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Case Details (Sorted by Vaccination Date)

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VAERS ID: 126205 (history)  
Age: 0.2  
Gender: Female  
Location: New York  
Vaccinated:1999-07-08
Onset:1999-07-08
   Days after vaccination:0
Submitted: 1999-07-09
   Days after onset:1
Entered: 1999-07-20
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457793 / 0 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402203A / 0 - / IM L
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0957 / 0 - / SC L
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988063 / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Anorexia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: cbc
CDC Split Type:

Write-up: day of vax, pt devel fever 101f & irritability for 12 hrs & loss of appetite


VAERS ID: 126174 (history)  
Age: 24.0  
Gender: Female  
Location: Georgia  
Vaccinated:1999-07-08
Onset:1999-07-08
   Days after vaccination:0
Submitted: 1999-07-13
   Days after onset:5
Entered: 1999-07-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0515H / - RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Chest pain, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: same day of vax pt exp light headedness, chest pain, weakness. treated w/fluids


VAERS ID: 126229 (history)  
Age: 1.0  
Gender: Female  
Location: Florida  
Vaccinated:1999-07-08
Onset:1999-07-20
   Days after vaccination:12
Submitted: 1999-07-21
   Days after onset:1
Entered: 1999-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 2 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1790H / - RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0437J / - LL / -

Administered by: Private       Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12days p/vax pt devel rash on left leg


VAERS ID: 126316 (history)  
Age: 66.0  
Gender: Female  
Location: Ohio  
Vaccinated:1999-07-08
Onset:1999-07-10
   Days after vaccination:2
Submitted: 1999-07-13
   Days after onset:3
Entered: 1999-07-26
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 7023AB / - - / -

Administered by: Private       Purchased by: Other
Symptoms: Myasthenic syndrome, Nervousness, Paraesthesia, Tremor, Vasodilatation
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: acupril water pill cardisine
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: bloodwork for calcium/potassium, all ok
CDC Split Type:

Write-up: 2day p/vax pt both legs became numb from the knee down. uncontrollable internal shaking/trembling from hips down. hot flash, weakness in upper limbs, nervous/trembling sensation throughout body.


VAERS ID: 126810 (history)  
Age: 1.0  
Gender: Female  
Location: California  
Vaccinated:1999-07-08
Onset:1999-07-14
   Days after vaccination:6
Submitted: 1999-07-26
   Days after onset:12
Entered: 1999-08-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Pyrexia, Rash, Somnolence, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6days p/vax pt ran fever, was lethargic & unresponsive. 8 days later pt devel a rash over her body.


VAERS ID: 126814 (history)  
Age: 1.3  
Gender: Female  
Location: California  
Vaccinated:1999-07-08
Onset:1999-07-18
   Days after vaccination:10
Submitted: 1999-07-23
   Days after onset:5
Entered: 1999-08-02
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 095770 / 3 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 095770 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0128J / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 458436 / - - / PO

Administered by: Private       Purchased by: Private
Symptoms: Erythema multiforme, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash began 10days p/vax on neck + upper chest; over next 2-3days began spreading to torso, arms, lower extremities; rash target erythema multiforme


VAERS ID: 126976 (history)  
Age: 43.0  
Gender: Female  
Location: Washington  
Vaccinated:1999-07-08
Onset:1999-07-08
   Days after vaccination:0
Submitted: 1999-07-21
   Days after onset:13
Entered: 1999-08-06
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 7302AA / - LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt rpt similar episode 9yr ago w/DT vax, fever, chills, nausea, vomiting~ ()~~~In patient
Other Medications: synthoid;eoshrogew
Current Illness: 4 cm laceration RLE
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type: WA991578

Write-up: 3-4hr p/vax pt devel fever 101, chills, nausea, vomiting; resolved within 8-12 hours


VAERS ID: 127341 (history)  
Age: 0.2  
Gender: Male  
Location: Ohio  
Vaccinated:1999-07-08
Onset:1999-07-10
   Days after vaccination:2
Submitted: 1999-07-12
   Days after onset:2
Entered: 1999-08-19
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0257J / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0257 / 0 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome, Unevaluable event
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neonatal disorders (narrow)

Life Threatening? No
Died? Yes
   Date died: 1999-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hep, 4/27/99
Current Illness: none
Preexisting Conditions: 35 week premature; 2 vessel cord; jaundice; sacral dimple; single kidney; low sono; hernia
Diagnostic Lab Data: at County Coroner
CDC Split Type:

Write-up: pt presented DOA; possible SIDS; possible maternal overlay;


VAERS ID: 127638 (history)  
Age: 1.9  
Gender: Male  
Location: Ohio  
Vaccinated:1999-07-08
Onset:1999-07-08
   Days after vaccination:0
Submitted: 1999-07-09
   Days after onset:1
Entered: 1999-08-26
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457790 / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Vasodilatation
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA per mom
Diagnostic Lab Data: NONE
CDC Split Type: OH99054

Write-up: 7/8/99 red area size of a Q tip appeared per mom;7/9/99 red area approx 5cm noted lt arm warm to touch-no irritability or fever noted;children''s APAP for fever;


VAERS ID: 128300 (history)  
Age: 0.2  
Gender: Unknown  
Location: New York  
Vaccinated:1999-07-08
Onset:1999-08-31
   Days after vaccination:54
Submitted: 1999-09-01
   Days after onset:1
Entered: 1999-09-16
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH - / 0 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 0 - / PO
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 0 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Cyanosis, Infection, Rhinitis, Skin discolouration, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Died? Yes
   Date died: 1999-08-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: preemie 34 wk gest w/ vesicostomy d/t urethral obstuction; Apgar 5-7, , hypotension, hyperbilirubinemia to 9 @ birth, intubated d/t abd ascites x3 day then infrequent apnea, bradycardia; cystocopy 8/99, bilateral ureteral stenosis
Diagnostic Lab Data: unkown
CDC Split Type: 899245020A

Write-up: p/vax pt devel congestion & a runny nose; seen by MD who observed pt to be mottled; pale & cyanotic; pt taken to ER & was intubated; attempts at resuscitation unsuccessful; Autopsy revealed urosepsis with E coli bacteria, pyelonephritis, cystitis, hydronephrosis, ureteral stenosis,


VAERS ID: 128516 (history)  
Age: 73.0  
Gender: Female  
Location: New York  
Vaccinated:1999-07-08
Onset:1999-07-09
   Days after vaccination:1
Submitted: 1999-08-30
   Days after onset:52
Entered: 1999-09-27
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1573H / - RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 7341A / - LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Lymphadenopathy, Serum sickness
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: levothyroxine
Current Illness: fibromyalgia
Preexisting Conditions: s/pthyroidectomy
Diagnostic Lab Data:
CDC Split Type:

Write-up: arthus type of reaction;redness on lt deltoid area 1 day p/inc progressively, w/lt axilla pain;called in 4-5 days later to report rxn & then given DPH;


VAERS ID: 129007 (history)  
Age: 0.2  
Gender: Female  
Location: New Jersey  
Vaccinated:1999-07-08
Onset:0000-00-00
Submitted: 1999-07-16
Entered: 1999-10-06
   Days after submission:82
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462356 / - - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 08773 / - LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 410003A / - - / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988048 / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: 899200022A

Write-up: p/vax pt devel fever of 102.5 & loose stools w/inc mucus content;pt hosp from 7/10/99 through 7/13/99 because of fever;7/16/99 stools still contained mucus;


VAERS ID: 173486 (history)  
Age: 41.0  
Gender: Female  
Location: Foreign  
Vaccinated:1999-07-08
Onset:2000-07-10
   Days after vaccination:368
Submitted: 2001-07-20
   Days after onset:375
Entered: 2001-07-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Optic neuritis, Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Optic nerve disorders (narrow), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular infections (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: CEREBROSPINAL FLUID: Oligoclonal signs-10/2000; ELECTROMYOGRAM-Normal; FINGER-NOSE MANEUVER-Mild Dysmetria of left upper limb-2000; MRI- Functiform signs-2000; Tendon Reflex: Exaggeration-2000.
CDC Split Type: 20010170661

Write-up: On 9/23/92, 10/23/92, 11/23/92, 12/08/93 and 7/8/99, the pt was vaccinated with Engerix-B at a dose of 20 mcg. In February 1998, the patient experienced median nerve distress at the right carpal tunnel with nocturnal pain and paresthesia (considered as non-events) for which she was treated with infiltration. On 07/08/1998, the patient received another injection of Engerix B at a dose of 20 mcg. On 7/10/00, 2 year after the last injection, the pt developed left hand paralysis and left eye retrobulbar optic neuritis. Therefore, the patient was treated with IV Methylprednisolone (solumedrol) for 3 days which was switched to per os delievery form for 1.5 month. MRI showed several punctiform signs. Oligoclonal signs were observed in cerebrospinal fluid. In October, 2000, neurological check-up was normal. Only a slight akwardness in right and movement was observed. at the end of october 2000, the patient''s experienced left upper limb dysesthia with left hand weakness. Nuerological examination showed mild amyotrophy of interossel palnares muscle (thumb and fifth finger abductor), hyposthesia mild dysmetria of the left upper limb infinger-nose maneuvre, exaggeration of tendon reflex and pyramidal tract lesion of upper limbs. diagnosis of multiple sclerosis was suspected The patient was then hospitalized and treated with infusions of methyprednisolone at a dose of 15 gm. On 02/21/2001, clinical examinations showed persistent parathesia. Therefore the patient initiated interferon-beta-1a (Avonex) In August 2001, the patient experienced left sciatica treated with unspecified corticoid drug this case was considered as incapcitating. This case was down graded from SU to SE on 10/12/01. the most recent information received on 10/12/01 reports the outcome of the patient as not yet recovered. Causality assessment was reported by the AFSSAPS as dubious for Engerix B It was noticed that the neurologist did not considered these events as adverse events.


VAERS ID: 175282 (history)  
Age: 2.0  
Gender: Male  
Location: Foreign  
Vaccinated:1999-07-08
Onset:1999-07-08
   Days after vaccination:0
Submitted: 2001-08-28
   Days after onset:782
Entered: 2001-09-14
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0831H / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abnormal behaviour, Autism
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES01081851

Write-up: Information has been received from a health authority concerning a 24 month old male pt who on 7/8/99 was vaccinated with a dose of MMRII, diphtheria toxoid (+) haemophilus b conjugate vaccine (+) pertussis vaccine (+) tetanus toxoid (TETRACT-HIB). The pt''s behavior changed within days and he was subsequently dx''d with autism. The reporter considered the pt''s autism to be disabling. As of 8/13/01, the pt had not recovered. It was reported that the case was closed. No further information is available. F/U states the US equivalent lot number was added to the report (627694/0831H).


VAERS ID: 182596 (history)  
Age: 48.0  
Gender: Male  
Location: Foreign  
Vaccinated:1999-07-08
Onset:1999-08-01
   Days after vaccination:24
Submitted: 2002-03-14
   Days after onset:956
Entered: 2002-03-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apraxia, Asthenia, Balance disorder, Cerebellar syndrome, Demyelination, Depression, Dysarthria, Dyskinesia, Dysphagia, Extensor plantar response, Hemiparesis, Memory impairment, Micturition urgency, Multiple sclerosis, Muscle disorder, Muscle spasticity, Paraesthesia, Skin ulcer, Somnolence, Visual disturbance
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Physical exam-dx''d cerebellar syndrome in 8/00; MRI-cerebral-numerous demyelinating lesions T2 weighted hypersignals in protuberances periventricular in 10/00; MRI-cerebral-supra and subtentorial lesions compatible with demyelinating disease
CDC Split Type: WAES0202USA01615

Write-up: Information has been received from a lawyer and from a health authority (through an association of pts) concerning a 48 year old male who on 12/26/98, 1/29/99 and 7/8/99 was vaccinated with the 1st, 2nd and 3rd doses of Hep-B vaccine recombinant, respectively (yeast) (10mcg), IM. Since 8/99, the pt has suffered from unusual asthenia and has experienced involuntary movement of the left foot (also reported as clonia of the left foot) and paresthesia of the right upper limb. In 11/99, the pt developed balance troubles (ebrious sensations) and paresthesia of the extremities. One month later, in 12/99, he developed paresthesia on the face, hand and foot on the left side with dysarthria, troubles of deglutition and micturition urgency. It resolved in 2 weeks. His condition aggravated with the onset of transient paresthesia and balance difficulties. In May-June, 2000, the pt developed another episode of paresthesia of both hands, balance troubles and micturition urgency. He was examined by a neurologist in 8/00 (also reported as during summer 2000), who dx''d a cerebellar syndrome. In 10/00, a cerebral MRI showed numerous demyelinating lesions of T2 weighted hypersignals in protuberance and periventricular white matter. In 1/01, the pt was hospitalized for a paresis of the right half of the body with dysarthria and deglutition troubles. In February-March, 2001, right hemiplegia relapsed and he was hospitalized again to be treated with infusions of methylprednisolone (Medrol) for 5 days. The pt''s "troubles" persisted in the right upper limb. Another cerebral MRI confirmed supra and subtentorial lesions compatible with a demyelinating disease. In 4/01, the pt was hospitalized for a speech therapy and infiltration of the right shoulder linked to a frozen shoulder. At the time of the report in 2/02, the pt suffered from severe asthenia and hypersomnia, paresthesia of both hands, sequela from the right hemiplegia and facial palsy, persistent dysarthria and deglutition troubles, dyspraxia, difficulty in focusing with the left eye, disability with the right upper and lower limbs leading to an ataxic walking, a spastic hypertonia. It was also reported that the pt continued to suffer from walking, balance and memory disorders, depression and a paresis of the right half of the body. Tendon reflexes were acute in the 4 limbs and a Babinski''s sign was present on the left side. The pt suffered also from anxious and depressive syndrome with suicidal thoughts and apragmatism despite a treatment with citolopram (20mg/day) and interferon (3 injections/week since 4/12/01). After investigation (not reported), multiple sclerosis was dx''d. The pt had several relapses involving hospitalizations. It was noted that the report is not medically confirmed. He is very disabled (70%) (also reported as 80%). Multiple sclerosis was considered by the reporter to be disabling. No further information is available. A 15-day follow up report received 12/24/2003 adds: Follow-up info from a lawyer noted that investigations performed in 2000 included: normal visual and auditive evoked potentials; somesthesic evoked potentials showed bilateral disorder of conduction in the cervical medullar fibers; MRI showed several T2 weighted hypersignals in the protuberance and in the periventricular areas evoking demyelinating disorder; CSF inflammatory and lymphocytic fluid. It was also reported that the pt was hospitalized several times; from 11/3/2000 to 11/4/2000 for a check-up; from 01/20/2001 to 01/21/2001 for dysarthria, deglutition troubles and pareses of the right half of the body and received infusions of methylprednisolone (Medrol); from 02/11/2001 to 03/16/2001 for the same episode (a 2nd MRI on 02/26/2001 confirmed the diagnosis of multiple sclerosis); from 03/19/2001 to 03/27/2001 for an infection (not reported). It was noted that the pt continued to suffer from a permanent disability of the right upper limb, dysarthria, severe asthenia and was very depressive. Multiple s


VAERS ID: 125643 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-12
   Days after onset:2
Entered: 1999-07-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: child lt deltoid almost to elbow had considerable swelling, redness & warmth-no pain, no fever reported;


VAERS ID: 126081 (history)  
Age: 0.3  
Gender: Male  
Location: Missouri  
Vaccinated:1999-07-09
Onset:1999-07-15
   Days after vaccination:6
Submitted: 1999-07-16
   Days after onset:1
Entered: 1999-07-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6916EA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 450253A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N08262 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4998190 / 1 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Gastrointestinal haemorrhage, Intestinal obstruction, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: hypertonicity
Diagnostic Lab Data: positive small bowel obs; positive ultrasound; positive enema
CDC Split Type:

Write-up: 6days p/vax pt exp vomiting, bloody stools, crying;Dx w/intussusception; ultrasound confirmed;Annual follow-up dated 10/12/00 provided no additional data.


VAERS ID: 126084 (history)  
Age: 49.0  
Gender: Male  
Location: Washington  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-12
   Days after onset:2
Entered: 1999-07-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 4 RA / -

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Diarrhoea, Eye disorder, Eye pain, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ippd connaught #250111 rt arm; Augmentin
Current Illness: resolving sinusitis
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: day p/vax pt felt feverish, eyes sting & burn, diffuse myalgias/arthralgias, nausea, diarrhea.


VAERS ID: 126091 (history)  
Age: 5.0  
Gender: Female  
Location: Alabama  
Vaccinated:1999-07-09
Onset:1999-07-11
   Days after vaccination:2
Submitted: 1999-07-12
   Days after onset:1
Entered: 1999-07-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0132J / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Neck pain, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: pallor
Preexisting Conditions: none;NKDA, no birth defects
Diagnostic Lab Data: XRAY hips, WNL-no bony abnormalities; ESR II
CDC Split Type:

Write-up: 2days p/vax pt c/o hip pain, temp 101.2 & stomach ache, positive point tenderness in bilateral trochanters per MD exam.


VAERS ID: 126111 (history)  
Age: 52.0  
Gender: Female  
Location: Virginia  
Vaccinated:1999-07-09
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1999-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 7345AA / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Myalgia, Oedema, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: allergies, hypertension
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt exp fever, swelling & body aches


VAERS ID: 126115 (history)  
Age: 0.4  
Gender: Female  
Location: Georgia  
Vaccinated:1999-07-09
Onset:1999-07-13
   Days after vaccination:4
Submitted: 1999-07-14
   Days after onset:1
Entered: 1999-07-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 910A2 / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0258J / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0651 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Infection, Injection site inflammation, Oedema, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: tylenol
Current Illness: na
Preexisting Conditions: na
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 4days p/vax pt inflamed inject site, looked red, infected, swollen. treatment, ice & warm salt soaks


VAERS ID: 126150 (history)  
Age: 0.16  
Gender: Male  
Location: Utah  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-13
   Days after onset:3
Entered: 1999-07-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 903A2 / - RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0964270 / - RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / - LL / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Cardiac arrest, Stupor, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? Yes
   Date died: 1999-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~0.00~Patient
Other Medications: tylenol
Current Illness: nasal stuffiness -+ np swab moraxella catarrbalis
Preexisting Conditions: nicu x 5d presummed congenital sepsis
Diagnostic Lab Data: not known care provided by ER
CDC Split Type:

Write-up: p/vax pt fed & then found unresponsive; asystolic on arrival to hosp; unable to resuscitate; all sutures split in cranium


VAERS ID: 126160 (history)  
Age: 21.0  
Gender: Male  
Location: California  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-15
   Days after onset:5
Entered: 1999-07-20
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4978252 / - LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 596C6 / 0 RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Hepatic function abnormal, Leukocytosis, Nausea, Paraesthesia, Paraesthesia oral
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cliocin
Current Illness: NONE
Preexisting Conditions: NONE KNOWN
Diagnostic Lab Data: liver function panel-mildly elevated, CBC, UA, chemistry panel, elevated white count w/left shift
CDC Split Type:

Write-up: 1day p/vax pt possibly had fever & chills; felt weak, nausea; in ER c/o tingling/numbness of hands, feet & mouth area; given IV fluids & adm to hosp; improved in less than 24 hrs;


VAERS ID: 126171 (history)  
Age: 1.5  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-07-09
Onset:1999-07-09
   Days after vaccination:0
Submitted: 1999-07-12
   Days after onset:3
Entered: 1999-07-20
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1344H / - - / SC L

Administered by: Private       Purchased by: Other
Symptoms: Convulsion, Febrile convulsion, Gaze palsy, Hypertonia, Hypotonia, Muscle twitching
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: CXR, norm; CBC WNL, WBC, RSSL
CDC Split Type:

Write-up: following vax pt exp 3 min seizure pt stiffened & fell straight, feet & legs jerked, eyes rolled up. then went limp. dx febrile sz.


VAERS ID: 126227 (history)  
Age: 2.0  
Gender: Male  
Location: Texas  
Vaccinated:1999-07-09
Onset:1999-07-12
   Days after vaccination:3
Submitted: 1999-07-21
   Days after onset:9
Entered: 1999-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1802H / 0 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: mri & eeg pending
CDC Split Type:

Write-up: approx 3days p/vax pt exp absence type seizures, staring off into space & decreased level of responsiveness. had several episodes over period of 8days.


VAERS ID: 126354 (history)  
Age: 1.0  
Gender: Female  
Location: Utah  
Vaccinated:1999-07-09
Onset:1999-07-19
   Days after vaccination:10
Submitted: 1999-07-19
   Days after onset:0
Entered: 1999-07-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 2 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0958H / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0303J / 0 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: nafl
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 10day p/vax pt woke up w/axillary temp of 100f & red raised rash on trunk, p/bath more on neck, face, diaper area.


VAERS ID: 126394 (history)  
Age: 1.5  
Gender: Male  
Location: Texas  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-10
   Days after onset:0
Entered: 1999-07-27
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7390AA / 3 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: well check
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: local rxn lt thigh erythematous 8x5 x 4.25cm toward inner aspect;warm to touch, swelling;


VAERS ID: 126414 (history)  
Age: 30.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-07-09
Onset:1999-07-09
   Days after vaccination:0
Submitted: 1999-07-12
   Days after onset:3
Entered: 1999-07-28
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0994610 / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest pain, Chills, Dyspnoea, Hypertonia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: IPPD, conng #249711, sc
Current Illness: none
Preexisting Conditions: chronic neck pain, sleep interuption
Diagnostic Lab Data: EKG, norm
CDC Split Type:

Write-up: p/vax pt devel chills, shivering progressing to muscle tightness & spasm in arms & legs, chest tightness, difficulty breathing.


VAERS ID: 126421 (history)  
Age: 8.0  
Gender: Male  
Location: South Carolina  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-15
   Days after onset:5
Entered: 1999-07-28
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2566D9 / 0 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: SC99037

Write-up: day p/vax pt devel hives on face.


VAERS ID: 126441 (history)  
Age: 0.5  
Gender: Female  
Location: North Carolina  
Vaccinated:1999-07-09
Onset:1999-07-16
   Days after vaccination:7
Submitted: 1999-07-16
   Days after onset:0
Entered: 1999-07-29
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890A2 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2808A2 / 2 RL / IM
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988045 / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: gastroesophageal reflux
Diagnostic Lab Data: barium enema
CDC Split Type: NC99054

Write-up: acute onset of vomiting & bloody stools;dx w/intussusception;resolved w/barium enema;


VAERS ID: 126444 (history)  
Age: 0.2  
Gender: Male  
Location: Tennessee  
Vaccinated:1999-07-09
Onset:1999-07-11
   Days after vaccination:2
Submitted: 1999-07-20
   Days after onset:9
Entered: 1999-07-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 0 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958A2 / 0 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N1165AA / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N1062 / 0 - / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988066 / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: KUB x-ray;BA enema
CDC Split Type:

Write-up: pt recv vax 7/9/99 & devel fever 102 on 7/11/99;pt vomited 7/12/99;hematochezia 7/12 - 7/13/99;intussusception reduced by radiography 7/14/99;


VAERS ID: 126461 (history)  
Age: 0.3  
Gender: Female  
Location: North Carolina  
Vaccinated:1999-07-09
Onset:1999-07-12
   Days after vaccination:3
Submitted: 1999-07-23
   Days after onset:11
Entered: 1999-07-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 - / -

Administered by: Military       Purchased by: Military
Symptoms: Abdominal pain, Agitation, Anorexia, Diarrhoea, Flatulence, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt , low grade fever & stiffness, 2mo old, rotavirus, dose 1~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: 1 mo premature, lactose intolerance
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 3 days p/vax pt had low grade fever, pt began to vomit p/feeding, appetite was off, fussy at times, diarrhea, looked like pt was gassy, colicky at times.


VAERS ID: 126462 (history)  
Age: 0.3  
Gender: Female  
Location: North Carolina  
Vaccinated:1999-07-09
Onset:1999-07-12
   Days after vaccination:3
Submitted: 1999-07-23
   Days after onset:11
Entered: 1999-07-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Agitation, Anorexia, Diarrhoea, Flatulence, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt low grade fever, 2months, 1 dose~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: 1 month premature, lactose intolorance
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 3days p/vax pt had low grade fever, vomit p/feeding, appetite was off, fussy at times, began having diarrhea, gassy, colicky at time.


VAERS ID: 126775 (history)  
Age: 52.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-07-09
Onset:1999-07-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1999-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 1 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Malaise, Mental impairment, Nasopharyngitis, Respiratory tract congestion, Tinnitus, Upper respiratory tract infection
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Arthritis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt-flushing, erythematous pruritic rash,no dypnea-ANTH #1;pt-unk rxn-flu~ ()~~0.00~In Patient
Other Medications: claritin w/ dose admin 1hr apart
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt exp 2 ecchymotic areas over lt thigh, 12x8cms & lt arm 2x2cms; general malaise; joint aches; . continue evaluation. seen by allergist Per follow-up: Ring in ears continues (Tinitis). Energy level still low. Frequent chest congestion and colds, URI. Prolonged period of fatigue. Sore muscles and painful joints, mental fog and impaired concentration as well as items listed to the right, I feel this anthrax shot has damaged my overall health and immune system.


VAERS ID: 126790 (history)  
Age: 1.0  
Gender: Female  
Location: Tennessee  
Vaccinated:1999-07-09
Onset:1999-07-09
   Days after vaccination:0
Submitted: 1999-07-22
   Days after onset:13
Entered: 1999-08-02
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / L
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 0 - / L

Administered by: Private       Purchased by: Other
Symptoms: Convulsion, Cyanosis, Dysphagia, Muscle twitching, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/recv vax pt exp jerking arms/legs, not responding to me, blue lips & legs, gagging or chocking, like a mild seizure


VAERS ID: 126805 (history)  
Age: 5.0  
Gender: Male  
Location: Florida  
Vaccinated:1999-07-09
Onset:1999-07-11
   Days after vaccination:2
Submitted: 1999-07-23
   Days after onset:12
Entered: 1999-08-02
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0132J / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302A1 / 3 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Oedema peripheral, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2days p/vax pt devel ? fever, hot to touch, swollen arm x1week. tx: ice, tylenol, warm compress


VAERS ID: 126869 (history)  
Age: 0.2  
Gender: Female  
Location: California  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-19
   Days after onset:9
Entered: 1999-08-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462317 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1363H / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 0 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Screaming, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Hostility/aggression (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: inconsolable crying for 72hr decreased feeding resulting in 50z weight loss;


VAERS ID: 126882 (history)  
Age: 42.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-07-09
Onset:1999-07-13
   Days after vaccination:4
Submitted: 1999-08-03
   Days after onset:21
Entered: 1999-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 1 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Ecchymosis, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hepA, Merck, 1prev dose, 4/5/99; ippd, conngt, #250311, 4/13/99
Current Illness: none
Preexisting Conditions: cholesterol
Diagnostic Lab Data: punch biopsy-outcome nonspecific
CDC Split Type:

Write-up: pt states sudden onset of multiple bruises 5 days p/recv 1st vax; bruises identified as 1'''' diam @inject site; 3 each 1'''' diam on waistline; 2 each 11/2''''x1'''' rt leg; 3'''' diam rt popliteal area; 1 on lt arm, lt forearm, lt thigh, lt knee


VAERS ID: 126910 (history)  
Age: 1.0  
Gender: Male  
Location: California  
Vaccinated:1999-07-09
Onset:1999-07-18
   Days after vaccination:9
Submitted: 1999-07-20
   Days after onset:2
Entered: 1999-08-04
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890A2 / 3 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402253A / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1550H / 0 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0799F / 2 - / PO

Administered by: Public       Purchased by: Other
Symptoms: Agitation, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: approx 9 days p/vax pt devel rash over the arms & legs; pt had fever (low grade)


VAERS ID: 127018 (history)  
Age: 22.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1999-07-09
Onset:1999-07-15
   Days after vaccination:6
Submitted: 1999-07-16
   Days after onset:1
Entered: 1999-08-09
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 0 LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0997390 / - RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0301J / 0 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: vitamins
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: blood tests of some king
CDC Split Type: MN99012

Write-up: devel lumps under arms;sore;mild fever @ noc;given 10 days course of ATB;


VAERS ID: 127037 (history)  
Age: 1.2  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-07-09
Onset:1999-07-23
   Days after vaccination:14
Submitted: 1999-08-01
   Days after onset:9
Entered: 1999-08-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: floride QD
Current Illness: teething
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: rash 14 days p/vax lots over chest, back (a few on arms, legs & face)-very fussy;


VAERS ID: 127648 (history)  
Age: 1.3  
Gender: Male  
Location: Idaho  
Vaccinated:1999-07-09
Onset:1999-07-09
   Days after vaccination:0
Submitted: 1999-07-09
   Days after onset:0
Entered: 1999-08-26
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462317 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453A / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1360H / 0 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798B / 0 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Asthma, Lacrimal disorder, Pruritus, Rhinitis, Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: ID99011

Write-up: p/vax pt started sneezing & rubbing eyes/nose, child had loud wheezing, eyes started watering, cheeks flushed, welts forming on legs & body;child weight 25#, given DPH referred to private MD for further eval;


VAERS ID: 128099 (history)  
Age: 0.7  
Gender: Female  
Location: Maine  
Vaccinated:1999-07-09
Onset:1999-07-15
   Days after vaccination:6
Submitted: 1999-09-01
   Days after onset:48
Entered: 1999-09-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abnormal faeces
SMQs:, Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt-8months; RRV-TV, dose #1; D~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: p/vax pt had D for nearly 29 days; p/29th day stool very hard; pt otherwise healthy


VAERS ID: 128113 (history)  
Age: 0.1  
Gender: Female  
Location: Alaska  
Vaccinated:1999-07-09
Onset:1999-07-13
   Days after vaccination:4
Submitted: 1999-09-02
   Days after onset:51
Entered: 1999-09-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0684E / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: CSF test abnormal, Convulsion, Encephalitis, Meningitis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: PCR-pos HSV Type II in spinal fluid
CDC Split Type:

Write-up: pt devel seizures 4 days p/vax; later found to have herpes meningitis; brother had cold sores


VAERS ID: 133372 (history)  
Age: 0.3  
Gender: Female  
Location: California  
Vaccinated:1999-07-09
Onset:2000-01-11
   Days after vaccination:186
Submitted: 2000-01-19
   Days after onset:8
Entered: 2000-01-21
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 48075 / 2 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Electrolyte imbalance, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: barium enema, abnormal electrolytes
CDC Split Type:

Write-up: Child had intussusception at 10 months of age reduced by enema.


VAERS ID: 150293 (history)  
Age: 40.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-07-09
Onset:0000-00-00
Submitted: 2000-03-17
Entered: 2000-03-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM 123B9 / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Arthralgia, Lethargy, Pyrexia, Rheumatoid arthritis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt experienced athralgia, MD told pt his arthritis may be due to Lyme Vaccine. The pt also experienced lethargy. The lethargy and the now dx rheumatoid arthritis persists. Also states temperature as high as 101 degrees. The follow up received on 8/28/00 states, "pt never called our office with any adverse reactions so we have no date of onset."


VAERS ID: 150465 (history)  
Age: 0.3  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-07-09
Onset:1999-11-01
   Days after vaccination:115
Submitted: 2000-03-20
   Days after onset:140
Entered: 2000-03-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462355 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1920H / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 1 LL / IM
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 48055 / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Intestinal obstruction
SMQs:, Gastrointestinal obstruction (narrow)

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:

Write-up: Intussusception 11/1999. Reduced by air enema.


VAERS ID: 150780 (history)  
Age: 35.0  
Gender: Male  
Location: Texas  
Vaccinated:1999-07-09
Onset:1999-07-30
   Days after vaccination:21
Submitted: 2000-04-01
   Days after onset:246
Entered: 2000-04-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV044 / 2 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt developed arthralgia in left hand lasting for 6 weeks. Pt also experienced left elbow pain with motion which is still present.


VAERS ID: 151154 (history)  
Age: 25.0  
Gender: Male  
Location: North Dakota  
Vaccinated:1999-07-09
Onset:1999-07-09
   Days after vaccination:0
Submitted: 1999-07-09
   Days after onset:0
Entered: 2000-05-02
   Days after submission:298
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV043 / 3 RA / UN

Administered by: Military       Purchased by: Military
Symptoms: Unevaluable event
SMQs:

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: Aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: None Stated


VAERS ID: 152640 (history)  
Age: 0.4  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-07-09
Onset:1999-07-15
   Days after vaccination:6
Submitted: 1999-12-22
   Days after onset:160
Entered: 2000-06-03
   Days after submission:163
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 - / -

Administered by: Public       Purchased by: Public
Symptoms: Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Abdominal x-ray - neg
CDC Split Type: 899256055L

Write-up: A physician reported that a 5 or 6 month old infant received Rota Shield and subsequently became lethargic and vomited 1 to 2 weeks following receipt of the vaccine. The infant was hospitalized. Abdominal x-ray was neg. The infant was discharged from the hospital. No further information was available at the date of this report. Follow up information received form the physician indicated that the infant recovered.


VAERS ID: 152653 (history)  
Age: 32.0  
Gender: Female  
Location: Washington  
Vaccinated:1999-07-09
Onset:0000-00-00
Submitted: 2000-05-26
Entered: 2000-06-05
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Foetal disorder, Postpartum haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Colace and vitamins
Current Illness: Pregnancy LMP-6/13/1999
Preexisting Conditions: spontaneous abortion
Diagnostic Lab Data: ultrasound-nml; serum alpha-fetoprotein-nml
CDC Split Type: WAES99101512

Write-up: Subsequently post vax, the pt was determined to be pregnant at the time of vaccination. LMP was 6/13/99. The estimated date of delivery was 3/20/00. The physician reported no complications at the time. The pt took a prenatal vitamin during the pregnancy. She also took Colace to prevent constipation. The pt gave birth to a normal male on 3/17/00. The pt experienced severe postpartum hemorrhage. The severe postpartum hemorrhage was considered a significant medical event. The infant experienced transient jaundice.


VAERS ID: 154419 (history)  
Age: 52.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-07-09
Onset:0000-00-00
Submitted: 1999-09-29
Entered: 2000-06-15
   Days after submission:260
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 0 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)

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: 19990204701

Write-up: Subsequently post vax, the pt developed a reddened area at the injection site. No treatment was given. This adverse event resolved after 1 1/2 weeks.


VAERS ID: 154569 (history)  
Age: 1.8  
Gender: Female  
Location: Alabama  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 1999-07-16
   Days after onset:6
Entered: 2000-06-19
   Days after submission:339
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462313 / 3 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site oedema, Purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: UNK
CDC Split Type: 899200085A

Write-up: One day post vax, pt developed an injection site reaction characterized by extreme swelling and a purpuric rash. The pt was seen by the physician on 7/12/99. No further information was available at the date of this report.


VAERS ID: 154684 (history)  
Age:   
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-07-09
Onset:0000-00-00
Submitted: 1999-07-16
Entered: 2000-06-19
   Days after submission:339
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES A909A2 / - - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 1203H / - - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1894H / - - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U1999004840

Write-up: Pt developed redness and a large knot at the injection site.


VAERS ID: 155072 (history)  
Age: 43.0  
Gender: Female  
Location: Florida  
Vaccinated:1999-07-09
Onset:1999-07-09
   Days after vaccination:0
Submitted: 2000-02-14
   Days after onset:220
Entered: 2000-06-21
   Days after submission:127
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (RABAVERT) / NOVARTIS VACCINES AND DIAGNOSTICS 208011 / 0 - / IM

Administered by: Public       Purchased by: Other
Symptoms: Diarrhoea, Headache, Influenza like illness, Vaccine positive rechallenge
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: A Febrile
Preexisting Conditions: allergy to eggs, irritable bowel syndrome and allergy to PCN
Diagnostic Lab Data:
CDC Split Type: 4186

Write-up: A 43 year old female has complained of severe headache for three hours after being treated each time with three dosed of Rabavert. The headache did not subside following the use of ibuprofen or other over-the-counter medications used for headaches. The headache eventually went away three days following the dose. She was pre-medicated with Benadryl before her fourth dose on 7/22/99 and did not experienced headaches. She plans to be pre-medicated prior to her fifth dose. Follow up information is pending. Information from follow-up report states: Follow-up report was received on 23 Nov 1999. The subject received RabAvert on 09 Jul 1999, 12 Jul 1999, 15 Jul 1999, and 22 Jul 1999. She also received human rabies immune globulin (HRIG) on 09 Jul 1999. She experienced headaces 3 hours after each RabAvert injection. She also experienced diarrhea which was very severe by the third vaccination and an "achy feeling like flu in body" which lessened after each repearted dose. She was treated with Imodium, and the headaches resolved on 23 Jul 1999 after taking over the counter Benadryl.


VAERS ID: 155391 (history)  
Age: 0.2  
Gender: Female  
Location: Utah  
Vaccinated:1999-07-09
Onset:1999-07-14
   Days after vaccination:5
Submitted: 1999-12-22
   Days after onset:161
Entered: 2000-06-23
   Days after submission:183
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462356 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0837J / 0 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / - RL / IM
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988105 / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Faeces pale, Irritability, Melaena
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypoglycaemia (broad)

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: IN June, 1999, infant developed oral thrush and was treated with a 14 day course of Diflucan.
Diagnostic Lab Data: Stool specimen-neg
CDC Split Type: U1999010880

Write-up: "A physician reported that a 2 month old female, within 5 days post vax, developed diarrhea which lasted 1 week followed by 3 episodes of bloody stools and then mucus in the stools which lasted 5 weeks. The infant was "fussy or colicky" and was seen by the physician on 8/24/99. On 8/26/99, the mother reported that the infant was more colicky and continued to have blood in her stools."


VAERS ID: 156128 (history)  
Age: 41.0  
Gender: Male  
Location: Unknown  
Vaccinated:1999-07-09
Onset:1999-09-01
   Days after vaccination:54
Submitted: 2000-07-07
   Days after onset:310
Entered: 2000-07-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Arthropathy, Asthenia, Bone disorder, Cyst, Feeling hot, Hypokinesia, Inflammation, Injury, Joint effusion, Joint stiffness, Pain, Pyrexia, Rheumatoid arthritis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: He has had some baseline discomfort in his knees that he contributes to his work as a construction worker. He has a history of irritable bowel syndrome, appendectomy, bone graft right ear (1984) and multiple fractures post 2 motor vehicle accidents; 1st one by motorcycle (1978) involving right elbow, ankle and foot; 2nd accident was by truck. He underwent exploratory and evidently has a tear at the gastroduodenal junction area. The pt also has a mastoiditis up to 10 years ago. His family history is positive for osteoarthritis (mother).
Diagnostic Lab Data: MRI-right knee showed horizontal tear of meniscus, X-rays of knee-nml, X-rays of foot-showed minimal osteoarthritis and he had 20 CC''s of inflammatory fluid aspirated from left knee for analysis and culture, Chest X-ray-nml, X-ray hands-degenerative joint disease, X-rays wrists shows tiny scattered subchondal cysts in both wrists and small erosions are noted consistent with rheumatoid arthritis, ALT, HGB, HCT, MCV, ESR, Sodium, AST, Total Bilirubin, MCH, Lymphocytes, Granulocytes, Basophils, Rh Factor, Parvovirus, Synovial Analysist, Mononuclear, Neutophils, etc.
CDC Split Type: 20000202101

Write-up: The pt received Lymerix on 6/4/99 and 7/9/99. In early September, 1999, he experienced an onset of symptoms described as "all joints could not bend" and heat, swelling and "constant pain, 24 hours a day". On 10/29/2000, pt reported a sudden onset of right medial foot discomfort starting about the end of August, 1999. He was told it was related to an old fracture. Soon thereafter, he developed shoulder, back and leg soreness. He noted inflammation with significant swelling and pain involving hand joints, wrists, left shoulder and elbows. He also noted pain and swelling involving his knees and metatarsal phalangeal joints of both feet. He additionally, complained of decreased energy level and morning stiffness. Impression was that the pt had "probable new onset rheumatoid arthritis" as the pt had polyarticular small and large joint symmetrical synovitis of the upper and lower extremities with a positive rheumatoid factor. Rheumatologist thought this was unlikely. Activities of daily living were noted to be hampered (could not grip hammer). He was continued on Celebrex. 11/3/99, visit with 2nd Rheumatologist: 3 weeks ago, fairly acute onset of fevers up to 101F, associated with swelling and pain of his right knee, which progressed to his left knee, also, had severe joint pain in his shoulders and various small joints of his hands. Pt seen by an Orthopedist. 11/18/99, dx''d with "seropositive rheumatoid arthritis". Pt had dramatic response to aspiration and injection of knee. 11/29/99, pt felt to have rheumatoid arthritis and possibly inflammatory osteoarthritis, so prednisone increased. Morning stiffness and has not been able to return to work. 1/3/00, synovial thickening of wrists and some hand joints, right knee effusion. 2/21/00, dx is seropositive rheumatoid arthritis of 4 months duration, unable to taper prednisone below 15 mg. Methotrexate 7.5mg added. This case is considered serious because the pt has been disabled, since he has been out of work. The most recent information received on 6/26/00 reports the outcome of the events as persisting. Latest FU states the pt has been determined to have the gene for rheumatoid arthritis.


VAERS ID: 157308 (history)  
Age: 1.25  
Gender: Male  
Location: Unknown  
Vaccinated:1999-07-09
Onset:0000-00-00
Submitted: 2000-05-16
Entered: 2000-07-19
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES - / - - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / - - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1848H / 0 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Injection site erythema, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99071980

Write-up: Subsequent to receiving vax the pt experienced redness and a large knot at the injection site. The pt was seen in a physicians office. follow up information indicated that the adverse event in question involved DTAP and not Varivax.


VAERS ID: 157353 (history)  
Age: 1.0  
Gender: Female  
Location: Michigan  
Vaccinated:1999-07-09
Onset:1999-07-09
   Days after vaccination:0
Submitted: 2000-05-16
   Days after onset:312
Entered: 2000-07-19
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0426J / - - / SC

Administered by: Other       Purchased by: Other
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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: NONE
Diagnostic Lab Data:
CDC Split Type: WAES99070737

Write-up: Subsequent to receiving varicella virus vaccine live the pt developed a welt about 3/4 inches in diameter just above the injection site. Pt was treated with ice and the swelling decreased. The physician had a concern about the particular lot of vaccine.


VAERS ID: 158063 (history)  
Age: 66.0  
Gender: Male  
Location: Minnesota  
Vaccinated:1999-07-09
Onset:1999-11-01
   Days after vaccination:115
Submitted: 2000-07-06
   Days after onset:247
Entered: 2000-07-27
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM LY120F9 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthritis, Hypokinesia, Joint stiffness, Myalgia, Pain, Polymyalgia rheumatica, Red blood cell sedimentation rate increased
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cholesterol meds (NOS)
Current Illness:
Preexisting Conditions: Elevated cholesterol
Diagnostic Lab Data: Sed rate-32 mm/hr-elevated, TSH, CBC and AST-results pending
CDC Split Type: 20000163701

Write-up: On 6/1/99 and 7/9/99, the pt had his 1st and 2nd .5 cc dose of Lymerix. About 4 months later, in November 1999, he developed sore muscles and stiff joints which became progressively worse. He went to a physician who used "ultrasound" to dx "inflammation". The pt was treated with an unknown NSAID. By April, 2000, he could "hardly get out of bed". On 4/3/00, he was seen be a physician who did tests. He was dx''d with polymyalgia rheumatica. He was found to have a very stiff hip and shoulder. On 4/5/00, he started on prednisone and after the 1st dose, his symptoms resolved. The physician did not think that the dx was related to Lymerix. The most recent information, received on 6/16/00, reports the condition of the vaccinee as completely resolved.


VAERS ID: 204263 (history)  
Age: 1.3  
Gender: Male  
Location: Nebraska  
Vaccinated:1999-07-09
Onset:1999-07-13
   Days after vaccination:4
Submitted: 2003-05-30
   Days after onset:1417
Entered: 2003-06-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0348J / - - / -

Administered by: Other       Purchased by: Other
Symptoms: Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: 0204USA01577

Write-up: Information has been received from a health professional concerning a male child who on 07/09/1999, at his 15-month checkup, was vaccinated with measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation)(lot # 630623/0348J). Concommitant vaccination on 07/09/1999 included diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid (manufacturer unknown). The child''s mother reported that on 07/13/1999 the child developed a swollen thigh from which he subsequently recovered. In follow-up it was reported that the child did not received the second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) vaccination at his 4-year old checkup. The child was given poliovirus vaccine inactivated and diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid and subsequently developed swelling with the diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid. The reporter no longer felt that the swelling was related to the measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation). It was unknown if the patient had received medical attention for his experience. No further information is expected.


VAERS ID: 206754 (history)  
Age: 78.0  
Gender: Male  
Location: Iowa  
Vaccinated:1999-07-09
Onset:1999-07-10
   Days after vaccination:1
Submitted: 2003-07-23
   Days after onset:1474
Entered: 2003-07-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / - - / -

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Joint stiffness, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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: Lung problem
Diagnostic Lab Data: Doctor just look how stiff I was
CDC Split Type:

Write-up: Very stiff and joint pain. Pain pills. I am very stiff to date. Took pain pills.


VAERS ID: 207929 (history)  
Age: 34.0  
Gender: Male  
Location: Texas  
Vaccinated:1999-07-09
Onset:1999-08-15
   Days after vaccination:37
Submitted: 2003-08-11
   Days after onset:1457
Entered: 2003-08-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV041 / 2 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Fatigue, Influenza like illness, Myalgia, Pyrexia, Testicular disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Fertility disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 1 month after Anthrax #3, developed muscle and joint pain (myalgia, arthralgia). Approx 6 weeks after Anthrax #3, developed testicular pain. Follow up: chronic myalgias, flu-like symptoms, fever, muscle aches, tiredness.


VAERS ID: 215542 (history)  
Age: 82.0  
Gender: Male  
Location: Iowa  
Vaccinated:1999-07-09
Onset:0000-00-00
Submitted: 2004-01-23
Entered: 2004-01-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -

Administered by: Public       Purchased by: Other
Symptoms: Arthritis, Infection, Medication error, Musculoskeletal stiffness, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (narrow), Medication errors (narrow)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0493514A

Write-up: This report described the occurrence of Lyme arthritis and/or Lyme disease in an 82 year old male pt who received Lyme disease vaccine recombinant OspA (LYMErix) for prophylaxis. This report was received as part of litigation proceedings, and has not been verified by a physician or other health care professional. The pt received injections of LYMErix on 6/8/99 and 7/9/99 "according to the client." This was considered to be a drug maladministration due to the fact that LYMErix is not indicated for immunizing individuals greater than 70 years of age. On 1/12/04, the pt''s attorney alleged that the pt developed "treatment resistant Lyme arthritis and/or treatment resistant Lyme disease," with symptoms including "aches, stiffness, and swelling of his lower extremities." The attorney further alleged that the pt suffered pain that was described as "at times debilitating" and which "severely limited her employment options and opportunities." According to the attorney the pt was under the care of a general practitioner, and received anti-inflammatory and other medications without relief of symptoms. Information from Annual Follow-up report states this adverse event was received through the litigation process. Additional information regarding the event, including outcome information, is being pursued through the litigation process and will be reported if obtained.


VAERS ID: 264639 (history)  
Age: 1.0  
Gender: Male  
Location: Georgia  
Vaccinated:1999-07-09
Onset:2006-10-10
   Days after vaccination:2650
Submitted: 2006-10-11
   Days after onset:1
Entered: 2006-10-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0442J / 0 LL / -

Administered by: Other       Purchased by: Other
Symptoms: Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TB skin test (L) forearm
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 25-30 red papular bumps over trunk, arms and face. To give Benadryl and use Calamine lotion.


VAERS ID: 281232 (history)  
Age: 1.1  
Gender: Female  
Location: Ohio  
Vaccinated:1999-07-09
Onset:2006-07-28
   Days after vaccination:2576
Submitted: 2007-05-16
   Days after onset:292
Entered: 2007-05-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1838H / 0 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Varicella
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0608USA01630

Write-up: Information has been received from a physician concerning an 8-year-old white female who on 09-JUL-1999 at 11:40AM was vaccinated in the left arm with a first dose of Varivax (Lot # 628697/1838H). On 28-JUL-2006 the patient broke out with chickenpox. Subsequently, the patient recovered. No additional information is expected.


VAERS ID: 303821 (history)  
Age: 0.2  
Gender: Female  
Location: California  
Vaccinated:1999-07-09
Onset:1999-09-14
   Days after vaccination:67
Submitted: 2008-01-29
   Days after onset:3059
Entered: 2008-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 0998410 / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER N0727 / 0 - / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 0 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dehydration, Haematochezia, Lethargy, Listless, Pallor, Vomiting, X-ray
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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: Intussusception~Rotavirus (no brand name)~~0.40~Patient
Other Medications:
Current Illness:
Preexisting Conditions: PMH: elevated WBCs at birth. NKDA.
Diagnostic Lab Data: X-ray was taken, then Barium Enema as a first step to retreat blocking. If not fixed, then surgery. Labs and Diagnostics: BE showed ileocolonic intussusception all the way to the descending colon. LFTs with LDH 788 and AST 37.
CDC Split Type:

Write-up: Vomiting all intake. Listless, Lethargic, Pale. Dehydrated. Finally a bloody diaper. 02/05/2008 Vax record recd from PCP and TC with PCP. Date of only Rotavirus vax given noted as 7/9/1999. WCC (2 month) on 7/9/1999 with normal exam except scaly seborrhea noted. WCC 8/31/99 with normal exam. OV 9/20/99 with c/o vomiting all day. PE (+) for Lethargy, depressed fontanelle, and a LLQ mass felt. Sent for admission to hospital with Assessment: AGE, ? malrotation, ? volvulus. F/U 9/23/99-child admitted with currant jelly stools. DX Intussusception. Reduced by Barium enema. 02/19/2008 MR received for DOS 9/20-21/1999 with D/C DX: Intussusception. Infant presented and treated as above. D/C home next day


VAERS ID: 315030 (history)  
Age: 9.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-07-09
Onset:2007-06-10
   Days after vaccination:2893
Submitted: 2008-05-16
   Days after onset:341
Entered: 2008-05-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0706USA02339

Write-up: Information has been received from a nurse concerning a 9 year old male who on 09-JUL-1999 was vaccinated with a dose of varicella virus vaccine live (Oka/Merck). On 10-JUN-2007, the patient developed a severe case of chickenpox with about 500 lesions. Unspecified medical attention was sought. No lab diagnostic studies were performed. As of 13-JUN-2007, the patient''s severe case of chickenpox persisted. There was no product quality complaint. Additional information is not expected.


VAERS ID: 127462 (history)  
Age: 1.3  
Gender: Male  
Location: Foreign  
Vaccinated:1999-07-09
Onset:1999-07-12
   Days after vaccination:3
Submitted: 1999-07-12
   Days after onset:0
Entered: 1999-08-23
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dermatitis bullous, Lymphocytosis, Pharyngitis, Purpura, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: 7/99 lumbar puncture-unsuccessful; white cells-12,480; polynuclears-29%; lymphocytes-61%
CDC Split Type: WAES99081188

Write-up: 7/12/99 exp high grade fever; 7/14/99 vesicular rash; 7/15/99 infected rhinopharyngitis; tx amoxicillin; 7/16/99 T 104 & purpuric spots; hosp; unsuccessful lumbar puncture;fever x 6 days, duration of rash unk as well as outcome;


VAERS ID: 126164 (history)  
Age: 36.0  
Gender: Male  
Location: Louisiana  
Vaccinated:1999-07-10
Onset:1999-07-10
   Days after vaccination:0
Submitted: 1999-07-16
   Days after onset:6
Entered: 1999-07-20
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -

Administered by: Military       Purchased by: Military
Symptoms: Abnormal dreams, Amnesia, Dehydration, Dizziness, Insomnia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: memory loss, dizziness, sleepless night, bad dreams, & dehydration


VAERS ID: 126776 (history)  
Age: 47.0  
Gender: Female  
Location: D.C.  
Vaccinated:1999-07-10
Onset:0000-00-00
Submitted: 1999-07-22
Entered: 1999-08-02
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV044 / 0 - / SC A

Administered by: Military       Purchased by: Military
Symptoms: Dermatitis contact, Injection site mass, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: contralateral peripheral neuropathy
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 48hr of tenderness + induration at vax site; max induration 6-7cm; devel dermatitis 3day p/vax, however, pt has hx of gardening w/ development of poison ivy dermatitis just like this; pt gardened day of vax


VAERS ID: 126835 (history)  
Age: 56.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-07-10
Onset:1999-07-13
   Days after vaccination:3
Submitted: 1999-07-21
   Days after onset:8
Entered: 1999-08-03
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES - / - - / IM

Administered by: Other       Purchased by: Other
Symptoms: Erythema multiforme, Hepatic function abnormal, Jaundice
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Severe cutaneous adverse reactions (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: liver function tests: elevated
CDC Split Type: 899203061A

Write-up: 3days p/vax pt devel erythema multiforme, became jaundiced, & was hosp on 7/19; pt remained hosp due to elevated liver function tests


VAERS ID: 126942 (history)  
Age: 8.0  
Gender: Female  
Location: Tennessee  
Vaccinated:1999-07-10
Onset:1999-07-16
   Days after vaccination:6
Submitted: 1999-07-21
   Days after onset:5
Entered: 1999-08-05
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0625H / 1 - / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Anorexia, Face oedema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: no
CDC Split Type: TN99024

Write-up: pt devel loss of appetite, rash (like poison oak) on face, both arms, mostly in bend of elbows; chest has small amount & mostly on cheeks & neck; swelling on jaws; recovering; treated w/meds


VAERS ID: 127000 (history)  
Age: 39.0  
Gender: Male  
Location: Oregon  
Vaccinated:1999-07-10
Onset:1999-07-10
   Days after vaccination:0
Submitted: 1999-07-10
   Days after onset:0
Entered: 1999-08-09
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 - / SC

Administered by: Other       Purchased by: Military
Symptoms: Pain, Testicular disorder
SMQs:, Fertility disorders (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: right testicular pain


VAERS ID: 127003 (history)  
Age: 41.0  
Gender: Male  
Location: Oregon  
Vaccinated:1999-07-10
Onset:1999-07-11
   Days after vaccination:1
Submitted: 1999-07-23
   Days after onset:12
Entered: 1999-08-09
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Dysuria, Ejaculation disorder, Penis disorder
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: burning w/urination & ejaculation approx 12-24 hr onset following inject; two pustules, tender to touch on penis


VAERS ID: 127443 (history)  
Age: 28.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:1999-07-10
Onset:1999-07-11
   Days after vaccination:1
Submitted: 1999-07-12
   Days after onset:1
Entered: 1999-08-23
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Asthenia, Hyperhidrosis, Influenza, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: p/vax pt c/o flu like symptoms; T100; sweats; itching joints; fatigue;


VAERS ID: 127445 (history)  
Age: 22.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:1999-07-10
Onset:1999-07-12
   Days after vaccination:2
Submitted: 1999-07-12
   Days after onset:0
Entered: 1999-08-23
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 - / SC

Administered by: Military       Purchased by: Private
Symptoms: Chest pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: EKG-WNL BP-102/60 p72 lungs clear bilat
CDC Split Type:

Write-up: p/vax pt devel substantial chest pain; body aches also present;


VAERS ID: 127727 (history)  
Age: 43.0  
Gender: Male  
Location: Delaware  
Vaccinated:1999-07-10
Onset:0000-00-00
Submitted: 1999-08-23
Entered: 1999-08-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 2 RA / -

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Asthenia
SMQs:, Guillain-Barre syndrome (broad), Arthritis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 3/31/99-p/vax ache began in rt shoulder, age 43;anthrax 1st in series; #fav043~ ()~~~In patient
Other Medications: IPPD, 7/13/99
Current Illness: NA
Preexisting Conditions: NA
Diagnostic Lab Data: CBC; ANA;SED RATE; RF;LFS
CDC Split Type:

Write-up: p/vax pt shoulder & elbow both ache on & off; sl diminished energy level;


VAERS ID: 128498 (history)  
Age: 30.0  
Gender: Female  
Location: California  
Vaccinated:1999-07-10
Onset:1999-07-16
   Days after vaccination:6
Submitted: 1999-09-11
   Days after onset:57
Entered: 1999-09-27
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 1 - / SC A

Administered by: Military       Purchased by: Military
Symptoms: Hypertonia, Injection site pain, Pain, Thinking abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: n/a~ ()~~~In patient
Other Medications: norplant
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: p/vax pt felt like muscular cramping in inj site; constantly sore & throbbing; pain @ inj site so severe pt couldn''t concentrate @ work; MD tx ibuprofen & physical therapy;


VAERS ID: 128916 (history)  
Age: 42.0  
Gender: Male  
Location: Tennessee  
Vaccinated:1999-07-10
Onset:1999-07-13
   Days after vaccination:3
Submitted: 1999-08-09
   Days after onset:27
Entered: 1999-10-05
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 0 RA / SC

Administered by: Military       Purchased by: Military
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: anthrax by Bioport lot# FAV043 given 7/24/99;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax w/rash covering both arms & groin area;rash very itchy & appears to dry up w/the use of DPH;


VAERS ID: 129671 (history)  
Age: 15.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-07-10
Onset:1999-07-22
   Days after vaccination:12
Submitted: 1999-10-05
   Days after onset:75
Entered: 1999-10-22
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1399H / 0 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Confusional state, Convulsion, Headache, Hypokinesia, Meningitis, Nuchal rigidity
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? Yes
   Date died: 1999-08-01
   Days after onset: 10
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES99092260

Write-up: p/vax pt devel h/a, stiff neck & a change in mental status, & was unable to walk;pt hosp;pt devel sz;8/1/99 pt died;initial eval & COD is aseptic meningitis;3 other cases viral meningitis is community during same time frame


VAERS ID: 154412 (history)  
Age: 62.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-07-10
Onset:0000-00-00
Submitted: 1999-09-29
Entered: 2000-06-15
   Days after submission:260
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 0 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

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: lower back stiffness
Diagnostic Lab Data:
CDC Split Type: 19990203851

Write-up: Subsequently post vax, the pt experienced joint pain in middle fingers of both hands spreading to whole hand.


VAERS ID: 157297 (history)  
Age: 23.0  
Gender: Female  
Location: Georgia  
Vaccinated:1999-07-10
Onset:1999-07-20
   Days after vaccination:10
Submitted: 2000-05-16
   Days after onset:301
Entered: 2000-07-19
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1657H / 0 - / SC

Administered by: Public       Purchased by: Private
Symptoms: Nausea, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:
CDC Split Type: WAES99071906

Write-up: 10 days post vax the pt experienced nausea and vomiting with low grade fever. the following day the pt developed five non-vesicular lesions on her arm with low grade fever and nausea. It was noted that the lesions did not become vesicular.


VAERS ID: 234693 (history)  
Age: 0.86  
Gender: Female  
Location: Ohio  
Vaccinated:1999-07-10
Onset:1999-07-13
   Days after vaccination:3
Submitted: 2005-03-08
   Days after onset:2065
Entered: 2005-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood glucose increased, Candidiasis, Diabetes mellitus, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

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: None
CDC Split Type:

Write-up: My daughter received the Hep B and Polio-OPV vaccines on July 10, 1999. On July 12-13th she developed thrush in her mouth (she was 10 1/2 months old). On July 14th she had lost 2 pounds from July 10th check-up (she only weighed 21 pounds at the time). On July 16th her blood sugar was 685 and she was diagnosed as having Type 1 diabetes, just 6 days after her vaccines were administered. 60 Day Follow up: Pt is now a type 1 diabetic. She showed signs on 7/13/99 (3 days after vaccine) and was diagnosed 7/16/1999. Per follow up report-Diabetes Type 1


VAERS ID: 292202 (history)  
Age: 42.0  
Gender: Male  
Location: Hawaii  
Vaccinated:1999-07-10
Onset:2000-02-15
   Days after vaccination:220
Submitted: 2007-10-04
   Days after onset:2787
Entered: 2007-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER 43 / 4 LA / UN

Administered by: Military       Purchased by: Military
Symptoms: Alopecia, Amnesia, Anger, Arthralgia, Back pain, Blepharospasm, Blood test, Chills, Computerised tomogram, Depression, Diarrhoea, Dizziness, Fatigue, Feeling drunk, Gastrooesophageal reflux disease, Hot flush, Hypoaesthesia, Hypokinesia, Insomnia, Libido decreased, Loss of consciousness, Lymphadenopathy, Migraine, Muscle spasms, Myalgia, Nuclear magnetic resonance imaging, Osteitis, Osteoarthritis, Pain, Paraesthesia, Pruritus, Skin papilloma, Sluggishness, Speech disorder, Squamous cell carcinoma, Swelling, Swelling face, Tenderness, Thirst, Throat tightness, Urticaria, Weight increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Osteonecrosis (broad), Ocular motility disorders (narrow), Skin malignant tumours (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: closing of throat~Anthrax (no brand name)~4~0.30~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: neuro, blood by VA could help on previous test, VA medical record with each condition reported MRIs, CAT Scans,
CDC Split Type:

Write-up: Full body aches and pain constant, ichy sensations, tingling sensations, full numbness in arms and legs, also numbness in head area, fatigue, depression episodes, throat reaction where it closed up similar to when someone is allergic to sea food which would cause me to pass out, insomnia, glads in throat swell, migrain sever headachs, finger joint and tissue swelling, dizzy, memory loss episodes, degeriation of joints also in lower, mid, upper back, and in the neck, angery out burst, feeling hot flashes, chills, tender hot to touch sensations on skin, weight gain, dirrea, slow moving, sluggish feeling like alcohol headach hang over like, sexual desire loss, loss of hair, wart growths around finger nails, squima carcinoma cancer, acide reflux, hard to find proper common words, or remember names of people who are well known to me, cramps in back, and leg muscles, in bottom of feet sensation of electrical current, swelling by both jaws below the ear lobes, facial sweeling, eyelid twiching, constant thirst, pain in knees but diagnosed with good healthy knees, hives, leg and foot cramps, I HAVE CONSISTANTLY GIVEN THIS INFORMATION AND THE VACINE TAKEN TO MY VA DOCTOR BUT THE DOCTOR IS NOT WILLING TO EXAMINE IN THE ADVERSE REACTION DIRECTION OF THE ANTRAX VACINE


VAERS ID: 127314 (history)  
Age: 38.0  
Gender: Male  
Location: Foreign  
Vaccinated:1999-07-10
Onset:1999-07-10
   Days after vaccination:0
Submitted: 1999-08-10
   Days after onset:31
Entered: 1999-08-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME) / BERNA BIOTECH, LTD 01488901 / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: colitis ulcerosa
Diagnostic Lab Data:
CDC Split Type: ADRTEA9903

Write-up: same day pt had severe local react -- redness, swelling & induration $g5cm; hosp; local infection was excluded; pt recovered under symptomatic tx; anti-inflammatory drug; anti-histaminic, ATB & was disch 7/15/99;


VAERS ID: 154318 (history)  
Age: 28.0  
Gender: Male  
Location: Foreign  
Vaccinated:1999-07-10
Onset:1999-07-10
   Days after vaccination:0
Submitted: 1999-08-10
   Days after onset:31
Entered: 2000-06-15
   Days after submission:310
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME) / BERNA BIOTECH, LTD 01488901 / 1 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site mass, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Colitis ulcerosa
Diagnostic Lab Data:
CDC Split Type: ADRTEA9903

Write-up: A 28 year old male subject received a 2nd dose of tetanus toxoid vaccine on 7/10/99, 7 weeks after a 1st dose on 5/18/99. The same day a severe local reaction developed (redness, swelling and induration $g5cm in diameter). On 7/12/99, the pt admitted himself to a hospital where a local infection was excluded. The pt recovered under symptomatic treatment (anti-inflammatory drug, anti-histaminic, antibiotic) and was discharged on 7/15/99.


VAERS ID: 126995 (history)  
Age:   
Gender: Male  
Location: Oregon  
Vaccinated:1999-07-11
Onset:1999-07-11
   Days after vaccination:0
Submitted: 1999-07-13
   Days after onset:2
Entered: 1999-08-09
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Back pain, Influenza, Injection site pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: lethargic feeling; flu like feelings; back & left arm aches (point of inject)


VAERS ID: 127296 (history)  
Age: 39.0  
Gender: Male  
Location: Washington  
Vaccinated:1999-07-11
Onset:1999-07-11
   Days after vaccination:0
Submitted: 1999-07-23
   Days after onset:12
Entered: 1999-08-17
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / -

Administered by: Military       Purchased by: Unknown
Symptoms: Muscle twitching, Pain, Skin nodule
SMQs:, Dyskinesia (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: burning in arm for 5 min''s
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/recv vax pt thumb devel a twitch (uncontrollable) 3 to 7 days post vax;day 1 to 14 p/vax pt exp large warm lump in upper forearm, pain in lump;


VAERS ID: 127740 (history)  
Age: 12.0  
Gender: Female  
Location: Tennessee  
Vaccinated:1999-07-11
Onset:1999-07-11
   Days after vaccination:0
Submitted: 1999-07-12
   Days after onset:1
Entered: 1999-08-30
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2934A2 / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1648H / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Chest pain, Hypertension, Nausea, Pain, Pharyngitis, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Acid pl;allergies ?PCN;
Diagnostic Lab Data: posassium 2.5;
CDC Split Type: TN99028

Write-up: pt became nauseated & passed out w/in 2min p/vax;pt was brought into clinic room & ammonia was used to bring back;awakened & then lost consciousness again;c/o chest pain, arm pain & throat pain;BP 123/89 & pulse 100;epi given & DPH;


VAERS ID: 129442 (history)  
Age: 53.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-07-11
Onset:1999-07-11
   Days after vaccination:0
Submitted: 1999-09-24
   Days after onset:75
Entered: 1999-10-18
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 RA / -
TTOX: TETANUS TOXOID (NO BRAND NAME) / CONNAUGHT LABORATORIES 093944009 / 0 LA / -

Administered by: Military       Purchased by: Military
Symptoms: Abdominal pain, Headache, Injection site hypersensitivity, Injection site mass, Injection site oedema, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: immed area of inj site was hot & swollen;the next day;7/12/99 feverish, stomach-cramped & became very fatigued;knot in arm is still there;


VAERS ID: 132571 (history)  
Age: 53.0  
Gender: Male  
Location: New York  
Vaccinated:1999-07-11
Onset:1999-07-11
   Days after vaccination:0
Submitted: 1999-11-27
   Days after onset:139
Entered: 1999-12-15
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 2 RA / SC

Administered by: Military       Purchased by: Unknown
Symptoms: Asthenia, Headache, Injection site hypersensitivity, Injection site mass, Myalgia, Pharyngitis, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6/11/99 was fatigued, weak, headach, lump on arm, nausea; 6/24/99 weak, fatigued, all bones ached, lump on arm; 7/11/99 headache, sore throat, large rash on neck w/in 1 hr of shot, lasted 2 weeks, raspberry type rash still persists.


VAERS ID: 134019 (history)  
Age: 41.0  
Gender: Male  
Location: Kansas  
Vaccinated:1999-07-11
Onset:1999-07-11
   Days after vaccination:0
Submitted: 2000-01-24
   Days after onset:197
Entered: 2000-02-15
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV044 / - - / -

Administered by: Military       Purchased by: Military
Symptoms: Asthenia, Chills, Immune system disorder, Influenza, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low immune system, tired all the time, no ambition to do anything, body aches, flu like symptoms, chills; can not get warmed up.


VAERS ID: 134082 (history)  
Age: 47.0  
Gender: Male  
Location: Mississippi  
Vaccinated:1999-07-11
Onset:0000-00-00
Submitted: 2000-02-09
Entered: 2000-02-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 RA / -

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Asthenia, Injection site hypersensitivity, Injection site mass, Pruritus, Weight increased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Moderate local rxn - hard nodule, rash, extreme itchness, local area. Chronic fatigue since July 1999. Weight gain. Joint sorness - minor.


VAERS ID: 192411 (history)  
Age: 0.6  
Gender: Male  
Location: New York  
Vaccinated:1999-07-11
Onset:0000-00-00
Submitted: 2001-10-17
Entered: 2002-11-01
   Days after submission:380
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH - / 1 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 - / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Unk
Preexisting Conditions: Food allergy
Diagnostic Lab Data: Unk
CDC Split Type: HQ6268621SEP2001

Write-up: A mother reported that her 7 month old son received his second dose of Rota Shield along with Hib-Titer, Orimune and DTaP (manufacturer unknown) vaccines on 7/11/99. On unspecified dates beginning in infancy, her son experienced bouts of diarrhea lasting for weeks at a time.


VAERS ID: 204129 (history)  
Age: 67.0  
Gender: Male  
Location: Oklahoma  
Vaccinated:1999-07-11
Onset:2001-09-25
   Days after vaccination:807
Submitted: 2003-05-28
   Days after onset:610
Entered: 2003-06-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0888H / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Laboratory test abnormal
SMQs:

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: Asthma NOS, hypertension NOS
Diagnostic Lab Data: Serum cholesterol 312 high, specimen appeared cloudy; serum hep A hep A IgM AB negative; serum triglyceride 1191 high, specimen appeared cloudy
CDC Split Type: WAES0207USA01063

Write-up: Information has been received from a 67 year old male surgeon with asthma and hypertension who on 12/4/98 was vaccinated in the deltoid with the first dose of hep A virus vaccine inactivated (626422/0603M). On 7/11/99 the surgeon was vaccinated in the deltoid with the second dose of hep A virus vaccine inactivated (627357/0888H). There were no illnesses at the time of the vaccinations. On 9/25/01 a hep A IgM antibody test yielded negative results. On that same day, high lab values were also yielded for cholesterol 312 and triglycerides 1191. The surgeon reported that he had no apparent immunity and no hep A antibodies. Subsequently, the surgeon recovered. The pt also experienced a similar event after vaccination with hep B vaccine (WAES0204USA02495) and also reported that other members of his family also had no measurable antibodies after vaccination with hep A virus vaccine (WAES0207USA01064). This is a consolidation of two reports concerning the same pt. No further info is available.


VAERS ID: 232525 (history)  
Age: 37.0  
Gender: Female  
Location: Virginia  
Vaccinated:1999-07-11
Onset:1999-07-18
   Days after vaccination:7
Submitted: 2005-01-19
   Days after onset:2012
Entered: 2005-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS - / 0 - / -

Administered by: Military       Purchased by: Military
Symptoms: Abdominal pain, Agitation, Amnesia, Arthralgia, Depression, Diarrhoea, Disturbance in attention, Erythema, Fatigue, Feeling abnormal, Feeling hot, Fibromyalgia, Gait disturbance, Gastrointestinal disorder, Headache, Hypersensitivity, Hypokinesia, Hypothyroidism, Influenza like illness, Malaise, Migraine, Nausea, Neck pain, Pain, Photophobia, Pruritus, Pyrexia, Rash, Skin disorder, Sluggishness, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypothyroidism (narrow), Depression (excl suicide and self injury) (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none at that time
Current Illness: Denies any illness with onset vaccinations. Having GI, myalgia, arthralgia etc that worsen with sequential vaccinations (4 AVA''s received).
Preexisting Conditions: Denies
Diagnostic Lab Data: Normal Values 8/2/2004 1/2/2003 8/2/2004 1/2/2003 Trig 130 114 Albumin 4.6 4.1 Chol 229 242 Globulin 2.8 3.3 HDL 117 124 Total Bili 0.2 0.2 LDL 86 95 Alk Phos 71 72 Chol/HDLC 2.0 2 AST 19 16 Glucose 51 67 ALT 20 17 BUN 9 13 Sed Rate 12 Creat 0.8 0.8 WBC 4.8 Na 137 141 RBC 4.19 K 5.0 5 Hgb 12.1 Cl 97 97 Hct 36.0 CO2 28 27 Plat 313 Calcium 9.8 9.6 Diff Wnl Total Prot 7.4 7.4 TSH 3.75 2.37
CDC Split Type:

Write-up: This healthy 42 year old began her Anthrax vaccinations in 1999. She reported feeling “loopy and weird” for approximately one week following her first immunization on 11 July 1999. She reported “loopy” as a sensation of her skeleton moving inside her and feeling her joints move but not a true ache. She reported flu-like symptoms of nausea, fatigue, fevers, and general body aches which she self treated with over the counter medications. She reported increasing severity and duration of the flu-like symptoms, fevers and body aches with each subsequent vaccination. After receiving anthrax #3 on 7 August 1999, she stated her overall joint pains were persisting for weeks at a time. She believed it to be a normal response to the vaccination and her increasing age (late 30's) so she just tolerated it. One week after the third anthrax vaccination, she began to experience terrible throbbing headaches. She described the headache beginning as a dull ache to the top of her cranium and within 30 minutes it was as if an ice pick were going through her forehead. She complained of photophobia and noise sensitivity. These headaches lasted 4-6 hours requiring use of Darvocet-N-100 to dull the headache allowing her to sleep. The headaches occurred once every two weeks for over a year and now (2004) occur approximately twice a year. She denies past history headaches, migraines, trauma, illness or use of glasses. She drank one cup coffee a day with no soda and occasional decaffeinated tea. She received her fourth anthrax vaccination on 7 January 2000. Within one week she reported increased feelings of generalized malaise, sluggishness, difficulties getting out of bed due to fatigue, feeling hot, and generalized body aches. These symptoms have never resolved and vary day to day. In September 2001 she saw her physician for “restriction in all activities of daily living” due to increasing pains and limitations in range of motion bilaterally to her hips, knees and neck. She stated she could walk but could no longer run due to the pain and had problems climbing stairs, lifting and using her arms. She reported problems with a stumbling gait with difficulty maintaining her balance. Her hip pain was a 9.5/10; her knees were a 4/10 requiring the use of a cane to assist in walking for 3-4 weeks. She reported a mild ache to both shoulders and neck at an 8/10 scale. The pain was worse if she moved her neck side to side or rotated her head. She denied any swelling to her joints, fevers, back pain, ankle or arm pain, tremors, muscular weakness or paresthesia. She also reported a symmetrical itchy redness to the sides of each hip joint approximately the size of an orange without swelling or being hot to touch. She believed it was a rash as there was no definitive diagnosis made. Hydrocortisone creams did resolve the rash. She also reported difficulty with her short term memory, problems concentrating and was constantly forgetting things Her discomfort became so intense she voiced “feelings of depression” and “having no will to live” to her physician. She was eventually diagnosed with depression, hypothyroidism, fibromyalgia and chronic fatigue syndrome (CFS) with migraine headaches and treated appropriately with resolution of her depression. As of this interview (2004) she continues to have symptoms of CFS, fibromyalgia and an occasional headache. She reported a family history of multiple sclerosis and an older sister with fibromyalgia after anthrax vaccinations. Concurrently she reported a history of “irritable bowel syndrome (IBS)” since receiving the 3rd and 4th anthrax (AVA) vaccination. Prior to receiving the 3rd shot, she had daily bowel movements “like clockwork.” Approximately 2 weeks after the 3rd and 4th AVA vaccination she reported occasional nausea with a rumbling stomach less than 15 minutes after eating and severe abdominal cramps and diarrhea. This routine occurred 6-7 times a day for approximately 6 months ultimately


VAERS ID: 126242 (history)  
Age: 1.7  
Gender: Male  
Location: New Hampshire  
Vaccinated:1999-07-12
Onset:1999-07-13
   Days after vaccination:1
Submitted: 1999-07-13
   Days after onset:0
Entered: 1999-07-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911A2 / 3 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn, amocicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: day following vax pt noticed flat, red rash at site. treated w/tylenol


VAERS ID: 126827 (history)  
Age: 1.6  
Gender: Female  
Location: Texas  
Vaccinated:1999-07-12
Onset:1999-07-12
   Days after vaccination:0
Submitted: 1999-07-12
   Days after onset:0
Entered: 1999-08-02
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1844H / 0 LL / SC

Administered by: Other       Purchased by: Unknown
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: TX99153

Write-up: red hives @ inject site; does not appear to itch


VAERS ID: 154981 (history)  
Age:   
Gender: Female  
Location: Alaska  
Vaccinated:1999-07-12
Onset:1999-07-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2000-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4998027 / - LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Dyspnoea, Hypoaesthesia, Injection site reaction, Muscle spasms, Pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

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: UNK
CDC Split Type: 899200162A

Write-up: One day post vax (07/13/1999) pt developed an injection site reaction the size of a half dollar and by the next day (07/14/1999) it was the size of the bottom of a Coke can. Pt reported losing the feeling in the tips of 3 fingers on her left hand. Pt was treated with Benadryl and Naproxen. On 07/15/1999 the pt reported that she could not feel any of the fingers on her left hand and the injection site reaction covered the entire upper left arm with dull pain over the rest of the arm. Pt also reported experiencing muscle spasms in her left arm, neck, back and upper half of her left leg. Pt also experienced labored breathing. Pt was treated with steroids.


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