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Found 533901 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:363333 (history)  Vaccinated:2000-10-01
Age:60.0  Onset:2009-10-02, Days after vaccination: 3288
Gender:Female  Submitted:2009-10-28, Days after onset: 26
Location:Connecticut  Entered:2009-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hx of hyperthyroidism
Diagnostic Lab Data: blood work ( cbc no $g in eos) U/A neg CT angio neg KUB neg
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1620X0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Angiogram, Blood test normal, Computerised tomogram normal, Injection site swelling, Pain, Urinary system X-ray, Urine analysis normal, X-ray normal
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 1. Swelling at the site of injection ( Large area ( no fever or chills 2. Waist high ( right) went to the ER for severe pain CT angio done to rule out AAA was neg Blood work ok U/A neg KUB neg

VAERS ID:160588 (history)  Vaccinated:2000-10-01
Age:  Onset:0000-00-00
Gender:Male  Submitted:2000-10-13
Location:Foreign  Entered:2000-10-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20000298621
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM 1IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER 1IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Other     Purchased by: Other
Symptoms: Aspiration, Cyanosis, Injection site vesicles, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Post vax, the vaccinee re-experienced fever and an injection site reaction with blisters. In addition, he developed vomiting and cyanosis during aspiration. Therefore the vaccinee was hospitalized.

VAERS ID:160357 (history)  Vaccinated:2000-10-02
Age:0.6  Onset:2000-10-04, Days after vaccination: 2
Gender:Male  Submitted:2000-10-09, Days after onset: 5
Location:Georgia  Entered:2000-10-05, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Raglan, Suprax, Zantac
Current Illness: otitis media
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4734402IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0815K2IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4701412IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720420IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site urticaria, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Post vax, the pt developed a local reaction consisting of urticaria. Urticaria was also located on the torso and extremities.

VAERS ID:160401 (history)  Vaccinated:2000-10-02
Age:1.3  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-03, Days after onset: 0
Location:New York  Entered:2000-10-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxil
Current Illness: otitis media
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4701412IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747170IMLL
Administered by: Private     Purchased by: Private
Symptoms: Febrile convulsion, Lethargy, Pyrexia, Staring, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Next day post vax, the pt spiked a temperature and had an episode of lethargy, vomiting, and eyes glazing over. No loss of consciousness. Responded to Motrin. Seen in physician''s office on 10/3-believed to have had a mild febrile seizure.

VAERS ID:160528 (history)  Vaccinated:2000-10-02
Age:21.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-03, Days after onset: 0
Location:Unknown  Entered:2000-10-13, 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: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV04832SC 
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Hypoaesthesia, Injection site erythema, Injection site swelling
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, slightly swollen arm where the shot was given. Strength loss in arm and fingers felt numb.

VAERS ID:160536 (history)  Vaccinated:2000-10-02
Age:0.8  Onset:2000-10-03, Days after vaccination: 1
Gender:Male  Submitted:2000-10-06, Days after onset: 3
Location:South Carolina  Entered:2000-10-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever;PREVNAR;2;.50;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0815K1IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4716542IMLL
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Pt experienced fever of 102-104 and extreme irritability for 4-5 days, post vax. Mom instructed to give Tylenol and Motrin during these times.

VAERS ID:160557 (history)  Vaccinated:2000-10-02
Age:54.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-10-03, Days after onset: 1
Location:Illinois  Entered:2000-10-16, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron pills, stool softener, Proventil, Polaramine
Current Illness: NONE
Preexisting Conditions: Allergy to pollen, grass, mold
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E64300HA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0710K0IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right shoulder to halfway down arm was reddened, edematous, painful around whole arm and was warm to touch. Ice applied. Vicodin, 2 administered hs-unable to sleep. Informed client to continue ice and she takes aspirin and to call MD. MD''s nurse states to continue with ice and pain medication. On 10/5/00, right arm had no soreness, edema or redness.

VAERS ID:160638 (history)  Vaccinated:2000-10-02
Age:0.3  Onset:2000-10-04, Days after vaccination: 2
Gender:Female  Submitted:2000-10-10, Days after onset: 6
Location:Ohio  Entered:2000-10-18, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4705261IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1040K1IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R06181IMRL
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Skin nodule
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: 48 hours post vax, the pt noticed a hardened area on leg and low grade fever of 99.7. Eased with Tylenol. Hardened area persisted until time of this report.

VAERS ID:160654 (history)  Vaccinated:2000-10-02
Age:57.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-10-03, Days after onset: 1
Location:Texas  Entered:2000-10-18, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: calcium, trazodone, cozaar, synthroid, Prempro
Current Illness: multiple sclerosis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0333AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0455 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site mass, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Approximately 6 hours post vax, the pt started running a high fever. The area became red, elevated and hot to the touch. 1

VAERS ID:160662 (history)  Vaccinated:2000-10-02
Age:1.3  Onset:2000-10-03, Days after vaccination: 1
Gender:Male  Submitted:2000-10-05, Days after onset: 2
Location:Arkansas  Entered:2000-10-18, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4734403IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0522K0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Received vaccines on 10/2/00. Mother noticed left thigh was red and swollen on 10/3/00. She comes to our office on 10/4/00 with a 7cm X 4cm area of mild erythema and induration. Instructed to monitor. On 10/6/00, redness was gone.

VAERS ID:160751 (history)  Vaccinated:2000-10-02
Age:26.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Male  Submitted:2000-10-03, Days after onset: 1
Location:Michigan  Entered:2000-10-19, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.1487H0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: 4 hours, post vax, pt developed dizziness and nausea. He vomited about 7 hours, post vax, developed diarrhea, nausea and vomiting and a temperature of 101F, by the next morning.

VAERS ID:160776 (history)  Vaccinated:2000-10-02
Age:20.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-06, Days after onset: 3
Location:D.C.  Entered:2000-10-20, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0088K1SCRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: On 10/3/00, the pt experienced an injection site that was erythematous, hot to the touch, and very swollen, a very stiff neck. On 10/6/00, the pt notified employee health the the injection site was warm to the touch and that she had a 2" x 1" area of erythema and swelling. Neck was also mildly stiff.

VAERS ID:160832 (history)  Vaccinated:2000-10-02
Age:3.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-04, Days after onset: 1
Location:California  Entered:2000-10-24, Days after submission: 20
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: 32 week prematurity, mild hemipheresis
Diagnostic Lab Data:
CDC Split Type: CA000111
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM668A20IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4712290IMLL
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The pt experienced localized redness and induration x 2 days. No fever and no limpness noticed.

VAERS ID:160942 (history)  Vaccinated:2000-10-02
Age:69.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-16, Days after onset: 13
Location:Pennsylvania  Entered:2000-10-25, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to adhesive tape
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E61750GA1IMRA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: Post vax, pt returned to office on 10/4/00 with local signs and symptoms of cellulitis of the right arm.

VAERS ID:160967 (history)  Vaccinated:2000-10-02
Age:1.3  Onset:2000-10-03, Days after vaccination: 1
Gender:Male  Submitted:2000-10-20, Days after onset: 17
Location:Connecticut  Entered:2000-10-25, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0539K0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Generalized urticaria, post vax, (less than 24 hours later); resolved with Benadryl.

VAERS ID:160996 (history)  Vaccinated:2000-10-02
Age:1.4  Onset:2000-10-12, Days after vaccination: 10
Gender:Male  Submitted:2000-10-23, Days after onset: 11
Location:Montana  Entered:2000-10-26, 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:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA5218AB4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R143322 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1503J0SCRL
Administered by: Private     Purchased by: Other
Symptoms: Rash macular, Upper respiratory tract infection
SMQs:, Hypersensitivity (narrow)
Write-up: Post vax, the pt developed URI symptoms, macular rash on trunk, extremities, and face.

VAERS ID:161054 (history)  Vaccinated:2000-10-02
Age:1.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-10-06, Days after onset: 4
Location:Virginia  Entered:2000-10-27, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ear infection 2 weeks prior
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: VA00037
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0052K2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1659J0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1856J0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: 2 hours post vax, the pt broke out in whelpy rash on thighs, back, and feet. Physician described rash as faint maculopapular rash. Mother states rash covered her whole body by next day and was raised.

VAERS ID:161113 (history)  Vaccinated:2000-10-02
Age:38.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-25, Days after onset: 22
Location:Pennsylvania  Entered:2000-10-31, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil, Synthroid
Current Illness:
Preexisting Conditions: Previous history of Lyme disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY128A20IMRA
Administered by: Private     Purchased by: Private
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Lyme vaccine received on 10/2/00 and the following day, pt reports she had a fever to 104F and muscle aches for 3 days.

VAERS ID:161152 (history)  Vaccinated:2000-10-02
Age:1.0  Onset:2000-10-10, Days after vaccination: 8
Gender:Female  Submitted:2000-10-12, Days after onset: 2
Location:Louisiana  Entered:2000-10-31, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: LA001001
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R14892SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1285J0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0521K0SCRL
Administered by: Private     Purchased by: Other
Symptoms: Rash papular
SMQs:
Write-up: 2mm X 3mm papules, especially on trunk. Started with just a few on 10/10/00 and then progressed from there.

VAERS ID:161165 (history)  Vaccinated:2000-10-02
Age:1.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Male  Submitted:2000-10-24, Days after onset: 21
Location:Texas  Entered:2000-11-01, Days after submission: 8
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: NONE
Current Illness: NONE
Preexisting Conditions: Reflux (GERD)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1969J2IMLL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES581313A2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0915J0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.04381C0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Hypoxia, Rash vesicular, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow)
Write-up: Respiratory distress with hypoxia, post vax. Viral vesicles on right buttocks; (Chickenpox type).

VAERS ID:161278 (history)  Vaccinated:2000-10-02
Age:49.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-24, Days after onset: 21
Location:Pennsylvania  Entered:2000-11-02, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lozol, Claritin
Current Illness: NONE
Preexisting Conditions: Hypertension, seasonal allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0267AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site pain, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Left upper extremity swelling and severe pain and itching. Treated with diphenhydramine, local measures.

VAERS ID:161547 (history)  Vaccinated:2000-10-02
Age:0.4  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-10-22, Days after onset: 20
Location:California  Entered:2000-11-07, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA000114
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4705250IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1925J0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R06920SCLL
Administered by: Other     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Mother stated that child had a seizure, 1 hour, post vax. Seizure was over as she was calling her mother.

VAERS ID:161898 (history)  Vaccinated:2000-10-02
Age:11.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-11-02, Days after onset: 31
Location:Texas  Entered:2000-11-14, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Lightheaded;Hep B (unknown mfr);1;10;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5158A21IMLA
Administered by: Private     Purchased by: Private
Symptoms: Coma, Injection site erythema, Rash erythematous, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: 10 minutes, post vax, pt had syncopal episode with fall from standing position, striking her head (posterior) on the floor. Pt initially unresponsive with eyes open X 30 seconds. Pt had erythematous rash (papular patches) on left upper extremity where IZ was received and around eyes and mouth. No respiratory problems. Child was monitored an additional hour and Benadryl. Rash present when she left but had decreased.

VAERS ID:161901 (history)  Vaccinated:2000-10-02
Age:16.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-10-17, Days after onset: 15
Location:Michigan  Entered:2000-11-14, 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: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5151A20IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Pt was given Hep-B vaccine. Mother called about 1/2 hour later, said that pt had red rash. Pt brought back to office and checked by doctor and was given Benadryl 50 mg IM and Aristocort Forte 40 mg IM and observed. No difficulty or anything.

VAERS ID:162226 (history)  Vaccinated:2000-10-02
Age:65.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Georgia  Entered:2000-11-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: The pt states that "my arm began to hurt, then it became red. The next day it was worse. I ran a fever of 101.6. I started swelling and itching. It went down to my elbow. It was still red and swollen".

VAERS ID:162448 (history)  Vaccinated:2000-10-02
Age:0.2  Onset:2000-10-09, Days after vaccination: 7
Gender:Male  Submitted:2002-02-05, Days after onset: 484
Location:Michigan  Entered:2000-11-22, Days after submission: 440
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bactroban, Tylenol, Mylicon
Current Illness: UNK
Preexisting Conditions: Gastrointestinal disorder, bullous impetigo
Diagnostic Lab Data: computerized tomogram - nml, blood culture - neg, CSF - neg, urine analysis - nml, polymerase chain reaction test for herpes simplex virus was negative., urine normal,The lab value for the sputum macrophage count was listed as both 100 and
CDC Split Type: U200100021
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0239K1IMLL
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER635268 IM 
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURR12500SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733370IMRL
Administered by: Other     Purchased by: Other
Symptoms: Decreased appetite, Hyperexplexia, Irritability, Staring, Vomiting
SMQs:, Acute pancreatitis (broad), Congenital, familial and genetic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)
Write-up: A physician reported that a 1 month old male pt received Prevnar, Recombivax-HB and IPV vaccines on 10/2/00. He was taken to the ER on 10/9/00 after he developed irritability, decreased oral intake, spitting up and strange episodes of not focusing and unusual startling and looking to the right side. He was transferred to the ER for further evaluation and was admitted to the pediatric neurology unit. This is 1 of 2 pts from this facility who had an adverse experience following receipt of Prevnar (lot 473337). The pt was presented to a hosp for concern of possible infantile seizure, Mom reports that he has had a 3 day history of increased in jerking episodes. f/u info rec''d from a HCP reported that a prenatal ultrasound was questionable for pylectasis. A newborn ultrasound was normal. It was indicated that a second f/u ultrasound had not been done but that it was recommended. Additionally on 10/6/00 the pt was vaccinated IM in the R thigh with a 1st dose of Tripedia Lot #U0039CA, and a 1st dose of IM in the L thigh of Haemophilus B lot #622363A. On 3/12/01, the pt was given a physical exam, at 7 months old the pt was 29 inches in height, 19 lbs and 46cm head circumference. a physician exam reported as normal and the assessment was reported as well. On 3/12/01, a developmental questionaire was completed. When your childis on hisstomach on a flat surfave can he lift heis chest using his arms for suport? yes. No further information is available. Fax correspondence rec''d 7/25/01 and forwarded on 8/23/01 it was reported F/U information rec''d from hlth professional rwported that the pt recovered. This is an amended report. From follow-up correspondence received on 02/04/2002 it was reported, "01/28/2002 to date no additional information at this time. No other DTaP or Prevnar." Follow-u on 07/25/2001 states that the pt recovered.

VAERS ID:162653 (history)  Vaccinated:2000-10-02
Age:11.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-10-25, Days after onset: 23
Location:North Carolina  Entered:2000-11-28, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NC00089
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5151A20IMRA
Administered by: Other     Purchased by: Other
Symptoms: Headache, Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Post vax, the pt developed a localized reaction with edema, pain, and erythema lasting 3 days. Complaint of headache for 3 days. Treated with Tylenol.

VAERS ID:163108 (history)  Vaccinated:2000-10-02
Age:26.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2000-11-27, Days after onset: 56
Location:New York  Entered:2000-12-05, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Chest x-ray neg. V/Q scan neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0334BA0IM 
Administered by: Private     Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Acute onset of SOB, fever 102 and chest pain within 24 hours.

VAERS ID:164415 (history)  Vaccinated:2000-10-02
Age:0.6  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-09, Days after onset: 6
Location:Oklahoma  Entered:2001-01-03, Days after submission: 86
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: OK0050
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM9580IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1036K0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R14890SCLL
Administered by: Public     Purchased by: Public
Symptoms: Crying, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad)
Write-up: Redness and pain at injection site X 7 days and also crying for extended periods of time X 7 days.

VAERS ID:164799 (history)  Vaccinated:2000-10-02
Age:70.0  Onset:2000-10-04, Days after vaccination: 2
Gender:Female  Submitted:2000-12-27, Days after onset: 84
Location:Oregon  Entered:2001-01-17, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: Allergic to ASA and Erythromycin.
Diagnostic Lab Data:
CDC Split Type: OR200043
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM658A41 RA
Administered by: Public     Purchased by: Private
Symptoms: Hypokinesia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: This patient complains of painful right arm from neck to fingers with difficulty lifting arm due to the pain. The patient has not yet sought treatment. She was advised to have her physician evaluate.

VAERS ID:164947 (history)  Vaccinated:2000-10-02
Age:1.2  Onset:2000-10-19, Days after vaccination: 17
Gender:Male  Submitted:2000-11-28, Days after onset: 40
Location:Pennsylvania  Entered:2001-01-19, Days after submission: 52
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: PA0110
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.920302SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1275J0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1687J0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: The child received the vax on 10/2/00. Returned to the clinic on 11/27/00. Mother said 1 week after the vaccine the child had a rash and fever of 103.9 axillary. Mother notified the physician. The child was treated with Tylenol and the fever began to come down.

VAERS ID:165004 (history)  Vaccinated:2000-10-02
Age:0.5  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2000-10-11, Days after onset: 8
Location:Colorado  Entered:2001-01-22, Days after submission: 103
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ1846605OCT2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES 2IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD. 2IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 0IM 
Administered by: Private     Purchased by: Other
Symptoms: Irritability, Rash papular
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: A 6 month old female received her 1st dose of Prevnar on 10/2/00, as well as, her 3rd doses of Acel-Imune and IPV and 1 day later, developed a flat, papular rash on her face, trunk and diaper area. She was also "a little" fussy. She was seen in the physician''s office and prescribed diphenhydramine.

VAERS ID:165024 (history)  Vaccinated:2000-10-02
Age:1.0  Onset:2000-10-27, Days after vaccination: 25
Gender:Female  Submitted:0000-00-00
Location:New Jersey  Entered:2001-01-22
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: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ3006431OCT2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R0398   
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4777170IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0521K0SC 
Administered by: Private     Purchased by: Other
Symptoms: Cough, Febrile convulsion, Otitis media, Pneumonia, Roseola, Somnolence, Staring, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: A mother reported that her 12 month old daughter received Prevnar, varicella and poliomyelitis vaccines on 10/2/00 and subsequently, developed a fever. On 10/11/00, her fever was 105.2F and the mother reports that she "may have had a febrile seizure because she was not responding appropriately and would just stare ahead at times". The mother treated her with Tylenol and the fever resolved. On 10/13/00, the child developed a rash on her trunk and face. On 10/16/00, she was seen by the physician who dx''d roseola. The roseola resolved on 10/18/00. On 10/23/00, the child developed a cough and fever of 103F. On 10/27/00, the fever resolved and she was seen by the physician who dx''d "a touch of pneumonia" and a left ear infection. She was treated with amoxicillin. As of 10/30/00, the child is improving but has developed "occasional vomiting due to coughing and gagging".

VAERS ID:165436 (history)  Vaccinated:2000-10-02
Age:28.0  Onset:2000-12-28, Days after vaccination: 87
Gender:Female  Submitted:2001-01-26, Days after onset: 29
Location:California  Entered:2001-01-31, 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: Macrobid
Current Illness:
Preexisting Conditions: Concurrent conditions: Pregnancy (LMP= 09/29/00), Urinary tract infection
Diagnostic Lab Data: ultrasound - no fetal tissue, ultrasound - 7.5 week sac without fetal poles or yolk sac, serum beta human
CDC Split Type: WAES00120052
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Abortion, Foetal disorder
SMQs:, Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)
Write-up: The pt received both vaccines in Mexico. On 11/14/00, the pt had positive pregnancy test with a LMP of 9/29/00 and an estimated due date of 7/6/02. On 12/28/00 an ultrasound revealed a 7.5 week sac without a fetal pole and yolk sac. On 12/27/00 an ultrasound revealed no fetal pole identified. On 12/28/00 the pt had a spontaneous abortion at 13 weeks. On 12/30/00 a pathology revealed no fetal tissue, only placental tissue that is consistent with either a blighted ovum or an abnormally developing pregnancy. Additional information has been requested.

VAERS ID:165514 (history)  Vaccinated:2000-10-02
Age:89.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2001-01-30, Days after onset: 120
Location:Georgia  Entered:2001-02-01, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: ESR 66, Skin biopsy And Vasculitis.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE)LEDERLE LABORATORIES468148   
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.U0449AA   
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Hypoaesthesia, Influenza like illness, Rash maculo-papular, Vasculitis
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Vasculitis (narrow), Hypersensitivity (narrow)
Write-up: This patient had flu like symptoms, splotches on legs, numbness in feet, weakness, and vasculitis.

VAERS ID:167005 (history)  Vaccinated:2000-10-02
Age:48.0  Onset:2000-11-02, Days after vaccination: 31
Gender:Female  Submitted:2001-02-05, Days after onset: 95
Location:Louisiana  Entered:2001-03-12, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0266BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Injection site pain, Skin discolouration
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Left arm and shoulder area got extremely sore and was unable to lift without pain. Could not lift above my head at all. Today, still somewhat sore and area of shot site discolored.

VAERS ID:167617 (history)  Vaccinated:2000-10-02
Age:5.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Female  Submitted:2001-03-14, Days after onset: 162
Location:Kentucky  Entered:2001-03-21, 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: Motrin
Current Illness: NONE
Preexisting Conditions: Allergies to PCN and Sulfa
Diagnostic Lab Data:
CDC Split Type: KY2001019
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0497K1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Anaphylactic reaction, Diarrhoea, Eye swelling, Injection site pain, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: On 10/3/00, had fever of 102F within 24 hours and diarrhea. Then eyes were swollen; itchy neck; red splotches on neck and legs. Received Motrin during this time every 6 hours from time of vaccination. At this time pain "doubled" from Hep-B. Mom wanted to refuse Hep-B #3. PMD signed medical exemption for anaphylactic reaction.

VAERS ID:167988 (history)  Vaccinated:2000-10-02
Age:1.3  Onset:2000-10-04, Days after vaccination: 2
Gender:Female  Submitted:2000-12-27, Days after onset: 84
Location:Illinois  Entered:2001-03-29, Days after submission: 92
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: HQ3360808NOV2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBPV: HIB POLYSACCHARIDE (HIBIMUNE)LEDERLE LABORATORIES471869   
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction
SMQs:
Write-up: Two days post vax, the pt developed an injection site reaction which the reporter did not characterize. That same day the pt was seen by a physician.

VAERS ID:168851 (history)  Vaccinated:2000-10-02
Age:1.0  Onset:2000-10-08, Days after vaccination: 6
Gender:Male  Submitted:2001-04-13, Days after onset: 187
Location:Maryland  Entered:2001-04-18, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO299BA IM 
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA550AA IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T0186   
Administered by: Private     Purchased by: Other
Symptoms: Dyspnoea, Hyperventilation, Irritability, Lethargy, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Evening of 10/8/00, began with low-grade fever (<101F); irritability; constant crying and on 10/9/00 had rash over body (low, red bumps); breathing difficulty with short, rapid and shallow breaths and lethargy.

VAERS ID:169459 (history)  Vaccinated:2000-10-02
Age:1.3  Onset:2000-10-12, Days after vaccination: 10
Gender:Male  Submitted:2000-11-10, Days after onset: 29
Location:New Jersey  Entered:2001-05-04, Days after submission: 174
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
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SC 
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash morbilliform
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Measles rash for 2 days and fever for 1 day.

VAERS ID:171019 (history)  Vaccinated:2000-10-02
Age:19.0  Onset:2001-05-27, Days after vaccination: 237
Gender:Female  Submitted:2001-06-01, Days after onset: 5
Location:Colorado  Entered:2001-06-11, Days after submission: 10
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Cultures show strain of bacteria to be Neisseria Meningitidis Group B
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE-A/C)CONNAUGHT LTD.    
Administered by: Other     Purchased by: Other
Symptoms: Bacterial infection, Meningitis
SMQs:, Noninfectious meningitis (narrow)
Write-up: On 05/31/2001 this patient''s mother called to report that this patient came down with bacterial meningitis on 05/27/01.

VAERS ID:174057 (history)  Vaccinated:2000-10-02
Age:45.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Male  Submitted:2001-07-30, Days after onset: 301
Location:New York  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: Cardiac disorder; cephalosporin (Duricep) and penicillin allergies.
Diagnostic Lab Data:
CDC Split Type: WAES00100739
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
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: Information has been received from a physician concerning a male pt who on 10/2/00 was vaccinated with pneumococcal vaccine 23 polyvalent. Subsequently, the pt experienced injection site swelling in the arm and a "low grade" temperature for approx. 4-5 days. Steroids were administered. Unspecified medical attention was sought. No further information is available.

VAERS ID:174059 (history)  Vaccinated:2000-10-02
Age:81.0  Onset:2000-11-04, Days after vaccination: 33
Gender:Female  Submitted:2001-07-30, Days after onset: 267
Location:Florida  Entered:2001-08-07, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00100749
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0945K0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from an RN concerning an 81 year old white female who on 10/2/00 was vaccinated with a 1st dose of pneumococcal vaccine 23 polyvalent, IM, the the right deltoid (lot 637094/0945K). On 10/4/00, the pt developed "red, warmth, edema 2.5" below injection site." On 10/5/00, the pt recovered. It was reported that the physician is concerned about using the remaining vaccine in the bottle. Two additional pts (WAES 0011721 and 0011722) had a similar experience following exposure to pneumococcal vaccine 23 polyvalent. Additional information has been requested.

VAERS ID:174994 (history)  Vaccinated:2000-10-02
Age:71.0  Onset:0000-00-00
Gender:Female  Submitted:2001-03-09
Location:Montana  Entered:2001-09-05, Days after submission: 179
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: etodolac; Levoxyl; nadolol; Premarin; Colestyramine; Detrol
Current Illness: Chest pain
Preexisting Conditions: Diarrhea NOS; Hypothyroidism; Urinary frequency
Diagnostic Lab Data: UNK
CDC Split Type: HQ2480419OCT2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES463720 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: A nurse reported that a 71 year old female received an injection of Pnu-Imune 23 on 10/2/00 and subsequently, developed an injection site reaction characterized by redness, swelling and itching. The pt''s husband insists that his wife received Pnu-Imune 23, 1 year ago; however, the pt does not remember this. She recovered.

VAERS ID:175784 (history)  Vaccinated:2000-10-02
Age:12.0  Onset:2000-10-03, Days after vaccination: 1
Gender:Male  Submitted:2001-09-24, Days after onset: 356
Location:Massachusetts  Entered:2001-09-27, 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: Albuterol; Flovent
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3232A40IM 
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt developed a temperature of 103F within 24 hours, post vax. No other symptoms developed. Resolved within 24 hours.

VAERS ID:186778 (history)  Vaccinated:2000-10-02
Age:30.0  Onset:2000-10-02, Days after vaccination: 0
Gender:Female  Submitted:2002-06-14, Days after onset: 620
Location:D.C.  Entered:2002-06-19, 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: NONE
Diagnostic Lab Data: MIR-brain, EEG-both normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0265T1IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURR13651SCLA
Administered by: Military     Purchased by: Military
Symptoms: Hallucination, Headache, Hypoaesthesia, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: 30 year old female with fever, delerium and severe headache one hour post IPV #2, Hep B #2. Also left sided numbness and pain. Fever and delerium subsided but left sided numbness and pain, HA continued.

VAERS ID:194863 (history)  Vaccinated:2000-10-02
Age:6.0  Onset:2002-12-03, Days after vaccination: 792
Gender:Male  Submitted:2002-12-06, Days after onset: 3
Location:Missouri  Entered:2002-12-11, 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: Claritan PRN, Albutrol Syrup
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM645A20  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0449K0  
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Varicella rash after immunization with Varivax

VAERS ID:207763 (history)  Vaccinated:2000-10-02
Age:0.8  Onset:2000-10-10, Days after vaccination: 8
Gender:Male  Submitted:2003-08-12, Days after onset: 1036
Location:Georgia  Entered:2003-08-12
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Urticaria Pigmentosa-9/18/2000 skin biopsy, 9/19/2000 CBC, Liver Package, CBC II testing Type 1 Diabetes-11/30/2000 sick visit to Pediatrician w/ severe vomiting, 12/01/2000 sick visit to Pediatrician w/ vomiting.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720422 LL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister, Dehydration, Diabetes mellitus, Ketoacidosis, Pigmentation disorder, Pollakiuria, Pruritus, Urticaria, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: 10/02/2000 my son received his 3rd installment of the Prevnar vaccine. After 2 months of heavily wetting diapers, being almost to the point of immobility, and throwing up for 2 weeks straight he was finally diagnosed with type 1 insulin dependant diabetes. 05/08/2000 after receiving his first installment of the same vaccine he developed a bump on the back of his neck. The doctors said it was a bug bite. The next appt. one month later it has spread to his back, stomach, bottom, face, legs. The doctors sent us to a dermotologist and after a biopsy he was diagnosed with urticaria pigmentosa. This disease causes histomine deposits on the skin that form blisters and itch constantly. The hospital discharge summary received on 11/20/03 states diabetic ketoacidosis, and dehydration.

VAERS ID:238257 (history)  Vaccinated:2000-10-02
Age:1.1  Onset:2004-05-22, Days after vaccination: 1328
Gender:Male  Submitted:2005-05-16, Days after onset: 359
Location:Massachusetts  Entered:2005-05-26, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0406USA00666
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Erythema, Infection
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a nurse concerning a 4 year old male with no pre-existing physician diagnosed allergies, birth defects, or medical conditions who on 10/02/2000 was vaccinated with a dose of varicella virus vaccine live. Concomitant therapy that day included a dose of hepatitis b virus vaccine rHBag. There was no other vaccinations within 4 weeks prior to 10/02/2000. On 05/22/2004 in the PM, the patient developed red spots all over his body, and it was getting worse. The patient was diagnosed with chickenpox. The patient was treated with diphenhydramine hydrochloride and aveeno as needed. There were no relevant diagnostic or laboratory tests. The outcome was reported as recovered.

VAERS ID:248890 (history)  Vaccinated:2000-10-02
Age:1.3  Onset:2005-11-27, Days after vaccination: 1882
Gender:Male  Submitted:2005-11-23, Days after onset: 4
Location:New Hampshire  Entered:2005-12-06, Days after submission: 13
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: Tried to do herpes-zoster PCR on scraping from rash. Test negative, but could not get much fluid to sample.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0782K  RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES472043  LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.13565 IMRL
Administered by: Private     Purchased by: Public
Symptoms: Herpes zoster
SMQs:
Write-up: 6 year old received Varivax at age 16 mo. Developed herpes-zoster (shingles) in right L-5 dermatome Nov 2005. No history of natural chicken pox infection.

VAERS ID:256089 (history)  Vaccinated:2000-10-02
Age:1.0  Onset:2005-05-05, Days after vaccination: 1676
Gender:Female  Submitted:2006-05-12, Days after onset: 372
Location:New York  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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0505USA02874
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0538K   
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Info has been received from an office manager concerning a 5 year old female who on 10/2/00, was vaccinated with a dose of varicella virus vaccine live. On 5/5/05, the pt experienced breakthrough varicella with about 20 lesions. It was noted that the lesions were almost gone b 5/9/05. No treatment was given and the pt recovered. Unspecified medical attention was sought. No product quality complaint was involved. Additional info has been requested.

VAERS ID:257141 (history)  Vaccinated:2000-10-02
Age:6.0  Onset:2006-01-04, Days after vaccination: 1920
Gender:Male  Submitted:2006-05-12, Days after onset: 127
Location:Unknown  Entered:2006-05-17, 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: UNK
CDC Split Type: WAES0601USA01540
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0537E   
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Rash vesicular, Skin ulcer, Viral infection
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a RN concerning a 6 yr old male who on 02Oct00 was vaccinated with a dose of varicella virus vaccine live (lot622850/0537E). Subsequently, on 04Jan06 the pt experienced mild varicella. Unspecified medical attention was sought. The RN noted that the pt experienced approx 10 varicella lesions. No outcome was reported. No product quality complaint was involved. Additional information has been requested.

VAERS ID:263518 (history)  Vaccinated:2000-10-02
Age:1.0  Onset:2006-09-24, Days after vaccination: 2183
Gender:Female  Submitted:2006-09-25, Days after onset: 1
Location:South Carolina  Entered:2006-09-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: bilateral otitis media
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3328D92IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0998K0SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725471IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0931K0SCRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: received varicella immunization 10/2/00. office vist 9/24/06 with diagnosis of chicken pox after md assessment. atarax for comfort

VAERS ID:281861 (history)  Vaccinated:2000-10-02
Age:1.0  Onset:2007-01-09, Days after vaccination: 2290
Gender:Male  Submitted:2007-05-16, Days after onset: 126
Location:Maryland  Entered:2007-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0701USA01014
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0768K0UNUN
Administered by: Private     Purchased by: Other
Symptoms: Rash papular, Rash pruritic, Varicella
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a healthcare worker concerning a 7-year-old male with no pertinent medical history or allergies who on 02-OCT-2000 (also reported as 20-OCT-2000) was vaccinated in the arm with a 0.5 mL dose of Varivax (Lot #635452/0768K). Concomitant therapy included MMR II. There was no illness at the time of vaccination. On 09-JAN-2007 at 09:00, the patient experienced a generalized, scattered papular rash which was itchy for 4-5 days. Unspecified medical attention was sought. The patient was diagnosed with chicken pox. No diagnostic studies or lab tests were performed. On 16-JAN-2007 the patient recovered. No additional information was provided. There was no product quality complaint involved. Additional information is not expected.

VAERS ID:166176 (history)  Vaccinated:2000-10-02
Age:35.0  Onset:2000-10-04, Days after vaccination: 2
Gender:Female  Submitted:2001-07-12, Days after onset: 281
Location:Foreign  Entered:2001-02-27, Days after submission: 134
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Allergic to Codeine. Drug allergy.
Diagnostic Lab Data: Ultrasound of arm-showed a small undetermined lesion "which might be an encysted collection". EMG-nml; CPK-nml
CDC Split Type: WAES00120434
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2IMRA
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Arthritis, Injection site inflammation, Injection site pain, Paraesthesia, Skin ulcer
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (narrow)
Write-up: Information has been received from a health professional concerning a 35 year old female who on 10/2/00 was vaccinated, IM in the right arm with the 3rd dose of Hep-B. Two or three days, post vax, the pt experienced injection site inflammation. The pt was treated with loratadine and alcohol dressings for 1 day. Pain of the vaccinated arm with ulnar extension persisted. The pt''s injection site inflammation was noted to last 1 day, however, she was considered not recovered at the time of the report. There were no reactions after the 1st or 2nd doses. The pt''s symptoms were considered "Significant Medical Events". No further information is available. Follow-up was received which indicated the EMG and CPK were normal. The pt still complained of slight intermittent paresthesia in the hand. The reporter "thought there was an anxious context". The outcome will be completed. No further information is available. F/U info has been rec''d that states the neurologist confirmed that there were no neurological symptoms and that pain was linked to a scapulohumeral polyarthritis. It was later reported that a dx of scapuloumeral periarthritis was made but needed to be confirmed by a rheumatologist. F/U infor has been rec''d from neurologist who reports the hooting, irradiating, mechanical, isolated pains wer still present as of 7/25/01 and were provoded by active and passive mobilization of the right shoulder and by pressure over the acromiodeltoid arch. He noted that the dx was pariarthritis of the shoulder developed subsewuently after the tumefaction followng the vaccination on 10/2/00. the neurological exam and electromyogram were normal. There is no further info available. the case is closed. The pt''s experience was considered an other important medical event. No further info is available.

VAERS ID:168616 (history)  Vaccinated:2000-10-02
Age:70.0  Onset:2000-10-07, Days after vaccination: 5
Gender:Female  Submitted:2001-04-03, Days after onset: 178
Location:Foreign  Entered:2001-04-12, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Essential thrombosis, hypertension
Diagnostic Lab Data:
CDC Split Type: FLU3APR
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Influenza like illness, Pyrexia, Systemic lupus erythematosus, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad)
Write-up: Post vax, pt experienced flu-like symptoms and an SLE reaction which resulted in hospitalization on 10/7/00. She developed the same symptoms as with previous vaccinations but her complaints increased. She had peaks of fever, symptoms from the lungs and hepatic influence. Investigation showed symptoms similar to SLE. She improved quickly after flu-like symptoms but the SLE reaction is persisting. The reporter has assessed the relationship of the Fluvirin vaccine to the flu-like symptoms, as probable due to connection in time and similar cases and to the SLE reaction as possible due to similar cases.

VAERS ID:173144 (history)  Vaccinated:2000-10-02
Age:13.0  Onset:2000-11-04, Days after vaccination: 33
Gender:Male  Submitted:2001-07-04, Days after onset: 241
Location:Foreign  Entered:2001-07-11, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: creatinine phosphokinase, vitamin D, parathormones, biogenic amines, ANA, anticardiolipin, CSF, EMG, EEG, thyroid check-up, MRI-all wnl; serologies for brucellosis, Lyme disease, hepatitis and rubella-all neg; enterovirus serology-old infec
CDC Split Type: 20010157641
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Asthenia, Back pain, Joint range of motion decreased, Pain, Rheumatoid arthritis, Viral infection
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: At the beginning of Nov 2000 pt developed lower limb pain, then upper limb pain which stretched to involve vertebral column and abdomen, leading to hospitalization. Pt also complained of asthenia. The pt experienced episodes of locking and functional disability. Physical exam and special neuro exam showed no abnormality except rachidian stiffness (hand-ground distance = 40 cm). Final diagnosis of ankylosing spondylitis was made. Pt was treated with diclofenac (Voltaren) and sulfasalazine (Salazopyrine). The most recent information received on 7/2/01 reports the outcome of the patient as not yet recovered. The follow up received on 1/7/03 states on 8/24/00, the subject was vaccinated with Engerix B. On 10/2/00, the subject received a second injection of Engerix B. On 11/4/00, one month after the last injection of Engerix B, the subject developed lower limbs pain, then upper limbs pain which extended to involve vertebral column and abdomen, with asthenia. The pt also experienced episodes of locking and functional disability. At an unspecified time, the pt was hospitalized. Clinical examination and especially neurological examination showed no abnormaltiy except rachidian stiffness (nand-ground distance=40cm). Biological examinations showed normal level for creatine phosphokinase, vitamine D, parathormonce, biogenic aminea, antinuclear antibodies, anticardiolipin. There were no abnormalities in cerobrospinal fluid, electromyogram, electroencephalogram, thyroid check-up and MRI. Serologies for brucellosis, Lyme''s disease, hepatitis and rubella were negative. Enterovirus serology showed a recent infection with ochovirus 30. Final diagnosis of ankylosing spondylitis was made. The pt was then treated with Voltarene and Salazopyrine. On 12/12/02, the pt was not yet recovered. He was found to be HLA B27 negative.

VAERS ID:181842 (history)  Vaccinated:2000-10-02
Age:  Onset:2000-10-14, Days after vaccination: 12
Gender:Female  Submitted:2002-02-26, Days after onset: 500
Location:Foreign  Entered:2002-03-01, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Septic screen-neg
CDC Split Type: U200200137
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 1IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER44917 SC 
Administered by: 0     Purchased by: 0
Symptoms: Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: It was reported that a less than 12 month old baby girl was concomitantly vaccinated on 10/2/00 with a 2nd dose of DTP, Hib, Polio and Meningococcal C vaccine. On 10/14/00, the pt presented with a petechial rash. The septic scream was negative. The baby girl was admitted to the hospital from 10/14/00 to 10/17/00. The reaction recurred after the 3rd dose but this time the parents did not seek help. Further data are not awaited; the case is closed.

VAERS ID:239052 (history)  Vaccinated:2000-10-02
Age:49.0  Onset:2005-05-22, Days after vaccination: 1693
Gender:Female  Submitted:2005-06-03, Days after onset: 12
Location:Foreign  Entered:2005-06-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: Alanine aminotransferase 156U/l; Aspartate aminotransferase 110U/l; Bilirubin total 1.1mg/dl; GGT 208U/l; Sonogram normal; Transaminases normal.
CDC Split Type: D0046693A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood bilirubin increased, Cholelithiasis, Drug ineffective, Gamma-glutamyltransferase abnormal, Hepatitis A, Viral infection
SMQs:, Liver related investigations, signs and symptoms (narrow), Liver infections (narrow), Acute pancreatitis (narrow), Lack of efficacy/effect (narrow), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This case was reported by a physician and described the occurrence of possible hep A infection (lack of efficacy) in a 53 year old female subject who was vaccinated with combined hep A, Hep B vaccine (Twinrix) for prophylaxis. Previous vaccination included combined hep A, hep B vaccine given on 04Jun1999 and 2Jul99. In Oct 2004 the transaminases had been normal. The subject had been in a foreign country in Nov 2004. On 02Oct00 the subject received 3rd dose of Twinrix adult (unk). On 22May05, 5 years after vaccination with Twinrix adult, the subject experienced upper abdominal pain. The subject was hospitalized due to suspect of gall colic. A sonogram was without pathologic findings, bile ducts were not visible in endoscopic retrograde cholangiopancreatography, so gall stones could not be excluded. On 23May05 transaminases were increased. On 24May05 hep A virus IgM antibodies were positive. A hep A infection was suspected. At the time of reporting the outcome of the events was unspecified.

VAERS ID:160387 (history)  Vaccinated:2000-10-03
Age:4.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:2000-10-06, Days after onset: 2
Location:Indiana  Entered:2000-10-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4716520IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Post vax, the pt developed a large circular area of erythema around injection on left upper arm. Treated with Benadryl.

VAERS ID:160405 (history)  Vaccinated:2000-10-03
Age:65.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-06, Days after onset: 3
Location:New York  Entered:2000-10-10, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Premarin, Chlorthalidone, K-dur, Zestril, calcium
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E59240GA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1217J IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Post vax, the pt had erythema in mid right deltoid extending to just below the elbow. Sight fluctuance mid lesion. No fever.

VAERS ID:160428 (history)  Vaccinated:2000-10-03
Age:0.3  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-03, Days after onset: 0
Location:New York  Entered:2000-10-11, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0317BB0IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1175K0IMRL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.T01860SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720420IMLL
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Crying, Injection site pain
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), Depression (excl suicide and self injury) (broad)
Write-up: The pt experienced high pitched crying for 1 hour post vax. The pt calmed down with Tylenol. The pt experienced slight tenderness of both thighs.

VAERS ID:160453 (history)  Vaccinated:2000-10-03
Age:7.5  Onset:2000-10-05, Days after vaccination: 2
Gender:Male  Submitted:2000-10-06, Days after onset: 1
Location:Kentucky  Entered:2000-10-11, 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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type: KY2000036
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4670074IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.T01170IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0585K1SCLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Two days, post vax, pt developed erythema, swelling and warmth. Is in the process of recovering.

VAERS ID:160548 (history)  Vaccinated:2000-10-03
Age:72.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Male  Submitted:2000-10-06, Days after onset: 2
Location:Ohio  Entered:2000-10-16, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Arthritis medication
Current Illness: NONE
Preexisting Conditions: Rheumatic heart valve damage as a child; CVA; Diabetes
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E65710HA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Pt developed red, hard area at site of injection. On 10/6/00 when pt reported it, it was 1-1 1/2" circular red, flat area. No pain or itching or hardness. Pt had reported it to MD on 10/4/00. On 10/9/00, the pt reported there was no redness or edema at site and feels fine.

VAERS ID:160554 (history)  Vaccinated:2000-10-03
Age:1.6  Onset:2000-10-04, Days after vaccination: 1
Gender:Male  Submitted:2000-10-04, Days after onset: 0
Location:Ohio  Entered:2000-10-16, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;Vaccine not specified;;2;In Sibling
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM960A22IMLA
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES601063A2IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R14332SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0498K0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Little red bumps on abdomen and on top and sides of feet. First noticed in the AM of 10/04/00. None are itching or painful. Has a rash. Mom reported at 14:00 on 10/4/99. Mom denies increase in diameter of rash or any respiratory distress. No treatment. Mom was instructed to report to physician if condition persists or worsens.

VAERS ID:160559 (history)  Vaccinated:2000-10-03
Age:5.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:2000-10-05, Days after onset: 1
Location:Massachusetts  Entered:2000-10-16, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0278CA4IMLA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R0507 SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: One day, post vax, developed red, swollen, hard and non-tender swelling around injection site (about 4" X 3 1/2").

VAERS ID:160659 (history)  Vaccinated:2000-10-03
Age:35.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-10, Days after onset: 7
Location:Nevada  Entered:2000-10-18, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lupron Depot/IM/GM/on 9/15/00/1 previously
Current Illness: NONE
Preexisting Conditions: Allergic to morphine, Demerol, Stadol
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site pain, Musculoskeletal stiffness, Pruritus
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Severe itching which started on 10/03/2000, approx. 20:00 and didn''t stop until 10/05/2000. Painful at the vaccine area and stiffness in left shoulder.

VAERS ID:160660 (history)  Vaccinated:2000-10-03
Age:15.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-04, Days after onset: 1
Location:Virginia  Entered:2000-10-18, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Chills the night before vaccination
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.R088520IMLA
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Dizziness, Flank pain, Headache, Injection site pain, Kidney infection, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)
Write-up: Mother called health dept. requesting manufacturer and lot # for rabies vaccine daughter rec''d yesterday. States she was questioning symptom''s following injection were a possible reaction and questioned if she should receive any more doses. Reports daughter experienced vomiting approx. 1 1/2 hours, post vax. Vomited X 3; no complaint of diarrhea. Temperature to 104F. Tepid tub bath taken and ibuprofen given and took Tylenol in between. Temperature decreased to 99F this AM and complaining of feeling weak. Also, complained of headache. Questioned mom if daughter had complained of any symptoms of illness prior to coming to clinic and she said only to meds. Only reaction to any previous vaccines was a mild fever with 1st baby shots. Mom stated with present vaccine, she complained of soreness, no redness or swelling. She relates temperature still down and still complaining of headache. Now also states muscles sore and experiencing dizziness when gets up out of chair. Vomited X 1, today when she tried to eat a banana; has kept down other fluids and soup. Had consulted with health pharmacist & he had recommended mom talk with daughter''s physician and let PMD make the call if she should continue series. Works for vet and discussed risk for exposure on the job. Mom states if pt continues to feel ill tomorrow, she will follow-up with PMD. Mom called and stated pt went to MD on Thursday and got a shot of antibiotics and started on Bactrim for kidney infection. She returned to PMD on Friday and was no better and was hospitalized for kidney infection. Hopes daughter will be discharged from hospital today. Says she ran a temperature of 102F in the hospital X1 and had complained of her side being sore last week but thought is was just a pulled muscle. Rabies shot cancelled today as pt still in hospital. Will contact health dept. when she is ready to resume. Mom did say that the pt''s doctor did say that pt''s symptoms were not due to Rabies pre-exposure vaccine; she did not have a vaccine reaction.

VAERS ID:160672 (history)  Vaccinated:2000-10-03
Age:26.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:2000-10-05, Days after onset: 1
Location:Mississippi  Entered:2000-10-18, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MS00038
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0986K1SCLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0138BA1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Eye disorder, Injection site pain, Musculoskeletal stiffness, Pharyngolaryngeal pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: My throat was very sore and scratchy, my eyes were very itchy and my right arm was very sore; it felt like the muscle was drawn up tightly. My arms, neck and body except for lower half, itches very badly; like it''s skin deep.

VAERS ID:160768 (history)  Vaccinated:2000-10-03
Age:77.0  Onset:2000-10-05, Days after vaccination: 2
Gender:Male  Submitted:2000-10-13, Days after onset: 8
Location:New York  Entered:2000-10-20, 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: NONE
Current Illness: NONE
Preexisting Conditions: hypertension
Diagnostic Lab Data: CBC - nml
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E61756GA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The pt experienced swelling, erythema of the entire arm.

VAERS ID:160809 (history)  Vaccinated:2000-10-03
Age:49.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-04, Days after onset: 1
Location:Florida  Entered:2000-10-23, 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: BP 160/95
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5816085901 IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Blood pressure increased, Dizziness, Dysgeusia, Hypersensitivity, Hypoaesthesia, Tachycardia, Vision blurred
SMQs:, Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Pt was dxed with allergic reaction just minutes post vax. Pt started to suffer numbness peripheral, blurred vision, tachycardia, fainting sensation, metallic taste. He was not hospitalized. He had no previous reaction from IZs. He was treated with Prednisone and was noted as having partial recovery.

VAERS ID:160867 (history)  Vaccinated:2000-10-03
Age:47.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-05, Days after onset: 2
Location:Missouri  Entered:2000-10-24, 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: Toprol XL
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MO2000076
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM667B61IMLA
Administered by: Other     Purchased by: Public
Symptoms: Headache, Nausea, Neck pain, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Body aches, headache and fever 100.5. Developed chills and nausea later that evening. 10/5/2000 still having aches and neck pain, headaches, nausea. Yesterday felt much worse.

VAERS ID:160889 (history)  Vaccinated:2000-10-03
Age:1.0  Onset:2000-10-10, Days after vaccination: 7
Gender:Male  Submitted:2000-10-17, Days after onset: 7
Location:Colorado  Entered:2000-10-25, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: born to a drug abusing mother
Diagnostic Lab Data: x-ray and ultra sound - neg, blood culture - neg
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM956A23IMRL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES450253A2IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R13302 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1325J0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: The pt developed right upper thigh cellulitis which was noted one week post vax. The pt was hospitalized for 2 days for IV antibiotics then changed to p.o. Doing well, no abscess noted.

VAERS ID:160914 (history)  Vaccinated:2000-10-03
Age:1.0  Onset:2000-10-11, Days after vaccination: 8
Gender:Male  Submitted:2000-10-19, Days after onset: 8
Location:Massachusetts  Entered:2000-10-25, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1327J0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720362IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0444K0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Irritability, Pyrexia, Rash maculo-papular, Roseola
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: Approximately 10 days post vax the pt developed a fever and fussiness, then experienced a red macular-papular rash, blanching, trunk and neck extremities. Possibly be roseola.

VAERS ID:161277 (history)  Vaccinated:2000-10-03
Age:64.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-23, Days after onset: 20
Location:Ohio  Entered:2000-11-02, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar, Maxide
Current Illness: NONE
Preexisting Conditions: Allergy to sulfa, WBC stays at 2000, Idiopathic Auto-immune neutropenia since childhood, hypertension
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1874J2IM 
Administered by: Private     Purchased by: Other
Symptoms: Headache, Injection site swelling, Pruritus, Pyrexia, Skin discolouration, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Allergic reaction within 1/2 hour, post vax, had swelling of arm where shot was given; 8" X 5" around and 2 1/2" high, welt within this area, itching (severe), discoloration of skin on arm, headache and fever for 36 hours. Doctor examined arm and prescribed liquid Benadryl. Swelling of arm lasted 1 week and itching also.

VAERS ID:161279 (history)  Vaccinated:2000-10-03
Age:49.0  Onset:2000-10-20, Days after vaccination: 17
Gender:Female  Submitted:2000-10-26, Days after onset: 6
Location:Florida  Entered:2000-11-02, 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: Diovan, labetalol, Premarin, prednisone, methotrexate, Klonopin
Current Illness: NONE
Preexisting Conditions: SLE, glomerulonephritis, hypertension
Diagnostic Lab Data: CBC-nml; UA-hematuria; cultures-unknown results
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1784H0SCLA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Arthritis, Cough, Flushing, Haematuria, Headache, Lymphadenopathy, Malaise, Myalgia, Pharyngolaryngeal pain, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (narrow), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad)
Write-up: Onset 10/20/00, in the afternoon with sore throat, dry cough, increasingly severe headache, flush. Awoke approx. 06:30 on 10/21/00, with elevated temperature, facial rash along with red facial flush, lymphadenopathy (especially suboccipital, cervical and post auricular), severe arthralgia/myalgia. By the time I arrived at ER, rash had spread over chest, back, abdomen and extremities and accompanied by chills and malaise. Rash persisted X 5 1/2 days. Persistent lymphadenopathy and arthritis.

VAERS ID:161429 (history)  Vaccinated:2000-10-03
Age:16.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-11-02, Days after onset: 30
Location:California  Entered:2000-11-07, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: blood pressure - 100/40, pulse 100
CDC Split Type: WAES00102026
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3199A21IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERR050621SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1083J1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0061AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Coma, Dyskinesia, Hyperhidrosis, Hypotension, Hypoventilation, Nausea, Pallor, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)
Write-up: Information has been received from an RN concerning a 16 year old Hispanic female pt who on 10/03/00 was vaccinated with a 2nd dose of MMRII, a 2nd dose of DT, a 2nd dose of poliovirus, and a 2nd dose of Hep-B. "Client received 3 vaccines (TD, HEP-B, IPV) and while receiving MMRII, the client became unresponsive, jerked back and experienced fine motor tremors. Blood pressure was 100/40, RR were shallow, pulse was thready a 100 BPM. On admin. at 51. Pt placed in trendelenberg. Pt experienced nausea without emesis. Pt remained pale, diaphoretic with knowledge of event until transported via 911 to hospital. No tests or laboratory work done." Subsequently, the pt recovered. Additional information has been requested. F/U upon internal review, the pt''s experience of fine motor tremors/seizures activity with clonic movement of upper arm was considered to be an important medical event. The pt''s 12 year old sister had a similar experience after vaccination with a first dose of MMR (WAES00100792). It has been determined that WAES00100590 is a duplicate report of WAES00102026. Therefore WAES00100590 is being deleted from our files and the reports consolidated into WAES00102026. This is an amended report. Upon internal review of the pt''s information it was determined that hospitalization was not required as previously reported. This is a corrected report as amended.

VAERS ID:161634 (history)  Vaccinated:2000-10-03
Age:15.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-31, Days after onset: 28
Location:Illinois  Entered:2000-11-08, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2692A20IMRA
Administered by: Private     Purchased by: Public
Symptoms: Dyspnoea, Erythema, Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Pt describes that after dose #1 of Hep-B on 10/3/00, that once she got home, she experienced red, botchy palms, that itched bilaterally and shortness of breath, lasting 1 hour in duration.

VAERS ID:162191 (history)  Vaccinated:2000-10-03
Age:0.2  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2000-10-04, Days after onset: 1
Location:Tennessee  Entered:2000-11-20, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TN00042
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0313CB0IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0298K0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01170SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725500IMLL
Administered by: Public     Purchased by: Public
Symptoms: Dry skin, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Child was vaccinated 10/03/00 around 14:00. Mother called clinic and stated that the child has a fever of 100.9F (R) and that she has a fine white rash on her face and back. States PMD has not returned her call. On 10/6/00, per call to mother; child is doing fine. Took child to pediatrician, who stated rash due to dry skin and treated with ointment.

VAERS ID:162614 (history)  Vaccinated:2000-10-03
Age:14.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Male  Submitted:2000-10-23, Days after onset: 20
Location:Washington  Entered:2000-11-27, Days after submission: 35
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
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1231H0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Sluggishness
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: 10-15 minutes post vax, pt was awake, appropriate oriented, but slightly slow to respond to verbal requests.

VAERS ID:163083 (history)  Vaccinated:2000-10-03
Age:55.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:2000-10-10, Days after onset: 6
Location:Texas  Entered:2000-12-05, Days after submission: 56
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol, Medroxy, progesterone
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: TX00138
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09895801IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: C/O swelling, redness, pain to injection site, body aches after injection x 1 day. Fever x 2 days.

VAERS ID:163086 (history)  Vaccinated:2000-10-03
Age:12.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Male  Submitted:2000-10-04, Days after onset: 1
Location:Texas  Entered:2000-12-05, Days after submission: 62
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: TX00135
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1751H1SC 
Administered by: Private     Purchased by: Public
Symptoms: Blood pressure increased, Eye irritation, Headache, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Corneal disorders (broad)
Write-up: B/P 152/102 increased heart rate, headache, eyes irritated. Saw nurse at ER told to give pt Tylenol. Did not see MD.

VAERS ID:163645 (history)  Vaccinated:2000-10-03
Age:13.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Male  Submitted:2000-11-29, Days after onset: 57
Location:Louisiana  Entered:2000-12-12, Days after submission: 13
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 red dye, PCN
Diagnostic Lab Data:
CDC Split Type: LA801201
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0494K0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Malaise, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Within 6 hours post vax, the pt developed red raised areas over face, neck, and chest. Mother stated that pt complained of dizziness and feeling sick.

VAERS ID:164813 (history)  Vaccinated:2000-10-03
Age:1.0  Onset:2000-10-14, Days after vaccination: 11
Gender:Female  Submitted:2001-01-09, Days after onset: 87
Location:Pennsylvania  Entered:2001-01-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tuberculin Skin Test
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1030J0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: This infant had a rash all over. Reported by the mother. Not seen by health care provider.

VAERS ID:165106 (history)  Vaccinated:2000-10-03
Age:49.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:2001-01-16, Days after onset: 104
Location:Minnesota  Entered:2001-01-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: MRI and EMG pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0298AA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt experienced severe arm pain, numbness and muscle soreness.

VAERS ID:166123 (history)  Vaccinated:2000-10-03
Age:59.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Unknown  Submitted:2000-10-26, Days after onset: 22
Location:Idaho  Entered:2001-02-22, Days after submission: 119
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ1938109OCT2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4998128 IMLA
Administered by: Private     Purchased by: Other
Symptoms: Parotid gland enlargement
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: A physician reported that a 59 year old pt received an injection of Tetanus Toxoid Adsorbed, Ultrafined on 10/3/00. The next day, the pt developed left parotid gland swelling.

VAERS ID:166280 (history)  Vaccinated:2000-10-03
Age:0.1  Onset:2000-10-04, Days after vaccination: 1
Gender:Male  Submitted:2001-03-22, Days after onset: 169
Location:Washington  Entered:2001-03-01, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0150K1IM 
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt reported post 1 day shot - cutaneous semi- circular erythema line developed, below injection site. After 2nd Hep B same thing happened. These cutaneous lesions are smooth (left thigh) and haven''t faded in 4 months.

VAERS ID:174062 (history)  Vaccinated:2000-10-03
Age:60.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:2001-07-30, Days after onset: 299
Location:Missouri  Entered:2001-08-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: iron deficiency anemia, pneumonia
Preexisting Conditions: erythromycin allergy; penicillin allergy
Diagnostic Lab Data:
CDC Split Type: WAES00101108
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0690K0IMLA
Administered by: 0     Purchased by: 0
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a RN concerning pt with post hospital follow up on iron deficiency, anemia, and recent pneumonia at the time of vaccination. Pt was vaccinated on 10/03/00 and 1 day post vaccination she experienced injection site swelling, redness, and pain radiating to her elbow. Unspecified medical attention was sought. Follow up information indicated that the pt had huge swelling of the area at the site of injection. The pt also complained of pain. The swelling/edema was noted on the posterior aspect of the elbow.

VAERS ID:174232 (history)  Vaccinated:2000-10-03
Age:33.0  Onset:2000-10-30, Days after vaccination: 27
Gender:Male  Submitted:2001-07-30, Days after onset: 272
Location:Unknown  Entered:2001-08-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00121033
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1214J IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Malaise, 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: Information has been received concerning a pt who on the same day of vaccination developed localized significant redness, swelling, and warmth of the third outer aspect of his upper arm. The pt also developed a fever of 103 and experienced malaise. The pt received unspecified over the counter medications for the fever. The pt recovered in 4 to 5 days.

VAERS ID:174251 (history)  Vaccinated:2000-10-03
Age:75.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Male  Submitted:2001-07-30, Days after onset: 299
Location:New Mexico  Entered:2001-08-07, 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: UNK
Current Illness:
Preexisting Conditions: Benign prostatic hyperplasia; chronic obstructive pulmonary disease; hypertension
Diagnostic Lab Data:
CDC Split Type: WAES01020489
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0710K1  
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Hypersensitivity, Rash erythematous, Swelling, Vasculitis
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (narrow), Hypersensitivity (narrow)
Write-up: In approximately 10/2000, pt was vaccinated with pneumococcal vaccine 23 polyvalent. On 10/04/00, pt experienced swelling and redness on the day after vaccination. The pt was seen by MD who noted several bright red spots on the left arm, one over the bicep, not palpable but almost vasculitic in nature. There was some diffuse redness in the lower arm. Possible allergic reaction or vasculitis. No infection. Subsequently, the pt recovered. The reporter indicated that other pts experienced events post vax: WAES 01020487, 01020488, 01020490 and 00102088. Addtl info has been requested. Pt has a history of vaccination with pneumococcal vaccine 23 polyvalent in 1/1992.

VAERS ID:176276 (history)  Vaccinated:2000-10-03
Age:1.0  Onset:2000-10-04, Days after vaccination: 1
Gender:Female  Submitted:2001-08-21, Days after onset: 321
Location:Oklahoma  Entered:2001-10-12, Days after submission: 52
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OK0143
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES941A0IM 
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0611J1IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURERP065720SC 
Administered by: Public     Purchased by: Private
Symptoms: Pyrexia, Rash, Screaming
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: Pt developed a high fever of 106F X 3 days. Screamed and cried all day and all night long. She developed a rash 2 days later and then was fine. Gave Tylenol and cool bath.

VAERS ID:216910 (history)  Vaccinated:2000-10-03
Age:52.0  Onset:2002-03-01, Days after vaccination: 514
Gender:Male  Submitted:2004-02-05, Days after onset: 706
Location:New York  Entered:2004-02-26, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Testing (NOS) for HLA-DR4 gene: Positive;
CDC Split Type: A0402374A
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS 2 LA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Laboratory test abnormal
SMQs:, Arthritis (broad)
Write-up: A physician reported the occurrence of arthralgia in a 52 year old male who was vaccinated with Lyme disease vaccine recombinant OsaA (Lymerix) for prophylaxis. The subject''s medical history, concurrent conditions, and concurrent medications were not reported. The subject received injections of Lymerix on 05/03/00, 06/08/00 and 10/03/00. The third injection was administered five months after the first injection, rather than the recommended interval of 12 months. In approximately March 2002, he began to experience arthralgia of the knees and ankels. He was seen by the physician. Testing for the HLA-DR4 gene was positive. The physician considered the arthralgia to be possibly related to Lymerix administration. As of 03/28/03, the arthralgia persisted.

VAERS ID:228747 (history)  Vaccinated:2000-10-03
Age:1.0  Onset:2004-10-23, Days after vaccination: 1481
Gender:Female  Submitted:2004-10-27, Days after onset: 4
Location:Pennsylvania  Entered:2004-11-03, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1032K2IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01212SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720431IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.07600SCLL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash, Rash papular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Fever 101.6 10/23/04. Resolved. 10/25 fever and rash started. No cough rhin. No exposure to varicella, not ill. No oral lesions. Multiple red papules trunk, arms, scalp (few). No vesicles. Approx 40 lesions. 10 mot lesions over next 2 days no vesicles. Not ill.

VAERS ID:573600 (history)  Vaccinated:2000-10-03
Age:5.0  Onset:2015-03-17, Days after vaccination: 5278
Gender:Female  Submitted:2015-04-10, Days after onset: 24
Location:Unknown  Entered:2015-04-13, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hormonal contraceptives (unspecified)
Current Illness: Contraception
Preexisting Conditions:
Diagnostic Lab Data: 03/17/2015, Measles antibody, Positive; 03/17/2015, Mumps antibody test, Negative; 03/17/2015, Rubella antibody test, Positive
CDC Split Type: WAES1503USA014286
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Extra dose administered, Measles antibody positive, Mumps antibody test negative, Rubella antibody positive
SMQs:
Write-up: This spontaneous report as received from a licensed practical nurse refers to a 19 year old female patient non pregnant. Concurrent conditions or medical history were not reported. The licensed practical nurse stated that on 02-DEC-1996, the patient was vaccinated with a first dose of M-M-R II (lot #, expiration date and route of administration unspecified). Later, on 03-OCT-2000, the patient was vaccinated with a second dose of M-M-R II (lot #, expiration date and route of administration unspecified). On 26-MAR-2015 was administered in error a booster dose of M-M-R II (Lot #: J014876 Expiration date: 21-NOV-2015) (dose not specified) third dose, intramuscular in the left arm in the deltoid. As concomitant drugs, unspecified oral contraceptives were reported. The nurse stated that the patient received the booster dose of M-M-R II due to titers, which were collected on 17-MAR-2015 as a part of pre-employment physical examination, where the antiviral tests showed immunity to measles and rubella but non-immunity to mumps. At the time of this report, the primary reporter was not aware of any adverse event of adverse effects concerning the patient, and she stated that the patient was otherwise healthy. She also stated that she did not had an extensive health history of the patient, therefore other details about patients history could not be provided. Additional information has been requested.

VAERS ID:163684 (history)  Vaccinated:2000-10-03
Age:71.0  Onset:2000-10-16, Days after vaccination: 13
Gender:Unknown  Submitted:2000-12-06, Days after onset: 51
Location:Foreign  Entered:2000-12-13, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, carbimalols, bendrofluazide, propanolol
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MPU2000006430
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.786402 IM 
Administered by: Other     Purchased by: Other
Symptoms: Guillain-Barre syndrome, Muscular weakness, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Hypersensitivity (broad), Respiratory failure (narrow)
Write-up: The pt was dx''d with probable Guillain-Barre Syndrome, which manifested into limb weakness and respiratory failure. The events occurred 13 days, post vax. Treatment with IV immunoglobulin; respiratory failure recovered, limb weakness improving. The reporter considered the reaction as serious, due to hospitalization and the reaction being life threatening.

VAERS ID:167080 (history)  Vaccinated:2000-10-03
Age:45.0  Onset:2000-10-03, Days after vaccination: 0
Gender:Female  Submitted:2001-03-07, Days after onset: 155
Location:Foreign  Entered:2001-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Myogram-viral inflammation, EMG L plexus neuropathy
CDC Split Type: WAES01022134
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site inflammation, Lymphadenopathy, Malaise, Neck pain, Neuralgia, Neuropathy, Paraesthesia, Paralysis, Viral infection
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad)
Write-up: Information has been received from a health professional concerning a 45 year old female pt who was vaccinated with a dose of Hep-B and subsequently in 2001, "the woman had a swollen axillary lymph node during 24 hours and felt unwell during 2 1/2 months". Then the pt had total paralysis of the vaccinated arm. It was reported that the pt went to a neurologist who dx''d "spreading nervous inflammation starting from the plexus. The general dx was reported as "post-vaccination syndrome". Paralysis, swollen axillary node and feeling unwell were considered to be disabling by the reporter. No further information is available. F/U info rec''d on 4/11/01 from the neurologist''s report on 1/16/01 indicated that since 12/00 (previously reported as 2001) the patient has been suffering from a painless paralysis in the L arm. She also had tingles in the arm, thumb pain and neck pain, but these disorders were stable. The pt has no past medical history she was perfectly healthy and takes no medication. Medical examination showed no atrophy. Passive function of the shoulder pain with stimulation. Sensitivity was completely intact. Reflexes trapezius 5/5, deltoids 5/2, supra spinatus 5/2, lat dorsi 5/23, triceps 5/4, biceps 5/4, brachio radialis 5/4.5, abd digit quinti 5/4, normally symnetrical. Reflexes of the arms, left side lower than right. According to the neurologist the pt suffers froma a plexopathy, probably related to an amyotrophic neuralgia of the shoulder. Prognosis: optimistic. The pt''s arm is supple and she exercises alot. The neurologist''s report form 2/10/01 indicated there was a big improvement of the pt''s condition. She went back to work also. The medical exam showed that only the M. supra spinatus was still paretic (degree 4) but the force was normal. According to the neurologist there was a possible relation between the hepatitis B vaccine and the symptoms. The conclusion of the neurologist he thinks that amyotrophic neuralgia of the shoulder could be attributable to a viral infection and suspects specifically he

VAERS ID:173150 (history)  Vaccinated:2000-10-03
Age:6.0  Onset:2001-03-01, Days after vaccination: 149
Gender:Female  Submitted:2001-07-10, Days after onset: 130
Location:Foreign  Entered:2001-07-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Temperature taken on Jun 2001 was 39 C
CDC Split Type: 20010162071
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (DITANRIX)SMITHKLINE BEECHAM  IM 
Administered by: 0     Purchased by: 0
Symptoms: Erythema, Granuloma, Injection site abscess, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 5 months after injection the pt developed redness and swelling of the injected arm. She developed a granuloma. The pt developed fever and an abscess. She was hospitalized to under go a surgical drainage of the abscess.

VAERS ID:188852 (history)  Vaccinated:2000-10-03
Age:71.0  Onset:2000-10-17, Days after vaccination: 14
Gender:Male  Submitted:2002-08-09, Days after onset: 661
Location:Foreign  Entered:2002-08-14, Days after submission: 5
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: Epanutin, furosemide, perindopril, phenobarbital
Current Illness:
Preexisting Conditions: Haematuria, mitral regurgitation, rectal bleeding, epilepsy NOS
Diagnostic Lab Data: Electroencephalography, blood glucose, serum blood urea, complete blood cell count, hepatic function tests, serum electrolytes test, thyroid function test-all normal
CDC Split Type: WAES0208USA01200
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERT57721 IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0768J IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Dyskinesia, Joint swelling, Muscular weakness, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Information has been received from a health professional concerning a 71 year old (previously reported as 70 year old) male with epilepsy and a history of mitral regurgitation, hematuria (no cause found), and rectal bleeding. On 10/03/00 the pt was vaccinated IM with a dose of pneumococcal vaccine 23 polyvalent (lot 632149/0768J; batch HK25940). Concomitant suspect therapy, that day, included an IM dose of influenza virus vaccine (Fluzone lot T57721). It was previously reported that the pt had received influenza virus vaccine in November 2000. Additional concomitant medication included Epanutin, phenobarbital, perindopril, and furosemide. The pt was reported to be well at the time of vaccination. Two weeks later, on approximately 10/17/00, the pt developed painful, swollen joints and some edema of his legs. By the following week, on approximately 10/24/00, he had developed generalized tremor of his upper limbs, including some jerky muscular movements and felt that his legs were weak. He continued to remain much the same with almost chorea type movements of the upper limbs, shakiness, and weakness. The pt was seen by a local physician, who was unable to find any "hard" neurological signs. Routine blood tests were reported to be normal, including CBC, urea, electrolytes, liver function tests, thyroid function tests, and blood sugar. EEG was also reported to be normal. The pt had several hospital admissions "for support" (dates not specified). It was noted that in spite of the repeated tests and investigations, no obvious causes for his symptoms were never found. The symptoms gradually improved with time and have slowly settled. The pt was reported to be recovering. Painful joints, swollen joints, edema, generalized tremor of upper limbs/jerky muscular movements/shakiness, and weakness were considered to be other important medical events. No further info is available. The case is closed.

VAERS ID:218211 (history)  Vaccinated:2000-10-03
Age:71.0  Onset:2000-10-20, Days after vaccination: 17
Gender:Male  Submitted:2004-03-25, Days after onset: 1252
Location:Foreign  Entered:2004-03-29, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Epanutin (phenytoin) 2 bd since 2/20/94. Phenobarbitone 1 bd and 3 tds since 3/30/94. Carbamazipine 1 bd since 6/5/99. Co-Proxamol 2 qds prn since 10/9/00. Frusemide since 12/4/00. Zopiclone start not indicated, but stopped taking 12/30/00.
Current Illness:
Preexisting Conditions: Spondylosis; Large bowel endoscopy; Mitral valve incompetence; Lower respiratory tract infection; Epilepsy; Left ventricular failure; Hemorrhoids; Ex-smoker; Echocardiography; Cataract; Radiculopathy; Perineal irritation
Diagnostic Lab Data:
CDC Split Type: E200400886
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Coordination abnormal
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: A 71 year old male patient received influenza vaccine, manufacturer and batch not reported, on 10/3/00. Concomitant medications (indications not specified). The patient experienced ataxia and polyarthralgia commencing on 10/20/00. The patient was reported as not recovered at the time of the report. The MHRA considered the reaction as serious (OMIC). There is no indication of the reporter''s assessment of seriousness. No further data expected. Case is closed.

VAERS ID:242948 (history)  Vaccinated:2000-10-03
Age:87.0  Onset:0000-00-00
Gender:Male  Submitted:2005-08-12
Location:Foreign  Entered:2005-08-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0508USA01072
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bacterial infection, Drug ineffective, Sepsis
SMQs:, Agranulocytosis (broad), Lack of efficacy/effect (narrow)
Write-up: It was reported in a published article and confirmed by the primary author that an 87 year old male, with no reported history, who on 10/3/00 was vaccinated with a dose of pneumococcal 23v polysaccharide vaccine. The patient developed pneumococcal bacteremia and was hospitalized on 5/18/01. Subsequently, the patient recovered from pneumococcal bacteremia. Other business partner numbers include E200503009 and E200502987 to E200503017. Additional information is not available. The case is closed. A copy of the published article is attached as further documentation of the patient''s experience.

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