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Case Details (Sorted by Vaccination Date)

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VAERS ID:177324 (history)  Vaccinated:2001-11-06
Age:34.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-06, Days after onset: 0
Location:Kansas  Entered:2001-11-07, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to ASA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40180330IM 
Administered by: Public     Purchased by: Other
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)
Write-up: Staff ARNP here received flu shot and had anaphylactic reaction. 2 other staff members had allergic reaction (itching).

VAERS ID:177512 (history)  Vaccinated:2001-11-06
Age:70.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Male  Submitted:2001-11-08, Days after onset: 1
Location:New York  Entered:2001-11-09, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: Checking Lyme titer
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Bells Palsy (left sided facial weakness)

VAERS ID:177677 (history)  Vaccinated:2001-11-06
Age:61.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-12, Days after onset: 6
Location:New Jersey  Entered:2001-11-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Paranate, Synthroid, Xanax and Restoril.
Current Illness: NONE
Preexisting Conditions: Hypothyroidism, mild sys. lupu, precancer of stomach
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 1 RA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Feeling hot, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: 4-5 after injection left arm from shoulder to elbow red, hot, swollen, painful to touch. Treatment: Zithromax 11/7 for cellulitis by PCP.

VAERS ID:177738 (history)  Vaccinated:2001-11-06
Age:27.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2001-11-08, Days after onset: 2
Location:Utah  Entered:2001-11-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: NONE
Preexisting Conditions: Allergy: erythromycin - Rx for depression
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE08791LA4IMRA
Administered by: Other     Purchased by: Other
Symptoms: Blood pressure increased, Dizziness, Hypoaesthesia, Nausea, Sensation of heaviness
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad)
Write-up: C/O R arm feeling numb and tingling, B/P 140/82 - c/o body feeling "heavy", dizziness and nausea - evaluated by paramedics @ site. Symptoms resolved 6 hrs later, returned to work took Ibuprofen.

VAERS ID:177782 (history)  Vaccinated:2001-11-06
Age:11.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-08, Days after onset: 2
Location:Wisconsin  Entered:2001-11-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin.
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5214A20IMLA
Administered by: Other     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 11/06/2001 at 10:30 pm the patient developed hives on her abdomen, neck, back, arm, and legs. The vaccine area was not affected. The patient was treated with Benadryl.

VAERS ID:177720 (history)  Vaccinated:2001-11-06
Age:0.1  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-07, Days after onset: 1
Location:North Carolina  Entered:2001-11-16, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Slight congestion
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC (WNL), BL cx (-), RSV (-), EEG (WNL), Monitored 24 hrs - d/c 11/8/01 in good condition.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0845L0IMLL
Administered by: Private     Purchased by: Public
Symptoms: Hypotonia, Pallor, Respiratory disorder, Salivary hypersecretion
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt became limp and was not breathing for about 1 minute. She was very pale and slightly foaming at the mouth. Mother did mouth to mouth, but pt still did not breathe for about 1 minute. Mother called 911. Pt was ok when EMS arrived. Pt was taken to ER by EMS and admitted by MD.

VAERS ID:177814 (history)  Vaccinated:2001-11-06
Age:35.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-08, Days after onset: 1
Location:Georga  Entered:2001-11-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel, Lithium, Wellbutrin and Ambien
Current Illness:
Preexisting Conditions: Allergic to penicillin, ASA, theophyline and PPD.
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESU0595AA0IMLA
Administered by: 0     Purchased by: 0
Symptoms: Pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The day after the vaccination the patient woke up with aches and a rash. The patient was treated with Benadryl.

VAERS ID:177820 (history)  Vaccinated:2001-11-06
Age:3.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Unknown  Submitted:2001-11-14, Days after onset: 7
Location:Unknown  Entered:2001-11-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4018028 IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: A 3-year-old was inadvertently given FluShield vaccine under the deltoid muscles, which was supposed to be given in the deltoid muscle. The area below the deltoid muscle became red and hot with a large induration on the day following the vaccination.

VAERS ID:177841 (history)  Vaccinated:2001-11-06
Age:35.0  Onset:2001-11-08, Days after vaccination: 2
Gender:Male  Submitted:2001-11-18, Days after onset: 10
Location:Maryland  Entered:2001-11-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM147F90IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction
SMQs:
Write-up: Forty-eight hours post vax the patient experienced a localized, transient rash.

VAERS ID:177842 (history)  Vaccinated:2001-11-06
Age:53.0  Onset:2001-11-08, Days after vaccination: 2
Gender:Male  Submitted:2001-11-08, Days after onset: 0
Location:Maryland  Entered:2001-11-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM147F90IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: Forty-eight hours post vax, the patient experienced a transient localized rash.

VAERS ID:177845 (history)  Vaccinated:2001-11-06
Age:0.6  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-08, Days after onset: 1
Location:Pennsylvania  Entered:2001-11-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC - elevated, WBC - elevated, Platelets - elevated.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0515BA2IM 
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA036AA2IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4808982IM 
Administered by: Private     Purchased by: Private
Symptoms: Febrile convulsion, Leukocytosis, Pyrexia, Thrombocythaemia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Approximately 24 hours post vax, the patient developed a high fever that resulted in a febrile seizure.

VAERS ID:177848 (history)  Vaccinated:2001-11-06
Age:12.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-13, Days after onset: 7
Location:Connecticut  Entered:2001-11-16, Days after submission: 3
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': CT200108
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0377L SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1705K SCRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The patient experienced swelling and pain of the left arm. The patient was seen in the ER and was advised to use Tylenol for the pain and cool soaks to the area.

VAERS ID:177861 (history)  Vaccinated:2001-11-06
Age:65.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-06, Days after onset: 0
Location:Colorado  Entered:2001-11-16, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Pt denies any allergies or previous reactions.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0945K1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site inflammation, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 11/06/2001 0.5cc Pneumococcal vaccine Polyvalent 23 given IM left deltoid at 12:10. Received telephone call at 3:55pm. Pt reports arm is red, swollen and warm to touch. Advised to call MD for exam. Pt to provider (of vaccine) office at 4:05 pm. Left arm swollen, red, warm to touch, edematous inflamed from left elbow to shoulder (around injection site). Pt was treated with Zyrtec and sent home. No further complaints reported. Received Influenza vaccine 0.5cc IM to Right arm with no reaction.

VAERS ID:177862 (history)  Vaccinated:2001-11-06
Age:6.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-09, Days after onset: 2
Location:Alaska  Entered:2001-11-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS507A21IMRA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5210A22IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT07571IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: DTap/IPV #2 (had never been immunized before 08/01). Mom called next AM, temp 104 degree and advised Tylenol/motrin every 4 hours, increased fluids. 11/08/2001 Afebrile but large localized reaction from right shoulder to elbow, red, hot, indurated.

VAERS ID:177863 (history)  Vaccinated:2001-11-06
Age:23.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-06, Days after onset: 0
Location:California  Entered:2001-11-16, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5231C60IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt immediately developed redness and swelling at the injection site with local welts, 30 seconds later. No other symptoms. Treated with ice X 30 minutes and redness and swelling subsided.

VAERS ID:177865 (history)  Vaccinated:2001-11-06
Age:52.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Male  Submitted:2001-11-08, Days after onset: 1
Location:Idaho  Entered:2001-11-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hx of pneumonia, hyperlipedemia, HTN, esophagitis
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.080260IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: L upper arm & proximal lower arm - mild to moderate swelling with mild erythema; slight warm to touch, mild pain.

VAERS ID:177874 (history)  Vaccinated:2001-11-06
Age:1.1  Onset:2001-11-08, Days after vaccination: 2
Gender:Female  Submitted:2001-11-09, Days after onset: 1
Location:Texas  Entered:2001-11-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD/ID/LA/0 previously (given on 10/29/01); Amoxicillin Suspension
Current Illness: Otitis Media
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0537DA3IMLL
Administered by: Other     Purchased by: Public
Symptoms: Pyrexia, Rash papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pt had a fever for 1 day, post vax. She also was on Amoxicillin for Otitis for 1 week. On 11/8/01, she developed a papular (? urticarial) rash. She was seen and treated with Atarax. Recovery is ongoing.

VAERS ID:177929 (history)  Vaccinated:2001-11-06
Age:40.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-17, Days after onset: 11
Location:Virginia  Entered:2001-11-19, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac, Atenol, Elmiron, Triametrine/HCTZ and Aspirin.
Current Illness: NONE
Preexisting Conditions: Allergic to preservative (DMSO) used in bladder wash; Asthma; Seasonal Allergies.
Diagnostic Lab Data:
CDC 'Split Type': VA01031
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40180281IMLA
Administered by: Public     Purchased by: Public
Symptoms: Discomfort, Dysphagia, Dyspnoea, Injection site erythema, Injection site oedema, Oedema, Paraesthesia, Pharyngolaryngeal pain, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Approximately 20 minutes after receiving the influenza injection on 11/06/2001, client reported that her hands, especially the palms, and her feet were itchy and that her hands seemed to be somewhat swollen, requiring her to remove her rings. RN informed her supervisor and telephoned the HD MD, who advised that this was a "normal variation" and that client should take 25mg of Benadryl when she gets home. About an hour later, around 4:05 PM, client reported to another nurse in Clinic that her bottom lip was itchy, slightly swollen and her tongue was tingling. This nurse consulted with the supervisor, who instructed her to promptly call MD for further guidance. MD advised client to take two 25 mg Benadryl immediately and go home, which client did. By the time the client arrived home, she was experiencing some difficulty swallowing along with some soreness in her throat and was beginning to have some difficulty breathing. Her husband accompanied her to the ER, where she received epinephrine with IV fluids, an injection of Benadryl and an oral dose of Prednisone. She was observed for an hour, her symptoms improved and she was discharged with a Prescription of Zantac and Claritin, as well as continued Prednisone. Client also reports that she has had some local redness, swelling and discomfort in the left deltoid area around the injection site.

VAERS ID:177957 (history)  Vaccinated:2001-11-06
Age:  Onset:2001-11-07, Days after vaccination: 1
Gender:Male  Submitted:2001-11-16, Days after onset: 9
Location:Arizona  Entered:2001-11-20, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Concurrent conditions: cardiac disorder
Diagnostic Lab Data:
CDC 'Split Type': WAES01111065
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1159L IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 11/7/01, one day post vax, pt experienced a bad reaction which included severe swelling and redness at injection site. The pt was seen in the ER and was admitted due to additional concerns with his pre-existing cardiac condition. The reporter indicated a concern with the lot number. It was reported that the pt''s wife (WAES 01111505) had a similar experience following exposure to pneumococcal vaccine 23 polyvalent. Addtl info has been requested.

VAERS ID:177979 (history)  Vaccinated:2001-11-06
Age:69.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-12, Days after onset: 5
Location:West Virginia  Entered:2001-11-20, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Penicillin and codeine
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE02781HA4IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1052L2IMRA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Marked swelling, warmth, edema shoulder to elbow.

VAERS ID:177988 (history)  Vaccinated:2001-11-06
Age:  Onset:2001-11-08, Days after vaccination: 2
Gender:Female  Submitted:2001-11-13, Days after onset: 5
Location:Michigan  Entered:2001-11-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0682AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt called, check out warm to touch, itching, red.

VAERS ID:177997 (history)  Vaccinated:2001-11-06
Age:68.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Male  Submitted:2001-11-09, Days after onset: 2
Location:Alaska  Entered:2001-11-20, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO573AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1449K1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Chills, Erythema, Feeling hot, Injection site induration, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Pt received pneumococcal vaccine right deltoid on 11/06/2001. 11/08/2001 telephoned PHN, notes induration (5 cm by 3 cm) erythema, warmth, tenderness, chills w/o fever. PHN referred to MD, diagnosed with cellulitis and placed on Keflex 500mg bid for 10 days. No prior reactions to vaccines.

VAERS ID:177998 (history)  Vaccinated:2001-11-06
Age:36.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-15, Days after onset: 9
Location:New York  Entered:2001-11-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0696BA IMLA
Administered by: 0     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Generalized urticaria 3-4 hives after vaccine.

VAERS ID:178049 (history)  Vaccinated:2001-11-06
Age:54.0  Onset:2001-11-14, Days after vaccination: 8
Gender:Female  Submitted:2001-11-20, Days after onset: 6
Location:California  Entered:2001-11-21, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin, Dyazide and K-dur
Current Illness: NONE
Preexisting Conditions: HTN and diabetes.
Diagnostic Lab Data:
CDC 'Split Type':
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MER: MEASLES + RUBELLA (MR-VAX II)MERCK & CO. INC.0733L SCLA
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)MERCK & CO. INC.0832L   
Administered by: Private     Purchased by: Private
Symptoms: Lymphadenopathy, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: On 11/14/2001 the patient developed swollen and painful lymph nodes behind the ears. On 11/19/2001 a rash appeared on the trunk, arms and legs.

VAERS ID:178063 (history)  Vaccinated:2001-11-06
Age:1.3  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2001-11-07, Days after onset: 1
Location:Texas  Entered:2001-11-21, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Omnicef and Histussin HC.
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIESU0536AA3IMLL
Administered by: Private     Purchased by: Private
Symptoms: Angioneurotic oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: The patient developed angioedema and urticaria.

VAERS ID:178076 (history)  Vaccinated:2001-11-06
Age:1.0  Onset:2001-11-13, Days after vaccination: 7
Gender:Male  Submitted:2001-11-14, Days after onset: 1
Location:Nevada  Entered:2001-11-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0159L0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0822L0SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: One week post vax the patient developed a rash on both arms at the sites of injection.

VAERS ID:178125 (history)  Vaccinated:2001-11-06
Age:3.0  Onset:0000-00-00
Gender:Male  Submitted:2001-11-14
Location:California  Entered:2001-11-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Neurofibromatosis.
Diagnostic Lab Data:
CDC 'Split Type':
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HEPA: HEP A (VAQTA)MERCK & CO. INC.0908L IMRA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Daily hives times 7 days.

VAERS ID:178138 (history)  Vaccinated:2001-11-06
Age:4.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2001-11-15, Days after onset: 9
Location:Texas  Entered:2001-11-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO676AA4IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Itching and swelling at vaccine site 1 day after, resolved 1 day later.

VAERS ID:178203 (history)  Vaccinated:2001-11-06
Age:0.3  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-13, Days after onset: 6
Location:Kentucky  Entered:2001-11-26, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': KY2001087
Vaccination
Manufacturer
Lot
Dose
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Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0514EA1IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS0267L1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T084221SCLA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash appeared on 11/7/01, and on 11/8/01, pt had rash over entire body.

VAERS ID:178269 (history)  Vaccinated:2001-11-06
Age:70.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-10, Days after onset: 4
Location:Illinois  Entered:2001-11-27, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Seasonal, PCN
Diagnostic Lab Data:
CDC 'Split Type':
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PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES04705940IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: given pneumo shot R deltoid. Given 11/6/01. started hurting that evening, Red and swollen on 11/7/01.

VAERS ID:178285 (history)  Vaccinated:2001-11-06
Age:0.2  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2001-11-12, Days after onset: 6
Location:Tennessee  Entered:2001-11-27, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0537CA0IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0853L1IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4815670IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT13910IMRL
Administered by: Private     Purchased by: Private
Symptoms: Cyanosis, Hypotonia, Pallor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt became limp and extremely pale after vaccination administration within 2-3 minutes. Slight cyanosis around mouth.

VAERS ID:178316 (history)  Vaccinated:2001-11-06
Age:47.0  Onset:2001-11-15, Days after vaccination: 9
Gender:Male  Submitted:2001-11-22, Days after onset: 7
Location:Pennsylvania  Entered:2001-11-28, Days after submission: 6
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zocor
Current Illness: NONE
Preexisting Conditions: Hypercholesterolemia
Diagnostic Lab Data: No spinal fluid cells. Arreflexia, weakness, spinal fluid protein increased.
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Unknown
Symptoms: CSF test abnormal, Guillain-Barre syndrome, Hyporeflexia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: Flu shot. Guillian Barre Syndrome, onset diagnosis 11/22/2001. Now in hospital on treatment. Per 1 year follow up: It is unknown if pt has recovered. Last seen 01/08/2002. Residual symptoms presented at 01/08/2002. Hyporeflexia and mild distal sensation. Follow up 12/13/2001: Phone # of comany who gave on original report."

VAERS ID:178323 (history)  Vaccinated:2001-11-06
Age:6.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-20, Days after onset: 14
Location:Texas  Entered:2001-11-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURV0674AA2IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1250K0SCRA
Administered by: Military     Purchased by: Military
Symptoms: Application site oedema, Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Post vax the patient was seen with a 9cm x 7 cm area of erythema, swelling and warmth at the site of the flu shot.

VAERS ID:178368 (history)  Vaccinated:2001-11-06
Age:48.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-20, Days after onset: 14
Location:Alabama  Entered:2001-11-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: DM,hearing loss
Preexisting Conditions:
Diagnostic Lab Data: CT head, blood work
CDC 'Split Type':
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PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.092360IMRA
Administered by: Private     Purchased by: Private
Symptoms: Anaphylactic reaction, Convulsion
SMQs:, Anaphylactic reaction (narrow), Systemic lupus erythematosus (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: Seizure with anaphylaxis

VAERS ID:178371 (history)  Vaccinated:2001-11-06
Age:1.0  Onset:2001-11-20, Days after vaccination: 14
Gender:Female  Submitted:2001-11-21, Days after onset: 1
Location:Virginia  Entered:2001-11-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0026L0SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0983L SC 
Administered by: Private     Purchased by: Private
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Pt developed 3 vesicles on chest, 4 vesicles on back, and 1 vesicle behind ear.

VAERS ID:178388 (history)  Vaccinated:2001-11-06
Age:10.0  Onset:2001-11-16, Days after vaccination: 10
Gender:Male  Submitted:2001-11-19, Days after onset: 3
Location:Texas  Entered:2001-11-28, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0904L2SCLA
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt developed miliary rash on face. He had no lymphadenopathy, fever, or any other signs of rubella.

VAERS ID:178415 (history)  Vaccinated:2001-11-06
Age:1.3  Onset:2001-11-13, Days after vaccination: 7
Gender:Female  Submitted:2001-11-16, Days after onset: 3
Location:Massachusetts  Entered:2001-11-29, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Febrile seizure. All lab wnl.
CDC 'Split Type':
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0375L1 RL
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), 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), Hypersensitivity (narrow)
Write-up: Received MMR on 11/16/2001. return to clinic on 11/19/2001 complained of rash for one week on upper extremities. Treated with Benadryl. On 11/14/2001 called AM RN, mild fever 100, took Tylenol, see on clinic at same day 2 PM with fever 101, had seizure in clinic around 2:20 PM, pt also decreased response.

VAERS ID:178445 (history)  Vaccinated:2001-11-06
Age:55.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-27, Days after onset: 21
Location:Maryland  Entered:2001-11-30, Days after submission: 3
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':
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE06751LA IMLA
Administered by: Private     Purchased by: 0
Symptoms: Anxiety, Asthma, Cough, Dyspnoea, Injection site hypersensitivity, Pruritus, Rash, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Post vax the patient stated the left deltoid was itching and red. The patient was treated with Benadryl. The patient also complained of tightness in her throat, a rash and shortness of breath. The patient became anxious, stated she needs air and wheezing started. The patient was treated with Albuterol Nebulizer. The patient''s coughing decreased with the nebulizer treatment. The patient''s chest and back were itching. The patient experienced hives on her neck and chest. The wheezing cleared and the patient''s throat was dry.

VAERS ID:178459 (history)  Vaccinated:2001-11-06
Age:  Onset:2001-11-10, Days after vaccination: 4
Gender:Male  Submitted:2001-11-27, Days after onset: 17
Location:Unknown  Entered:2001-12-03, Days after submission: 6
Life Threatening? No
Died? Yes
   Date died: 2001-11-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01111393
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: 0     Purchased by: 0
Symptoms: Asphyxia, Injury
SMQs:, Acute central respiratory depression (broad), Accidents and injuries (narrow), Hostility/aggression (broad)
Write-up: Information has been received from an RN concerning a 6 day old male relative who on 11/6/01 was vaccinated with Hep-B vaccine recombinant (yeast). On 11/10/01, the child died. The cause of death was unknown. Autopsy report states child''s age at time of death to be 18 days old. Cause of death is traumatic compression of head and chest due to overlaying, manner of death accidental.

VAERS ID:178482 (history)  Vaccinated:2001-11-06
Age:53.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-08, Days after onset: 1
Location:Virginia  Entered:2001-12-03, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin 10 mg 1 tablet for 7 days. Cortisone cream topically BID. Triantherene
Current Illness: NONE
Preexisting Conditions: High blood pressure
Diagnostic Lab Data:
CDC 'Split Type': VA01035
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4018028 IMLA
Administered by: Public     Purchased by: 0
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Day 1: after injection itching. Day 2: wheals, rash over left upper and lower arm, intense itching.

VAERS ID:178487 (history)  Vaccinated:2001-11-06
Age:30.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-26, Days after onset: 20
Location:Virginia  Entered:2001-12-03, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC 'Split Type':
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40180261 RA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain, Asthma, Oedema, Pain, Pyrexia, Vasodilation procedure, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Received vaccine at 2:30 PM. Symptoms began 6 PM that day, stomachache, vomiting, temp 101.3, muscle and back ache, swollen left eye, redness, asthma-had to go to PMD for asthma treatment. Recovery took 5 days. Return to work 11/12/2001. Pt had had her first flu shot last year.

VAERS ID:178498 (history)  Vaccinated:2001-11-06
Age:4.8  Onset:2001-11-19, Days after vaccination: 13
Gender:Male  Submitted:2001-11-20, Days after onset: 1
Location:Arizona  Entered:2001-12-03, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURUO536DA4IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0909L1IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT14463SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0733L1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0793L0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: One cm slightly tender erythematous, indurated subcutaneous area with control crust in the left arm site of Varivax injection. Treated with Benadryl chewable q 4 hours PRN and steroid topical cream daily PRN.

VAERS ID:178504 (history)  Vaccinated:2001-11-06
Age:40.0  Onset:2001-11-08, Days after vaccination: 2
Gender:Female  Submitted:2001-11-23, Days after onset: 15
Location:Nebraska  Entered:2001-12-03, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pesogen
Current Illness: NONE
Preexisting Conditions: Environmental allergies
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0098L0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: Two to three days post injection noticed 2 larger red, raised, itchy areas along with 2 smaller areas of the same description.

VAERS ID:178548 (history)  Vaccinated:2001-11-06
Age:65.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-13, Days after onset: 7
Location:Massachusetts  Entered:2001-12-04, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baby ASA, Cardizem, Isordil, Norvac, Visken, Zantac, Premarin, NTG patch
Current Illness: NONE
Preexisting Conditions: Heart disease, allergic to latex, dermatitis, S/P MI, Repair of left rotator cuff AUG 2001.
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO676AA IMRA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4749391IMLA
Administered by: Private     Purchased by: Public
Symptoms: Chills, Injection site hypersensitivity, Nausea, Oedema, Pain, Vasodilation procedure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Three hours after receiving the pneumonia shot in the left deltoid, developed severe painin upper arm to elbow to under arm pit. In 4-5 hours after injection, developed swelling, redness, hotness and "hardness" of upper arm. Also, chills and nausea. Lasted 2 full days then symptoms gradually decreased 3 or 4 days.

VAERS ID:178612 (history)  Vaccinated:2001-11-06
Age:1.6  Onset:2001-11-16, Days after vaccination: 10
Gender:Male  Submitted:2001-11-27, Days after onset: 11
Location:Washington  Entered:2001-12-05, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: autoimmune pancytopenia, chronic atelectasis, cirrhosis
Preexisting Conditions: RML pneumonia, hepatosplenomegaly, hepatitis , autoimmune pancytopenia
Diagnostic Lab Data: Normal head CT scan CSF increased protein, 2 WBC /mm3
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU0669AA0IMLL
Administered by: Private     Purchased by: Public
Symptoms: CSF test abnormal, Guillain-Barre syndrome, Muscular weakness, Paralysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: Seen 11/18/01 with progressive lower extremity weakness. By 11/30/01 could not move lower extremities: had loss of reflexes. Sent to ED where diagnostic work up began. Diagnosis of Guillain-Barre Syndrome ultimately made. Per 1 year follow up: Pt recovered. Done well with therapy time.

VAERS ID:178648 (history)  Vaccinated:2001-11-06
Age:4.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Male  Submitted:2001-11-08, Days after onset: 1
Location:Arkansas  Entered:2001-12-05, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM513A24IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT08413SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1387K1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Oedema, Vasodilation procedure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pt arm red and swollen 3" by 6". Mother noticed at 1600 11/07/2001. Child playing as usual without complaint.

VAERS ID:178738 (history)  Vaccinated:2001-11-06
Age:10.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-16, Days after onset: 9
Location:Nebraska  Entered:2001-12-07, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sore Throat
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type': NE016
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3071A20IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1389K1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Pyrexia, Vasodilation procedure
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)
Write-up: Developed low grade reaction 24 hours following Hep B and MMR immunization. Reaction consisted of headache, flushed face and fever ranging from 99 to 100.9. Pt''s mother reported she began to feel better on the evening of 11/09/2001.

VAERS ID:178755 (history)  Vaccinated:2001-11-06
Age:15.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-16, Days after onset: 9
Location:Nebraska  Entered:2001-12-07, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline and ibuprofen 600 mg TID
Current Illness: Tendonitis and acne
Preexisting Conditions:
Diagnostic Lab Data: Liver enzymes, Bilirubin, MRI
CDC 'Split Type': NE017
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3071A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hepatitis, Pruritus
SMQs:, Hepatitis, non-infectious (narrow), Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: On 11/05/2001 pt saw physician for tendonitis. Given ibuprofen 600mg. On 11/06/2001 had 1st hep B dose about 3:30 PM. On 11/07/2001 pt reports itching prior to bed. On 11/08/2001 mother obtained Benadryl 25 mg, gave the pt some. Pt continued to take ibuprofen and a drug (minocycline) for acne. On 11/11/2001 noon mother informed nurse that pt was itching all night. Told to increase Benadryl to 50 mg and consult physician if not improved by tomorrow. On 11/12/2001 pt saw physician who thought she had developed hepatitis. He stopped all medication and sent her back to school. On 11/13/2001 pt saw pediatrician. Pediatrician did numerous tests, placed pt on bedrest and told mother he thought she may have Hepatitis A and this probably had nothing to do with immunizations. Live enzymes markedly elevated from results obtained. Immunization nurse called to follow up with mother on how pt was feeling and was given this information. On 11/14/2001 pt returned for results of blood test. Tests were negative for hepatitis. Further tests will be done on 11/16/2001. More blood tests and a MRI were done on 11/16/2001. Results are not known at this time. Mother was informed that I am filling out this form. On 11/19/2001 no results from test to date. mother will sign release of information form so the doctor will send test results to school nurse.

VAERS ID:178882 (history)  Vaccinated:2001-11-06
Age:1.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-30, Days after onset: 23
Location:New York  Entered:2001-12-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Cellulitis of the thigh right Keflex.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS965A2 IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESP1434 IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURR0236 IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0585K IMLL
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Swelling of the thigh (Right) after vaccination.

VAERS ID:178941 (history)  Vaccinated:2001-11-06
Age:46.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-12-05, Days after onset: 28
Location:New York  Entered:2001-12-12, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1449K1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt developed swelling, heat and erythema of arm. Treated with cold compresses and it resolved in 2 weeks.

VAERS ID:178993 (history)  Vaccinated:2001-11-06
Age:44.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-11-18, Days after onset: 12
Location:Massachusetts  Entered:2001-12-13, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Latex Sensitive
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO682AA0 RA
Administered by: Private     Purchased by: Private
Symptoms: Flushing, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: Approximately 16 minutes after flu injection client complained of itchiness all over body and upper body including face was very flushed. Epinephrine 1:1000 0.35cc injected into flu injection site approximately 18 minutes after original flu shot. 911 called at the same time, 4-5 minutes after 1st epinephrine injection. Complained of numb, tingling feeling about face, neck and hands. Second Epi 1:1000 0.15cc injected into the same area. BP 158/84 P 60 Transported to Emergency Room via ambulance approximately 25 minutes after flu vaccine given.

VAERS ID:179032 (history)  Vaccinated:2001-11-06
Age:79.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-12-07, Days after onset: 30
Location:Unknown  Entered:2001-12-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1456K IM 
Administered by: 0     Purchased by: 0
Symptoms: Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pt received pneumonia vaccine in right deltoid and flu vaccine in left deltoid on 11/06/2001. On 11/07/2001, pt experienced red, swollen arm. On 11/08/2001 pt went to MD and was given "5 pills".

VAERS ID:179037 (history)  Vaccinated:2001-11-06
Age:41.0  Onset:2001-11-08, Days after vaccination: 2
Gender:Female  Submitted:2001-12-10, Days after onset: 32
Location:Michigan  Entered:2001-12-14, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Left shoulder X-ray negative.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR0685AA  LA
Administered by: Other     Purchased by: Unknown
Symptoms: Joint range of motion decreased, Pain
SMQs:, Arthritis (broad)
Write-up: Initial pain post-injection followed by vigorous, throbbing pain from lateral aspect of upper humerus to anterior mid-humerus and continuing to posterior aspect of forearm and hand. Visited family physician 1 week post-injection. Am now receiving physical therapy. Arm pain and limited movement left arm.

VAERS ID:179110 (history)  Vaccinated:2001-11-06
Age:79.0  Onset:2001-11-09, Days after vaccination: 3
Gender:Female  Submitted:2001-11-20, Days after onset: 11
Location:Colorado  Entered:2001-12-17, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple meds for multiple problems
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': CO01023
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1456K0IM 
Administered by: Public     Purchased by: Private
Symptoms: Oedema, Vasodilation procedure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pneumonia vaccine given 11/06/2001. Next day pt experienced red and swollen arm. Two days after shot went to MD given "5 pills".

VAERS ID:179159 (history)  Vaccinated:2001-11-06
Age:55.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-12-16, Days after onset: 39
Location:Alabama  Entered:2001-12-18, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, asthma and diabetic.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE00931HA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Second day soreness and redness at site that got worse traveled into the arm, to the shoulder and up into the neck, all happened over a 3 week period. Still have pain in right side of neck, arm has pain to the touch and when laid on. Hurts to pick anything up. Pain traveled from injection site into the shoulder, slight swelling in the neck area. Still having pain.

VAERS ID:179187 (history)  Vaccinated:2001-11-06
Age:4.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Male  Submitted:2001-11-08, Days after onset: 1
Location:Georga  Entered:2001-12-18, Days after submission: 40
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: NONE
CDC 'Split Type': GA01107
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM992A24IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT06243SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.M0021L1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness & warmth to 1/3 upper R arm. Active no other S&S. Tx: ice to area/benadryl.

VAERS ID:179290 (history)  Vaccinated:2001-11-06
Age:48.0  Onset:2001-11-09, Days after vaccination: 3
Gender:Female  Submitted:2001-11-27, Days after onset: 18
Location:Maryland  Entered:2001-12-20, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0694AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Heart rate increased, Nasal congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Approx. 1 hours and 45 minutes, post vax, the pt experienced rapid heart beat, wheezing, congestion, heaviness in mid-chest. No history of asthma. The pt thought the room where symptoms occurred had a strong "moldy smell". The time course was 45 minutes then wheezing stopped, congestion gone and heaviness had diminished. She refused treatment.

VAERS ID:179314 (history)  Vaccinated:2001-11-06
Age:47.0  Onset:2001-11-11, Days after vaccination: 5
Gender:Male  Submitted:2001-12-14, Days after onset: 33
Location:New York  Entered:2001-12-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol; Naproxen; Ecotrin; Vitamin B1; Multivitamins
Current Illness: NONE
Preexisting Conditions: History of CVA; history of MI; chronic cervical spine problems
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE04851KA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Neck pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: About 5 days, post vax, the pt developed neck pain radiating into his left scapula, left deltoid and left axilla. No symptoms in the days immediately following the administration of the vaccine. Still symptomatic.

VAERS ID:179392 (history)  Vaccinated:2001-11-06
Age:44.0  Onset:2001-11-15, Days after vaccination: 9
Gender:Male  Submitted:2001-11-28, Days after onset: 13
Location:Georga  Entered:2001-12-26, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH4008284  LA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Injection site erythema, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: A 44 year old male vaccinated at 14:00 on 11/6/01 (do not know which vaccine vial used, but presumed to be same as 11/5). On 11/15/01 recheck revealed primary response along with 4cm area of redness extending down medial arm from vaccine site. Recheck on 11/16/01 revealed only faint redness of medial arm in area previously described, 5-6 erythematous "rays" noted extending from vaccine site in all quadrants. Pt was afebrile and site was not tender. Because of previous 3 cases of presumed cellulitis among 11/5/01 and 11/6/01 vaccinees, the pt was treated with cephalexin as a precaution. Recheck of site on 11/19/01 revealed afebrile pt with no real change in appearance of site. On 11/20/01, e-mail from pt stated that scab had fallen off, "all is looking fine" and no other problems. Clinical dx: probable lymphangitic response to vaccine, r/o early cellulitis.

VAERS ID:179394 (history)  Vaccinated:2001-11-06
Age:47.0  Onset:2001-11-15, Days after vaccination: 9
Gender:Male  Submitted:2001-11-28, Days after onset: 13
Location:Georga  Entered:2001-12-26, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to penicillin
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH4008284  LA
Administered by: Other     Purchased by: Public
Symptoms: Cellulitis, Erythema, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: A 47 year old male was vaccinated at 10:45 on 11/6/01. On 11/13/01 recheck, noted to be c/w primary response. On 11/15/01 recheck because of "increased redness, swelling and tenderness of site that revealed 1.5cm primary response with 3" X 4" surrounding erythema and induration with sharply defined borders. Temperature noted to be 99.1F. Pt empirically begun on cephalexin 500mg BID. Recheck on 11/16/01 revealed a temperature of 97.8F and 1.5cm scab surrounded by 1.25-1.5cm of induration with faint erythematous border. Border was not sharply defined at this point. On 11/19/01 recheck, reveal "trace scattered induration at margin of primary response" with "very faint scattered erythema mostly distal to primary response site". Clinical dx: probable cellulitis, r/o vigorous primary response to vaccine.

VAERS ID:179510 (history)  Vaccinated:2001-11-06
Age:30.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-12-09, Days after onset: 32
Location:Tennessee  Entered:2001-12-27, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonazpam
Current Illness: History of Epilepsy
Preexisting Conditions: Allergy to terbutaline sulfate; history of epilepsy
Diagnostic Lab Data: NONE
CDC 'Split Type': TN01065
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0601L1SCLA
Administered by: Public     Purchased by: Private
Symptoms: Malaise, Oedema, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: On 11/07/2001 pt woke up 4 AM with temp 104.6, took antipyretic, stayed in bed all day, felt bad and ached all over. Face swollen, no difficulty breathing, stayed in bed. Thursday temp of 100 F. Still had joint pain with movement. No seizure activity.

VAERS ID:179658 (history)  Vaccinated:2001-11-06
Age:71.0  Onset:2001-11-08, Days after vaccination: 2
Gender:Male  Submitted:2001-12-26, Days after onset: 48
Location:Tennessee  Entered:2002-01-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: PCN, tetanus
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1070K1IM 
Administered by: Public     Purchased by: Other
Symptoms: Cellulitis, Erythema, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: The patient c/o of pain, erythema, edema and cellulitis at injection site.

VAERS ID:179727 (history)  Vaccinated:2001-11-06
Age:3.8  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2001-12-20, Days after onset: 44
Location:New Jersey  Entered:2002-01-07, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: sensitivity to Phenebarbitol at birth
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0694AA0IM 
Administered by: Private     Purchased by: 0
Symptoms: Cough, Nasal congestion, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Patient experienced a 101 degree F fever, loss of appetite, "head cold" type symptoms (congestion, excess mucous, cough. He was treated with expectorant, cough suppressant, decongestant, antihistamine, and eventually antibiotics for an ear infection.

VAERS ID:179729 (history)  Vaccinated:2001-11-06
Age:1.0  Onset:2001-11-16, Days after vaccination: 10
Gender:Female  Submitted:2001-12-22, Days after onset: 36
Location:Idaho  Entered:2002-01-07, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil was taken after vaccination
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: blood & urine cultures, basic metabolic panel, specimen draw, susceptibility panel.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0024L0  
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES0465L2  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.4815420  
Administered by: Private     Purchased by: Private
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: A few days post-vaccination, patient experienced a fever of 101 degrees f. She was then fine until around 1700 hours on the 14th. Her fever then continued and escalated until around 0130 on 11/15/2001, when she experienced a fever of 103-104 degrees F. she then had a seizure and was transported to the hospital. At the hospital she was treated with Motrin.

VAERS ID:179730 (history)  Vaccinated:2001-11-06
Age:48.0  Onset:2001-11-11, Days after vaccination: 5
Gender:Female  Submitted:2001-12-23, Days after onset: 42
Location:California  Entered:2002-01-07, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Progestrone,Estrpgen, Folic Acid, ASA
Current Illness: URI
Preexisting Conditions: NONE
Diagnostic Lab Data: Sonogram
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE73100LA0 LA
Administered by: Public     Purchased by: 0
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: 11/11/2001-Seven weeks into her pregnancy, the patient had a spontaneous abortion.

VAERS ID:179800 (history)  Vaccinated:2001-11-06
Age:80.0  Onset:2001-11-09, Days after vaccination: 3
Gender:Male  Submitted:2001-12-21, Days after onset: 42
Location:Florida  Entered:2002-01-09, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroids tabs
Current Illness: NO
Preexisting Conditions: Penicillin
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU681AA  LL
Administered by: Public     Purchased by: Public
Symptoms: Cough, Dizziness, Fatigue, Nasal congestion, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: approximately thee days post vaccination, the patient experienced dizziness, fatigue, fever, sore throat,"stuffy" head ans some coughing. these symptoms lasted three to four days.

VAERS ID:179813 (history)  Vaccinated:2001-11-06
Age:51.0  Onset:2001-11-22, Days after vaccination: 16
Gender:Female  Submitted:2002-01-02, Days after onset: 41
Location:California  Entered:2002-01-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estratest
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: I woke up in the middle of the night itching with hives all over my body, on 11-22-01 went to my own family doctor on 11-22-01. Said he didn''t know what caused the hives.

VAERS ID:179965 (history)  Vaccinated:2001-11-06
Age:3.7  Onset:2001-11-08, Days after vaccination: 2
Gender:Female  Submitted:2001-11-09, Days after onset: 1
Location:Wisconsin  Entered:2002-01-14, Days after submission: 66
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': WI0136
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM5148A22IMRA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5206A22IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT07571SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0235L0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 11/8/01, the pt had redness, swelling and warmth in the right upper arm. Saw a doctor in the clinic on 11/8/01 at 14:30 and was prescribed amoxicillin. Stated MD thought it was a local allergic reaction. On 11/9/01, the swelling extended to lower arm. Will call MD.

VAERS ID:179983 (history)  Vaccinated:2001-11-06
Age:68.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-08, Days after onset: 1
Location:Washington  Entered:2002-01-15, Days after submission: 68
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: High blood pressure; Sjogren''s Syndrome
Diagnostic Lab Data:
CDC 'Split Type': WA011809
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4018027 IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1449K IMLA
Administered by: Public     Purchased by: 0
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: I had a flu shot and pneumonia shot. I swelled up to past my elbow. It was painful and red.

VAERS ID:180161 (history)  Vaccinated:2001-11-06
Age:15.0  Onset:2001-11-08, Days after vaccination: 2
Gender:Female  Submitted:2001-11-12, Days after onset: 4
Location:Pennsylvania  Entered:2002-01-18, Days after submission: 67
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0604K2 RA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Chest pain, Injection site pain, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)
Write-up: Pt experienced general malaise, joint pain, soreness in arm at injection site and pain in chest with deep breath.

VAERS ID:180633 (history)  Vaccinated:2001-11-06
Age:17.0  Onset:2001-11-07, Days after vaccination: 1
Gender:Female  Submitted:2001-11-16, Days after onset: 9
Location:Pennsylvania  Entered:2002-01-29, Days after submission: 74
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: 11/8 - CBC/normal
CDC 'Split Type': PA0204
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE04831KA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Rash macular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt reports within 24 hr''s after receiving vaccine they developed 5cm diameter circular, pruritic macular exanthem at injection site. No fever, no previous reaction to flu vaccines, no cold or fever symptoms 2 wks prior to receiving vaccine, No allergy to eggs. Pt was given 10 days antibiotic (Keflex) for cellulitis.

VAERS ID:180672 (history)  Vaccinated:2001-11-06
Age:5.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-01-18, Days after onset: 73
Location:Virginia  Entered:2002-01-29, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM522A24IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Parent reports injection site swollen, red, and hot from shoulder to elbow. Red for over 30 days. Extreme irritability.

VAERS ID:180758 (history)  Vaccinated:2001-11-06
Age:40.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-01-21, Days after onset: 76
Location:Unknown  Entered:2002-01-31, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0676AA IM 
Administered by: 0     Purchased by: 0
Symptoms: Pruritus, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: influenza vaccine administered. patient experienced itching, hives and throat tightening.

VAERS ID:180906 (history)  Vaccinated:2001-11-06
Age:34.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-01-28, Days after onset: 83
Location:Michigan  Entered:2002-02-05, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Pregnant
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR0685AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Pruritus, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Client had reddened, itchy, puffy and nickel sized area on left cheek one hour after immunization. was given ice pack and instructed to call MD if any concerns. On 11-12-01, symptoms resolved.

VAERS ID:181295 (history)  Vaccinated:2001-11-06
Age:  Onset:2001-11-06, Days after vaccination: 0
Gender:Unknown  Submitted:2001-12-17, Days after onset: 41
Location:Kansas  Entered:2002-02-12, Days after submission: 57
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: UNK
CDC 'Split Type': HQ8216708NOV2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4018033 IM 
Administered by: Public     Purchased by: Public
Symptoms: Feeling abnormal, Pruritus
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Hypersensitivity (broad)
Write-up: A physician reported that an unidentified patient received Flu Shield (2001-2002 Formula) (influenza virus vaccine, trivalent, types a & b/2001-2002 formula) on 6 Nov 2001. One hour post immunization, the patient experienced itching around the mouth and "feeling funny". The patient was treated with fexofenadine hydrochloride (Allegra) and the symptoms resolved. No additional information was available as of the date of this report.

VAERS ID:181322 (history)  Vaccinated:2001-11-06
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2001-11-20
Location:Colorado  Entered:2002-02-12, Days after submission: 84
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ8428114NOV2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Other     Purchased by: Other
Symptoms: Feeling hot, Injection site erythema, Injection site pain, Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: A pharmacist reported that a pt received a dose of flu shield on 11/06/2001 and within 6-8 hours, developed an injection site reaction measuring 6cm to 8cm in diameter characterized by redness, swelling, heat and pain. The reporter indicated that 9 pts experienced this reaction; however, they are not presently identifiable. Additional reports will be generated when identifying info is provided.

VAERS ID:181364 (history)  Vaccinated:2001-11-06
Age:14.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2002-02-04, Days after onset: 90
Location:Arkansas  Entered:2002-02-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PCN
Diagnostic Lab Data: Chest X ray normal, Eos Increased 72.
CDC 'Split Type': AR0203
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5202A21IMLA
Administered by: Private     Purchased by: Other
Symptoms: Chest pain, Dyspnoea, Injection site induration, Laboratory test abnormal, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Fever 101F times 1 week, Eosinophil increased 72, felt ill. 3X5X1 induration @ site. SOB and chest pain times few days.

VAERS ID:181525 (history)  Vaccinated:2001-11-06
Age:76.0  Onset:2001-11-13, Days after vaccination: 7
Gender:Female  Submitted:2002-02-06, Days after onset: 85
Location:Texas  Entered:2002-02-20, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE reported
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': TX02021
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE06731KA IMLL
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Gait disturbance, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad)
Write-up: Client states she developed back pain several days after vaccination, then big toe became numb progressive to feet and legs up to hips. By day 10 was unable to walk. continues to need a cane for stability. regained ability to walk approximately 2 weeks ago.

VAERS ID:181940 (history)  Vaccinated:2001-11-06
Age:41.0  Onset:2001-11-20, Days after vaccination: 14
Gender:Female  Submitted:2002-03-01, Days after onset: 101
Location:Michigan  Entered:2002-03-05, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair; Advair; Atrovent inhalers; Proventil as needed
Current Illness: NONE
Preexisting Conditions: Asthma; Allergies to MSG, Erythromycin and strawberries
Diagnostic Lab Data: CBC, Sedimentation Rate, CPK, liver and kidney panels-all nml
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE083412A0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Severe myalgias and fatigue for 6 weeks, requiring the use of analgesics and muscle relaxants.

VAERS ID:182593 (history)  Vaccinated:2001-11-06
Age:52.0  Onset:0000-00-00
Gender:Female  Submitted:2002-03-04
Location:Georga  Entered:2002-03-18, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin, Provera
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH4008284  LA
Administered by: Other     Purchased by: Public
Symptoms: Feeling hot, Injection site pain, Injection site swelling, Musculoskeletal stiffness, Skin irritation
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Small pox vaccine administered by 15 punctures to left deltoid region on 11/06/2002. Vaccination complicated by irritation from tape. Vaccinoid response noted and scab fell off in December. In late Jan. 2002, pt noted episodic throbbing pain of inferior left deltoid and stiffness of left shoulder. Warmth and swelling of left deltoid on 03/01/2002 and prescribed Vioxx.

VAERS ID:183300 (history)  Vaccinated:2001-11-06
Age:34.0  Onset:2001-11-08, Days after vaccination: 2
Gender:Female  Submitted:2001-12-01, Days after onset: 23
Location:Hawaii  Entered:2002-04-09, Days after submission: 128
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0899L SC 
Administered by: Public     Purchased by: 0
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: The pt delivered on 11/4/01 and was given Rubella vaccine on 11/6/01, the day of discharge. Noted Bell''s Palsy on (R) the next morning, 11/8/01. Still with palsy.

VAERS ID:185768 (history)  Vaccinated:2001-11-06
Age:26.0  Onset:2001-11-22, Days after vaccination: 16
Gender:Female  Submitted:2002-05-15, Days after onset: 173
Location:Unknown  Entered:2002-05-30, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01114618
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Rash vesicular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning a 26 year old female who on 11/06/01 was vaccinated with the first dose of varicella virus vaccine live. On 11/22/01, the pt noticed six pox marks on her body which were dispersed in different areas and were described as being consistent with chickenpox. The pt also stated that her arm was sore and red at the injection site and reported that she experienced burning at the injection site . At the time of this report, the chickenpox type rash had resolved, however , the injection site pain was still bothering her. The outcome of the injection site erythema and burning was unknown. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:186198 (history)  Vaccinated:2001-11-06
Age:72.0  Onset:2001-11-20, Days after vaccination: 14
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:2002-06-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lithium, Synthroid, Tums, vitamins
Current Illness: NONE
Preexisting Conditions: Hypothyroid
Diagnostic Lab Data: NONE
CDC 'Split Type': MA0203
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO676AA4IMLA
Administered by: Public     Purchased by: Public
Symptoms: Joint range of motion decreased
SMQs:, Arthritis (broad)
Write-up: Four days after receiving flu shot, Ms Katz noticed that she was having difficulty raising her left arm. She reported this to me on 11/21/01. She had no visible signs of redness or swelling and ROM was WNL. Seen by dr on 11/27/01. No signs of infection. No treatment. On 01/29/01, arm was "much better".

VAERS ID:186969 (history)  Vaccinated:2001-11-06
Age:56.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-03-18, Days after onset: 132
Location:Maryland  Entered:2002-06-26, Days after submission: 99
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Zantac, Humibid, Flonase, Intal Ventolin. Acemcort, Albute, Benadryl
Current Illness: NONE
Preexisting Conditions: Allergic to sulfa, codeine; asthma; pulmonary fibrosis; arthritis
Diagnostic Lab Data: Lung and chest x-ray
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Asthenia, Chest pain, Headache, Hypoacusis, Hypoaesthesia, Injection site erythema, Injection site swelling, Migraine, Nasal congestion, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hearing impairment (narrow)
Write-up: Searing pain at base of brain. Searing pain through shoulders and lungs. pains and chills throughout body. Pain and ringing in ears. Swelling and redness at site of injection. Migraine headache for 2 days after injection. Pain and deadness in arm. Feel like been hit with a sledgehammer. Fever, Severe congestion, Weakness, Loss of hearing. Annual follow up on 12/16/03: "Vaccine recipient did not recover from the adverse events that were reported for this vaccination. I am still suffering with headaches and odd thrushing spasm in my head. The ringing in the ears continues as does the loss of hearing. Concentration is poor and I am plagued by fatigue. On exposure to the sun and heat my face breaks out with red bumps. It is grossly unfair that I have not received compensation for my pain, suffering, lethargy, weight gain etc. Burning in lungs, unable to cool down after being exposed to heat.

VAERS ID:188394 (history)  Vaccinated:2001-11-06
Age:82.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-07-30, Days after onset: 265
Location:Arizona  Entered:2002-08-02, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES01111505
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1159L0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a physician concerning an 82 year old white female pt with no known medical history who on 11/6/01, at 09:30, was vaccinated SC, in the left arm, with the 1st dose of pneumococcal vaccine 23 polyvalent (lot 641115/1159L). There was no illness at the time of vaccination. On 11/6/01 (previously reported as 11/7/01), the pt experienced a bad reaction which included severe swelling and redness. The pt was seen in the ER. There was no relevant diagnostic tests or lab data. The reporter expressed a concern with the lot number. The records of testing prior to release of this lot have been checked by GMP Compliance and found to be satisfactory. The lot complies with the standards of the Center for Biologics Evaluation and Research and was released. The pt''s husband (WAES 01111065) had a similar experience following exposure to pneumococcal vaccine 23 polyvalent. F/U information received on 5/9/02, stated that the pt recovered, on an unspecified date. There was no disability or long-term adverse effect noted. No further information is available.

VAERS ID:188453 (history)  Vaccinated:2001-11-06
Age:72.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2002-07-30, Days after onset: 265
Location:Washington  Entered:2002-08-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Femoral artery bypass, Asthma NOS, Cardiac disorder NOS, Specific allergy (drug), Hypersensitivity NOS, Cardiovascular disorder NOS
Diagnostic Lab Data:
CDC 'Split Type': WAES01114250
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0994L1  
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Chest discomfort, Chills, Erythema, Injection site reaction, Injection site swelling, Tenderness
SMQs:, Anaphylactic reaction (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a registered nurse concerning a 72 year old Caucasian male with asthma, heart disease, a morphine allergy, an intolerance to lorezapam (Ativan), poor circulation and a history of bypass to leg. On 11/6/01 at 10:00 am the patient was vaccinated with a second dose of pneumococcal vaccine 23 polyvalent (lot # 640744/0994L), in the right deltoid. Concomitant therapy that day included a flu vaccine. There was no illness at the time of vaccination. It was reported that on 10/11/94 the patient received the first dose. The second dose does not comply with the recommended dosage schedule. The patient reportedly within one to two hours, after the second dose, felt weak and had chills with receipt of the vaccine. The patient also had chest tightness and thought a heart attack. He took two aspirin and the chest pain went away. Later that night, his arm was very sore and swollen, also described as tightly swollen. The patient developed a severe local reaction at the injection site described as red, tender, swollen and painful. It was reproted that the symptoms started to get better the next day. However, the arm began to swell and he had more painful discomfort, described as very sore. The discomfort gradually diminished over 4 days. It was reported that the entire episode lasted for two weeks. The patient sought unspecified medical attention and recovered on 11/20/01/ It was noted that when flu shots first came out the patient became very ill after the first dose of the two dose series. No further information is expected.

VAERS ID:191828 (history)  Vaccinated:2001-11-06
Age:48.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-12-26, Days after onset: 50
Location:Maryland  Entered:2002-10-23, Days after submission: 300
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': U200101160
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO964AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthma, Chest pain, Tachycardia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: It was reported that a 48 year old female received a Fluzone SV ''01-''02 vaccination, lot # U0694Aa on 11/06/01 at 1;15 pm. By 3pm, she reported a rapid heart beat, heaviness & tightness in mid-chest and wheezing She is not, nor ever has been asthmatic. This lasted 45 minutes until 3:45 pm. Patient refused any follow-up. She said that the room where it was administered smelled "moldy" and this might have triggered a reaction.

VAERS ID:192930 (history)  Vaccinated:2001-11-06
Age:44.0  Onset:2002-11-06, Days after vaccination: 365
Gender:Male  Submitted:2002-11-08, Days after onset: 2
Location:California  Entered:2002-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I take a multivitamin and mineral supplement daily.
Current Illness: I felt fine,perfectly healthy
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER?0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Chills, Pain, Stomach discomfort, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Flu shot received around 10:15 am (11/6/02). Aches noted by 3:00pm, chills by 4:00pm. Went home early from work. Sour stomach, threw up at midnight. Slept poorly. Tired and achy next day, able to hold down food and worked 4 hours. Never had such a reaction to a flu shot before.

VAERS ID:194387 (history)  Vaccinated:2001-11-06
Age:1.3  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-11-26, Days after onset: 385
Location:Oklahoma  Entered:2002-12-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': WAES01110846
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1589K3IMRL
Administered by: Other     Purchased by: Other
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)
Write-up: Information has been received from a medical assistant concerning a 16 month old female with no past medical history and no known allergies who on 11/6/01 was inadvertently vaccinated with a fourth dose of haemophilus B conjugate vaccine (+) hepatitis B vaccine recombinant (yeast) (lot #638136/1589K), IM in the right thigh. There was no illness at the time of vaccination. It was reported that on 11/6/01 at 2:00PM the patient developed a bruise at the injection site. The mother described the bruise as the size of her hand. The patient sought unspecified medical attention. No further information is expected.

VAERS ID:202626 (history)  Vaccinated:2001-11-06
Age:2.0  Onset:2003-04-24, Days after vaccination: 534
Gender:Male  Submitted:2003-04-30, Days after onset: 6
Location:New York  Entered:2003-05-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Public     Purchased by: Public
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: On 4/24/03 - Pt presented with chicken pox.

VAERS ID:210858 (history)  Vaccinated:2001-11-06
Age:32.0  Onset:2002-10-25, Days after vaccination: 353
Gender:Female  Submitted:2003-10-14, Days after onset: 354
Location:California  Entered:2003-10-23, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor; Maxalt MLT; Compazine; Tylenol; Aleve; Keflex
Current Illness: Patient has had asthma in November 1990, that continues; hyperlipidemia in November 2000 that continues and allergic rhinitis.
Preexisting Conditions: Patient was involved in a MTA 09 Study and was vaccinated on 11/6/01. Patient had gestational diabetes in June 1998 and again in April 2000. The patient recovered after delivery. The patient has a history of asthma, hyperlipidemia and allergic rhinitis.
Diagnostic Lab Data: Lab results showed the patient having Type II Diabetes Mellitus. On 12/11/02: glucose 272 and GHb AlC 10.2. On 10/29/02: glucose 305 and GHb AlC 10.4.
CDC 'Split Type': 200302328
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUB034AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diabetes mellitus, Laboratory test abnormal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)
Write-up: This subject is a 32 year old female patient who was diagnosed with having Type II Diabetes Mellitus, on 10/25/02, approximately one year after receiving a dose of MENOMUNE A/C/Y/W-135, lot number UB034AA, given IM in the left arm on 11/06/2001. The patient was involved in a MTA-09 Adult Meningitis Study at this time. The subject was diagnosed with diabetes by lab results, no other symptoms or adverse events were reported. On 12/11/02, her glucose was 272 and GHb AlC was 10.2. And on 10/29/02, her glucose was 305 and her GHb AlC was 10.4. The patient was started on 500mg of Glucophage on 10/25/02. The patient had gestational diabetes in June 1998 and again in April 2000. She recovered from this after delivery. The patient has a history of asthma, hyperlipidemia and allergic rhinitis. At the time of vaccination, the patient was taking Lipitor, Maxalt MLT, Compazine, Tylenol and Aleve for migraines. The patient was also taking Keflex for an infected finger. The event of Type II Diabetes mellitus was reported by the investigator as unrelated to the study vaccine. (OMIC).

VAERS ID:215020 (history)  Vaccinated:2001-11-06
Age:0.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2004-01-09, Days after onset: 794
Location:Texas  Entered:2004-01-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC 'Split Type': A0388123A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS   LA
Administered by: Public     Purchased by: Other
Symptoms: Urticaria, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: This report describes the occurrence of hives in a 1 day old male who received hepatitis B vaccine recombinant (Engerix-B) for prophylaxis. This report was received from the pt''s mother and has not been verified by a physician or other healthcare professional. The subject had no relevant medical history. Concurrent medical conditions and concurrent medications were not specified. On 11/06/2002, the subject received his first injection of hepatitis B vaccine recombinant (Engerix-B). Twelve hours later, the subject developed hives. The hives resolved two days later. The reporter stated the subject had developed hives after each subsequent injection of Engerix-B and diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (Infanrix) (see report number A0388124A). The subject was seen by a dermatologist who allegedly reported the hives may be a reaction to the vaccines. Comment: This report has been linked to report A0388124A due to the same pt and same reporter.

VAERS ID:232327 (history)  Vaccinated:2001-11-06
Age:33.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-10-10, Days after onset: 337
Location:Unknown  Entered:2005-01-14, Days after submission: 827
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron tablets 11Jan01 Daily
Current Illness:
Preexisting Conditions: Pregnant (Sex: Female)
Diagnostic Lab Data:
CDC 'Split Type': PJP200100409
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE04811KA IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Nausea, Unintended pregnancy
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Normal pregnancy conditions and outcomes (narrow)
Write-up: A report was received from a health professional on 07Nov01, concerning a 32 year old female pt, who was administered the Fluvirin vaccine on 06Nov01 whilst 7 weeks pregnant. The pt experienced nausea and dizziness in the evening on 06Nov01. The pt had a pregnancy test 2 weeks previously which tested positive. Per the pt, her obstetrician said she was 7 weeks pregnant. The pt experienced nausea and dizziness in the evening of 06Nov01. At the time of the report the pt had recovered. There was insufficient information to determine the reporter''s causality assessment.

VAERS ID:232343 (history)  Vaccinated:2001-11-06
Age:69.0  Onset:2001-11-09, Days after vaccination: 3
Gender:Male  Submitted:2002-10-10, Days after onset: 334
Location:Unknown  Entered:2005-01-14, Days after submission: 827
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': PJP200100438
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES 1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: A report was received from a health professional on 11/13/2001, concerning a 69 year old male, who experienced an injection site reaction, 3 - 4 days after receiving the Fluviron vaccine on 11/06/2001. On 11/09/2001, the patient experienced severe pain at the injection site, approximately 3 - 4 days after receiving the Fluvirin vaccine in the deltoid portion of his left arm. There were no signs of infection of inflammation including redness and tenderness at the injection site. The patient had received previous influenza vaccinations (brand unspecified) without incidence. The patient did not receive any treatment for the pain. At time of report, the pain had continued for 3 days but was improving. The reporter has assessed the relationship of the study medication to the event as probable.

VAERS ID:178720 (history)  Vaccinated:2001-11-06
Age:6.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2001-12-04, Days after onset: 28
Location:Foreign  Entered:2001-12-07, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluticasone; salmeterol; salbutamol; paracetamol
Current Illness: Asthma
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC 'Split Type': PNP2001004310
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES760847 IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site hypersensitivity, Lymphadenopathy, Oedema, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: ON 06-NOV-2001, the pt experienced redness, swelling, itchiness and some hardness over the circumference of the arm around the injection site and over two thirds of the upper extending onto the top of the shoulder and into the axilla, after receiving the Fluvirin vaccine. The pt also experienced enlarged lymph nodes. Therapeutic measures taken as a result of these events included paracetamol and antihistamines. At time of report, the pt was recovering. There was insufficient information to determine the reporter''s causality assessment.

VAERS ID:179343 (history)  Vaccinated:2001-11-06
Age:29.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2001-12-19, Days after onset: 43
Location:Foreign  Entered:2001-12-26, Days after submission: 7
Life Threatening? Yes
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': 20010375931
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS  IMLA
Administered by: 0     Purchased by: 0
Symptoms: Hypotension, Loss of consciousness, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (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), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: On 06-NOV-2001 pt received the first Twinrix vaccine together with a DTP vaccination. An unknown time shortly post vaccination, the pt experienced circulatory shock with unconsciousness and hypotension, lasting 30 seconds. The pt showed no signs for any illness and no allergic symptoms. The pt was brought into shock position. According to follow up information from 17-DEC-2001 the event was life threatening. The most recent information received on 17-DEC-2001 reports the pt as recovered. The reporter specified circulatory shock with unconsciousness as possibly related to the vaccination. Hyotension was not specified concerning the casualty.

VAERS ID:179716 (history)  Vaccinated:2001-11-06
Age:75.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Female  Submitted:2002-02-27, Days after onset: 113
Location:Foreign  Entered:2002-01-07, Days after submission: 51
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: phenprocoumon (Marcumar)
Current Illness:
Preexisting Conditions: Recurrent venous thrombosis and arteria cerebral media infarction with convulsions in 1997.
Diagnostic Lab Data: WBC-16,000/microL; Body temperature-40C; Serum C-reactive protein-16.2 mg/L
CDC 'Split Type': WAES0112USA02362
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Injection site erythema, Laboratory test abnormal, Pyrexia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a health professional concerning a 75 year old female who on 11/6/01 was vaccinated with a dose of pneumococcal vaccine 23 polyvalent. Twelve hours, post vax, the pt developed a fever up to 40C and convulsions. An injection site redness was also observed and the pt was hospitalized. She was administered amoxicillin and clavulin acid and recovered completely. Additional information is expected. It was noted that no permanent anticonvulsive therapy was given. The pt was discharged from the hospital on 11/15/01, and recovered completely. No further info is available. File closed.

VAERS ID:187284 (history)  Vaccinated:2001-11-06
Age:55.0  Onset:2001-11-14, Days after vaccination: 8
Gender:Female  Submitted:2002-07-05, Days after onset: 232
Location:Foreign  Entered:2002-07-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: Chronic sinusitis; ovariectomy; appendicectomy and left menisectomy
Diagnostic Lab Data: Liver function test-normal
CDC 'Split Type': B0257547A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5137A60  
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Fatigue, 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), Arthritis (broad)
Write-up: Report number 20010296451 describes the occurrence of polyarthralgia in a 55 year old female pt vaccinated with Engerix B for hep b prophylaxis. The pt''s relevant medical history included chronic sinusitis, ovariectomy, appendicectomy and left menisectomy. In 1998, allergologic check up was negative. Concurrent medications and medical conditions are not specified. On 11/06/2001, the pt was vaccinated for the first time with Engerix B at a dose of 20mg/day. Eight days later, the pt developed fits of fever at 39.5 C and polyarthralgia localized at hands with joint edema, fatigue and myalgia. The pt received a corrective treatment with Dafalgen. Within two days, fever had resolved. At an unspecified date, liver function test was normal. Within three weeks, polyarthralgia had resolved. This case was considered as medically serious by the reporter. The most recent info received on 02/01/2002 reports the outcome of the pt as recovered without sequelae. The reporter''s causality assessment is definitively related to Engerix B.

VAERS ID:191308 (history)  Vaccinated:2001-11-06
Age:1.4  Onset:2002-07-21, Days after vaccination: 257
Gender:Female  Submitted:2002-10-11, Days after onset: 82
Location:Foreign  Entered:2002-10-14, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC 'Split Type': HQ4537607OCT2002
Vaccination
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Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4771751IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug ineffective, Meningitis
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow)
Write-up: Information has been received from a healthcare professional concerning a 25 month old female. On 11/6/01, at 17 months of age, she received her second dose of Prevnar. On 7/21/02, she developed meningitis. She was hospitalized. She recovered. No further info was available at the date of this report. Reported on 02/27/2003: "Follow-up information received on 02/17/2003 provided clarification of laboratory results. Information has been received from a healthcare professional concerning a 25-month-old female. On 11/06/2001, at 17 months of age, she received her second dose of Prevenar. On 07/21/2002, she developed meningitis. She was hospitalized. An unspecified culture revealed Streptococcus pneumoniae. Serotyping was not performed because the sample was destroyed. She recovered. This report was received from Wyeth, Portugal (Reg. No. 96-Prev/SP/006).

VAERS ID:232261 (history)  Vaccinated:2001-11-06
Age:6.0  Onset:2001-11-06, Days after vaccination: 0
Gender:Male  Submitted:2002-10-10, Days after onset: 337
Location:Foreign  Entered:2005-01-14, Days after submission: 827
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone; Calpol; Salmeterol; Salbutamol
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC 'Split Type': PJP200100431
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES760847 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site reaction, Injection site swelling, Lymphadenopathy, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: A report was received from a foreign regulatory authority concerning a 6 year old male patient who experienced an injection site reaction and enlarged lymph nodes, which were considered to be serious as they were medically significant (OMIC), after receiving the Fluvirin vaccine on 11/6/01. Relevant medical history includes asthma, for which the patient was receiving concomitant medications Fluticasone, Salmeterol, Salbutamol, and Paracetamol. On 11/6/01, the patient experienced redness, swelling, itchiness and some hardness over the circumference of the arm around the injection site and over two thirds of the upper arm extending onto the top of the shoulder and into the axilla, after receiving the Fluvirin vaccine. The patient also experienced enlarged lymph nodes. Therapeutic measures taken as a result of these events included paracetamol and antihistamines. At time of report, the patient was recovering. There was insufficient information to determine the reporter''s causality assessment.

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