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Case Details (Sorted by Vaccination Date)

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VAERS ID: 115067 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Ohio  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-16
   Days after onset:0
Entered: 1998-10-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456819 / 1 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1232H / 1 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO699 / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Crying, Insomnia, Screaming
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)

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

Write-up: Pt recv vax on 10/16/98; 1 hr later pt exp high pitched screaming for 4 hr; pt slept 15 min at a time.


VAERS ID: 115165 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Unknown  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-19
   Days after onset:2
Entered: 1998-10-21
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 498822 / UNK - / -

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

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

Write-up: area of 3x5 swollen & warm around inj site;


VAERS ID: 115206 (history)  
Form: Version 1.0  
Age: 57.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:1998-10-18
   Days after vaccination:2
Submitted: 1998-10-20
   Days after onset:2
Entered: 1998-10-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988212 / 1 RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Facial palsy, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hearing impairment (broad)

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

Write-up: dx Bell''s Palsy, facial paralysis, swelling;


VAERS ID: 115214 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-21
   Days after onset:5
Entered: 1998-10-23
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 01998P / 2 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Laryngospasm
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Inhalers
Current Illness: NONE
Preexisting Conditions: bee sting, allergy-throat closing rxn in past, allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt states exp throat tightening 20min p/vax;sx lasted 5-7min, per pt & then resolved;pt was @ home, no tx x/advised to take DPH;pt called clinic p/sx had resolved;


VAERS ID: 115268 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-19
   Days after onset:3
Entered: 1998-10-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0510H / 2 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450190 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Asthma, Condition aggravated
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: no hx of asthma or bronchospasm
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: onset of severe bronchospasm w/in 2min of MMR, DTAP vax;no hypotension, no angioedema-resolved w/nebulizer albuterol p/10-15min;


VAERS ID: 115293 (history)  
Form: Version 1.0  
Age: 64.0  
Gender: Female  
Location: Michigan  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0965760 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Myalgia, Pain, Urticaria, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: theophyline;Covera;Provasid;Pred;
Current Illness: copd;C-defical
Preexisting Conditions: rash w/minocin;COPD;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI98122

Write-up: pt recv vax 16OCT98 & awakened day following vax 17OCT98 w/hives on lt thigh size 1"-1 1/2" spreading to buttock (lt on 18OCT);painful;T99-99.3;buttock still red raised areas, painful;


VAERS ID: 115294 (history)  
Form: Version 1.0  
Age: 46.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-19
   Days after onset:2
Entered: 1998-10-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Unknown
Symptoms: Arthralgia, Dysuria, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zocor;Pepcid;Flonase;ASA
Current Illness: NONe
Preexisting Conditions: CAD, GERD
Allergies:
Diagnostic Lab Data: UA abnormal;
CDC Split Type:

Write-up: dysuria, generalized myalgia, arthralgias, fever, chills & nausea;


VAERS ID: 115316 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-16
   Days after onset:0
Entered: 1998-10-26
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -

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

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

Write-up: broke out in hives on lt buttock & lt upper thigh;rx DPH;


VAERS ID: 115380 (history)  
Form: Version 1.0  
Age: 78.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-23
   Days after onset:6
Entered: 1998-10-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 3AM 17OCT98 arose from sleep to get dressed;became very dizzy, could not stand & fell to the floor;climbed back into bed still dizzy & went to sleep;awoke 2hr later was still unsteady;later it passed off;


VAERS ID: 115384 (history)  
Form: Version 1.0  
Age: 0.7  
Gender: Male  
Location: California  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-20
   Days after onset:4
Entered: 1998-10-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 3 RL / -
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988214 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2725A2 / 3 LL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: tri-vi-flor
Current Illness: old OM
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash;fever;irritable;sl lethargy;rx DPH, observe;


VAERS ID: 115413 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Washington  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-23
   Days after onset:7
Entered: 1998-10-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0968420 / 1 - / IM

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

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

Write-up: hives, swelling in periorbital area;


VAERS ID: 115467 (history)  
Form: Version 1.0  
Age: 52.0  
Gender: Female  
Location: California  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-22
   Days after onset:6
Entered: 1998-10-30
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0971880 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dysarthria, Hypokinesia
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: negative CT scan & ultrasound;
CDC Split Type: U199800686

Write-up: pt recv vax 16OCT98 & reportedly w/in 3hr of vax pt exp dysarthria that lasted 45min;pt also exp diff controlling lt index finger & thumb;pt hosp over night for observation;


VAERS ID: 115484 (history)  
Form: Version 1.0  
Age: 42.0  
Gender: Female  
Location: Maryland  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-27
   Days after onset:10
Entered: 1998-10-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988203 / UNK LA / -
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923820 / UNK RA / -

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

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

Write-up: 17OCT98-18OCT98 pt devel redness, swelling, warmth, pain to rt upper arm; tx w/med;


VAERS ID: 115501 (history)  
Form: Version 1.0  
Age: 44.0  
Gender: Female  
Location: South Dakota  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-21
   Days after onset:5
Entered: 1998-10-30
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0968380 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Dyspepsia, Injection site pain, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: SD99026

Write-up: Pt recv vax on 10/16/98; on 10/16/98 pt exp tenderness at vax site; on 10/17/98 pt exp upset stomach and achiness, fever, nausea.


VAERS ID: 115575 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Ohio  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-19
   Days after onset:3
Entered: 1998-11-02
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 451463 / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OH98082

Write-up: lt upper arm, lateral side red, indurated, tender & painful for 1wk;


VAERS ID: 115585 (history)  
Form: Version 1.0  
Age: 63.0  
Gender: Female  
Location: Ohio  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-19
   Days after onset:3
Entered: 1998-11-02
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0971890 / 3 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 454379 / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Premarin;Fosomex
Current Illness: NONe
Preexisting Conditions: hayfever, dust pollen, sinus only
Allergies:
Diagnostic Lab Data: NOEN
CDC Split Type: OH98077

Write-up: immed felt itching @ site;area hot to touch;19OCT98 swelling down to elbow;+ swelling & warmth rt arm;mild erythema medial arm;


VAERS ID: 115895 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Male  
Location: California  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-29
   Days after onset:13
Entered: 1998-11-05
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV034 / 1 - / -

Administered by: Military       Purchased by: Military
Symptoms: Dry skin, Pain, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: skin test to vaccine negative;
CDC Split Type:

Write-up: 5min p/vax burning sensation of face;2hr later itch all over;next day face tight dry, later peeled;seen in acute care VS nl-face red;rx epi, DPH;


VAERS ID: 115896 (history)  
Form: Version 1.0  
Age: 55.0  
Gender: Female  
Location: Ohio  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-16
   Days after onset:1
Entered: 1998-11-05
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0977170 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1452E / 1 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Hypokinesia, Infection, Myalgia, Pain, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Elavil;
Current Illness: NONE
Preexisting Conditions: ragweed, cats, grass, trees, harrington rods in back;
Allergies:
Diagnostic Lab Data: NOEn
CDC Split Type:

Write-up: states rt arm became red & sore;became unable to move arm d/t pain;went to hosp ER;told infect in arm & given ATB;


VAERS ID: 116059 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Male  
Location: Indiana  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-11-05
   Days after onset:20
Entered: 1998-11-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0974000 / 1 LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 454956 / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cellulitis, Cough, Dyspnoea, Injection site hypersensitivity, Laryngitis, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp fever 104, excessive crying @ 2mo w/DTP dose 2;sibling exp same @ 6mo w/3~ ()~~~In patient
Other Medications: Lanoxin;aldactone;Lasix;Inderal;
Current Illness: NONE
Preexisting Conditions: hypoplastic lt heart synd;double outlet rt ventricle pulmonary stenosis, immunodeficiency missing subclass IV
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: rt deltoid became red Friday evening Saturday 17OCT98, arm worse, T103.6 ear;seen by MD 19OCT98 w/6" long x 3 1/2" wide are of cellulitis @ inj site;med given;2NOV98 had croupy cough & fever seen MD dx pneumonia placed on cefzil;


VAERS ID: 116073 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Tennessee  
Vaccinated:1998-10-16
Onset:1998-10-27
   Days after vaccination:11
Submitted: 1998-10-30
   Days after onset:3
Entered: 1998-11-09
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 934600 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Bloodwork, CT scan, M.R.I., EEG-all within normal limits
CDC Split Type: TN98048

Write-up: Pt recv vax on 10/16/98; on 10/27/98 pt exp seizure.


VAERS ID: 116093 (history)  
Form: Version 1.0  
Age: 41.0  
Gender: Female  
Location: Missouri  
Vaccinated:1998-10-16
Onset:1998-10-18
   Days after vaccination:2
Submitted: 1998-10-27
   Days after onset:9
Entered: 1998-11-09
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0984540 / UNK RA / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0967100 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hypokinesia, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO98068

Write-up: 2 days p/vax pt exp deep, aching pain in lt deltoid muscle;states pain in from lt shoulder to lt elbow;pt states has difficulty lifting w/lt arm now;


VAERS ID: 116111 (history)  
Form: Version 1.0  
Age: 50.0  
Gender: Male  
Location: Ohio  
Vaccinated:1998-10-16
Onset:1998-10-21
   Days after vaccination:5
Submitted: 1998-11-05
   Days after onset:15
Entered: 1998-11-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0983290 / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Arthralgia, Dermatitis bullous, Headache, Myalgia, Oedema peripheral, Rash maculo-papular, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: lab CBC, sed rate, chem-nl;
CDC Split Type:

Write-up: 21OCT98 pt c/o joint & muscle ache & h/a;23OCT ankles edematous;25OCt severe edema of ankles w/blisters on calves, red raised areas on heels;size of fingernail, ankles red & inflamed;saw MD & was given cortisone & medrol pack;


VAERS ID: 116396 (history)  
Form: Version 1.0  
Age: 59.0  
Gender: Female  
Location: Florida  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-11-09
   Days after onset:23
Entered: 1998-11-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0967040 / UNK RA / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / -

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

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

Write-up: Pt recv vax on 10/16/98; on 10/17/98 pt exp vax site pain w/ 2 red welts (2-3 in), hotness; tx=Decadron shot, cortisone cream x2 day; pt imp 2-3 day


VAERS ID: 116501 (history)  
Form: Version 1.0  
Age: 48.0  
Gender: Female  
Location: Ohio  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-29
   Days after onset:13
Entered: 1998-11-18
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 097717C / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, Malaise, Myalgia, Oedema, Oedema peripheral, Thinking abnormal, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Feldane;cyotec;Lozs;Elavil;Attace;Provara;Cardina;
Current Illness: no acute illness
Preexisting Conditions: HTN, arthritis, depression
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: OH98090

Write-up: pt exp soreness in arm w/in 1hr p/vax; took APAP;swelling in arm 2hr later;5hr p/vax diff concentrating, malaise, felt hot & pt thought face was feeling puffy;went home 6hr p/vax entire arm & extending to mid back feet swollen;


VAERS ID: 116770 (history)  
Form: Version 1.0  
Age: 57.0  
Gender: Female  
Location: Texas  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-30
   Days after onset:13
Entered: 1998-11-24
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975800 / UNK LA / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0906E / UNK RA / -

Administered by: Public       Purchased by: Private
Symptoms: Cellulitis, Injection site hypersensitivity, Paraesthesia, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: 4/98 Cartilage overgrowth
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: TX98168

Write-up: Pt recv vax on 10/16/98; on 10/17/98 pt exp cellulitis of Rt arm w/ red, itching,swelling & fever; numb hands to neck; tx=Keflex


VAERS ID: 116790 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Female  
Location: Michigan  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-11-19
   Days after onset:33
Entered: 1998-11-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975770 / 1 - / IM A

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

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

Write-up: Pt recv vax on 10/16/98; on 10/17/98 pt exp redness/erythema x1 day at vax site


VAERS ID: 116801 (history)  
Form: Version 1.0  
Age: 67.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-11-09
   Days after onset:23
Entered: 1998-11-25
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0978660 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0871H / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Coronary artery disease, Diabetes mellitus, Unevaluable event
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec, lanoxin, coumadin, immodium PRN;insulin
Current Illness: NONE
Preexisting Conditions: CAD/diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: NJ9827

Write-up: pt expired w/in 24h of vax;no apparent allergic response;


VAERS ID: 116983 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Female  
Location: Virginia  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-18
   Days after onset:1
Entered: 1998-12-01
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0970170 / 1 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Asthenia, Chills, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Flutamide,birth control, prilecek
Current Illness: NA
Preexisting Conditions: seasonal, environmental
Allergies:
Diagnostic Lab Data: CBC-nl
CDC Split Type:

Write-up: feeling very tired & weak;switching back & forth from sweating spells, then chills;


VAERS ID: 117139 (history)  
Form: Version 1.0  
Age: 63.0  
Gender: Male  
Location: Georgia  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-28
   Days after onset:12
Entered: 1998-12-07
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0969610 / 3 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0304H / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Oedema peripheral, Pyrexia, Skin striae
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE;routine DPH
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA98113

Write-up: pain, redness, swelling lt deltoid muscle inner axilla down to mid lt forearm;red streak w/o edema;T101-102;


VAERS ID: 117158 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Male  
Location: Colorado  
Vaccinated:1998-10-16
Onset:1998-10-22
   Days after vaccination:6
Submitted: 1998-10-26
   Days after onset:4
Entered: 1998-12-07
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455726 / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0981H / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 1010H / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0793F / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cortisone topical cream
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CO98048

Write-up: Pt recv vax on 10/16/98; on 10/22/98 pt exp red, raised bumps behind left knee;tx=cortizone cream


VAERS ID: 117267 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-12-03
   Days after onset:48
Entered: 1998-12-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0946450 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)

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

Write-up: crying for 3hr non-stop;APAP;


VAERS ID: 117326 (history)  
Form: Version 1.0  
Age: 73.0  
Gender: Male  
Location: Montana  
Vaccinated:1998-10-16
Onset:1998-11-03
   Days after vaccination:18
Submitted: 1998-11-20
   Days after onset:17
Entered: 1998-12-14
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988210 / UNK RA / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0871H / UNK LA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Eyelid ptosis, Facial palsy, Lacrimal disorder
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Lacrimal disorders (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin;Verapamil;ASA;
Current Illness: cold sore
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MT98032

Write-up: rt eye watering, partial paralysis of face nerve rt side w/ptosis;rt corner of mouth not totally paralyzed;pred given;


VAERS ID: 117445 (history)  
Form: Version 1.0  
Age: 67.0  
Gender: Male  
Location: Florida  
Vaccinated:1998-10-16
Onset:0000-00-00
Submitted: 1998-12-10
Entered: 1998-12-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981820 / UNK LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pain, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: fever, chills, pain, achy all over lasted 1 day;


VAERS ID: 117463 (history)  
Form: Version 1.0  
Age: 38.0  
Gender: Female  
Location: California  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-20
   Days after onset:3
Entered: 1998-12-16
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: Pt recv vax on 10/16/98; on 10/17/98 pt exp fever (99.4), malaise


VAERS ID: 117678 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:1998-11-05
   Days after vaccination:20
Submitted: 1998-11-18
   Days after onset:13
Entered: 1998-12-28
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0053H / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Cellulitis, Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Intal, Phenobarle, Cisapride, Zantac, Albuterol, Atrovent, Lactalose
Current Illness: Tegretol-induced hepatitis
Preexisting Conditions: Cerebral palsy, seizures, asthma, chronic aspiration
Allergies:
Diagnostic Lab Data: Culture of vesicle-results pending
CDC Split Type: PA9866

Write-up: Pt recv vax on 10/16/98; on 11/5/98 pt exp vesicular rash on trunk x 2-3 day & bullae, cellulitis


VAERS ID: 117721 (history)  
Form: Version 1.0  
Age: 71.0  
Gender: Female  
Location: Kansas  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-26
   Days after onset:10
Entered: 1998-12-28
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0978720 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1508E / UNK RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hypokinesia, Myalgia, Oedema peripheral, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: KS98046

Write-up: Pt recv vax on 10/16/98; on same day pt exp achy arm, swollen arm w/ rash, unable to move arm, fever (102); tx=Aspercreme


VAERS ID: 117806 (history)  
Form: Version 1.0  
Age: 67.0  
Gender: Female  
Location: Alaska  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-19
   Days after onset:3
Entered: 1998-12-29
   Days after submission:71
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0973980 / UNK LA / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1173E / UNK LA / -

Administered by: Public       Purchased by: Unknown
Symptoms: Chills, Dermatitis bullous, Ecchymosis, Myasthenic syndrome, Pain, Paralysis, Vasodilatation
SMQs:, Severe cutaneous adverse reactions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: not ill
Preexisting Conditions: pollen allergy-some food allergies-no eggs;
Allergies:
Diagnostic Lab Data:
CDC Split Type: AK98028

Write-up: blisters under breasts red & raised 330PM Friday;lt arm felt paralyzed-weak, black & blue by evening-hot to touch-3" x 6", chills;painful on saturday;took DPH;


VAERS ID: 118759 (history)  
Form: Version 1.0  
Age: 1.1  
Gender: Female  
Location: California  
Vaccinated:1998-10-16
Onset:1998-11-02
   Days after vaccination:17
Submitted: 1999-02-01
   Days after onset:91
Entered: 1999-02-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / SC A

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: devel rash on body @ least 18 vesicles p/varicella vaccine;no history exposure to chickenpox;


VAERS ID: 118969 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-11-09
   Days after onset:23
Entered: 1999-02-11
   Days after submission:94
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978193 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Laboratory test abnormal, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: calan, naproxen
Current Illness: NONE
Preexisting Conditions: Hx of breast cancer (right) w/ lumpectomy 6.5 yr ago;hypertension, hemorrhoids, amenorrhea since chemotherapy;
Allergies:
Diagnostic Lab Data: Prolactin level-elevated
CDC Split Type: 898314095A

Write-up: Pt recv vax on 10/16/98; on 10/17/98 pt exp swollen & painful breasts


VAERS ID: 120760 (history)  
Form: Version 1.0  
Age: 27.0  
Gender: Male  
Location: Unknown  
Vaccinated:1998-10-16
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1999-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV017 / 3 - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp papular rash @ inj site w/dose 1&2 anthrax;~ ()~~0.00~Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/each of first 3 immun, pt devel a papular rash @ the site;they were progressively worse w/subsequent vax;p/3rd vax the rxn was more generalized w/severe pruritus & dermatitis;abd area became infected d/t scratching;


VAERS ID: 121234 (history)  
Form: Version 1.0  
Age: 51.0  
Gender: Female  
Location: Illinois  
Vaccinated:1998-10-16
Onset:1998-12-02
   Days after vaccination:47
Submitted: 1999-04-01
   Days after onset:120
Entered: 1999-04-15
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0972870 / 4 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dysgeusia, Dysphagia, Eye disorder, Facial palsy, Headache, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: sulfa allergy
Allergies:
Diagnostic Lab Data: CBC;Chem screen;
CDC Split Type:

Write-up: p/vax pt did not feel well, had waves of nausea until 2DEC lt eye weak;had difficulty w/drinking, h/a;5DEC Bell''s palsy dx, tx w/pred; as of 1APR cont w/altered taste & lt eye vague weakness;


VAERS ID: 121744 (history)  
Form: Version 1.0  
Age: 39.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-10-26
   Days after onset:10
Entered: 1999-04-26
   Days after submission:181
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 557C6 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamins, olivex
Current Illness:
Preexisting Conditions: allergic to codeline, allergic to compazine
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980254861

Write-up: pt exp red line & 4-5 red blotchy circles at the injection site.


VAERS ID: 122103 (history)  
Form: Version 1.0  
Age: 67.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:0000-00-00
Submitted: 1999-05-06
Entered: 1999-05-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 0981810 / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Hypotonia, Movement disorder, Myasthenic syndrome, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: FLU101220599

Write-up: Pt recv vax on 10/16/98; post vax pt exp discomfort, tingling, paresthesia, weak lt leg; pt cont difficulty grasping w/ lt hand


VAERS ID: 124869 (history)  
Form: Version 1.0  
Age: 76.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:0000-00-00
Submitted: 1999-05-27
Entered: 1999-06-07
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. 20208KA / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none rpt
Allergies:
Diagnostic Lab Data: none rpt
CDC Split Type: MPI981953A

Write-up: p/recv vax pt exp a hard lump size of quarter. further info requested


VAERS ID: 124870 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1998-10-16
Onset:0000-00-00
Submitted: 1999-05-27
Entered: 1999-06-07
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. 20208KA / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: none rpt
Allergies:
Diagnostic Lab Data: none rpt
CDC Split Type: MPI981953B

Write-up: p/vax pt exp hard lump the size of quarter.further info requested


VAERS ID: 125868 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: California  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1999-07-12
   Days after onset:269
Entered: 1999-07-14
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Injection site mass, Injection site oedema, Injection site pain, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data~ ()~~~In patient
Other Medications: synthroid
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98101333

Write-up: p/recv vax pt devel swelling & redness in arm; quite a sizable area above elbow was swollen & painful to touch; also had real tiredness; pt recovered 10/18 however pt stated the area still feels little hard;


VAERS ID: 125874 (history)  
Form: Version 1.0  
Age: 46.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1999-07-12
   Days after onset:269
Entered: 1999-07-14
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Hypokinesia, Injection site hypersensitivity, Injection site oedema, Injection site pain, Oedema peripheral, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No Relevant Data~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98101549

Write-up: p/vax pt exp inj site & rt arm pain, edema, rash immobility, warm to touch;pt arm was described as being taught;f/u from pt adverse exp resolved as of 10/20/98;


VAERS ID: 127983 (history)  
Form: Version 1.0  
Age: 84.0  
Gender: Female  
Location: Arkansas  
Vaccinated:1998-10-16
Onset:1998-10-21
   Days after vaccination:5
Submitted: 1998-10-27
   Days after onset:6
Entered: 1999-09-03
   Days after submission:310
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975860 / 1 LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 445636 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: K-dur;Insulin, diltiazem, Nitrostat, Lasix, coumadin, Propulsid;
Current Illness: NONE
Preexisting Conditions: Insulin-dependent diabetes mellitus, congestive heart failure, coronary artery disease, cardiac arrhythmia;allergic to PCN, IV dye, sulfa;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 898306049A

Write-up: p/vax pt reported pain @ inj site;pt was advised to be seen by MD but declined;pt recovered;


VAERS ID: 133549 (history)  
Form: Version 1.0  
Age: 56.0  
Gender: Female  
Location: Texas  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1998-10-30
   Days after onset:13
Entered: 2000-02-01
   Days after submission:459
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975800 / UNK LA / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0906E / UNK RA / -

Administered by: Public       Purchased by: Private
Symptoms: Cellulitis, Injection site hypersensitivity, Oedema, Paraesthesia, Pruritus, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Cellulitis, bright red, itching, fever, rt deltoid. Hands bilaterally numb up to her neck. Still has problems under arm and around elbows itching and minimal swelling.


VAERS ID: 133909 (history)  
Form: Version 1.0  
Age: 65.0  
Gender: Male  
Location: Ohio  
Vaccinated:1998-10-16
Onset:2000-01-04
   Days after vaccination:445
Submitted: 2000-01-31
   Days after onset:27
Entered: 2000-02-14
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1508E / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Pneumonia, Pyrexia, Sepsis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lasix, Lanoxin, Klonipin, Lipitor,K Tabs
Current Illness: NONE
Preexisting Conditions: HTN, CAD, COPD,depression,hyperlipidemia
Allergies:
Diagnostic Lab Data: WBC-25,000; CXR-rt lower lobe infiltrate; blood /sputum culture-positive for pneumococcal septicemia
CDC Split Type:

Write-up: Seen in ER on 1/11/00; admitted to hospital on 1/12/00 for Pneumonia & Septicemia. Pt had fever of 103.


VAERS ID: 154871 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-12-04
   Days after onset:49
Entered: 2000-06-21
   Days after submission:564
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0980540 / UNK RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Ecchymosis, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: NONE
Preexisting Conditions: PCN, Sulfur allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: U1998006530

Write-up: Several hours post vax, pt experienced hives and blotches resembling black and blue marks. From additional information received on 12/4/98, it was reported, "tightening of throat, was seen by physician at ER and states received a prescription for prednisone but did not fill it. Client took 2 Benadryl and gradually improved within 3-4 days." It was reported that the pt recovered from this experience.


VAERS ID: 154884 (history)  
Form: Version 1.0  
Age: 56.0  
Gender: Female  
Location: Florida  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-12-31
   Days after onset:76
Entered: 2000-06-21
   Days after submission:537
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0984610 / 1 RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Eye discharge, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Glaucoma (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U1998006800

Write-up: Pt experienced red eyes with drainage.


VAERS ID: 154888 (history)  
Form: Version 1.0  
Age: 54.0  
Gender: Female  
Location: North Carolina  
Vaccinated:1998-10-16
Onset:0000-00-00
Submitted: 1998-11-23
Entered: 2000-06-21
   Days after submission:575
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 0975770 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800685

Write-up: It was reported that a 54 year female received Fluzone SV 98-99 USP vaccine on 10/16/1998. Reportedly sometime after the vaccination the pt experienced a large red area at the site of injection. The pt also experienced a 3-cm lump and pain at the injection site left deltoid to elbow.


VAERS ID: 156996 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Indiana  
Vaccinated:1998-10-16
Onset:1999-03-11
   Days after vaccination:146
Submitted: 2000-05-16
   Days after onset:431
Entered: 2000-07-17
   Days after submission:62
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: negative varicella antibody
CDC Split Type: WAES99051039

Write-up: Subsequent to receiving first and second doses of varicella virus vaccine live the pts laboratory tests revealed a negative varicella antibody titer.


VAERS ID: 168320 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Florida  
Vaccinated:1998-10-16
Onset:2001-03-20
   Days after vaccination:886
Submitted: 2001-03-28
   Days after onset:8
Entered: 2001-04-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0955H / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1051H / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)

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

Write-up: 20-30 erythematous lesions with central papule. Dad dx''d with varicella 10-14 days after child''s breakout.


VAERS ID: 198602 (history)  
Form: Version 1.0  
Age: 52.0  
Gender: Female  
Location: Georgia  
Vaccinated:1998-10-16
Onset:1999-02-01
   Days after vaccination:108
Submitted: 2002-10-21
   Days after onset:1357
Entered: 2003-03-03
   Days after submission:133
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV017 / 3 - / -

Administered by: Military       Purchased by: Military
Symptoms: Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen
Current Illness: NONE
Preexisting Conditions: PCN, Iodine, Lanolin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of gait imbalance (drifts to the right) since February 1999. Symptoms getting progressively worse. Received 3 anthrax injections; the 3rd 3 months before gait problems began.


VAERS ID: 213547 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Unknown  
Vaccinated:1998-10-16
Onset:1998-10-23
   Days after vaccination:7
Submitted: 2003-12-01
   Days after onset:1865
Entered: 2003-12-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Anaphylactic reaction, Face oedema, Oedema peripheral, Rash, Tongue oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0303USA01803

Write-up: Information has been received from a medical assistant concerning a 11 week old male pt who on 10/16/98 or 10/19/98 was vaccinated with a dose of Haemophilus B conjugate vaccine (+) hep B vaccine recombinant (625231/1598E is invalid for this product). Concomitant medication administered on 10/16/98 included doses of poliovirus vaccine inactivated, and diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid. The reporter stated that on 10/23/98 the pt developed symptoms of swelling of the hands, feet, face and tongue, and also had a "pimple rash" on his upper back, but did not have any difficulty breathing. The reporter confirmed that the pt was diagnosed with an "anaphylactic reaction" at the hospital, and not a "prophylactic-like reaction" to Haemophilus B conjugate vaccine (+) hep B vaccine recombinant, as previously reported. The reporter stated that the pt received his 2 month vaccinations at another facility. At the time of the report, the pt was "four and a half years old." He had not received anymore of his childhood immunizations since the 2 month vaccines and his parents wanted to get him "caught up" on vaccinations. The medical assistant questioned whether there was a suggested "skin testing technique, to see if he will react adversely again." She also reported that she was contacted "other pharmaceutical companies" in reference to this case and requested any protocols for allergy testing of their vaccines. Upon internal review, anaphylactic reaction was determined to be an other important medical event (OMIC). Additional info has been requested.


VAERS ID: 221784 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Male  
Location: Kentucky  
Vaccinated:1998-10-16
Onset:2004-01-17
   Days after vaccination:1919
Submitted: 2004-05-14
   Days after onset:117
Entered: 2004-05-25
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 628404/1175H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 626960/0847H / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Infection, Rash vesicular, Skin ulcer
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0401USA01406

Write-up: Information has been received from a certified medical assistant concerning a 6 year old black male with no pertinent medical history and no known allergies who on 16-Oct-1998 was vaccinated in the left arm with a dose of varicella virus vaccine live (Lot #626960/0847H). There was no illness at the time of vaccination. Concomitant therapy that day included a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (Lot #628404/1175H) administered in the right arm. On 18-Jan-20404 the patient presented to the physician''s office with a case of chickenpox breakthrough. The child was noted to have a papular, vesicular rash that first appeared on his stomach and then spread to the rest of his body. No fever was noted. The child was treated with acetaminophen (Tylenol), diphenhydramine hydrochloride (Benadryl), and rest. The outcome was reported as not recovered. Unspecified medical attention was sought. There was no product quality complaint. Follow-up information indicated that the adverse event onset was on 17-Jan-2004. Seventy-two percent of the lesions were on his stomach, with more lesions daily moving to his legs and arms. Treatment included diphenhydramine hydrochloride (Benadryl), acetaminophen (Tylenol), and rest. Additional follow up information indicated that the patient developed a rash with vesicles that started on the patient''s stomach and "spread all over" over several days. Additional follow-up information indicated that the patient recovered 5 days after onset. The reporter indicated that she had seen two other cases of breakthrough chickenpox in the last couple of months. No further information is expected.


VAERS ID: 233813 (history)  
Form: Version 1.0  
Age: 1.01  
Gender: Female  
Location: Maryland  
Vaccinated:1998-10-16
Onset:2005-02-14
   Days after vaccination:2313
Submitted: 2005-02-14
   Days after onset:0
Entered: 2005-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0602L / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)

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

Write-up: Patient developed mumps in spite of recieving both MMR''s.


VAERS ID: 115694 (history)  
Form: Version 1.0  
Age: 84.0  
Gender: Male  
Location: Foreign  
Vaccinated:1998-10-16
Onset:1998-10-22
   Days after vaccination:6
Submitted: 1998-10-30
   Days after onset:8
Entered: 1998-11-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH E81021EB2 / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Back pain, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: diabetes unspecified;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: EML981946

Write-up: pt recv vax & exp gen malaise, pain in limbs & lumbar/cervical spine & pyrexia 6 days p/vax;pt hosp 4 days p/onset of sx & tx w/med;


VAERS ID: 116345 (history)  
Form: Version 1.0  
Age: 38.0  
Gender: Female  
Location: Foreign  
Vaccinated:1998-10-16
Onset:1998-10-16
   Days after vaccination:0
Submitted: 1998-11-10
   Days after onset:25
Entered: 1998-11-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 661A4 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaphylactoid reaction, Asthma, Condition aggravated, Dizziness, Laryngospasm, Pyrexia, Vasodilatation
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dystonia (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: anaphylaxis, asthma;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980271821

Write-up: pt recv vax 16OCT98 & same day 30 seconds p/vax devel anaphylactic rxn w/flushing of arm, face & trunk, fever, bronchospasm, restriction of airways (swelling of thorax) & dizziness;reporter MD considers event to be r/t vax;


VAERS ID: 117866 (history)  
Form: Version 1.0  
Age: 53.0  
Gender: Male  
Location: Foreign  
Vaccinated:1998-10-16
Onset:1998-11-13
   Days after vaccination:28
Submitted: 1998-12-30
   Days after onset:47
Entered: 1999-01-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Affect lability, Headache, Vasodilatation
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WAES98125227

Write-up: pt recv vax 16OCT98 & 13NOV98 pt exp flushing, h/a & emotional instability & was hosp;13NOV98 pt recovered from flushing, h/a & emotional instability;


VAERS ID: 129819 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Female  
Location: Foreign  
Vaccinated:1998-10-16
Onset:1998-10-17
   Days after vaccination:1
Submitted: 1999-10-25
   Days after onset:373
Entered: 1999-10-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Laboratory test abnormal, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ankylosing spondylarthritis;
Allergies:
Diagnostic Lab Data: 12/21/98 Brain magnetic resonance imagery-sl unsprecsied abn;6/21/99 brain magnetic resonance imaery-sl unprecised lesions;11/98 cervical magnetic resonance imagery-nl;LP-nl;neuro exam-nl;7/12/99 neuro exam-nl;
CDC Split Type: 1999027389

Write-up: p/vax pt devel paresthesia (face & limbs) & pain;pt hosp;neurologic exam, LP & cervical MRi were nl;brain MRI revealed minor unprecise lesions;7/12/99 according to nl neurologic exam dx MS r/o;


VAERS ID: 176714 (history)  
Form: Version 1.0  
Age: 51.0  
Gender: Male  
Location: Foreign  
Vaccinated:1998-10-16
Onset:1998-10-18
   Days after vaccination:2
Submitted: 2002-06-25
   Days after onset:1346
Entered: 2001-10-25
   Days after submission:243
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Back pain, Hyperhidrosis, Lipodystrophy acquired, Myalgia, Necrosis
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Lipodystrophy (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valproic acid (Depakine)
Current Illness: UNK
Preexisting Conditions: Epilepsy
Allergies:
Diagnostic Lab Data: MRI of knee in 10/98-Cytosteatonecrosis (fat necrosis). Dec 1998: knee x-ray unchanged.
CDC Split Type: 20010243331

Write-up: On 10/16/98, the pt received an injection of Engerix-B. On 10/18/98, 2 days, post vax, the pt experienced sweating increased, myalgia, asthenia and lumbar pain, leading to hospitalization. The most recent information received on 10/12/01, reports the outcome of the pt as not yet recovered. Causality assessment was reported as dubious for Engerix-B and valproic acid (Depakine). The follow up states cytosteatonecrosis (lipodystrophy). Knee MRI revealed cytosteatonecrosis. Two months after hospitalization, knee x-ray were unchanged. There was no more pain. The pt was in good health. Depakine was discontinued. The most recent info received on 6/10/02 reports the outcome of the pt as recovered with sequelae.


VAERS ID: 322387 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Foreign  
Vaccinated:1998-10-16
Onset:2007-11-01
   Days after vaccination:3303
Submitted: 2008-08-15
   Days after onset:288
Entered: 2008-08-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Balance disorder, Central nervous system lesion, Coordination abnormal, Diagnostic procedure, Facial palsy, Fatigue, Formication, Hemiparesis, Hypoaesthesia, Inappropriate schedule of drug administration, Motor dysfunction, Multiple sclerosis, Nausea, Neurological examination abnormal, Nuclear magnetic resonance imaging brain abnormal, Sensory loss, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Vestibular disorders (narrow), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Colopathy; Lower limb fracture; Road traffic accident; Immunisation
Allergies:
Diagnostic Lab Data: diagnostic radiology, 19Feb08, medullary MRI normal; magnetic resonance imaging, 21Mar08, four lesions present at the cerebral with a marked inflammatory activity; neurological examination, discrete decreased on Barre & on right Mingazzini w/slight motor deficit on test (4+/5); neurological examination, slight disorder of coordination w/finger-nose test; neurological examination, slight diminution of B/L sensation diapason observed on lower limbs; test or measurement, 23Nov07, EDSS results was at 3; test or measurement, 23Nov07, different exams lead to clinical aspect & radiological evocator dymelinisating pathology; test or measurement, 23Nov07, about 15 lesions of white substance w/hypersignal in T2 & Flair (4+/5); test or measurement, 23Nov07, increased by gadolinium R hemiparesis (4+/5) hypesthesia w/touch at time of injection & diapason; test or measurement, EDSS results was at 2
CDC Split Type: WAES0808USA02001

Write-up: Information has been received from an agency concerning a 21 year old female with a history of colopathy, road trip accident with fracture of lower limbs at the age of 3 and previous vaccinations included TETRACOQ P1 on 17-Apr-1986, P3 on 19-Jun-1986, a booster dose of DT POLIO on 05-Feb-1992; ENGERIX B first dose on 30-Apr-1996 and second dose on 31-May-1996, who on 16-OCT-1998, was vaccinated with MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3). Suspect therapy included DT POLIO (SANOFI PASTEUR) on 19-Jun-1997, the third dose of ENGERIX B (OTHER MANUFACTURER), IM on 05-Nov-1996, a dose of INFANRIX (OTHER MANUFACTURER), IM on 09-Mar-2006, a booster dose of TETRACOZ (SANOFI PASTEUR), IM on 25-May-1987 and a dose of RUDI-ROUVAX (SANOFI PASTEUR), IM on 03-Apr-1988. Both vaccines were administered via intramuscular route and manufactured by other companies. Batch numbers were not reported regarding all the vaccines administered. According to the patient, in April 2007, she presented vertigo, nausea and asthenia which lasted one month. Three weeks before hospitalization of 03-Dec-2007, she had formication and right facial paralysis observed at awakening. A week later, formication extended on the upper and lower right limbs then appeared on the right hemiparesis. At the time of her first consultation on 23-Nov-2007, a scan and cerebral MRI were performed. Different exams lead to clinical aspect and radiological evocator demyelinisating pathology: about fifteen lesions of white substance with hypersignal in T2 and Flair (4+/5), increased by gadolinium sensitive right hemiparesis (4+/5) hypoesthesia with touch, at time of injection and diapason. EDSS result was at 3. The patient was treated with SOLUMEDROL (1g/day) for three days with a good tolerance and sensorimotor disorder of the right hemi-body improved. Consultation on 19-Feb-2008: since the last hospitalization in December, the patient remained asthenic and during and period of 1 and 2 days, she felt an important sensation of generalized weakness. Medullary MRI was normal. Clinical exam showed a discrete decreased on Barre and on the right Mingazzini with a slight motor deficit on test (4+/5), a slight disorder of coordination with the finger-nose test and a slight diminution of bilateral sensation diapason were observed on the lower limbs. EDSS result was at 2. Consultation on 21-Mar-2008: four lesions were present at the cerebral MRI with a marked inflammatory activity. Clinically, the patient presented important fatigability and a balance disorder with no evidence of new flare. A treatment with BETAFERON was given, however it was stopped in June 2008, the patient did not support the medicine. Multiple sclerosis was considered to be disabling. Other business partner numbers included: E2008-07618.


VAERS ID: 115325 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: Washington  
Vaccinated:1998-10-17
Onset:1998-10-17
   Days after vaccination:0
Submitted: 1998-10-19
   Days after onset:2
Entered: 1998-10-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: asthmacort inhaler
Current Illness: NONE
Preexisting Conditions: welbutrin 1wk prior to vax
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: severe itching on bottom of feet-hives on back, red circle & arm sore @ inj site 5hr post vax;


VAERS ID: 115407 (history)  
Form: Version 1.0  
Age: 49.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1998-10-17
Onset:1998-10-17
   Days after vaccination:0
Submitted: 1998-10-26
   Days after onset:9
Entered: 1998-10-28
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Arthritis, Back pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Loestrin
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: IVP flatplate of abd;
CDC Split Type:

Write-up: dx as acute toxic arthritic rxn to vax w/in 4 to 6 hr post vax low back pain began & progressed for next 5 to 7 days w/acute pain to low back & hips, w/fever, chills, treated in ER for severe pain;


VAERS ID: 115421 (history)  
Form: Version 1.0  
Age: 41.0  
Gender: Female  
Location: Nevada  
Vaccinated:1998-10-17
Onset:1998-10-17
   Days after vaccination:0
Submitted: 1998-10-23
   Days after onset:6
Entered: 1998-10-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0984620 / UNK RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid;Estrace
Current Illness: NONE
Preexisting Conditions: hasimoto''s thyroiditis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: arm swelled up;red;warm;itching;


VAERS ID: 115474 (history)  
Form: Version 1.0  
Age: 60.0  
Gender: Male  
Location: Rhode Island  
Vaccinated:1998-10-17
Onset:1998-10-17
   Days after vaccination:0
Submitted: 1998-10-20
   Days after onset:3
Entered: 1998-10-30
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 7+ LA / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / -

Administered by: Public       Purchased by: Other
Symptoms: Dizziness, Gait disturbance, Speech disorder
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ASA;Zantac
Current Illness: NONE
Preexisting Conditions: MI in MAR93;
Allergies:
Diagnostic Lab Data:
CDC Split Type: RI9806

Write-up: c/o dizziness-lightheaded-unsteady gait;slurred speech;


VAERS ID: 116369 (history)  
Form: Version 1.0  
Age: 81.0  
Gender: Female  
Location: Washington  
Vaccinated:1998-10-17
Onset:1998-10-18
   Days after vaccination:1
Submitted: 1998-10-20
   Days after onset:2
Entered: 1998-11-13
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988203 / UNK LA / IM

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

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

Write-up: pt recv vax 17OCT98 & 18OCT98 c/o a hive like rash;no SOB or diff breathing;given pred for hives;


VAERS ID: 117128 (history)  
Form: Version 1.0  
Age: 68.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1998-10-17
Onset:1998-10-17
   Days after vaccination:0
Submitted: 1998-10-17
   Days after onset:0
Entered: 1998-12-07
   Days after submission:51
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1389E / UNK RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Confusional state, Dyspnoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: hx of vasovagal rxn
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MA9846

Write-up: pt had diff breathing & confusion immed p/vax;pt was transported by ambulance to ER; MD stated pt had vasovagal rxn but not d/t vax;


VAERS ID: 117297 (history)  
Form: Version 1.0  
Age: 50.0  
Gender: Male  
Location: Washington  
Vaccinated:1998-10-17
Onset:1998-10-17
   Days after vaccination:0
Submitted: 1998-10-17
   Days after onset:0
Entered: 1998-12-11
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0968380 / 1 - / IM

Administered by: Other       Purchased by: Private
Symptoms: Asthenia, Vasodilatation
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA981503

Write-up: pt c/o heat sensation in lt pectoral muscle & lt arm felt very heavy (5min p/shot) for 20-25min a/releasing pt;


VAERS ID: 117577 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: New Jersey  
Vaccinated:1998-10-17
Onset:1998-10-20
   Days after vaccination:3
Submitted: 1998-10-27
   Days after onset:7
Entered: 1998-12-18
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4978307 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Hypokinesia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-benign; Blood cultures-negative
CDC Split Type: 898302036A

Write-up: Pt recv vax on 10/17/98; on 10/19/98 pt exp fever (101); on 10/21/98 pt exp fever (104.4F), decreased activity & appetite


VAERS ID: 117787 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Male  
Location: Alaska  
Vaccinated:1998-10-17
Onset:1998-10-19
   Days after vaccination:2
Submitted: 1998-10-30
   Days after onset:11
Entered: 1998-12-29
   Days after submission:60
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1188H / 2 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: had EEG done in followup visit-no abnormalities noted per mom report;
CDC Split Type: AK98029

Write-up: prolonged seizure 19OCT98 4AM;


VAERS ID: 132917 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Delaware  
Vaccinated:1998-10-17
Onset:1999-02-28
   Days after vaccination:134
Submitted: 1999-12-20
   Days after onset:295
Entered: 1999-12-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 4 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Alopecia, Amnesia, Arthralgia, Coordination abnormal, Epistaxis, Injection site mass, Injection site pain, Insomnia, Migraine, Myalgia, Thinking abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: B-12, RPR, TsH,CBC,CHEM 17,ESR
CDC Split Type:

Write-up: 1st vax on 9/25/98, 2nd vax on 10/17/98, 3rd vax on 11/4/98, 4th vax on 4/30/99. Began symptoms end of Feb/1999, insomia, migraine h/a, muscle pain in legs while lying down, joint pain in legs, hair loss (patch in back of head), equilibrium


VAERS ID: 116650 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1998-10-17
Onset:1998-10-25
   Days after vaccination:8
Submitted: 1998-11-18
   Days after onset:24
Entered: 2000-06-21
   Days after submission:580
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981800 / 1 RA / -

Administered by: Public       Purchased by: Private
Symptoms: Chest pain, Laryngospasm, Sinusitis
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

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

Write-up: 1wk p/vax pt had chest & throat tightness;went to hosp ER 25OCT dx was sinus infect & also flu shot rxn;f/u MD appt w/Md on 10NOV;


VAERS ID: 117346 (history)  
Form: Version 1.0  
Age: 37.0  
Gender: Female  
Location: Montana  
Vaccinated:1998-10-18
Onset:1998-10-19
   Days after vaccination:1
Submitted: 1998-11-20
   Days after onset:32
Entered: 1998-12-14
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 02298P / UNK - / IM A

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: thyroid
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MT98028

Write-up: warm, reddened, hardened area-cellulitis appearance;softball size still sore on 20NOV98;


VAERS ID: 117833 (history)  
Form: Version 1.0  
Age: 50.0  
Gender: Female  
Location: California  
Vaccinated:1998-10-18
Onset:1998-10-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1998-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20168HB / 2 RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Agitation, Asthenia, Coordination abnormal, Hypertonia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp muscle spasms, weaknes, ataxia, panic attacks @ 49yr old w/flu vax;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: hx of allergy to soy, corn, agglutin;parathyroid disease;celiac disease
Allergies:
Diagnostic Lab Data: 15DEC98 CT scan;EEG scheduled
CDC Split Type:

Write-up: c/o muscle spasms, weakness, ataxia, panic attacks;went to PMD;19NOV saw MD did not believe shot was connected to sx;saw neuro 15DEC98; doing CT scan today;EEG scheduled;


VAERS ID: 121947 (history)  
Form: Version 1.0  
Age: 54.0  
Gender: Female  
Location: Louisiana  
Vaccinated:1998-10-18
Onset:0000-00-00
Submitted: 1998-12-10
Entered: 1999-05-06
   Days after submission:146
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 898345101A

Write-up: pt recv vax & devel polymyalgia rheumatica;


VAERS ID: 117668 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Female  
Location: Foreign  
Vaccinated:1998-10-18
Onset:1998-11-16
   Days after vaccination:29
Submitted: 1998-12-17
   Days after onset:31
Entered: 1998-12-28
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: PREGNANT
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: 19980278251

Write-up: Pt recv vax on 10/18/98; on 11/5/98 pt had positive PREGNANCY test; on 11/16/98 pt exp miscarriage


VAERS ID: 115720 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Female  
Location: Michigan  
Vaccinated:1998-10-19
Onset:1998-10-22
   Days after vaccination:3
Submitted: 1998-10-26
   Days after onset:4
Entered: 1998-11-04
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0977210 / 7+ - / IM

Administered by: Public       Purchased by: Private
Symptoms: Asthenia, Lymphadenopathy, Myalgia, Oedema, Oedema peripheral
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cutaflam, Orthonova
Current Illness: NONE
Preexisting Conditions: Rheumatoid arthritis, allergy to Penicillin & Amoxicillin
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt recv vax on 10/19/98; on 10/22/98 pt exp sore LA, swollen, fatigue


VAERS ID: 115738 (history)  
Form: Version 1.0  
Age: 82.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1998-10-19
Onset:1998-10-20
   Days after vaccination:1
Submitted: 1998-10-23
   Days after onset:3
Entered: 1998-11-04
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0304H / 2 RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Premarin-Zestril;Prilosec
Current Illness: NONE
Preexisting Conditions: NKA-HBP
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 20OCT98 early AM for several days erythema rt forearm below inj site;sl swelling inner elbow area-sl pruritus redness & swelling by 23OCT98 denies discomfort;


VAERS ID: 116149 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Male  
Location: Georgia  
Vaccinated:1998-10-19
Onset:1998-10-30
   Days after vaccination:11
Submitted: 1998-11-02
   Days after onset:3
Entered: 1998-11-10
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1047H / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Benadryl, Duracef
Current Illness: NONE
Preexisting Conditions: Reactive airway disease
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt recv vax on 10/19/98; on 10/30/98 pt exp red, bruised, warm, swelling (11x11.5cm)


VAERS ID: 116272 (history)  
Form: Version 1.0  
Age: 75.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1998-10-19
Onset:1998-10-20
   Days after vaccination:1
Submitted: 1998-11-09
   Days after onset:20
Entered: 1998-11-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975780 / 6 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Claritin, Hydroxyzine
Current Illness: NONE
Preexisting Conditions: Environmental allergies, NKDA, asthma
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: MA9819

Write-up: Pt recv vax on 10/19/98; on 10/20/98 pt exp itchy palms of hands, fingers, toes & scalp, hives under LA & torso area; tx=Hydroxyzine


VAERS ID: 116823 (history)  
Form: Version 1.0  
Age: 69.0  
Gender: Female  
Location: Utah  
Vaccinated:1998-10-19
Onset:1998-10-19
   Days after vaccination:0
Submitted: 1998-11-06
   Days after onset:18
Entered: 1998-11-25
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 498820 / UNK RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0871H / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Premarin;Synthroid;Dyazide;
Current Illness: NONE
Preexisting Conditions: diabetes, HTN, hypothyroid
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: UT981820

Write-up: pt recv vax & reported red, firm, warm, very tender lt upper arm, redness & swelling migrated to lower 2/3 outer aspect of lt arm;


VAERS ID: 116894 (history)  
Form: Version 1.0  
Age: 65.0  
Gender: Female  
Location: Maryland  
Vaccinated:1998-10-19
Onset:1998-10-20
   Days after vaccination:1
Submitted: 1998-10-27
   Days after onset:7
Entered: 1998-11-27
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HD / UNK LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 454378 / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site pain, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: 10/19/98 recvd vax. 10/20/98 pain & redness in rt arm& inc over several days at inj site. 10/22/98 dx w/cellulitis. rx w/ antibiotics.10/27/98 pink area @ site & "not feeling well".11/2/98 arm better.


VAERS ID: 116952 (history)  
Form: Version 1.0  
Age: 78.0  
Gender: Male  
Location: Colorado  
Vaccinated:1998-10-19
Onset:1998-10-28
   Days after vaccination:9
Submitted: 1998-11-24
   Days after onset:27
Entered: 1998-11-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Chills, Dehydration, Dyspepsia, Hyperhidrosis, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt recv flu vax every yr; exp same rx~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Pt recv vax on 10/19/98; on 10/28/98 pt exp flu sxs of achy, chills, sweaty, stomach ache, weak body x 3dy


VAERS ID: 117820 (history)  
Form: Version 1.0  
Age: 52.0  
Gender: Female  
Location: North Carolina  
Vaccinated:1998-10-19
Onset:1998-10-20
   Days after vaccination:1
Submitted: 1998-10-27
   Days after onset:7
Entered: 1998-12-30
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0934600 / UNK LA / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Injection site mass, Injection site oedema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: pt stated on 26OCT98 had reacted to flu shot in past 7 was allergic to egg whites, cigars, mold, mildew;
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC98071

Write-up: pt recv vax 19OCT98 & states that arm became swollen about the size of a quarter @ inj site by next day it hurt somewhat;did not have any inc swelling or pain until 25OCT98;arm began itching & swelling more;induration close to site;


VAERS ID: 118953 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: New York  
Vaccinated:1998-10-19
Onset:1998-10-19
   Days after vaccination:0
Submitted: 1998-10-21
   Days after onset:2
Entered: 1999-02-11
   Days after submission:113
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988212 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt has recv prev doses of influenza virus vac w/o adverse exp~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 898300109A

Write-up: pt recv vax 19OCT98 & devel an inj site rxn characterized by swelling & warmth;pt also felt flushed;


VAERS ID: 118954 (history)  
Form: Version 1.0  
Age: 51.0  
Gender: Female  
Location: New York  
Vaccinated:1998-10-19
Onset:1998-10-20
   Days after vaccination:1
Submitted: 1998-10-21
   Days after onset:1
Entered: 1999-02-11
   Days after submission:113
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988212 / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 898300110A

Write-up: pt recv vax 19OCT98 & devel an inj site rxn characterized by redness, swelling & warmth;


VAERS ID: 150487 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Female  
Location: Unknown  
Vaccinated:1998-10-19
Onset:1998-11-01
   Days after vaccination:13
Submitted: 2000-03-21
   Days after onset:506
Entered: 2000-03-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV017 / 3 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Antinuclear antibody, Arthralgia, Fatigue, Liver function test abnormal, Memory impairment, Myalgia, Rash, Visual disturbance, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LFT-abn, WBC-elevated, Follow-up tests ANA-postive.
CDC Split Type:

Write-up: Skin rashes, joint pain, muscle aches and pain, fatigue, vision problems, memory problems. Time course: October 1998 to present. Treatment: Prescription medications. Currently, under doctor''s care. Treatment is still going on. Follow-up information recieved 07/20/00, indicates that pt''s events are ongoing and unresolve. These include severe joint/leg pain, muscle aches, skin rashes, fatigue, short term memory loss, and vision problems. Has received dx of Reflex Sympathetic Dystrophy syndrome from a pain management specialist.


VAERS ID: 279796 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: New York  
Vaccinated:1998-10-19
Onset:0000-00-00
Submitted: 2007-05-16
Entered: 2007-05-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1245H / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0604USA00420

Write-up: Information has been received from a registered nurse (RN) concerning an 8-year-old white female who on 19-OCT-1998 was vaccinated with a dose of Varivax (lot# 627875/1245H). Subsequently the patient experienced a generalized rash of less than 50 lesions. Medical attention was sought and the patient was seen by a physician. No hospitalization was required. No outcome was reported. Additional information has been received from a woman who reported that no further information is available on this patient.


VAERS ID: 280298 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1998-10-19
Onset:2006-04-06
   Days after vaccination:2726
Submitted: 2007-05-16
   Days after onset:405
Entered: 2007-05-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Blister, Exposure to communicable disease, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Vesicoureteric reflux
Allergies:
Diagnostic Lab Data: none
CDC Split Type: WAES0604USA01814

Write-up: Information has been received from a registered nurse concerning an 8 year old female with vesicoureteric reflux and no drug reactions/allergies who on 19-OCT-1998 was vaccinated with a dose of Varivax. There was no illness at the time of vaccination. There was no concomitant medication. On 06-APR-2006 the patient experienced a rash on her right neck, extremities, and body. It was noted that the rash started on her neck and spread to her extremities. Twenty to twenty-five vesicular lesions were noted. She was seen in the office on 07-APR-2006 with no fever and less then 50 lesions (with some lesions crusted over). She was treated with Benadryl. It was noted that one and a half weeks prior to onset of symptoms, the patient was exposed to an aunt who had shingles. There were no lab diagnostic studies performed. The outcome was reported as recovering. There was no product quality complaint. Follow up information indicated that the patient recovered on 08-APR-2006. It was also noted that the patient was exposed to shingles 1.5 weeks prior to onset. No additional information is expected.


VAERS ID: 288950 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Male  
Location: Unknown  
Vaccinated:1998-10-19
Onset:1999-02-01
   Days after vaccination:105
Submitted: 2007-08-24
   Days after onset:3125
Entered: 2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER FAV034 / 4 - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Biopsy lung abnormal, Cough, Culture stool negative, Dyspnoea, Eosinophilia, Eosinophilic pneumonia, Headache, Night sweats, Pyrexia
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: scoliosis
Allergies:
Diagnostic Lab Data: Feb 2000 lung bx showed eosinophilic infiltrate and lung thickening; pulmonary smears X4 (1/06) neg; stool cx (1/06) neg 9/17/07-records received-CXR: apical infiltrates bilaterally. White count 18000 with atypical lymphocytes. Blood culture no growth. Legionella none detected.
CDC Split Type:

Write-up: massive headaches beginning in Feb99 which resolved sometime in 1999. Nite sweats beginning in July99 and resolved in Aug99; breathing problems beginning in Aug 99. 12/12/99 admitted to hospital for cough, fever.1/26/2000 admitted to NH for cough dx with eosinophilic pnuemonia 9/17/07-records received for DOS 12/22-12/24/99-admitted with 2 week history of fever, cough most lately with some hemoptysis, 10 pound weight loss. Shortness of breath, lungs clear. Impression:bilateral apical infiltrates, rule out tuberculosis, rule out atypical viral disease


VAERS ID: 115462 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Foreign  
Vaccinated:1998-10-19
Onset:1998-10-19
   Days after vaccination:0
Submitted: 1998-10-26
   Days after onset:7
Entered: 1998-10-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apathy, Blood creatine phosphokinase increased, Condition aggravated, Convulsion, Hostility, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt hx there was a similar episode 1yr ago (no vax), neuro investigations @ that time did not reveal any epileptic disease;prev vax tolerated well;hosp MD psychogenic or hysteric rxn suggested;
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800706

Write-up: pt recv vax & 5min later became apathic followed by atypical convuls;became aggressive punching people around him;pt sleeping;creatine kinase elevated to 950;


VAERS ID: 116385 (history)  
Form: Version 1.0  
Age: 70.0  
Gender: Female  
Location: Foreign  
Vaccinated:1998-10-19
Onset:1998-10-20
   Days after vaccination:1
Submitted: 1998-11-13
   Days after onset:24
Entered: 1998-11-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: EML981919

Write-up: pt recv vax & died suddenly the day p/vax 19OCT98;


VAERS ID: 117018 (history)  
Form: Version 1.0  
Age: 1.7  
Gender: Male  
Location: Foreign  
Vaccinated:1998-10-19
Onset:1998-10-29
   Days after vaccination:10
Submitted: 1998-11-23
   Days after onset:25
Entered: 1998-12-02
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Confusional state, Convulsion, Injury, Salivary hypersecretion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800835

Write-up: pt recv vax 19OCT98 29OCT98 1AM pt had a sz, froth from the mouth & unconscious for 1/2hr to 2/4hr;child woke up crying;pt was confused & remained overnight in hosp;pt had fallen & bumped its head;


VAERS ID: 117762 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Male  
Location: Foreign  
Vaccinated:1998-10-19
Onset:1998-10-19
   Days after vaccination:0
Submitted: 1998-12-21
   Days after onset:63
Entered: 1998-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Atrioventricular block, Dyspnoea, Palpitations, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Salmonella lab test
CDC Split Type: WAES98121023

Write-up: Pt recv vax in 10/98; one day post vax pt exp fainting; pt hosp w/ objectivation of an antiventricular block type II; salmonella infections


VAERS ID: 120444 (history)  
Form: Version 1.0  
Age: 64.0  
Gender: Female  
Location: Foreign  
Vaccinated:1998-10-19
Onset:1998-12-12
   Days after vaccination:54
Submitted: 1999-03-16
   Days after onset:94
Entered: 1999-03-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuritis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: 18DEC98 electromyography characteristics of GBS
CDC Split Type: WAES99030854

Write-up: pt recv vax 19OCT98 & pt hosp because of neuritis;18DEC98 GBS was verified by electromyogram findings;


VAERS ID: 229971 (history)  
Form: Version 1.0  
Age: 41.0  
Gender: Female  
Location: Foreign  
Vaccinated:1998-10-19
Onset:1998-12-04
   Days after vaccination:46
Submitted: 2004-12-03
   Days after onset:2191
Entered: 2004-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (TD-RIX) / GLAXOSMITHKLINE BIOLOGICALS 12136A9 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Asthenia, Depression, Gait disturbance, Hyperkinesia, Hypokinesia, Hypotonia, Immune system disorder, Infection, Laboratory test abnormal, Lipoma, Lymphoedema, Neuropathy, Pain, Paraesthesia, Tenderness, Tremor, Urinary tract disorder, Varicose vein
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Akathisia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (narrow), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Climen (Cestradiol valerate + Cyproterone acetate)
Current Illness: UNK
Preexisting Conditions: Abrasion; Adhesiolysis; Adipositas; Adenectomy; Appendectomy; Bilateral ovariectomy; Body fat disorder; Breast node removed; Conization Uterocervical; Cyst removal; Endometriosis; Female sterilization; Genu Varus; Gonathrosis; Laparoscopy; Ovarian Cystectomy; Ovary Removal; Painful feeling; Recurrent Infection; Tonsillectomy; Uterectomy; Varicose vein
Allergies:
Diagnostic Lab Data: Angiotensin converting enzyme 26Jul99 uneventful, antistreptolysin titre 08Dec98 negative, beta 2 microglobulin 26Jul99 0.9mg/L, Borrelia burgdorferi immunoglo 08Dec98 0.37, 30Mar1999 0.22, 08Dec98 0.41, 30Mar1999 0.51, C-reactive protein 08Dec98 negative, C reactive protein 26Jul1999 negative, C1 inhibitor functional assay 26Jul1999 uneventful, complement factor C3 26Jul99 uneventful, complement factor C4 26Jul99 uneventful, Immune complex assay 26Jul99 uneventful, Immune complex assay 26Jul99 no increase, immunoglobulin A 26Jul99 229mg/dl, Immunoglobulin G 26Jul99 993mg/dl, Immunoglobulin M 26Jul99 160mg/dl, Metabolic function test 30Mar99 relative low, neurological examination 24Jun99 normal, phlebography 31Aug99 uneventful, Rheumatoid Factor 08Dec98 negative, Ultrasound thyroid 30Mar99 normal. Examinations on 30March99: Fluorescent antibody test showed that Borreliose IgG titre was <1:128, Borreliose IgM titre was <1:32. Examinations on 14June99: Radiology: findings of knee joints were corresponding to the subject''s age (wide joint cavity of both sides, bony fine structure was uneventful). Sonography: No signs of effusion or Baker''s cyst. Light reflex rheography: no signs of haemodynamic block. Venous occlusion plethyemography, no findings in arterial inflow, venous capacity and venous outflow. Duplex ultrasonography: trunk varicosis third stadium , left side. Exclusion of insufficiency of guide veins. Femoral blood vessels were uneventful. Examinations on 26July1999 showed: Tenderness on pressure and slightly indurated impressive infiltration in knee joint area (on the right side more than on the left side). Serum electrophoresis: uneventful. Rheumatic factors, HLA B27, antinuclear antibodies and antineutrophilic cytoplasmic antibodies were negative. No local, systematic, chronic or inflammatory findings like rheumatoid arthritis or systematic vasculitis were found as a cause of complaints. Examinations on 31Aug99 showed: Phlebography right side: no signs of trunk varcosis of great and small saphenous vein. A venous aneuroysm was excluded. Examinations on 31Aug99 showed: Phlebography right side: no signs of trunk varicosis of great and small saphenous vein. A venous aneurysm was excluded. Examinations on 19Nov99: Duplex ultrasonography showed uneventful arterial and venous blood vessels. Examinations on 23December02: Magnetic resonance: no Baker''s cyst, no arthritis, no pathological process in knee joints. Moderate synovial irritated effusion of both sides. Examinations on 17Jan03: Fluorenscence microscopy: antinuclear antibodies, esDNA, deDNA and histons were negative. ENA differentiation was very slightly positive. Examination on 29Jan03: Magnetic resonance of lumbar region: mild osteochondrosis of lower thoracic vertebrae. Chondrosis of lumbar vertebrae 4/5, bilateral invertebrae disc protrusion (3mm). Chondrosis of lumbar vertebre 5 and sacral vertebre 1, slightly invertebrae disc protrusion (no destruction process). Magnetic resonance of head: no intracranial cerebral mass, encephalitis disseminate and vascular malformation was excluded. Minimal serious sinusistis maxillaris left side. Examinations on 04February 2004: Restricted movement of lumbar region in final position. Slightly limited internal rotation movement of both legs (hip joints). Menicoid narrowing of both hip joints and double bone ad acetabulum (right side). A tender retropatellar crepitation was palpable. Examinations on 24Apr03 showed: CD16 and killer cells were 6% (standard: 7-20) and 90 cells/mc1 (standard 120-350), CD4 T helper cells were 57% (standard 35-55) and quotient CD4/CD8 was 3.4 (standard 1.2 -3.2). Examinations on 03June03: Electromyography and nerve conduction velocity: uneventful (n. peroneus both side, right n. tibialis, right n. suralis). No signs of polyneuropathy.
CDC Split Type: D0044918A

Write-up: A physician reported the occurrence of pain syndrome of both knees and legs in a 40 year old female nurse who was vaccinated with poliomyelitis vaccine (polio sabin S), tetanus diphtheria vaccine (Td-Rix) and Influsplit SSW for prophylaxis. Concurrent medical conditions included tonsillectomy (1976), appendectomy (1960), abrasion (1984), cyst removal (1985), laparoscopy (1986), conization (1967), female sterilization (1989), ovarian Cystectomy (1991), abdominal hysterectomy and adenexctomy (1992), bilateral ovariectomy (1996), ovariectomy (1996) of the right side, breast node removal (1997), adhesiolysis of colon (2000), endometriosis, adipositas, fat distribution disorder, bilateral genu varum, suspected beginning gonarthrosis (left side), recurrent infections and trunk varicosis stadium 3 left leg. Concurrent medication was estradiol valerate (Climen) since 1996. According to the reporting physician the subject received three vaccinations (Polio sabin S, Influsplit SSW and Td-rix) on 19Oct1998. Different information regarding the vaccinations was received in different reports (on 07May03 DTP vaccination and on 29Sep04 polio, tetanus and influenza vaccination). According to reporting physician the subject consulted the physician with throat infection and recurrent depressive syndrome on 17Nov98. On 04Dec98 the subject consulted the physician complaining the first time about pain in both knees and legs. Pain in both knees and legs was persisting until today. Different information regarding the onset of pain was received in different reports (report from May03 three to two days post test results was negative for rheumatoid factor and Borrelia antibody. C-reactive protein and antistreptolysin titre were uneventful. Reports received as follow up information were as follow: Internist''s report from 19Jan99: Subject complaint about pain in both popliteal areas, at night more intense as during the day with radiation to upper and lower legs. A lipoma like swelling in both popliteal areas to be inducted by the complete substitution therapy due to status post ovariectomy of both sides and probable cause, especially because subject''s body fat changed since the substitution therapy, Lymph drainage and a change in hormonal balance were recommended. Endocrinologist''s report from 30Mar99: No signs of endocrinological disease. Thyroid function was normal. The subject''s basal metabolism rate was relatively low, which was leaded back to the subject''s decrease in muscles mass. The physician recommended a change in medication (from Climen to Estraderm). Orthopaedist''s report from 14Jun99: Clinical examinations showed bilateral genu varum. Ischiocrural muscles were shortened. Radiological findings of knee joints were according to the subject''s age. Sonographically there were no signs of effusion of Baker''s cyst. Physio therapy and muscle relaxant medication were recommended. General practitioners report from 14Jun99: A massive painful lymphoedema on both sides (stadium 1), a beginning gonarthrosis (left side), lumboischialgia and trunk varicosis left side (stadium 3) were diagnosed. Regulatory lymph drainages and discontinuation of oestrogen treatment were recommended. Neurological/ psychiatric report from 24June99: Pain in knees with sometimes gait disturbance and weakness of legs were reported. Neurological status was continuous regular. According to the physician there was a psychodynamic generated pain of lower body, projected onto popliteal areas. Neurosepsychologically the pain is understood as correlation between amputation pain and castrations pain of men. Psychological therapy recommended. Immunologists report from 26Jul99: In this report additionally paraesthesia in both lower legs was described. No signs of systematic rheumatic disease or vascular disease. No signs of systematic, chronic inflammatory diseases like rheumatoid arthritis or systemic vasculitis. The subject was treated with Ibuprofen and gastric medicine (Zytotec). Orthopaedists report from 04Feb03: Restricted movement of lumbar region in final position. Slightly limited internal rotation movement of both legs (hips joints). Menicoid narrowing of both hip joints and double bone ad acetabuIum (right side). A tender retropatellar crepitation was palpable. The events could not be clarified by orthopaedic examination. Medical practice report from 07April03: In this report additionally lymph node swelling was described. In the physicians view it was absolutely understandable that the events occurred four years ago in temporal association with the polio and simultaneously given influenza vaccination. He stated that the inner restlessness and paraestesia in the region of the peripheral extremities were not unusual after polio vaccination. He stated that the quotient between T helper cells and T-Suppressor cells showed clearly autoimmune signs, therefore (including all previous findings) epitope specific cytotoxic lymphocytes were persisting and diagnosed an autoimmune syndrome due to a post polio syndrome and a peripheral polyneuropathy of autoimmune source. He recommended modulated T helper cells vaccine and extraxcorporal photophoresis. Immunologists report from 07May03: In this report additionally tremor and sudden fasciculations of the whole body were reported. It could be confirmed that he former examined CD4/CD6 quotient was slightly increased, but the absolute proportion showed standard values. According to the report an autoimmune disease or an autoimmune defect disease could be excluded. Neurologists report from May03: In this report it was mentioned that previously a neurologist suspected fibromyalgia. The reporting physician assumed the tremor of both legs at night and the paraestesia to be a restless leg syndrome. Therefore, the subject was treated first with cabergoline and because of bad toleration in the sense of restlessness and after that mirtazapine. Medical confirmation from 03Aug03: The physician diagnosed a reactive arthritis. Bioenergetic diagnostics showed vaccination stress. Because of temporal association be considered that there a causality between the vaccination and the events. Homeopathist''s report (hospital report) from 24May04: The subject was hospitalized from 26Apr to 28Apr04. In this report additionally recurrent stress and food dependent pain of sternum and epigastrium since four weeks was reported. A fasting cure and psychotherapy was planned, but the subject left the hospital after two days, because she felt lonely. Physician''s report from 29Sept04: According to Chinese medicine diagnostic the subject was suffering from a blockade of the renal and vesicula area. The subject was treated with poliomyelitis nosodes (D5 to D200, IM injection twice per week), berberis similiaplex (drops) and Lymphomyosot (drops). After this therapy the subject was mainly without pain. Therapy: According the reporting physician the subject received treatment of orthodox medicine as well as homeopathic therapy. On 17Nov98 the subject was treated with Tonsillitis PMD for throat infection and with hypericum for recurrent depressive syndrome. Acupuncture of unknown period. Multiple therapies with tricyclic antidepressive drugs, flupirtine maleate, cortinsone and levodope were reported. Under treatment with flupirtine maleate and cortinsone the events improved temporary. Follow up 8/19/05: Pain syndrome, knee joint pain, lower leg pain unresolved. Outcome of other events unknown.


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