/01". "Pt had seizure and was taken by rescue squad to hospital ER on 2/5/01. Fever was 101F and was dx''d with ear infections at ER". Per mom, she is to see PMD on 2/8/01.

VAERS ID:166157 (history)  Vaccinated:2001-01-31
Age:1.0  Onset:2001-02-13, Days after vaccination: 13
Gender:Female  Submitted:2001-02-15, Days after onset: 2
Location:New Hampshire  Entered:2001-02-26, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NH0104
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1280K0SC 
Administered by: Private     Purchased by: Public
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: Rash on side after vaccine. erythema, macula papule.

VAERS ID:166160 (history)  Vaccinated:2001-01-31
Age:32.0  Onset:2001-02-01, Days after vaccination: 1
Gender:Female  Submitted:2001-02-02, Days after onset: 1
Location:Oregon  Entered:2001-02-26, Days after submission: 24
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: Allergic to cats, fresh fruit/vegetables, scolosis (L) leg shorter 3/4".
Diagnostic Lab Data:
CDC Split Type: OR200102
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1419K1IMLA
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain upper, Insomnia, Malaise, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Pt reports rash, hive like spots appeared on chest day after receiving #2 Hep B. Spots itch. Friday morning (2 days after, increased spots, stomachache , malaise, insomnia.

VAERS ID:166225 (history)  Vaccinated:2001-01-31
Age:21.0  Onset:2001-01-31, Days after vaccination: 0
Gender:Male  Submitted:2001-02-06, Days after onset: 6
Location:Illinois  Entered:2001-02-28, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI symptoms
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC - nml
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3338A2 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cognitive disorder, Confusional state, Depersonalisation, Dizziness, Dry mouth, Feeling hot, Headache, Neck pain, Upper respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: One hour post vax, the pt became dizzy, confused, decrease in comprehension, complained of headache and neck burning, dry mouth, "Hot", had URI. The pt had fatigue and ache 1 week prior to vax. Diagnosed with disassociative reaction of unclear origin

VAERS ID:166229 (history)  Vaccinated:2001-01-31
Age:1.3  Onset:2001-02-03, Days after vaccination: 3
Gender:Male  Submitted:2001-02-06, Days after onset: 3
Location:Minnesota  Entered:2001-02-28, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 10/00 EEG-nml; 2/1 CBC-nml
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)PFIZER/WYETH4733793IMRA
PNC: PNEUMO (PREVNAR)PFIZER/WYETH4725492IMLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Pyrexia, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Fever, seizure-like activity, 24 hours, post vax, PCV #2 on 10/30/00. Fever, seizure-like activity, 48 hours, post vax, PCV #3 on 1/31/01.

VAERS ID:166338 (history)  Vaccinated:2001-01-31
Age:1.5  Onset:2001-02-20, Days after vaccination: 20
Gender:Female  Submitted:2001-02-28, Days after onset: 8
Location:Wisconsin  Entered:2001-03-02, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747251IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1357J0SCRL
Administered by: Private     Purchased by: Other
Symptoms: Contusion, Petechiae, Purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)
Write-up: Mother reports 14 days post vaccine, pt had bruising. Pt was seen 2/20 by physician. Physician noted purpura, bruising 2nd petechia,. PH 39,000 (INR PT/PTT normal) 2/26 PH 26,000. No treatment currently. Report to follow.

VAERS ID:166415 (history)  Vaccinated:2001-01-31
Age:3.0  Onset:2001-02-01, Days after vaccination: 1
Gender:Male  Submitted:2001-02-05, Days after onset: 4
Location:New Jersey  Entered:2001-03-05, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712130IMLA
Administered by: Private     Purchased by: Private
Symptoms: Psychomotor hyperactivity
SMQs:, Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: Was fine the day of the IZ, but became extremely active "could not sit still". He was running from room to room, unable to calm himself from the next afternoon at about 13:30 until about 20:00. He fell asleep at that time and woke up fine. Mother had felt that she had to almost restrain him, so he would not hurt himself.

VAERS ID:166426 (history)  Vaccinated:2001-01-31
Age:0.3  Onset:2001-01-31, Days after vaccination: 0
Gender:Male  Submitted:2001-01-31, Days after onset: 0
Location:Michigan  Entered:2001-03-05, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4734421IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4730021IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T047221SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720501IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: At 15:00, gave injection of DTAP and HIB (2 different sites, same right thigh) leg became bright red in color, a few bumps noted; I got the doctors to look at baby and we administered 1/2 tsp Benadryl. The pt is to follow-up with an allergist.

VAERS ID:166569 (history)  Vaccinated:2001-01-31
Age:4.0  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2001-02-08, Days after onset: 8
Location:California  Entered:2001-03-06, Days after submission: 26
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: glucose - nml
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0137BAA4IMLL
HEPA: HEP A (VAQTA)MERCK & CO. INC.0792K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R148923SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1086J1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Feeling cold, Hyperhidrosis, Pallor, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: The pt became faint after the vaccines were administered, The pt experienced sweating, cold skin, shaking, paleness, dizziness. Treated with Benadryl and rest.

VAERS ID:166671 (history)  Vaccinated:2001-01-31
Age:4.1  Onset:2001-02-01, Days after vaccination: 1
Gender:Male  Submitted:2001-02-13, Days after onset: 12
Location:Virginia  Entered:2001-03-06, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Chronic abdominal pain especially after eating.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0357CA4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T0533 SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1277K1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: IZ reaction on 1/31/01. Upper arm swollen 11cm X 11cm on 2/2/01. No pain at site. Received Claritin 1 1/2 tsp every day. No further complaints with next doctor''s visit on 2/12/01.

VAERS ID:166704 (history)  Vaccinated:2001-01-31
Age:11.0  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2001-02-01, Days after onset: 1
Location:Delaware  Entered:2001-03-07, Days after submission: 34
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
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3723A2 IM 
Administered by: Military     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Within 20 minutes from the time of this patient''s shot, a rash broke out on her neck. The following day the rash is still on her face. No difficulty breathing or wheezing.

VAERS ID:167034 (history)  Vaccinated:2001-01-31
Age:1.1  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2001-02-20, Days after onset: 20
Location:Georgia  Entered:2001-03-13, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA01014
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM958A23IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1617H3IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R143723 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0408K0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0525K0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Hemiparesis, Irritability, Rash, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: The patient''s mother states, on 01/31/01 this baby was very irritable, not sleeping, and a rash appeared on 02/01/01. She called the health dept and told to take her to the doctor. The mother states the baby had a seizure on 02/07/01 and was hospitalized for one day. The baby okay, but the same states the mother. The baby''s right side weak states mother. The mother is to call the child''s MD to inform of the child''s condition.

VAERS ID:167061 (history)  Vaccinated:2001-01-31
Age:0.5  Onset:2001-02-02, Days after vaccination: 2
Gender:Male  Submitted:2001-02-02, Days after onset: 0
Location:Georgia  Entered:2001-03-13, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA01008
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM973A22IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0290K2IMLL
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site oedema, Subcutaneous nodule
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: On 02/02/2001, the infant woke this AM with right leg swollen at the site of vaccine. Red and has knot under skin. The god parent took the child to the MD.

VAERS ID:167236 (history)  Vaccinated:2001-01-31
Age:0.7  Onset:2001-02-02, Days after vaccination: 2
Gender:Male  Submitted:2001-03-12, Days after onset: 38
Location:Montana  Entered:2001-03-19, 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 (INFANRIX)SMITHKLINE BEECHAMA972A22IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1368K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R13452 LL
Administered by: Public     Purchased by: 0
Symptoms: Lymphadenopathy, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 2 days post vaccine pt developed rash to cheeks, trunk and back of head, swollen glands to back of neck. Rash persists to cheeks and trunk.

VAERS ID:167969 (history)  Vaccinated:2001-01-31
Age:0.8  Onset:2001-02-01, Days after vaccination: 1
Gender:Male  Submitted:2001-03-22, Days after onset: 49
Location:Ohio  Entered:2001-03-29, 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: URI
Preexisting Conditions: Prematurity
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0320AB2IMLL
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 2/1/01, pt''s left thigh was swollen and red. Treated with cold compresses initially and then warm compresses after 24 hours.

VAERS ID:168475 (history)  Vaccinated:2001-01-31
Age:1.2  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2001-03-05, Days after onset: 33
Location:Georgia  Entered:2001-04-10, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data: Pt had chest x-ray and blood work in ER which parent states were all negative
CDC Split Type: GA01022
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0707K2IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R14372SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1656J0SCLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747340IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt developed a fever up to 103 and parent states she almost had a seizure. Pt was taken to the ER and was advised that it could be from the vax. Parent also advised to treat with Motrin between doses of Tylenol. Fever lasted for 2 days and then resolved.

VAERS ID:168476 (history)  Vaccinated:2001-01-31
Age:0.7  Onset:2001-01-31, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Georgia  Entered:2001-04-10
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 (INFANRIX)SMITHKLINE BEECHAM972A22IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747340IMRL
Administered by: Other     Purchased by: Public
Symptoms: Crying, Decreased appetite, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad)
Write-up: Pt experienced a persistent fever for 2 days, persistent crying for 2-3 days and refused foods for 2 days.

VAERS ID:169006 (history)  Vaccinated:2001-01-31
Age:14.0  Onset:2001-02-09, Days after vaccination: 9
Gender:Male  Submitted:2001-02-22, Days after onset: 13
Location:Iowa  Entered:2001-04-24, Days after submission: 60
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
HEPA: HEP A (VAQTA)MERCK & CO. INC.0118K0IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESR11690IMLA
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA287AA0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Non-itchy rash on neck, trunk, arms and legs, starting on 2/9/01. Reported from pt''s mother on 2/16/01. States she hasn''t noticed the rash since 2/14/01.

VAERS ID:172112 (history)  Vaccinated:2001-01-31
Age:42.0  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2001-05-15, Days after onset: 103
Location:Unknown  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: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES01020180
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: On 01/31/2001 within a few hours of vaccination the patient developed vesicles. The following day the patient developed ''many vesicles'' and was seen by a nurse practitioner. Additional information has been requested.

VAERS ID:172173 (history)  Vaccinated:2001-01-31
Age:1.0  Onset:2001-02-09, Days after vaccination: 9
Gender:Male  Submitted:2001-05-15, Days after onset: 94
Location:Florida  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: Upper respiratory infection
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01020967
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1240K0SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Skin ulcer
SMQs:
Write-up: On 02/09/2001 the patient had a few lesions. In follow-up, the patient''s mother called the physician''s office on 02/12/2001 to report the patient had ''several spots''. The onset of the spots was 02/09/2001. Unspecified medical attention was sought. The nurse also reported on the patient''s mother who had a experience following the child''s vaccination with varicella virus vaccine live. Additional information has been requested.

VAERS ID:171054 (history)  Vaccinated:2001-01-31
Age:1.0  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2001-05-09, Days after onset: 97
Location:Michigan  Entered:2001-06-12, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: MI2001004
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO3313A3IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.786K2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1273K0SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4749511IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1143K0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Difficulty in walking, Oral intake reduced, Pyrexia, Weight decreased
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad)
Write-up: Post vaccines pt wouldn''t walk for 3 weeks with fever. Cried, wouldn''t eat. Lost weight.

VAERS ID:172136 (history)  Vaccinated:2001-01-31
Age:1.3  Onset:2001-02-03, Days after vaccination: 3
Gender:Male  Submitted:2001-06-14, Days after onset: 130
Location:Ohio  Entered:2001-06-20, Days after submission: 6
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: NONE
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER1425R2IMRL
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER4766773IMLL
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER1379K0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1152K0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: (Pneumonia) Having problem breathing, 2 days after having shots. Went to hospital 3 days after having shots. Was in the hospital for 4 days and 3 nights. Went home on antibiotics for 2 weeks and on nebulizer for a month. I then switched his doctor and he put him on more antibiotics. He then recovered in mid-March.

VAERS ID:174938 (history)  Vaccinated:2001-01-31
Age:7.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2001-09-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES    
Administered by: 0     Purchased by: 0
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: This patient had cellulitis at the injection site from administration of pneumococcal vaccine Prevnar. Required antibiotics to treat the cellulitis.

VAERS ID:179917 (history)  Vaccinated:2001-01-31
Age:0.4  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2001-10-17, Days after onset: 258
Location:Connecticut  Entered:2002-01-14, Days after submission: 89
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Urticaria;PREVNAR;;.00;In Patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ7103615OCT2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES  IM 
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES  IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES  IM 
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: A physician reported that an infant rec''d Prevnar, Hib-Titer, and Acel-Imune vaccines on 1/31/01. That day, she developed urticaria.

VAERS ID:181650 (history)  Vaccinated:2001-01-31
Age:  Onset:2001-02-01, Days after vaccination: 1
Gender:Unknown  Submitted:2001-04-19, Days after onset: 76
Location:Illinois  Entered:2002-02-22, Days after submission: 309
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: HQ6796502FEB2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES    
Administered by: Private     Purchased by: Other
Symptoms: Injection site mass, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: A pharmacist reported that a child received an injection of tetanus toxoid adsorbed, purogenated on 01/31/2001. On 02/01/2001, the child developed a fever of 104 deg. F. and a "golf ball size" mass at the injection site. No further info was available at the date of this report.

VAERS ID:182264 (history)  Vaccinated:2001-01-31
Age:36.0  Onset:2001-12-27, Days after vaccination: 330
Gender:Female  Submitted:2002-11-19, Days after onset: 327
Location:Unknown  Entered:2002-03-13, Days after submission: 251
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Pregnancy
Preexisting Conditions:
Diagnostic Lab Data: A maternal serum alpha fetal protein test on 7/19/01 was negative x 3. serum varicella zoster - results not reported.
CDC Split Type: WAES01052089
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  IM 
Administered by: Private     Purchased by: Other
Symptoms: Laboratory test abnormal, Unevaluable event
SMQs:
Write-up: Information has been received from a registered nurse concerning a 36 year old female who on 01/31/2001 was vaccinated with one dose of varicella virus vaccine live. On 05/21/2001, the pt learned that she was approximately 6 weeks pregnant. Follow-up information indicated that the pt was tested for varicella antibodies prior to vaccination with varicella virus vaccine live. The pt''s prior pregnancies all resulted in full term births with no birth defects. The pt did not experience a local reaction at the vaccination site or varicella or herpes zoster symptoms post vaccination. On 12/27/2001 at 40 weeks gestation she gave birth to a male. His birth weight was 8 lb. 4 oz. He was born with an accessory digit attached to his left pinky. There were no complications during pregnancy, labor/delivery. An ultrasound was done during the pregnancy but the results were not reported. A maternal serum alpha fetal protein test on 07/19/2001 was negative x 3. There were no illnesses or infections during the pregnancy and not concurrent medical conditions or concomitant medications. Follow up information received from the pediatrician''s office manager who reported that the infant''s medical record notes that aside from the notation of the supernumerary digit, the baby appears to be healthy and normal. The ligation procedure took place in the hospital prior to the newborn''s discharge and was not well documented in the pediatric record. A biopsy was done on the tissue from the left digit skin tag. The digit was described as small, pink, nodular tissue measuring 0.7cm overall. Microscopic examination of the tissue sections showed skin and subcutaneous tissue with cartilage and focal ossification. The diagnosis was Digit from left hand. Excision consistent with accessory digit. Follow up information received on 11/11/02 stated that the mother was a gravide 6 para 5 who following an 8 hour and 29 minute labor and artificial rupture of membranes with clear fluid, had a vaginal delivery of a boy with 8/9 Apgar''s. The infant''s birth weight was 8lbs 4ozs and length of 20 inches. On 12/27/01, the infant had a ligation and excision of a supernumerary digit on the left hand. At the same time, a Gomco circumcision was performed. Blood loss was estimated as minimal, and the infant was reported to be in good condition with no complications following the procedures. At 2 weeks of age, the infant weighed 8lbs 14ozs, was 21 inches in length, and had a head circumference of 38cm. This case is part of the pregnancy registry. Additional info has been requested.

VAERS ID:182343 (history)  Vaccinated:2001-01-31
Age:31.0  Onset:2001-01-31, Days after vaccination: 0
Gender:Female  Submitted:2002-03-07, Days after onset: 400
Location:Unknown  Entered:2002-03-13, 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: hydrodiuril, plaquenil
Current Illness:
Preexisting Conditions: codeine allergy, rheumatoid arthritis
Diagnostic Lab Data:
CDC Split Type: WAES01030764
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1426K0IM 
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad)
Write-up: Information has been received from a 31 year old white female with rheumatoid arthritis and codein allergy who on 01/31/2001 was vaccinated IM with a first dose of heb b vaccine recombinant. Concomitant medications included hydroxychloroquine sulfate, and hydrochlorothiazide. On 01/31/2001 the pt experienced fever, started to feel weak and body aches. The pt stated that the symptoms continued "on and off for a couple of weeks." The pt did not get second vaccine because of the experience she had. Follow-up info from a registered nurse indicated that several hours after receiving hep b vaccine recombinant, the pt had severe body aches, low grade fever and weakness. The pt''s rheumatoid arthritis symptoms increased dramtically. Subsequently her rheumatoid arthritis had stabilized. No further info is available.

VAERS ID:184672 (history)  Vaccinated:2001-01-31
Age:36.0  Onset:2001-09-01, Days after vaccination: 213
Gender:Female  Submitted:2002-05-15, Days after onset: 256
Location:Unknown  Entered:2002-05-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Pregnancy NOS (LMP-01/01/01)
Diagnostic Lab Data: Beta-human chorionic-positive
CDC Split Type: WAES01020608
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Pyelonephritis
SMQs:
Write-up: Information has been received from a physician, through the pregnancy registry, concerning a 36 year old female with no known allergies, past medical history or previous pregnancy who had her last mentrual period on 01/01/2001. On 01/25/2001 her pregnancy test was negative. On 01/31/2001 was vaccinated with one dose of varicella vaccine. There was no concurrent medicaiton. The pt did not have a local reaction, varicella symptoms or herpes zoster post-vaccination. On 02/06/2001 her pregnancy test was positive. On 02/15/2001 and 03/15/2001, the pt underwent routine ultrasounds which were normal. The pt declined an amniocentesis and alpha fetoprotein tests. In approximately September 2001, the pt experienced pyelonephritis and received treatment with Keflex for treatment until delivery. On 10/09/2001 the pt delivered a normal female baby weighing 8 lb. 5 oz. It was noted that the pt experienced cephalopelvic disproportion during labor/delivery. There was no concurrent medical condition. The infant did not have any feature of congential varicella zoster syndrome. No further info is available.

VAERS ID:190791 (history)  Vaccinated:2001-01-31
Age:46.0  Onset:2001-02-01, Days after vaccination: 1
Gender:Female  Submitted:2001-03-14, Days after onset: 41
Location:Oklahoma  Entered:2002-09-30, Days after submission: 564
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type: U200100423
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURR13462 SCRA
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUA243AA SCLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURR04472  RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: It was reported that a 46 year old female patient received Typhim VI, an IPOL and a Menomune A/CY/W-135 vaccinations on 01/31/01 reportedly a day after the injections the patient developed pain in her shoulder and arm around injection site, numbness in her fingers. She was seen by her family physician who told her it was a "protein reaction" and treated her with Flxeril and Celebrex. The symptoms are still not resolved. From additional correspondence received on 03/09/01, it was reported. "Patient was asked to call us about condition -but did not.'' Additional patient, vaccine, vaccine administrator and responsible facility information was provided.

VAERS ID:206661 (history)  Vaccinated:2001-01-31
Age:1.5  Onset:2001-01-31, Days after vaccination: 0
Gender:Male  Submitted:2003-07-24, Days after onset: 903
Location:Pennsylvania  Entered:2003-07-25, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Eosinophilic Gastroenteritis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIEST02833 LL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER950UZ2 RL
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Irritability, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: Patient fell asleep on ride home after receiving DTaP and IPV. Awoke screaming a short time after arriving at home. His skin was hot, red lacy rash on legs, low grade fever. He screamed inconsolably for approximately 3 hours. I contacted the office to report, dr suggested tylenol. Crying subsided, but rash lasted for approximately 3 months.

VAERS ID:255759 (history)  Vaccinated:2001-01-31
Age:1.0  Onset:2005-04-15, Days after vaccination: 1535
Gender:Female  Submitted:2006-05-12, Days after onset: 392
Location:Ohio  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:
Preexisting Conditions: NONE
Diagnostic Lab Data: 4/18/05 diagnostic pathological: no evidence of malignancy, cell findings are consistent with herpes cytopathic effect.
CDC Split Type: WAES0504USA03896
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T04722IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1512K0IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES47254G0IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0928K0SC 
Administered by: Private     Purchased by: Private
Symptoms: Herpes zoster, Pain
SMQs:
Write-up: Information has been received from a physician concerning a 5 yr old white female, with no medical history and no allergies, who on 31Jan01 was vaccinated with a 0.5ml SC first dose in the left leg of varicella virus vaccine live (lot 636571/0928K). Concomitant vaccines administered on the same day included a third IM dose in the right leg of poliovirus inactivated (Ipol), a first IM dose in the right leg of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (lot 637423/1512K) and a first IM dose in the left leg of pneumococcal 4 6B 9V 14 18C 19F 23F conj vaccine (crm197) (PREVNAR). There was no illness at the time of vaccination and no adverse events following prior vaccinations. It was reported that the pt as brought into the office on 16Apr05 complaining of leg pain. The pt was brought back into the office on 10Apr05 with the same complaint. The physician then diagnosed the pt with herpes zoster and prescribed acyclovir. It was noted that as of last evening the physician did not have any follow up on the pt. Unspecified medical attention was sought. No product quality complaint was involved. Follow up information from a physician indicated that the onset of severe right thigh pain was 15Apr05. The pt experienced continuous pain over 2-3 days. Then there was an onset of a rash on her right calf. A Tzanck smear of the right calf showed no evidence of malignancy and the cell findings were consistent with a herpes cytopathic effect. The pt responded to acyclovir. It was reported that on 21Apr05 the pt recovered. Additional information is not expected.

VAERS ID:169879 (history)  Vaccinated:2001-01-31
Age:57.0  Onset:2001-02-12, Days after vaccination: 12
Gender:Female  Submitted:2001-05-10, Days after onset: 86
Location:Foreign  Entered:2001-05-16, Days after submission: 6
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:
Diagnostic Lab Data: Liver biochemistry showed diffuse affected liver with slightly elevated ALAT, alkaline phosphatase and LDH, CT scan of the abdomen showed noting focal except benin cyst in the R kidney, Mamogram showed also nothing. Liver biochemistry was o
CDC Split Type: 20010113551
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM  IM 
Administered by: 0     Purchased by: 0
Symptoms: Alanine aminotransferase increased, Hepatitis, Influenza like illness
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow)
Write-up: This report describes the occurrence of an hepatitis in a 57 year old female subject receiving Havrix. On 01/21/01, a dose of Havrix was given. On 02/12/01, 12 days after the vaccination, this female subject developed Hepatitis. Subsequently, she was hospitalized. As of 05/08/01, at the time of this report she had completely recovered and was discharged. The reporting physician considered the event to be possibly related to Havrix. additional info has been requested but will unlikely be available. F/U pt was hospitalized with a 10 day history of flu like symptoms. she was found to have slightly low serum-albumin concentration and a postitve titre for anti-hepatitis A IgK was found. Other hepatitis serology came out neg. Her codtion which was interpreted as a vacci provoded serum sickness with tocically or allergically provoked influence on the live quickly. Imporved and she was discarged after 10 days on liver surveillence. ambulatory control of smooth myocyte antibodies was slightly postitive.

VAERS ID:165588 (history)  Vaccinated:2001-02-01
Age:1.0  Onset:2001-02-02, Days after vaccination: 1
Gender:Female  Submitted:2001-02-02, Days after onset: 0
Location:Florida  Entered:2001-02-06, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: pulse ox - 99%
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747342IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0933K0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Apnoea, Bradycardia, Cyanosis
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Within 15 seconds of 2nd vaccine the pt developed bradycardia, cyanosis, and rigid apnea, head turned right. Pt given stimulation for apnea and O2 and pulse ox monitoring. Pt regained normal state approximately 5-10 minutes later. Entire episode lasted 2-3 minutes.

VAERS ID:165660 (history)  Vaccinated:2001-02-01
Age:1.5  Onset:2001-02-01, Days after vaccination: 0
Gender:Male  Submitted:2001-02-05, Days after onset: 4
Location:South Dakota  Entered:2001-02-07, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: cold, slight cough
Preexisting Conditions: chronic rhinitis, vascular birthmark right back-flank, hypopigmented patch right forearm
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO321AC3IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1146K0SCLL
Administered by: Private     Purchased by: Other
Symptoms: Cough, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (narrow)
Write-up: Patient developed a hoarse cough and elevated pink/red rash on trunk of body. The incident was reported to physician and family was instructed to give Benadryl. On 2/2/01 the rash was reported to be gone. Patient''s mother felt this was a reaction to Varivax because the patient developed a rash on left thigh

VAERS ID:165721 (history)  Vaccinated:2001-02-01
Age:0.2  Onset:2001-02-02, Days after vaccination: 1
Gender:Female  Submitted:2000-02-05, Days after onset: 363
Location:Wisconsin  Entered:2001-02-09, Days after submission: 370
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
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM950A20IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1588K0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01180IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720510IMRL
Administered by: Private     Purchased by: Private
Symptoms: Crying
SMQs:, Depression (excl suicide and self injury) (broad)
Write-up: The infant is screaming and crying.

VAERS ID:165772 (history)  Vaccinated:2001-02-01
Age:38.0  Onset:2001-02-05, Days after vaccination: 4
Gender:Female  Submitted:2001-02-07, Days after onset: 2
Location:North Dakota  Entered:2001-02-12, 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: Viral infection
Preexisting Conditions:
Diagnostic Lab Data: Pulse Oximetry-93%; P-114
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM671A40IM 
Administered by: Other     Purchased by: Private
Symptoms: Chest discomfort, Dyspnoea, Heart rate increased, Pallor, Palpitations, Viral infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: On 2/5/01, pt awoke with heart pounding, chest discomfort, SOB and pale. At 07:15, saw MD for signs and symptoms above. Pulse Oximetry-96%, P-114. Physician told pt that the cause of symptoms were likely, viral infection.

VAERS ID:165890 (history)  Vaccinated:2001-02-01
Age:1.9  Onset:2001-02-01, Days after vaccination: 0
Gender:Female  Submitted:2001-02-02, Days after onset: 1
Location:Alabama  Entered:2001-02-14, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: bilateral otitis media
Preexisting Conditions: reactive airway disease, former 32 week preemie, develop delay, speech delay.
Diagnostic Lab Data:
CDC Split Type: AL0101
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40082261IMLA
Administered by: Private     Purchased by: Public
Symptoms: Febrile convulsion, Otitis media, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt has fever of 103-104 for 2 days. Diagnosed with otitis media, seen in office 2/1 9:20-10:30am - treated with Amoxil, also received 2nd influenza vaccine, has history of reactive airway disease. Pt presented on 2/1 at 14:30 to ER with 103 temp, febrile seizure lasting 7-8 minutes stiffening of extremities, eyes rolled upward. Pt received IM Rocephin for otitis media. Pt discharged from ER at 0045 2/2/2001, alert, nontoxic.

VAERS ID:165965 (history)  Vaccinated:2001-02-01
Age:1.3  Onset:2001-02-02, Days after vaccination: 1
Gender:Male  Submitted:2001-02-08, Days after onset: 6
Location:Kentucky  Entered:2001-02-16, 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: NONE
Current Illness: NONE
Preexisting Conditions: Allergies to shell fish.
Diagnostic Lab Data:
CDC Split Type: KY2001011
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0356AA3IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01872SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0584K0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Irritability, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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)
Write-up: No reaction at the time of immunizations. Went to doctor the next day with his right leg swollen, red and with increased warmth. This is contained above the knee. The leg does not appear tender. He has been running a low-grade fever. He has had a clear runny nose. Appetite is good, but fussier than usual. Dx''d with a reaction to shots. If the child worsens or develops fever, mother is to call. Mother called on Saturday morning and said child''s fever spiked to 102F. She was going to bring him over so I could recheck him, but when I called back in the afternoon, father said the fever had resolved. It was down below 100F, he was much better, leg was less swollen and they felt he would do well.

VAERS ID:165995 (history)  Vaccinated:2001-02-01
Age:1.5  Onset:2001-02-02, Days after vaccination: 1
Gender:Male  Submitted:2001-02-02, Days after onset: 0
Location:New Jersey  Entered:2001-02-20, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0356BA3IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm from just above elbow to shoulder became red, swollen, warm and indurated but not painful.

VAERS ID:166073 (history)  Vaccinated:2001-02-01
Age:1.1  Onset:2001-02-01, Days after vaccination: 0
Gender:Male  Submitted:2001-02-07, Days after onset: 6
Location:California  Entered:2001-02-22, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733411IMRL
Administered by: Other     Purchased by: Other
Symptoms: Hypersensitivity, Purpura, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)
Write-up: The pt was seen on 1/18/01 for gastroenteritis. The pt had follow-up visit on 2/1/01 and received Prevnar. The pt experienced a rash, allergic reaction to Prevnar versus purpura.

VAERS ID:166146 (history)  Vaccinated:2001-02-01
Age:52.0  Onset:2001-02-02, Days after vaccination: 1
Gender:Male  Submitted:2001-02-13, Days after onset: 11
Location:Louisiana  Entered:2001-02-26, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin X 2 per day, Glucophage, Altace, Lipitor, ASA
Current Illness: NONE
Preexisting Conditions: diabetes, heart disease
Diagnostic Lab Data:
CDC Split Type: LA010204
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40082262IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dysphonia, Hypersensitivity, Oedema peripheral, Pain, Pharyngolaryngeal pain, Pruritus, Rheumatoid arthritis, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (narrow)
Write-up: On 2/2/01, approx. 18:00, feet started to itch, then broke out in "hives" on trunk and right hand started to swell then had hoarseness and "sore" throat. Went to ER at 19:00 and was there until 23:59 and went home. Put on Zantac and Benadryl. Was given IV and shot of Benadryl at 2nd time in ER. (Was at hunting camp, Friday, when reaction occurred. Returned home at midnight after being seen in ER. On 2/3/01, Saturday AM, symptoms of itching, hives and pain and swelling in both hands had returned. He then went to local ER and was seen by ER MD and wife states he was given IV and injection and sent home. Told at both visits to the ER''s that it was an allergic reaction to the flu vaccine, as this was all that was different or unusual in his routine. He has had previous flu shots in the past years. He was improved after treatments and pain and swelling started to resolve. No breathing problems. No problems Saturday or Sunday. On Monday, 2/5/01, at approx. 07:00, had started to complain of pain and swelling in right hand and left hand and feet starting to itch again. Experienced "sore throat" and hoarseness again. He went to his local MD and was admitted to the hospital and given Benadryl, Zantac IV and other things "pain meds") He was hospitalized from 2/5/01 until 2/8/01. Discharged on 2/9/01 and told by MD that he had Rheumatoid Arthritis and given Vioxx for pain and given "Z-pack" for inflammation. Wife comes to health unit today, 2/13/01, to inform me of pt''s adverse reactions to flu vaccine. He is still having problems. Right hand swollen and pain in right arm. Also, feet have started to itch again as of yesterday. He is not convinced that he has Rheumatoid Arthritis and feels that his symptoms are still related to adverse vaccine reaction. Went to see another doctor for a second opinion and further treatment as he is very uncomfortable. It was suggested that he go to another hospital that has an arthritis clinic. Per annual follow up: Patient has had no more complications from the influenza vaccine from last year. He has not taken any more influenza vaccine as per doctor''s order.

VAERS ID:166377 (history)  Vaccinated:2001-02-01
Age:13.0  Onset:2001-02-13, Days after vaccination: 12
Gender:Male  Submitted:2001-02-17, Days after onset: 4
Location:New York  Entered:2001-03-05, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Platelet count-low
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1377K3IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Platelet count decreased, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad)
Write-up: Purpuric spots, low platelet count picture similar to ITP.

VAERS ID:166425 (history)  Vaccinated:2001-02-01
Age:0.5  Onset:2001-02-01, Days after vaccination: 0
Gender:Female  Submitted:2001-02-02, Days after onset: 1
Location:Massachusetts  Entered:2001-03-05, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Motrin at time of visit
Current Illness: Mild cold symptoms
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0313BA2IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4733762IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733462IMLL
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site warmth, Screaming
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad)
Write-up: Child began high pitched scream about 1 hour, post vax, lasting about 45 minutes. Later in the day, a red line was noted from the injection site followed by hot, red, local reaction. Local reaction persisted through 2/2/01 AM visit.

VAERS ID:166561 (history)  Vaccinated:2001-02-01
Age:1.3  Onset:2001-02-01, Days after vaccination: 0
Gender:Female  Submitted:2001-02-01, Days after onset: 0
Location:Minnesota  Entered:2001-03-06, Days after submission: 33
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: Allergy to peanut butter, tomatoes, eggs
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUA552AA3IMLA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1424K2IMLA
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESU0328PA3IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Eye swelling, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Post vaccine pt had dry cough, and developed hives on face, eye swollen, and hives spread to chest, back, abdomen.

VAERS ID:166570 (history)  Vaccinated:2001-02-01
Age:31.0  Onset:2001-02-02, Days after vaccination: 1
Gender:Female  Submitted:2001-02-05, Days after onset: 3
Location:Kansas  Entered:2001-03-06, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA373AB1SCLA
Administered by: Military     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site reaction, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: The pt experienced left arm itching, redness, painfulness, and low grade fever.

VAERS ID:166629 (history)  Vaccinated:2001-02-01
Age:0.7  Onset:2001-02-01, Days after vaccination: 0
Gender:Female  Submitted:2001-02-07, Days after onset: 6
Location:New York  Entered:2001-03-06, 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: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0276CA2IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1275K2IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4749571IMLL
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Injection site swelling, 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: Swelling and pain on right thigh, post injection. Had a fever X 2 days. Use warm compresses.

VAERS ID:166657 (history)  Vaccinated:2001-02-01
Age:4.0  Onset:2001-02-18, Days after vaccination: 17
Gender:Female  Submitted:2001-03-01, Days after onset: 11
Location:Virginia  Entered:2001-03-06, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: URI
Preexisting Conditions: NONE
Diagnostic Lab Data: platelets - 4,000, WBC - 10.5
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES0299BA4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T04714SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1379K1SCRA
Administered by: 0     Purchased by: 0
Symptoms: Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: The pt experienced ITP on 2/20/01.

VAERS ID:166768 (history)  Vaccinated:2001-02-01
Age:23.0  Onset:2001-02-03, Days after vaccination: 2
Gender:Male  Submitted:2001-02-26, Days after onset: 23
Location:California  Entered:2001-03-08, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0443SCLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: This patient had redness, tender to the touch, swelling for one week, largest area at approximately 75 mm x 75 mm.

VAERS ID:167575 (history)  Vaccinated:2001-02-01
Age:  Onset:2001-02-01, Days after vaccination: 0
Gender:Unknown  Submitted:2001-03-16, Days after onset: 43
Location:New Hampshire  Entered:2001-03-21, Days after submission: 5
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: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01030309
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1237K IM 
Administered by: Other     Purchased by: Other
Symptoms: Blood disorder, Thrombosis
SMQs:, Haematopoietic cytopenias affecting more than one type of blood cell (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)
Write-up: Information has been received from a hospital worker concerning a patient who in February 2001, was vaccinated with Pneumococcal vaccine 23 polyvalent. Subsequently the patient experienced blood clots. Unspecified medical attention was sought. No other Info was available. Upon internal review, blood clots were considered to be an Other Important Medical Event. Follow up on 06/29/2001: "Patient date of birth and age at time of vaccination is not provided."

VAERS ID:167600 (history)  Vaccinated:2001-02-01
Age:2.8  Onset:2001-02-02, Days after vaccination: 1
Gender:Female  Submitted:2001-02-09, Days after onset: 7
Location:Michigan  Entered:2001-03-21, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4705253IMLL
Administered by: Other     Purchased by: Public
Symptoms: Injection site swelling, 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: Mom phoned clinic on 2/2/01 with complaint of fever. No provider available. Advised to give Motrin for fever and monitor. Mother denies redness or swelling. Advised to seek ER if no improvement. On 2/6/01, presents in clinic with complaint of still having fever. Reports the site of injection swelled up 2 times normal size. No swelling at this time. No fever.

VAERS ID:167917 (history)  Vaccinated:2001-02-01
Age:48.0  Onset:2001-02-01, Days after vaccination: 0
Gender:Female  Submitted:2001-03-01, Days after onset: 28
Location:Texas  Entered:2001-03-28, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEUR413AA SC 
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Pt developed a bruise at the injection site that spread up the arm and down towards the elbow, characterized by lines of black, blue and yellow. Symptoms lasted for over one week.

VAERS ID:170927 (history)  Vaccinated:2001-02-01
Age:1.1  Onset:2001-02-12, Days after vaccination: 11
Gender:Female  Submitted:2001-05-30, Days after onset: 106
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: UNK
Current Illness:
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type: WAES01021191
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0997K0  
Administered by: Private     Purchased by: Other
Symptoms: Infection, Rash morbilliform
SMQs:, Hypersensitivity (narrow)
Write-up: Information has been received from a health professional concerning a 13 month old female who on 02/01/01 was vaccinated with the first dose of MMRII (lot #636659/0997K) in the left arm. On 02/12/01, the patient developed a red rash on her abdomen, chest, back, neck and face. On the following day, 02/13/01, she was seen by a physician and the rash was over the entire body and face. The patient was ordered diphenhydramine (Benadryl) for itching as needed. The diagnosis was measles rash related to therapy with MMRII. It was reported that the patient recovered. No additional information is expected.

VAERS ID:174255 (history)  Vaccinated:2001-02-01
Age:  Onset:2001-02-01, Days after vaccination: 0
Gender:Unknown  Submitted:2001-07-30, Days after onset: 178
Location:Unknown  Entered:2001-08-07, 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: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01030154
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1237K   
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis
SMQs:
Write-up: Information has been received from a hospital worker concerning two pts who in 2/2001 were vaccinated with pneumococcal vaccine 23 polyvalent (lot #1237K). Subsequently, pts experienced cellulitis. Unspecified medical attention was sought. No other information was available. It was reported that another pt (WAES 01030309) had an adverse experience after receiving same vax with the same lot #. The reporter expressed a concern with the lot. The records of testing prior to release of this lot have been checked by Biological Quality Assurance and found to be satisfactory. The lot complies with the standards of the Center for Biologics Evaluation and Research and was released. Addtl info has been requested.

VAERS ID:178662 (history)  Vaccinated:2001-02-01
Age:  Onset:2001-02-01, Days after vaccination: 0
Gender:Unknown  Submitted:2001-11-30, Days after onset: 302
Location:Illinois  Entered:2001-12-05, Days after submission: 5
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: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01031058
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a RN concerning and unidentifiable pt who in approximately February 2001, was vaccinated with a dose of Comvax. Subsequently the pt developed a small knot under the injection site. It was reported that the knot has not resolved yet. Unspecified medical attention was sought. it was reported that 4 other pts had a similar experience following exposure to Comvax. Additional information has been requested.

VAERS ID:182579 (history)  Vaccinated:2001-02-01
Age:29.0  Onset:2002-02-06, Days after vaccination: 370
Gender:Female  Submitted:2002-02-17, Days after onset: 11
Location:Illinois  Entered:2002-03-18, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: sectral , luvox, clonopin
Current Illness:
Preexisting Conditions: v-fib, OCD, depression
Diagnostic Lab Data:
CDC Split Type: IL02007
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0376L1SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0386AA2 LA
Administered by: Other     Purchased by: Public
Symptoms: Arthralgia, Confusional state, Dizziness, Dry mouth, Insomnia, Lethargy, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: Pt c/o dry mouth, dizziness, muscle aches, joint pain, lethargy, slight confusion, low grade temperature per phone call. Received MMR & TD 2/6/02 in afternoon. Stated symptoms began that night & he couldn''t sleep. He called Health office from his apt with above complaints. Had no one to take him to doctor. Ambulance called and pt to nearest ED. Please see copy of ED notes attached.

VAERS ID:183188 (history)  Vaccinated:2001-02-01
Age:56.0  Onset:2001-02-01, Days after vaccination: 0
Gender:Male  Submitted:2002-04-02, Days after onset: 425
Location:New Jersey  Entered:2002-04-04, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM147B9   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Arthritis, Disturbance in attention, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Arthritis (narrow)
Write-up: Mental incoherency, joint problems in knees, ankles, shoulders and elbows. Pain in discomfort and slight swelling. Mental disorientation. achy, fatigue

VAERS ID:183264 (history)  Vaccinated:2001-02-01
Age:3.0  Onset:2001-10-01, Days after vaccination: 242
Gender:Male  Submitted:2002-03-19, Days after onset: 169
Location:Michigan  Entered:2002-04-09, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MI2002024
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0328BA2 RL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES4747041 LL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEUR018722 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1284K0 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747260 LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1238K0 LA
Administered by: Public     Purchased by: Public
Symptoms: Skin ulcer
SMQs:
Write-up: Child received Varivax 2-1-01. On 10/1/01, child broke out in "full blown" case of chickenpox per mother. Child was taken to PP for verification.

VAERS ID:187583 (history)  Vaccinated:2001-02-01
Age:21.0  Onset:2001-08-01, Days after vaccination: 181
Gender:Female  Submitted:2002-05-30, Days after onset: 302
Location:Unknown  Entered:2002-07-15, Days after submission: 46
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: Diagnostic labs in 8/01-measles and rubella titers (+) and mumps titer .97 equivocal
CDC Split Type: WAES01092207
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1SC 
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Information has been received from a health professional concerning a 21 year old female with no past medical history or allergies who in "childhood" and in 2/01 was vaccinated with the 1st and 2nd dose of MMRII, respectively. There was no concomitant therapy. In 8/01, the pt had titers drawn which revealed that the mumps titer was .97 which was considered to be equivocal. It was also reported that the pt had a lack of sero-conversion. The measles and rubella titers were positive. Additional information has been requested.

VAERS ID:187767 (history)  Vaccinated:2001-02-01
Age:38.0  Onset:2001-02-03, Days after vaccination: 2
Gender:Male  Submitted:2002-07-17, Days after onset: 528
Location:West Virginia  Entered:2002-07-19, Days after submission: 2
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ranitidine, Naprofen, Prochlorphrazine maleate
Current Illness: NONE
Preexisting Conditions: Sinus bradycardia, gastroesophageal reflux disease, bunionectomy, superficial isolation of the abdominal wall during childhood
Diagnostic Lab Data: Urea N results, Creatinine results 1.4 MG/DL, Sodium results 140MMOL/L, Potassium results 3.7 mmol/L, Chloride results 104.1 mmol/L, CO2 results 27 mmol/L, Protein Total results 6.2, Albumin results 3.5 gm/dl, Bilirubin results .4 mg/l, AST
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURE71740LA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Aphasia, Back pain, Guillain-Barre syndrome, Muscular weakness, Musculoskeletal stiffness, Pyrexia, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad)
Write-up: The patient is a 38 year old male who recently had a flu shot on 2/1/01, two days later on 2/3/01 he developed weakness of both lower legs from hips to legs. He reported to the ER on 2/4/01 where he was assessed as having back pain from muscle strain and was sent home on Naproxin. He returned on 2/6/01 with progression of weakness of both lower extremities and stiffness of both shoulders, digressed vocal tone, slurred speech and worsening of generalized proximal muscle weakness. ER physician discussed with neurologist at hospital and MD suspected of Guillain Barre Syndrome, was advised to start the patient on immunoglobulin at 400 mg per kg per day. On 2/6, the patient received only 12 grams of immunoglobulin. On 2/7, he had 28 grams of immunoglobulin. When I saw him on 2/7, he felt 60% improvement of the lower extremities weakness and improvement in the speech. He had no respiratory difficulty, no palpitation. The patient stated that he had a mild URI with fever and chills about one week before the flu shot. PAST MEDICAL HISTORY: Fracture of right ankle in 4/00, symptoms of heart burn suspected of gastroesophageal reflux disease, history of bunionectomy in 1986 both sides, history of superficial isolation of the abdominal wall during childhood. FAMILY HISTORY: Mother deceased at age of 42 of CA uterus and rectum. Father deceased at age 27 with melanoma, strong family history of diabetes mellitus and stroke. The patient does not smoke, does not drink alcohol. He works at a plastic company. PHYSICAL EXAMINATION: Vital signs are stable. The patient was conscious, alert, oriented, cranial nerves intact. He complained of weakness of both legs but on the physical examination, he was ambulatory, no weakness noted, deep tendon reflexes normal, Babinski negative. Lungs are clear. Heart with regular sinus rhythm, no peripheral edema. On 2/8, the patient''s symptoms recovered completely 100%. He ambulated around ICU and speech was clear. Discussed with neurology and felt that the patient can be discharged. ASSESSMENT: Diagn

VAERS ID:200637 (history)  Vaccinated:2001-02-01
Age:3.0  Onset:2003-02-13, Days after vaccination: 742
Gender:Male  Submitted:2003-03-06, Days after onset: 21
Location:California  Entered:2003-04-01, Days after submission: 26
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: UNK
Preexisting Conditions: Otitis media
Diagnostic Lab Data: A workup was performed which yielded the following abnormal electrolyte results: glucose 203; sodium 138; potassium 2.9; chloride 93; CO2 28. WBC ranged from 50,000 to 52,000; platelet count 667; haemoglobin 12. The cerebrospinal fluid resu
CDC Split Type: HQWYE680226FEB03
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 0  
Administered by: Other     Purchased by: Other
Symptoms: Bacterial infection, Coma, Depressed level of consciousness, Laboratory test abnormal, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: A physician reported that a 3 year old male received a single dose of Prevnar in February 2001. In February 2003, at 5 years of age, the child developed fever. The child''s mother stated that her son''s fever had persisted for seven days before he was seen in an emergency room on 2/23/03. A diagnosis of ear infection was made and he was treated with ear drops. On 2/24/03, according to the reporter, the mother indicated that her son developed vomiting. He had a decreased level of consciousness. A workup was performed which yielded the following abnormal electrolyte results: glucose 203; sodium 138; potassium 2.9; chloride 93; CO2 28. WBC ranged from 50,000 to 52,000; platelet count 667; haemoglobin 12. It was determined that he was septic and might be meningitic. He was treated with IV Rocephin. A lumbar puncture attempt was unsuccessful due to the child''s state of agitiation. He was then transported to another medical facility. Physical examination revealed a temperature of 103.2 degrees F, pulse 108, respirations 13 and blood pressure was 124/88. O2 saturation was performed, the results were 92% on room air (borderline hypoxic); and 100% with blow-by oxygen. The examining physician indicated that the child appears to have a nonfocal neurologic examination; he is not talking and does not open his eyes. He appears to be in an altered level of consciousness. He expresses local pain and thrash around when being probed; moves all extremities. The child sits right up when bending his neck, thus, demonstrating a stiff neck. A DIC panel was ordered; the results were not yet available. A spinal tap was performed, 3cc of purulent cloudy fluid was obtained. The cerebrospinal fluid results were grossly abnormal. Laboratory tests were performed which yielded the following results: CSF white cell count 7880; neutrophils 98% with intracellular bacteria present; CSF glucose 0 and CSF protein, exceedingly elevated 476. The CSF gram stain showed gram-positive cocci in chains. His blood pressure remained stable about 104 to 107 over

VAERS ID:204372 (history)  Vaccinated:2001-02-01
Age:39.0  Onset:2002-03-01, Days after vaccination: 393
Gender:Female  Submitted:2003-05-30, Days after onset: 454
Location:Unknown  Entered:2003-06-04, Days after submission: 5
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: UNK
Diagnostic Lab Data: Titer shows she is non-immune to mumps
CDC Split Type: WAES0209USA00686
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Information has been received from a 39 year old female who in November 2000 and February 2001, was vaccinated with a first and second dose of MMR II. The results of a "titer" done in March 2002,showed that the pt is "still non-immune to mumps." Unspecified medical attention was sought. Additional info has been requested.

VAERS ID:220499 (history)  Vaccinated:2001-02-01
Age:3.0  Onset:2003-02-03, Days after vaccination: 732
Gender:Male  Submitted:2004-05-14, Days after onset: 465
Location:North Carolina  Entered:2004-05-18, 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: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: Dermatological: Confirmed shingles; Body height: 34 inches; Body temp: 98.2; Body weight: 35lbs;
CDC Split Type: WAES0303USA02250
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Rash erythematous
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a LPN concerning a 36 month old white male with an unknown medical history (previously reported as no medical history and no known drug allergies) and an unknown history of chickenpox who on 02/01/01 was vaccinated SC in the right lower thigh witha first dose of varicella virus vaccine live (Lot # 9043905, invalid for this product). There was no concomitant medication. It was unknown if the pt was ill at the time of vaccination, had any adverse events following prior vaccinations, pt was ill at the time of vaccination, had any adverse events following prior vaccinations, or had a recent exposure to chickenpox or herpes zoster. It was unknown if the pt developed a rash at the injection site or elsewhere within 42 days after vaccination because the pt was not given the vaccination at the reporters'' office. On 02/03/03 the pt was seen in the office for shingles. The date he started with symptoms was not available. The affected area was described as a fine, red rash with raised bumps under the right arm, right back and side and up to the right shoulder. Clear vesicles on an erythematous base were noted on the right upper back, right chest and right upper arm per dermatology. The pt had a temperature of 98.2 at the time of the office visit. The maximum temperature was unknown. It was noted that a direct fluorescent antibody and PCR was not done at the reporter''s office. The pt''s pain was rated an 9 on a scale of 1 to 10. That same day the pt was seen by a dermatolgoist who confirmed shingles and treated him with acyclovir and aceptaminophen prn. It was also reported that the pt had "probable" shingles. On 02/07/03 the pt was seen in the office for a non-related left ear infection with no mention on his chart of the shingles. On 03/24/03 it was reported that there had been no further contact from the pt''s parent and it was unknown if he had been seen again by the dermatologist. On 05/06/03 information was received from a LPN that the pt had recovered on an unknown date. No further in

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