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Found 583703 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:131383 (history)  Vaccinated:1999-10-28
Age:29.3  Onset:1999-10-29, Days after vaccination: 1
Gender:Female  Submitted:1999-11-03, Days after onset: 5
Location:Wyoming  Entered:1999-11-26, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood culture;CBC;WBC 16,000;
CDC Split Type: WY9918
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982870 LA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4598370IMLL
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site pain, Leukocytosis, Lymphadenopathy, Oedema, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pain & redness on lt arm near & around inj site;seen in ER & put on IV ATB;CBC & blood cult done;arm was warm & red;pain & redness spread to armpit & lt side of breast;to ER;T99.5;lt arm was warm to touch;hot & red around inj site;pain;

VAERS ID:131448 (history)  Vaccinated:1999-10-28
Age:33.5  Onset:1999-10-30, Days after vaccination: 2
Gender:Male  Submitted:1999-11-11, Days after onset: 12
Location:New York  Entered:1999-11-29, Days after submission: 18
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI, Neuro MD
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0169AB IMRA
Administered by: Other     Purchased by: Private
Symptoms: Hypertonia, Multiple sclerosis, Myasthenic syndrome, Myopathy, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: muscle spasms, weakness in rt leg; noticed sx worsened; numbness, tingling on both legs;dx myopathy, MS;

VAERS ID:131450 (history)  Vaccinated:1999-10-28
Age:52.8  Onset:1999-11-10, Days after vaccination: 13
Gender:Female  Submitted:1999-11-23, Days after onset: 13
Location:South Carolina  Entered:1999-11-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Diagnostic Lab Data: spintal tap confirmed dx;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0111AB  LA
Administered by: Unknown     Purchased by: Other
Symptoms: CSF test abnormal, Guillain-Barre syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: p/vax pt began w/numbness in feet;11/18 dx w/GBS per MD;

VAERS ID:132280 (history)  Vaccinated:1999-10-28
Age:5.3  Onset:1999-10-29, Days after vaccination: 1
Gender:Male  Submitted:1999-12-02, Days after onset: 34
Location:Minnesota  Entered:1999-12-28, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asthma med
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MN99023
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982850IMLA
Administered by: Public     Purchased by: Public
Symptoms: Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Was due for 2nd flu shot today. Called because of "no show", parent stated wasn''t coming because he was ill & vomiting for a week after getting 1st flu shot. Was questioning a reaction to the 1st vax & will not be continuing the series.

VAERS ID:131713 (history)  Vaccinated:1999-10-28
Age:72.0  Onset:1999-10-28, Days after vaccination: 0
Gender:Female  Submitted:1999-11-10, Days after onset: 13
Location:Oregon  Entered:1999-12-29, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE~ ()~~0.00~Patient
Other Medications: Atenolol; PREMARIN; Thyroid
Current Illness: NONE
Preexisting Conditions: List upon request
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNGM
Administered by: Other     Purchased by: Other
Symptoms: Anorexia, Asthenia, Asthma, Chills, Cough, Dizziness, Dyspnoea, Laryngospasm, Pyrexia, Somnolence
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: none stated

VAERS ID:154024 (history)  Vaccinated:1999-10-28
Age:  Onset:1999-10-28, Days after vaccination: 0
Gender:Unknown  Submitted:2000-01-26, Days after onset: 90
Location:Virginia  Entered:2000-06-13, Days after submission: 138
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ7518206DEC1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Pyrexia, Rash, Serum sickness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Within hours post vax, the pt developed fever, arthralgias, and a rash which appeared on various parts of the body. A dx of serum sickness was made and the pt was treated with prednisone. Symptoms reoccurred when the prednisone was tapered.

VAERS ID:154029 (history)  Vaccinated:1999-10-28
Age:28.0  Onset:1999-12-10, Days after vaccination: 43
Gender:Female  Submitted:1999-12-20, Days after onset: 10
Location:Wisconsin  Entered:2000-06-13, Days after submission: 175
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loestrin
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ8312113DEC1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Hypoaesthesia, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: A nurse reported that a 28-year-old female received Flu Shield on 10/28/99 and 10/29/99. She developed cellulitis. She was treated with Keflex twice daily. The pt recovered within 5 days. On 12/10/99, the pt developed numbness, tingling, and weakness in most of her affected arm.

VAERS ID:154274 (history)  Vaccinated:1999-10-28
Age:  Onset:1999-10-28, Days after vaccination: 0
Gender:Female  Submitted:1999-11-05, Days after onset: 8
Location:Indiana  Entered:2000-06-15, Days after submission: 222
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: Allergic to aspirin, PCN and sulfa.
Diagnostic Lab Data: UNK
CDC Split Type: FLU2311199
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02879P0IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Back pain, Dyspnoea, Influenza, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4 hours post vax, pt complained of lower back pain over both kidney areas. 3 hours later, all joints and muscles hurt and it was difficult to breath. Symptoms gradually became worse. Saw doctor at office and had a fever. Physician diagnosed light case of flu and prescribed Advil and Tylenol. Symptoms lasted for 2 1/2 days.

VAERS ID:155303 (history)  Vaccinated:1999-10-28
Age:1.4  Onset:1999-10-28, Days after vaccination: 0
Gender:Male  Submitted:2000-05-24, Days after onset: 209
Location:Minnesota  Entered:2000-06-22, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99102342
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Three hours post vax, the pt developed a high temperature and rash. The pt sought unspecified medical attention.

VAERS ID:157733 (history)  Vaccinated:1999-10-28
Age:20.0  Onset:2000-02-21, Days after vaccination: 116
Gender:Female  Submitted:2000-03-24, Days after onset: 32
Location:Texas  Entered:2000-07-21, Days after submission: 118
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ1184023FEB2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Other     Purchased by: Private
Symptoms: Chills, Joint swelling, Pain
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Approximately 4 months post vax, this pt experienced chills, aches, and swollen joints. Pt was seen in the ER and indicated that she had experienced those symptoms for "some time."

VAERS ID:160154 (history)  Vaccinated:1999-10-28
Age:1.9  Onset:2000-09-26, Days after vaccination: 334
Gender:Male  Submitted:2000-09-26, Days after onset: 0
Location:Massachusetts  Entered:2000-09-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P00902IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.034721IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1002J0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Breakthrough chickenpox dx on 9/26/00.

VAERS ID:162068 (history)  Vaccinated:1999-10-28
Age:44.0  Onset:0000-00-00
Gender:Female  Submitted:1999-11-03
Location:Iowa  Entered:2000-10-06, Days after submission: 337
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ4268102NOV1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES  IM 
Administered by: Public     Purchased by: Other
Symptoms: Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: A pharmacist reported that a 44 year old female received an injection of Pnu-Imune 23 on 10/28/99 and subsequently developed an injection site swelling which extended to the entire arm. No further information was available at the time of the report.

VAERS ID:162070 (history)  Vaccinated:1999-10-28
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2000-03-28
Location:California  Entered:2000-10-06, Days after submission: 191
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ4718205NOV1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES463747 IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site reaction
SMQs:
Write-up: A pharmacist reported that a pt received Pnu-Imune 23 on 10/28/99 or 10/29/99 and subsequently developed an injection site reaction. The pt was treated with antihistamines and applications of ice. The pt recovered. This is 1 of 3 pts from this facility who had an adverse experience following receipt of Pnu-Imune 23, lot 463747.

VAERS ID:162279 (history)  Vaccinated:1999-10-28
Age:40.0  Onset:1999-10-28, Days after vaccination: 0
Gender:Female  Submitted:1999-11-02, Days after onset: 5
Location:Tennessee  Entered:2000-10-13, Days after submission: 345
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U1999008250
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES  IM 
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: It was reported that a female pt received a Fluzone SV ''99-''00 vaccination on 10/28/99. Reportedly, within 5 hours, post vax. the pt developed urticaria.

VAERS ID:161886 (history)  Vaccinated:1999-10-28
Age:70.0  Onset:1999-10-28, Days after vaccination: 0
Gender:Female  Submitted:2000-11-06, Days after onset: 375
Location:Nebraska  Entered:2000-11-14, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Dralestin, Indocin, Demerol, Novahistine, Darvon, erythromycin, Talwin, Darvoset
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0159AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Pharyngolaryngeal pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Sore throat, fever, vomiting and diarrhea (continuous for 8 hours). In hospital had IV''s and IV antibiotic (I had taken charcoal prior to hospital stay). 7 hour hospital stay.

VAERS ID:163286 (history)  Vaccinated:1999-10-28
Age:12.0  Onset:1999-11-08, Days after vaccination: 11
Gender:Female  Submitted:1999-11-17, Days after onset: 9
Location:New Jersey  Entered:2000-11-14, Days after submission: 363
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ritalin
Current Illness:
Preexisting Conditions: attention deficit disorder
Diagnostic Lab Data:
CDC Split Type: 19990302291
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1IM 
Administered by: Private     Purchased by: Other
Symptoms: Vitreous floaters
SMQs:, Retinal disorders (narrow)
Write-up: Approximately 11 days subsequent to receiving dose 2 of Engerix B, the pt experienced floaters in her left eye. No treatment was given. The most recent information received, reports that the condition of the pt is resolving.

VAERS ID:163295 (history)  Vaccinated:1999-10-28
Age:12.0  Onset:1999-11-13, Days after vaccination: 16
Gender:Male  Submitted:2000-10-26, Days after onset: 347
Location:Unknown  Entered:2000-11-14, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: eczema during summer
Diagnostic Lab Data:
CDC Split Type: 19990312281
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Feeling hot, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The mother of the pt told the reporter that 16 days post vax the pt experienced red and hot face and a rash that spread from the face to chest, legs and arms. The reporter thought that the symptoms lasted for approximately 24 hours. The most recent information reports the condition of the pt is resolved.

VAERS ID:167533 (history)  Vaccinated:1999-10-28
Age:0.7  Onset:1999-10-28, Days after vaccination: 0
Gender:Female  Submitted:2001-03-07, Days after onset: 496
Location:Maryland  Entered:2001-03-15, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00063265
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0322J2  
Administered by: Private     Purchased by: Private
Symptoms: Croup infectious, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Information has been received from a physician concerning an 8 month old female who on 10/28/99 was vaccinated with a 3rd dose of Hepatitis B vaccine recombinant. On 10/28/99, the patient developed wheezing and a "croup-like" illness. Subsequently, the patient recovered. Additionally subsequent to this event. It was noted that the patient also experienced a similar reaction after vaccination with Varicella Virus vaccine live on 05/11/00. Additional information has been requested.

VAERS ID:171001 (history)  Vaccinated:1999-10-28
Age:  Onset:2000-02-28, Days after vaccination: 123
Gender:Male  Submitted:2001-05-15, Days after onset: 441
Location:Unknown  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00032839
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Herpes zoster, Pruritus, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 02/28/2000, the pt developed a breakthrough case of shingles on his right leg, below his knee and down to his foot. The pt sought medical attention and was treated with calamine lotion for the itching. At the time of the report he had dried scabs on his leg. No further information is available.

VAERS ID:182463 (history)  Vaccinated:1999-10-28
Age:4.0  Onset:2002-01-25, Days after vaccination: 820
Gender:Female  Submitted:2002-01-21, Days after onset: 4
Location:North Carolina  Entered:2002-03-14, Days after submission: 52
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES  IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0718J0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Varicella - many, many lesions. Full blown case, despite immunization.

VAERS ID:183770 (history)  Vaccinated:1999-10-28
Age:0.2  Onset:1999-11-01, Days after vaccination: 4
Gender:Female  Submitted:2002-04-08, Days after onset: 888
Location:Florida  Entered:2002-04-23, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI, CT Scan, Blood tests, Genetic tests
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURUO040CA0IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.129LKJ0IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.129J0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURP07390SCLL
Administered by: Private     Purchased by: Other
Symptoms: Balance disorder, Crying, Difficulty in walking, Growth retardation, Headache
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Uncontrollable crying, pulling hair as if she had a severe pain "headache." Head stopped growing. pt is taking therapy for balance walking. (not walkin).

VAERS ID:238787 (history)  Vaccinated:1999-10-28
Age:4.0  Onset:2005-01-24, Days after vaccination: 1915
Gender:Female  Submitted:2005-05-16, Days after onset: 111
Location:Massachusetts  Entered:2005-06-01, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0502USA00085
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0722J SC 
Administered by: Private     Purchased by: Public
Symptoms: Headache, Nasal congestion, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from an employees in a MD office concerning a 9 year old white female who on 10/28/1999 was vaccinated SQ with her first dose of varicella virus vaccine live. On 01/24/05 the pt developed a stuffy nose and a HA. The pt also developed 10-25 lesions on her face, torso, and arms. As of 01/28/05 the pt recovered. Additional information has been requested.

VAERS ID:337989 (history)  Vaccinated:1999-10-28
Age:1.0  Onset:2009-01-19, Days after vaccination: 3371
Gender:Male  Submitted:2009-01-22, Days after onset: 3
Location:Maryland  Entered:2009-01-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR I)MERCK & CO. INC.107630SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.103050SCRA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash, Varicella
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Started breaking out 1/19. Itches - rash. No known exposure. No fever. DX: Varicella

VAERS ID:132237 (history)  Vaccinated:1999-10-28
Age:6.6  Onset:0000-00-00
Gender:Male  Submitted:1999-12-03
Location:Foreign  Entered:1999-12-07, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Priorix given 10/28/99;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 1999031343
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)
Write-up: p/vax pt grandma report child suffering from diabetes mellitus established in 11/99;

VAERS ID:158723 (history)  Vaccinated:1999-10-28
Age:0.3  Onset:1999-10-28, Days after vaccination: 0
Gender:Female  Submitted:2000-08-10, Days after onset: 287
Location:Foreign  Entered:2000-08-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: HQ9618109AUG2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER3320911IM 
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4626841IM 
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER 1PO 
Administered by: Other     Purchased by: Other
Symptoms: Bacterial infection, Irritability, Purpura, Screaming, Sepsis
SMQs:, Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Same day post vax, the pt developed a purpuric rash on both legs, screaming, and irritability. She was hospitalized and treated as meningococcal septicemia. The treatment was not specified. She recovered.

VAERS ID:160601 (history)  Vaccinated:1999-10-28
Age:11.0  Onset:1999-11-01, Days after vaccination: 4
Gender:Male  Submitted:2000-10-06, Days after onset: 339
Location:Foreign  Entered:2000-10-17, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES00100059
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Tinnitus, Vertigo, Visual disturbance
SMQs:, Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (narrow), Hypoglycaemia (broad)
Write-up: It was reported that sometime in the following month post vax, in approximately November 1999, the pt was hospitalized due to vertigo, abnormal vision, and tinnitus. The reporter indicated that a relationship between the pt''s adverse experiences and the vaccination was possible. The pt''s outcome is unknown.

VAERS ID:130170 (history)  Vaccinated:1999-10-29
Age:21.4  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-10-29, Days after onset: 0
Location:Ohio  Entered:1999-11-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: kit supplement
Current Illness: NONE
Preexisting Conditions: frequent PVC
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0136AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: sudden onset of near-syncope & severe lethargy w/ 1 1/2hr;BP 150/104, monitor;to ER via amb;

VAERS ID:130256 (history)  Vaccinated:1999-10-29
Age:1.8  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 3
Location:Indiana  Entered:1999-11-03, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pt recv flu vax;
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: IN99037
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7387AA3 LL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESP0898AA3 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1087J0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0452J0 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: local rxn-tennis ball size erythema, tenderness, swelling;

VAERS ID:130275 (history)  Vaccinated:1999-10-29
Age:46.5  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-10-30, Days after onset: 0
Location:Washington  Entered:1999-11-03, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oxcodone;methadone
Current Illness: NONE
Preexisting Conditions: chronic pain;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: severe vomiting 9 hr post vax;

VAERS ID:130290 (history)  Vaccinated:1999-10-29
Age:22.6  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-11-03, Days after onset: 4
Location:Ohio  Entered:1999-11-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft;Orthocept
Current Illness: had bronchites 10day prior
Preexisting Conditions: PCN-hive;sulfa-itchy;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES00103AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: c/o pain & numbness in whole lt arm 9arm where inj given) the day p/vax;

VAERS ID:130297 (history)  Vaccinated:1999-10-29
Age:68.9  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 3
Location:West Virginia  Entered:1999-11-04, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: had rt side storke in past
Preexisting Conditions: allergic to demeral
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982552 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1584H1 RA
Administered by: Public     Purchased by: Unknown
Symptoms: Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt c/o swelling in arm to the wrist & pain in the underarm;

VAERS ID:130343 (history)  Vaccinated:1999-10-29
Age:14.6  Onset:1999-10-31, Days after vaccination: 2
Gender:Female  Submitted:1999-11-02, Days after onset: 2
Location:Massachusetts  Entered:1999-11-05, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD66  LA
Administered by: Other     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: p/vax pt noticed redness & soreness 10/31/99;pt w/redness & warmth measuring 2 1/2 x 1 1/2;

VAERS ID:130581 (history)  Vaccinated:1999-10-29
Age:57.9  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:1999-11-01, Days after onset: 3
Location:California  Entered:1999-11-08, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: PPD by Parkedale lot# 00769P given 10/29/99;
Current Illness:
Preexisting Conditions: HTN;arthritis (choulders/back/lt knees);rt hemiplegia;
Diagnostic Lab Data: NOne
CDC Split Type: CA990138
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E29199HA IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES459041 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pain lt arm;swollen lt arm;mild erythema of upper lt bicep area;

VAERS ID:130589 (history)  Vaccinated:1999-10-29
Age:38.0  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-11-04, Days after onset: 5
Location:West Virginia  Entered:1999-11-08, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo Provera;OTC allergy meds;
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982554 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Ecchymosis, Pain, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt c/o soreness of arm;used ice pack for pain;bruising since 11/2/99;11/4/99 pt broke out in hives all over body w/itching;advised to go to ER;

VAERS ID:130599 (history)  Vaccinated:1999-10-29
Age:13.2  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-03, Days after onset: 5
Location:Florida  Entered:1999-11-08, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONe
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0103AA  RA
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)
Write-up: broke out w/hives approx 2hr p/vax;given DPH;hives cont off & on for 3 days;

VAERS ID:130712 (history)  Vaccinated:1999-10-29
Age:72.5  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 3
Location:California  Entered:1999-11-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA990131
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4590410IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: pain great enough to keep from rasing arm-swollen, red x 48hr;hot to touch;shoulder to elbow, red;feels much better 11/1/99;

VAERS ID:130729 (history)  Vaccinated:1999-10-29
Age:51.6  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-08, Days after onset: 10
Location:Indiana  Entered:1999-11-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA
Current Illness: NA
Preexisting Conditions: lt mastectomy;
Diagnostic Lab Data: NA
CDC Split Type: IN99040
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02979P IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1584H0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, 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), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt devel a fever of 104, chills, muscle aches, h/a, nausea w/no vomiting, w/in 12hr of vax;sx resolved in 72hr;

VAERS ID:130755 (history)  Vaccinated:1999-10-29
Age:51.9  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:1999-11-01, Days after onset: 3
Location:Maryland  Entered:1999-11-15, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Lescol;Paxil
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: EEG-nl;CAT Scan-negative;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982490IMLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: 2-2 1/2hr p/vax lost consciousness;uncontrolled shaking (sz).Hospitalized & dxed w/ new onset seizures.

VAERS ID:130779 (history)  Vaccinated:1999-10-29
Age:1.3  Onset:1999-10-30, Days after vaccination: 1
Gender:Male  Submitted:1999-11-09, Days after onset: 10
Location:Connecticut  Entered:1999-11-15, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUA463AB0IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESU0008B0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N09560SCRL
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)
Write-up: hive body rash 24hr p/vax;

VAERS ID:130785 (history)  Vaccinated:1999-10-29
Age:53.7  Onset:1999-11-08, Days after vaccination: 10
Gender:Female  Submitted:1999-11-11, Days after onset: 3
Location:South Carolina  Entered:1999-11-15, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0928J0SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Arthralgia, Face oedema, Lymphadenopathy, Pharyngitis, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: started w/achy joints, swollen gland especially behind lt ear;rash started on face down neck, chest, arms-fever, sore throat;rash spread, itchy, eyes swollen;saw MD;

VAERS ID:130810 (history)  Vaccinated:1999-10-29
Age:52.8  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Maine  Entered:1999-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: as child egg sensitivity, asthma now, allergies to cats, dust
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0131AA  LA
Administered by: Public     Purchased by: Other
Symptoms: Chest pain, Dyspnoea, Hypertension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad)
Write-up: tightness in chest, difficulty breathing;blood pressure elevated;p/40min into getting shot 144/98 which is high for pt;better p/40min-1hr feeling better;

VAERS ID:130817 (history)  Vaccinated:1999-10-29
Age:61.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-10, Days after onset: 12
Location:Illinois  Entered:1999-11-15, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Verapamil;HCTZ;Prempro
Current Illness: NONE
Preexisting Conditions: HTN, seasonal allergies;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU163AA1 A
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 8cm erythematous indurated skin rxn day of vax;

VAERS ID:130882 (history)  Vaccinated:1999-10-29
Age:82.2  Onset:1999-10-30, Days after vaccination: 1
Gender:Male  Submitted:1999-11-14, Days after onset: 15
Location:California  Entered:1999-11-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cozar
Current Illness:
Preexisting Conditions: cirrhosis
Diagnostic Lab Data: CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4637471SCLA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site mass, Leukocytosis, Oedema, Pyrexia, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: devel diffuse induration & erythema involving whole LUE & fever 103.5 & leukocytosis;adm to hosp;

VAERS ID:130896 (history)  Vaccinated:1999-10-29
Age:68.2  Onset:1999-10-30, Days after vaccination: 1
Gender:Male  Submitted:1999-11-04, Days after onset: 5
Location:California  Entered:1999-11-18, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4637470SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: devel pain, redness, swelling in rt deltoid & numbness in fingers;

VAERS ID:130958 (history)  Vaccinated:1999-10-29
Age:35.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 3
Location:Arizona  Entered:1999-11-19, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: past hx of mult allergens;
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0159AA IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Cough, Injection site hypersensitivity, Injection site mass, Injection site oedema, Nausea, Rhinitis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: inj site indurated, edematous, reddened;pt c/o weakness, nausea,cough, runny nose;site returning to nl size on 3rd day, constitutional sx remain but are less virulent;

VAERS ID:130959 (history)  Vaccinated:1999-10-29
Age:68.0  Onset:1999-11-10, Days after vaccination: 12
Gender:Female  Submitted:1999-11-16, Days after onset: 6
Location:Massachusetts  Entered:1999-11-19, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fosamax, Estrogen patch, multivitamin, itamin E;warfarin;does not use other dietary or herbal supplements;
Current Illness:
Preexisting Conditions: allergies to thorazine (given in error in place of Dramamine) & ampicillin;type II diabetes-controlled, not on any meds @ present;hx of kidney stones;thinks may have lupus but has not been given this dx;
Diagnostic Lab Data: INR 69;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Red blood cell sedimentation rate decreased
SMQs:
Write-up: pt exp an elevated INR p/vax;pt INR were w/in nl range prior to vax;when checked on 11/10/99 INR was 69;MD stopped warfarin for 3 days;2nd day INR dec to 4.8 or 4.9;did not have the values for the subsequent INR tests;

VAERS ID:131020 (history)  Vaccinated:1999-10-29
Age:74.1  Onset:1999-11-01, Days after vaccination: 3
Gender:Female  Submitted:1999-11-18, Days after onset: 17
Location:Virginia  Entered:1999-11-22, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications: vitamin E
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: lyme titers negative;ANA negative;CBC WNL;RF negative;uric acid WNL;ESR 25 (0-30);
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E29199HA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: lt migratory polyarthralgias & myalgias x 2-3 wk;afeb;vital signs stable;tx large joint inj, PO pred; NSAIDS & Darvocet;

VAERS ID:131024 (history)  Vaccinated:1999-10-29
Age:46.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-04, Days after onset: 6
Location:Texas  Entered:1999-11-22, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~ ~~In patient
Other Medications: Vitamins;Paxil;Inhalers PRn;Accolate BID;ASA;Trazadone;
Current Illness: NONE
Preexisting Conditions: asthma, angina
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0165AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1247H0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Pyrexia, Tachycardia, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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)
Write-up: p/vax pt began having chills, fever, flushed warm to touch, (did not check temp) had taken APAP;site of pneumovax inj began to swell, redness & very painful from shoulder to elbow;heart racing & chest pain;

VAERS ID:131367 (history)  Vaccinated:1999-10-29
Age:68.8  Onset:1999-11-08, Days after vaccination: 10
Gender:Female  Submitted:1999-11-18, Days after onset: 10
Location:California  Entered:1999-11-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: routine mamogram 9was past due)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESP14270IMLA
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA035AA0SCRA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Lymphadenopathy, Pain
SMQs:, Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 10 days p/vax noticed tenderness in rt arm pit & shoulder area;noticed tender swelling in arm pit;sought MD advise as a result of this;armpit cont to be tender;also tiredness;

VAERS ID:131368 (history)  Vaccinated:1999-10-29
Age:26.9  Onset:1999-11-12, Days after vaccination: 14
Gender:Male  Submitted:1999-11-24, Days after onset: 12
Location:Virginia  Entered:1999-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT Scan head-negative;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER4998334 IMA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Facial palsy, Paraesthesia, Vestibular disorder
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Vestibular disorders (narrow)
Write-up: dizziness, numbness lt side of face;ER dx labyrinthitis, early Bells palsy saw MD believes d/t flu vax;

VAERS ID:131376 (history)  Vaccinated:1999-10-29
Age:45.1  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 3
Location:Florida  Entered:1999-11-24, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Narvasc;
Current Illness: NONE
Preexisting Conditions: HTN
Diagnostic Lab Data: NONE
CDC Split Type: FL99044
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02189P IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash under lt breast approx 5PM 10/29/99 using cortisone cream on rash;11/1/99 generalized rash on back, arms, thighs, & palms of hands;pt to see pvt MD 11/1/99;

VAERS ID:131551 (history)  Vaccinated:1999-10-29
Age:44.8  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-11-01, Days after onset: 2
Location:Arkansas  Entered:1999-11-29, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: had similar rxn to aleve 2-3wk ago;
Diagnostic Lab Data:
CDC Split Type: AR9949
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0165AA0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: red & raised whelps itching;

VAERS ID:131589 (history)  Vaccinated:1999-10-29
Age:52.8  Onset:1999-10-31, Days after vaccination: 2
Gender:Male  Submitted:1999-11-01, Days after onset: 1
Location:New York  Entered:1999-11-30, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998281 IMLA
Administered by: Other     Purchased by: Private
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: soreness, swelling under lt armpit;no exudate;

VAERS ID:131629 (history)  Vaccinated:1999-10-29
Age:0.4  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:1999-11-09, Days after onset: 11
Location:California  Entered:1999-12-02, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EEG-nl;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7389221 LL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1014H1 RL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N04911 RL
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: tremor activity (@ house) c/w a partial complex sz;nl EEG done 1wk later;

VAERS ID:131654 (history)  Vaccinated:1999-10-29
Age:39.1  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:1999-11-01, Days after onset: 3
Location:South Carolina  Entered:1999-12-02, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: allergies:PCN, ASA;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0241SC 
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Headache, Injection site hypersensitivity, Injection site mass, Injection site oedema, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 24hr p/vax had swelling w/induration & erythema @ injs ite;very tired w/ h/a & nausea evening of shot & all of next day;@ 72hr 25mm induration w/erythema @ inj site;

VAERS ID:132549 (history)  Vaccinated:1999-10-29
Age:37.2  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-11-29, Days after onset: 30
Location:Nebraska  Entered:1999-12-15, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 300mg tid
Current Illness: NONE
Preexisting Conditions: Allergy to Flouriscein dye
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0127AA IMA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: itching all over, no hives or rash. No wheezing. TX self with OTC Benodryl.

VAERS ID:131813 (history)  Vaccinated:1999-10-29
Age:44.0  Onset:1999-11-11, Days after vaccination: 13
Gender:Female  Submitted:1999-11-18, Days after onset: 7
Location:Kansas  Entered:1999-12-19, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to shell fish
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1543H SCLA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Conjunctivitis, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 11/11/99 pt wode with a rash on face that spread to arms and back. Very itchy. Some ache in joints, red sclera on 11/16/99 and 11/17/99. No drainage. Saw PA at her MD''s office - MMR reaction. Tx with Zyrtec and cortisone cream.

VAERS ID:132669 (history)  Vaccinated:1999-10-29
Age:66.4  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-05, Days after onset: 7
Location:Iowa  Entered:1999-12-21, Days after submission: 46
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Premarin
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Cardiac series-neg.; CT of head-neg
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.129110 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Injection site pain, Oedema peripheral, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: 10/29/99:Pt. received Pneumo shot and later that evening developed syncope,became light-headed, & had arm pain at injection site.11/26/99:pt presented w/ swollen autecubital area & slight numbness.Tx w/ Keflex

VAERS ID:132266 (history)  Vaccinated:1999-10-29
Age:69.7  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-08, Days after onset: 10
Location:Wisconsin  Entered:1999-12-28, Days after submission: 50
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lopressor, Premarin
Current Illness: NONE
Preexisting Conditions: Hypertension
Diagnostic Lab Data:
CDC Split Type: WI99035
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982572IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1693H0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt. developed swelling, the size of 1/2 orange, at injection site, with area of redness and warmth down to elbow, which lasted about 3 days.

VAERS ID:132268 (history)  Vaccinated:1999-10-29
Age:35.3  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:1999-11-03, Days after onset: 5
Location:Oklahoma  Entered:1999-12-28, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OK9959
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02089P4IMLA
Administered by: Other     Purchased by: Other
Symptoms: Face oedema, Laryngospasm, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dystonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Generalized hives, throat & ear swelling.

VAERS ID:132274 (history)  Vaccinated:1999-10-29
Age:28.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-19, Days after onset: 21
Location:Washington  Entered:1999-12-28, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESP1427520IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Acute onset of LUQ abdominal pain, 2 hrs. after vax, lasting about 10 hrs. No nausea, vomiting, diarrhea or fever. Symptoms resolved spontaneously without sequelae.

VAERS ID:131720 (history)  Vaccinated:1999-10-29
Age:35.0  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-10-31, Days after onset: 1
Location:Pennsylvania  Entered:1999-12-29, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: prilosec, celexa
Current Illness: NONE
Preexisting Conditions: depression, acid reflux, allergy, steroid treatment for feet edema
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982670IMLA
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt states she has had a rash that began the morning after getting her flu shot.

VAERS ID:131724 (history)  Vaccinated:1999-10-29
Age:57.5  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-11-03, Days after onset: 4
Location:Michigan  Entered:1999-12-29, Days after submission: 56
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02989P IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4664450 RA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: R/arm sore after shot. Within 24 hrs, arm was red, hot, swollen to "twice it''s normal size". Med provider ordered Benadryl & ice packs for 24 hrs, followed by heat which began on Monday. Above symptoms, resolving.

VAERS ID:131849 (history)  Vaccinated:1999-10-29
Age:1.7  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:1999-12-02, Days after onset: 34
Location:Ohio  Entered:1999-12-29, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness: NONE
Preexisting Conditions: Congenital Ptosis left upper lid, recurrent otitis media
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P07392SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0939J0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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)
Write-up: Right leg swelling, itching at inject site, also urticaria. Given 2 tsp benadryl elixir and placed under ovservation for 30 minutes.

VAERS ID:131888 (history)  Vaccinated:1999-10-29
Age:44.4  Onset:0000-00-00
Gender:Male  Submitted:1999-11-01
Location:Georgia  Entered:1999-12-29, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0131AA0IMA
Administered by: Public     Purchased by: Private
Symptoms: Headache, Hypertonia, Neck pain, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Pt developed stiffness and soreness in left arm and left side of neck. Numbness down to left hand into fingers. Pt also experienced a headache.

VAERS ID:131902 (history)  Vaccinated:1999-10-29
Age:50.8  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 3
Location:Nebraska  Entered:1999-12-29, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0129AA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Body aches and fever 2 hours after the shot.

VAERS ID:131903 (history)  Vaccinated:1999-10-29
Age:44.1  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:1999-11-04, Days after onset: 6
Location:Wisconsin  Entered:1999-12-29, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WI09045
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02189810IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Hyperhidrosis, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Pt reported having chills, diaphoresis, weakness, malaise with 1-2 hours post vax. Felt he probably had a fever but took acetaminophen throughout the day to reduce discomfort. Sx''s persisted for 2 days.

VAERS ID:131929 (history)  Vaccinated:1999-10-29
Age:49.8  Onset:1999-10-30, Days after vaccination: 1
Gender:Male  Submitted:1999-11-15, Days after onset: 16
Location:Wisconsin  Entered:1999-12-29, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prinivil, 10mg
Current Illness: NONE
Preexisting Conditions: High blood pressure
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982290IMLA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4587450IMRA
Administered by: Private     Purchased by: Private
Symptoms: Face oedema, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 10/30/99, pt broke out in hives & rash all over body. Took Benadryl and improved by next day. On 11/2/99, pt at ball game, & eyes started to swell. Started Benadryl again & improved. No further episodes.

VAERS ID:132029 (history)  Vaccinated:1999-10-29
Age:  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Missouri  Entered:1999-12-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Asthma; takes inhaler
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0149CA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Bronchitis, Chills, Dizziness, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: Approx. 1 hr. after vax, pt. became nauseated, cold, diaphoretic, clammy, dizzy and also had 1 bout of LBM. Pt. missed almost a week of work. Went to Dr and was later dx''d w/bronchitis.

VAERS ID:132409 (history)  Vaccinated:1999-10-29
Age:64.0  Onset:1999-11-03, Days after vaccination: 5
Gender:Male  Submitted:1999-11-08, Days after onset: 5
Location:Louisiana  Entered:2000-01-06, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No acute illness
Preexisting Conditions: PCN allergy, dx w/ Cerebellar Ataxia & Cervical dystonia
Diagnostic Lab Data:
CDC Split Type: LA991203
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU0156AA3IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0871H0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 11/3 4 days post vax, started itching, no rash. Broke out next day. Told at ER had poison ivy. Presents today w/ red raised rash on R arm from antecubital area to outer lower arm. No rash on L, pt stated did have on 11/6. Private MD felt Per follow-up: Pt received the flu and pneumonia vaccine on 10-29-1999. Pt here today stating he started itching on 11 3-1999 or 11-4-1999, but had no rash. Stated on 11-5-99 broke out in rash on right arm and had itching around ankles. States went to hospital to the ER. States was told he had poison ivy and was given CELESTONE injection and was told to take BENADRYL over the counter. States was also given cream to put on rash. Presents today with red raised rash on right arm from antecubital area down outer lower arm. No rash noted on left arm pt stated did - have rash on left arm on Sat 11/6 or Sunday 11-7. Pt went to private MP Dr. Pt''s wife reported that Dr felt rash was due to pneumonia vaccine.

VAERS ID:132449 (history)  Vaccinated:1999-10-29
Age:29.6  Onset:1999-11-03, Days after vaccination: 5
Gender:Female  Submitted:1999-12-03, Days after onset: 30
Location:New Jersey  Entered:2000-01-06, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Mother had problem with previous vax. Pt exp stiff neck with first Hep B vax.
Other Medications: Excedrin, Depoprovera
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2829A21IMLA
Administered by: Private     Purchased by: Private
Symptoms: Nuchal rigidity
SMQs:
Write-up: Stiff neck. Resolved after 2 days.

VAERS ID:132469 (history)  Vaccinated:1999-10-29
Age:22.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 3
Location:Georgia  Entered:2000-01-06, Days after submission: 66
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA99163
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS00199P0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Neck pain, Oedema, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad)
Write-up: Adverse event started a couple of hrs after vax was given; arm became warm to touch & swollen greater than 50 cent piece. Neck also sore and swollen.

VAERS ID:132470 (history)  Vaccinated:1999-10-29
Age:64.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-01, Days after onset: 3
Location:Georgia  Entered:2000-01-06, Days after submission: 66
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA99164
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS00199P1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: Lt arm where vaccine was given has a red area just above elbow the size of an orange which is warm to the touch.

VAERS ID:132474 (history)  Vaccinated:1999-10-29
Age:39.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-16, Days after onset: 18
Location:Georgia  Entered:2000-01-06, Days after submission: 51
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Had same rxn with previous Flu shots.
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: GA99169
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0118AA2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: C/o having tenderness & redness at injection site.

VAERS ID:133432 (history)  Vaccinated:1999-10-29
Age:  Onset:1999-11-26, Days after vaccination: 28
Gender:Female  Submitted:2000-01-17, Days after onset: 52
Location:Unknown  Entered:2000-01-24, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zithromax "Pfizer" UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ0453713JAN2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Haemoptysis, Pneumonia, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Klebsiella Pneumonia: 11/26/99 pt coughed up copious amts of dark red blood twice. 11/27 pt hospitalized. Diag w/ bleeding Klebsiella pneumonia. Xray showed blood clot on lung. Treated w/ Ceftin (Roche). Had rxn. Treated w/ Benadryl.

VAERS ID:133541 (history)  Vaccinated:1999-10-29
Age:12.2  Onset:1999-11-13, Days after vaccination: 15
Gender:Male  Submitted:2000-01-18, Days after onset: 66
Location:Unknown  Entered:2000-01-29, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: WBC 12.4, lymphocyte 6.6, monocyte 16.4, eosinphil 3.9, poly 50, band 26, sed rate 55
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  IM 
Administered by: 0     Purchased by: 0
Symptoms: Dehydration, Dermatitis exfoliative, Eye disorder, Laboratory test abnormal, Leukocytosis, Leukoplakia oral, Mouth ulceration, Pharyngitis, Rash, Red blood cell sedimentation rate increased, Stevens-Johnson syndrome, Weight decreased
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Gastrointestinal premalignant disorders (narrow), Oropharyngeal neoplasms (narrow), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Symptoms started with sore throat 11/6/99. Mouth covered with white superficial painful peeling surface.Injection of both eyes.Progressed into ulcers of oral mucosa of throat and lips. Dehydration, weight loss, rash. Stephens Johnson synd.

VAERS ID:133470 (history)  Vaccinated:1999-10-29
Age:0.0  Onset:1999-11-01, Days after vaccination: 3
Gender:Male  Submitted:2000-01-13, Days after onset: 73
Location:New Jersey  Entered:2000-02-01, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Cough after 2 mo DPT, HIB (1st dose).
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4643031IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS512453A1IMRL
Administered by: Private     Purchased by: Private
Symptoms: Cough
SMQs:, Anaphylactic reaction (broad)
Write-up: Mother claims DPT & HIBTITTER given on 10/29 & 8/25/99 led to a prolonged cough, no fever in the child.

VAERS ID:133769 (history)  Vaccinated:1999-10-29
Age:30.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-02, Days after onset: 4
Location:Texas  Entered:2000-02-07, Days after submission: 97
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid med/Hormone
Current Illness: NONE
Preexisting Conditions: Thyroid problems
Diagnostic Lab Data: NONE
CDC Split Type: 99TX257
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0165AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Chills, Hyperhidrosis, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)
Write-up: Took vaccine 8:30am-s/s started 10:00am with sore arm. By 10:00pm, arm was aching, chills, then sweating. By next morning, was ok.

VAERS ID:133891 (history)  Vaccinated:1999-10-29
Age:60.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-20, Days after onset: 22
Location:New York  Entered:2000-02-11, Days after submission: 83
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: NY99045
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS01989P2IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypokinesia, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pain in finger tips post vax. Devel pain w/ range of motion from shoulder to below elbow. No open areas, redness, warmth.

VAERS ID:133989 (history)  Vaccinated:1999-10-29
Age:86.0  Onset:1999-11-18, Days after vaccination: 20
Gender:Male  Submitted:2000-01-21, Days after onset: 64
Location:Washington  Entered:2000-02-15, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Chest X-ray, blood work, urinalysis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982470IM 
Administered by: Public     Purchased by: Military
Symptoms: Chills, Headache, Hyperhidrosis, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)
Write-up: 10 days post vaccination, pt experienced malaise, headache, chills alternating with profuse sweating - all symptoms lasting for six weeks.

VAERS ID:150083 (history)  Vaccinated:1999-10-29
Age:39.0  Onset:1999-11-14, Days after vaccination: 16
Gender:Male  Submitted:2000-03-04, Days after onset: 111
Location:Texas  Entered:2000-03-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Altace, Lipitor
Current Illness: pruritus
Preexisting Conditions: hypertension, hyperlipidemia, impaired glucose tolerance
Diagnostic Lab Data: CBC, hepatic profile, HIBV, LPR, ESR, C-Reactive protein (all negative)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1661H0SC 
Administered by: Private     Purchased by: Private
Symptoms: Lymph node pain, Pain, Paraesthesia, Pruritus, Rash papular
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed generalized pruritus for 3 weeks, papular rash in intercostal areas, followed by intermittent achy, pin prick dysesthesias and tender lymph nodes that exacerbated in 2/00. Papular erythema, pain in both hands, chronic illness. Annual follow - up states the pt occassionally experiences papulo-pustular lesions and also a papular rash. A follow up report received 6/12/2000 adds: Pt reports info given in box 18 was in error. The generalized pruritis occurred on 11/14/1999 and lasted approx 3 weeks. He was given Varivax "as a precaution" after exposure to a pt with sore throat and "weird type" lymph nodes who later developed chicken pox-like rash. "There was no time to do a titer" so Varivax given to this physician. A "few days" after the Varivax both the pt and his wife, an ICU nurse, developed "weird rashes". The rash abated, but in February he developed pain in left arm and 2 weeks later itching. A "lymphatic cord" was noted in left arm and mild "chickenpox lesions". In late February he developed a rash on his hands and peeling goes to the present. Intermittent appearance of papular rash on his back and aches and pains in medial aspect of arms (lsp left) and thighs. Aches and pains temporarily relieved with aspirin. Also has tried acyclovir x 2 which "helped rash temporarily". The "cord" in left arm was diagnosed as ulnar entrapment neuropathy" and is "probably coincidental". Pt consulted with a doctor at CDC who stated there some similar reports. He also spoke with Merck who offered to biopsy lesions, but none are vesicular at present. Pt will fax and mail a complete progress note and lab test results currently available.

VAERS ID:150735 (history)  Vaccinated:1999-10-29
Age:7.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:2000-03-30, Days after onset: 153
Location:Kentucky  Entered:2000-04-04, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: EEG-nml, MRI-nml
CDC Split Type: WAES00032779
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0251J IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0115J SC 
Administered by: Other     Purchased by: Other
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)
Write-up: Information has been received from a company representative concerning a male pt who received several vaccination, the same day of the vaccination the pt experienced seizures, presented to a MD and was hospitalized for 4 - 5 days. Per the pt''s mother on 11/8/99,the pt had a normal EEg and MRI and was "doing fine." Additional information has been requested.

VAERS ID:150885 (history)  Vaccinated:1999-10-29
Age:33.0  Onset:2000-03-01, Days after vaccination: 124
Gender:Male  Submitted:2000-04-05, Days after onset: 34
Location:Unknown  Entered:2000-04-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0242SC 
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Nausea, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Pt states, post vax, he started feeling light-headed, dizziness and nausea. The symptoms started after a couple of months. Also, noticed loss of weight. (loss 20 lbs). No active duty.

VAERS ID:151825 (history)  Vaccinated:1999-10-29
Age:26.0  Onset:0000-00-00
Gender:Male  Submitted:2000-04-21
Location:Maryland  Entered:2000-05-10, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20000013491
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 10/29/99, the pt received his first IM-deltoid dose of Lymerix. A few days later, he experienced redness, swelling, and pain on the entire deltoid. Symptoms worsened over a couple of days, and then resolved within a few days. No treatment was given. The most recent information received on 1/17/00 reports the condition of the pt is resolved.

VAERS ID:154012 (history)  Vaccinated:1999-10-29
Age:51.0  Onset:1999-11-05, Days after vaccination: 7
Gender:Female  Submitted:1999-12-23, Days after onset: 48
Location:North Carolina  Entered:2000-06-13, Days after submission: 172
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ5768316NOV1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
Administered by: Private     Purchased by: Other
Symptoms: Influenza like illness
SMQs:
Write-up: A nurse reported that a 51 year old female inadvertently received an overdose of vax. On 11/5/99, she developed flu symptoms. As of 11/12/99, her symptoms persisted.

VAERS ID:154108 (history)  Vaccinated:1999-10-29
Age:  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:2000-01-17, Days after onset: 80
Location:California  Entered:2000-06-13, Days after submission: 147
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ5242310NOV1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998230 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site urticaria, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Within 30 minutes post vax, the pt developed hives at the injection site and intense generalized itching. She was seen in the ER and recovered within 90 minutes without treatment.

VAERS ID:154267 (history)  Vaccinated:1999-10-29
Age:65.0  Onset:1999-11-04, Days after vaccination: 6
Gender:Female  Submitted:1999-12-01, Days after onset: 27
Location:New York  Entered:2000-06-15, Days after submission: 196
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Spandex, polyester and wool allergies
Diagnostic Lab Data: UNK
CDC Split Type: FLU2211199
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUOGEN)PARKDALE PHARMACEUTICALS02879P0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Skin burning sensation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed a bad rash and hives all over the body, one week post vax. She took prednisone to clear it up but was advised by the physician to stop. She continues to experience hives and rash with itching and burning.

VAERS ID:156421 (history)  Vaccinated:1999-10-29
Age:8.0  Onset:1999-11-06, Days after vaccination: 8
Gender:Female  Submitted:2000-05-15, Days after onset: 190
Location:Pennsylvania  Entered:2000-07-13, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: fracture of wrist
Diagnostic Lab Data:
CDC Split Type: WAES99110713
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0441J0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 7 days post vax the pt developed an atypical rash on her neck and scattered on her face, jawline, her right eyelid, left cheek and 5 larger crusted areas at the sternoclavicular area in a necklace pattern and bilateral sides of neck. One lesion was noted at the injection site. The rash was described as discrete, pink and varying in size with no vesicles. Crusting was apparent with no more than 25 lesions noted. Pt was afebrile and pruritic. The pt sought unspecified medical treatment.

VAERS ID:162284 (history)  Vaccinated:1999-10-29
Age:43.0  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-12-13, Days after onset: 44
Location:Colorado  Entered:2000-10-13, Days after submission: 304
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: U1999008760
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0148AA IM 
Administered by: Other     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: It was reported that a female pt received a Fluzone SV ''99-''00 vaccination on 10/29/99. Approx. 24 hours, post vax, the pt developed a generalized rash on both legs. The pt was reportedly seen by a NP. From additional information received on 12/9/99, it was reported, "no follow-up; pt wouldn''t return phone call".

VAERS ID:162312 (history)  Vaccinated:1999-10-29
Age:44.0  Onset:1999-10-30, Days after vaccination: 1
Gender:Male  Submitted:2002-07-17, Days after onset: 991
Location:Georgia  Entered:2000-10-13, Days after submission: 642
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U1999009350
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Hypotonia, Injection site pain, Myasthenic syndrome, Nuchal rigidity, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: It was reported that a 44 year old male received a Fluzone ''99-''00 and an unspecified vaccination on 10/29/99. Reportedly, on 10/31/99, the pt developed body aches, injection site pain, muscle spasms, headache, stiff neck and muscle cramps in legs. From additional information received on 12/9/99, it was reported that 24 hours, post vax, the pt developed soreness at the injection site, tingling in left side, numbness, muscle weakness and stiffness, headaches and muscle spasms from neck to toes. The pt saw his primary physician, an orthopedic specialist and allergist. The pt has a referral for neurologist. Follow up #1: During internal auditing of all files, it was deemed necessary to amend the report by updating the adverse event coding (deleted twitching and added myasthenia and paresthenia).

VAERS ID:162365 (history)  Vaccinated:1999-10-29
Age:57.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-12-29, Days after onset: 61
Location:Missouri  Entered:2000-10-13, Days after submission: 288
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U1999011240
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0127AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Injection site haemorrhage, Injection site pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: It was reported that a female pt received a Fluzone SV ''99-''00 vaccination on 10/26/99. Reportedly on 10/29/99, the pt complained of left arm being sore and bruised. On 11/1/99, the pt complained of left side swelling of back. During the week of 12/8/99, the pt went to the Chiropractor and was treated with heat and electrical stimulation, which helped relax her back. On 11/27/99, the pt went to the ER and was referred to a vascular surgeon. On 12/6/99, the pt went to a vascular surgeon, who referred the pt to an Orthopedic Surgeon. The pt saw a MA on 12/27/99.

VAERS ID:162546 (history)  Vaccinated:1999-10-29
Age:  Onset:1999-10-29, Days after vaccination: 0
Gender:Male  Submitted:2000-08-10, Days after onset: 286
Location:Montana  Entered:2000-10-13, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U2000004750
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0166AA IM 
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Dysgeusia, Fatigue
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: One hour post vax, the pt reported feeling tired, lightheaded and had a "vinegar taste in her mouth", that self resolved. The pt reportedly recovered from this experience. No additional info was provided from correspondence returned on 07/25/2000. No further info is anticipated, this case is closed.

VAERS ID:162547 (history)  Vaccinated:1999-10-29
Age:  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:2000-08-10, Days after onset: 286
Location:Montana  Entered:2000-10-13, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U2000004760
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0166AA IM 
Administered by: Other     Purchased by: Other
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 3 hours post vax, the pt developed hives and a rash across her shoulders posteriorly, that self resolved. The pt reportedly recovered from this experience. No additional info was provided from correspondence returned on 07/25/2000. No further info is anticipated, this case is closed.

VAERS ID:163279 (history)  Vaccinated:1999-10-29
Age:21.0  Onset:1999-10-29, Days after vaccination: 0
Gender:Female  Submitted:1999-11-08, Days after onset: 10
Location:California  Entered:2000-11-14, Days after submission: 372
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19990293361
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: During the night after the vax was received, the pts arm became red and warm and she developed a rash. By three days post vax the pt had a generalized rash. The physician instructed the pt to take Benadryl. It is unknown whether or not the pt took the Benadryl. The most recent information received reports the condition of the pt is unknown.

VAERS ID:169831 (history)  Vaccinated:1999-10-29
Age:37.0  Onset:1999-10-30, Days after vaccination: 1
Gender:Female  Submitted:1999-11-09, Days after onset: 10
Location:Virginia  Entered:2001-05-15, Days after submission: 552
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: History of hernia
Diagnostic Lab Data: Skin scraping
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0135AA0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site reaction, Pruritus, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 24 hours, post vax, had itching in the injection site, then development of macular eczema-like lesions on trunk and arms.

VAERS ID:171955 (history)  Vaccinated:1999-10-29
Age:23.0  Onset:2000-12-18, Days after vaccination: 416
Gender:Female  Submitted:2001-05-15, Days after onset: 147
Location:Unknown  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Serum varicella zoster - negative
CDC Split Type: WAES00121872
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6315241012J1SC 
Administered by: 0     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Post vax, on 12/18/2000, the patient was negative for varicella virus serum antibodies. Unspecified medical attention was sought for the patient. No additional information is expected.

VAERS ID:185205 (history)  Vaccinated:1999-10-29
Age:2.9  Onset:2001-07-18, Days after vaccination: 628
Gender:Female  Submitted:2002-05-15, Days after onset: 301
Location:Unknown  Entered:2002-05-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01072005
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a health professional concerning a 33 month old female who on 29 OCT 1999 was vaccinated with varicella virus vaccine live. On 18 JUL 2001, the patient presented with a "break-through" chicken pox rash on the trunk of her body, with no fever. The health professional also reported about another patient (WAES #01072287). No further information is available.

VAERS ID:252733 (history)  Vaccinated:1999-10-29
Age:0.8  Onset:0000-00-00
Gender:Unknown  Submitted:2006-03-10
Location:Unknown  Entered:2006-03-14, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: MEDICAL HISTORY: Hives; Jaundice; Prematurity; Apgar score. CONCURRENT CONDITIONS: Peanut allergy; Facial dysmorphism; Muscle tone decreased; Allergy to nuts; High arched palate; Hirsutism; Drug hypersensitivity.
Diagnostic Lab Data: electroencephalography - 03/04/03 - suggest diffuse cerebral dysfunction. chromosomal analysis - 09/17/01 - normal. deoxyribunucleic acid - 09/17/01 - negative DNA studies for Fragile-X and Angelman syndrome. serum alkaline - 12/19/06 - 168 U/L. serum aspartate - 12/19/06 - 43 U/L. laboratory test - 46, XY - high resolution karyotype. laboratory test - norma - FISH for 15q11-13 with methylation studies for Angelman syndrome. laboratory test - 04/08/06 - titers drawn. urine nickel test - 13 mg/g. laboratory test - norma - fragile X studies. segmented neutrophil - 12/19/06 - 59.3%. serum alanine - 12/19/06 42 U/L. serum cholesterol - 04/20/04 - 173 MG/D - high. urine homovanillic acid - normal.
CDC Split Type: WAES0603USA00707
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1094J   
Administered by: Other     Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aphasia, Aspartate aminotransferase normal, Autism, Autism spectrum disorder, Blood alkaline phosphatase normal, Blood cholesterol normal, Chromosome analysis normal, DNA test for fragile X, Decreased eye contact, Developmental delay, Electroencephalogram abnormal, Febrile convulsion, Fluorescent in situ hybridisation, Immune system disorder, Karyotype analysis normal, Laboratory test, Laboratory test normal, Mental retardation, Nervous system disorder, Neurodevelopmental disorder, Neutrophil percentage, Speech disorder developmental, Staring
SMQs:, Liver related investigations, signs and symptoms (narrow), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received regarding a case in litigation concerning a patient who was vaccinated, as an infant, with hepatitis B virus vaccine rHBsAg (yeast) (manufacturer unknown). As a result of the mercury contained in the thimerosal containing vaccination, the child suffers, and will continue to suffer from neurological and immunological damage with symptoms including, but not limited to developmental delay, loss of language and failure to meet certain social and motor milestones. Upon internal review, neurological and immunological damage, development delay and loss of language were considered to be other important medical events (OMIC). Additional information has been requested. This is in follow-up to report (s) previously submitted on 3/20/2006: Information has been received regarding a case in litigation on concerning a patient who was vaccinated, as an infant, with a dose of hepatitis B virus vaccine rHBsAG (yeast) on 28-JAN-1999 (lot #628746/1667H), 06-MAR-1999 (lot#623354/1739H) and 29-OCT-1999 (lot #629872/1094J) respectively. As a result of the mercury contained in the thimerosal containing vaccinations, the child suffers, and will continue to suffer from neurological and immunological damage with symptoms including, but not limited to developmental delay, loss of language and failure to meet certain social and motor milestones. Other vaccination history included a first (lot 1001460), second (lot 7383AA), third (1387AA) and fourth (lot U004009) dose of diphtheria toxoid (+) pertussis acellular 1-component vaccine (+) tetanus toxoid on 06-MAR-1999, 05-MAY-1999, 16-JUL-1999, and 01-MAY-2000 respectively, a first (lotN0788AA), second (lot N0877AA), third (lot N180AA), and fourth (lot N1166AB) dose of Hib conj vaccine (tet toxoid) (ACTHIB) given on 06-MAR-1999, 05-MAY-1999, 16-JUL-1999 and 01-MAY-2000 respectively, a first (lot P03001), second (lot P0358), and third (E1294) dose respectively of inactivated poliovirus vaccine on 06-MAR-1999, 05-MAY-1999 and 06-JUL-2000 respectively; a first dose of measles virus vaccine lives (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (MSD) (lot 631474/1350J) on 13-JAN-2000 and first (lot 471207) and second (lot 471214) dose of pneumococcal 4 6B 9V 14 18C 19F 23F conj vaccine (CRM197) (PREVNAR) on 01-MAY-2000 and 06-JUL-2000 respectively. Follow-up information was received from medical records which indicated that the 10-week-old male has an allergy to peanuts and nuts, amoxicillin (+) clavulanate potassium (AUGMENTIN) (resulting in hives), over-the-counter cold medication, and promethazine, dysmorphic facial features, hirsutism, a high arched palate, low axial tone, a history being born 18 day premature with an Apgar score of 6 and 9 and jaundice after birth. It was also noted that the maternal pregnancy was complicated by maternal exacerbation of asthma for which she was on inhaler medication (PROVENTIL). On 11-MAR-2000, the patient ws seen in the emergency room for a febrile seizure that lasted approximately two minutes. On 02-FEB-2001, he was seen by a physician where it was reported that he had a febrile seizure at 10:30 p.m. (on approximately 01-FEB-2001) while sleeping. The seizure lasted for four minutes. It was also noted that the patient had poor speech and autism was questioned. On 15-FEB-2001, the patient had an audiology consult due to delayed speech and development. The mother reported that her son was the product of a normal pregnancy, labor, and delivery, healthy at birth, with no significant history of ear disease or any other health problems. The audiology test results indicated that there were no consistent and reliable responses below 30 dBHL, however the possibility of a mild hearing loss could not be ruled out. On 28-FEB-2001, he was seen by a physician and noted to have poor eye contact and appeared to fixate on objects like a pen. He was referred to a neurologist to rule out autism versus ne

VAERS ID:255850 (history)  Vaccinated:1999-10-29
Age:1.2  Onset:2005-04-22, Days after vaccination: 2002
Gender:Male  Submitted:2006-05-12, Days after onset: 385
Location:South Carolina  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0504USA04351
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection, Infection transmission via personal contact
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Info has been received from a physician concerning a 6 year old male who on 10/29/99, was vaccinated with a dose of varicella virus vaccine live. On 4/22/05, the pt developed breakthrough varicella with 3 lesions after being exposed to another previously vaccinated classmate that contracted chickenpox. Unspecified medical attention was sought. A product quality complaint was not involved. No further info is available. The physician who also reported that one female child and approximately 6 other children developed breakthrough varicella after vaccination with varicella virus vaccine live.

VAERS ID:347439 (history)  Vaccinated:1999-10-29
Age:1.0  Onset:2008-12-04, Days after vaccination: 3324
Gender:Female  Submitted:2009-05-15, Days after onset: 161
Location:Kentucky  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0812USA02011
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0724J SCUN
Administered by: Other     Purchased by: Other
Symptoms: Exposure to communicable disease, Varicella post vaccine
SMQs:
Write-up: Information has been received from a registered nurse concerning a 10 year old female patient who on 29-OCT-1999 was vaccinated with a dose of VARIVAX (Oka/Merck), lot number 631301/0724J, 0.5 ml, subcutaneous. It was reported that on 04-DEC-2008 the patient developed rash and on 05-DEC-2008 the patient was at physician''s office where was diagnosed with chickenpox. The nurse stated that the patient had about 30-30 "water filled blisters" scattered all over her body; patient was recently exposed to her grandfather who has shingles. Patient is recovering. Follow-up information received on 12-JAN-2009. A medical assistant stated that the patient developed "20-30 spots" after exposure to a grandparent with shingles "over weekend". Patient not recovered. No further information is available.

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