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Found 485503 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:174875 (history)  Vaccinated:2001-08-28
Age:0.3  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-08-31, Days after onset: 3
Location:West Virginia  Entered:2001-09-04, Days after submission: 4
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: EEG on 8/31/01- no results reported.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM950A21IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA576AB1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T11501 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815431IMRL
Administered by: Public     Purchased by: Public
Symptoms: Dysphagia, Dyspnoea, Erythema
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Pt was found in the bed red in the face and did not seem herself. She seemed to be short of breath and unable to swallow. Was brought to ER where blood sugar and blood gases were found to be normal and was warm to touch. Temperature was 98.3 by ear. Was sent to Morgantown for a EEG on 08/31/2001.

VAERS ID:174960 (history)  Vaccinated:2001-08-28
Age:10.0  Onset:2001-08-30, Days after vaccination: 2
Gender:Male  Submitted:2001-09-04, Days after onset: 5
Location:Virginia  Entered:2001-09-05, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0448L0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Rash macular
SMQs:, Hypersensitivity (narrow)
Write-up: Macular rash both forearms with a small amount on chest and face.

VAERS ID:175133 (history)  Vaccinated:2001-08-28
Age:4.0  Onset:2001-08-29, Days after vaccination: 1
Gender:Female  Submitted:2001-08-29, Days after onset: 0
Location:Tennessee  Entered:2001-09-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM996424IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T11463SCLL
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: Soft tissue infection -cellulitis at injection site

VAERS ID:175170 (history)  Vaccinated:2001-08-28
Age:23.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-08-28, Days after onset: 0
Location:West Virginia  Entered:2001-09-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 8/28/01 Tubersol given in right forearm
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3375A40IMLA
Administered by: Public     Purchased by: Private
Symptoms: Coma, Nausea
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt immediately complained of nausea and became unresponsive. Epipen was given and pt was sent to ER.

VAERS ID:175209 (history)  Vaccinated:2001-08-28
Age:1.3  Onset:2001-08-29, Days after vaccination: 1
Gender:Female  Submitted:2001-09-04, Days after onset: 6
Location:Illinois  Entered:2001-09-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM986A23IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1586K2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1283K0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mother states, the morning after receiving vaccinations, left leg became very red, swollen and hot to touch. Child was scratching at it. Child was hot but temperature was not taken. Seen by MD on 8/30/01 and given Benadryl and ibuprofen. On 9/4/01, child has recovered.

VAERS ID:175251 (history)  Vaccinated:2001-08-28
Age:4.0  Onset:2001-08-29, Days after vaccination: 1
Gender:Male  Submitted:2001-08-31, Days after onset: 2
Location:Pennsylvania  Entered:2001-09-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Sulfa drug allergy
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0378AA4IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T114823SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1387K1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site mass, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt had a local reaction to DTAP characterized by a firm area that was warm with erythema, measuring 6cm X 8cm. No fever. Treated with Motrin 2 1/2 tsp QID prn pain, cool compress and recheck in 1 week.

VAERS ID:175254 (history)  Vaccinated:2001-08-28
Age:1.3  Onset:2001-08-28, Days after vaccination: 0
Gender:Male  Submitted:2001-08-29, Days after onset: 1
Location:Louisiana  Entered:2001-09-11, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxil 250 3/4 tsp TID; Dimetapp
Current Illness: Sinusitis; Right serous otitis
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM996A23IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA623AA3IMRL
Administered by: Private     Purchased by: Private
Symptoms: Crying, Hypersensitivity
SMQs:, Angioedema (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow)
Write-up: Mom states that child woke up screaming and holding his legs into his body. Unable to calm and went to ER and was told it was "a reaction to pertussis in the DTAP that he had received earlier that day at the doctor''s office". Went to ER at 22:30 and was given Motrin at ER.

VAERS ID:175255 (history)  Vaccinated:2001-08-28
Age:25.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-08-31, Days after onset: 3
Location:Kentucky  Entered:2001-09-11, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1882K0SCLA
Administered by: Public     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Injection given on 8/28/01 and states rash started on 8/28/01 PM. Rash was on both arms, legs and chest. Over the counter allergy meds taken (Benadryl). Rash resolved on 9/4/01 AM.

VAERS ID:175257 (history)  Vaccinated:2001-08-28
Age:2.2  Onset:2001-08-29, Days after vaccination: 1
Gender:Male  Submitted:2001-08-30, Days after onset: 1
Location:Wisconsin  Entered:2001-09-11, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM995A23IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0969K3IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0235L0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Dyskinesia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad)
Write-up: Pt started running an elevated temperature in late afternoon on 8/29/01. He then began to have small jerking movements of arm, head and tongue stuck out. This lasted for a while. At 01:00, on 8/30/01, temperature was 102.5F (ax); no jerking. Mom did not check temperature on the afternoon of 8/29/01. Today he is fine with no temperature; no jerking and is playing.

VAERS ID:175357 (history)  Vaccinated:2001-08-28
Age:9.0  Onset:2001-08-29, Days after vaccination: 1
Gender:Male  Submitted:2001-09-06, Days after onset: 8
Location:Nevada  Entered:2001-09-14, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0352AU0IMLA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM520A20IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T11280 RA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Rash papular
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Mother describes pt complaining of a rash all over his body. Upon examination, child was found to have red papules over torso and face/head. Denies itching. Afebrile. Denies difficulty breathing on 9/5/01, but states child did complain of difficulty catching breath on 8/29/01. No medical treatment sought.

VAERS ID:175364 (history)  Vaccinated:2001-08-28
Age:4.0  Onset:2001-08-30, Days after vaccination: 2
Gender:Male  Submitted:2001-08-30, Days after onset: 0
Location:Pennsylvania  Entered:2001-09-14, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol prn
Current Illness: NONE
Preexisting Conditions: Developmental Delay; Recurrent OM; RAD
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0878AA IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T1148 SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0016L SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site erythema, Injection site swelling
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt''s left arm developed swelling with erythema (large swelling of upper arm) and red on 8/30/01, about 48 hours, post vax. Treated with Tylenol.

VAERS ID:175365 (history)  Vaccinated:2001-08-28
Age:35.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-09-04, Days after onset: 7
Location:Florida  Entered:2001-09-14, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0742L1SCRA
Administered by: Other     Purchased by: Other
Symptoms: Rash macular
SMQs:, Hypersensitivity (narrow)
Write-up: Pt experienced scattered red and itchy blotches on face, arm and abdomen X 5 during the past 4 days that lasted for a few hours, the resolved. Benadryl taken for relief.

VAERS ID:175368 (history)  Vaccinated:2001-08-28
Age:13.0  Onset:2001-08-30, Days after vaccination: 2
Gender:Male  Submitted:2001-08-30, Days after onset: 0
Location:Mississippi  Entered:2001-09-14, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': MS01038
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1375K2 RA
Administered by: Public     Purchased by: Private
Symptoms: Hypokinesia, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Vaccine administered 08/28/01. Came to the Health Dept again on 08/30/01, wanting a doctors excuse, says "can''t move arm", "swollen", no "feeling in arm and shoulder". No visible swelling, no local reaction resides holding forearm bent. Sent to PMD.

VAERS ID:175372 (history)  Vaccinated:2001-08-28
Age:23.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-08-28, Days after onset: 0
Location:Unknown  Entered:2001-09-14, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tubersol-Aventis Pasteur C0619AA
Current Illness:
Preexisting Conditions: Denied yeast allergy.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3375A4 IM 
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Coma, Convulsion, Nausea
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Tubersol was given in the right forearm. Then Hepatitis B was given IM in the left deltoid. The patient was complaining of nausea immediately. Approximately 40 seconds later nonresponsive. Epi pen was given. The patient did respond to questions approximately 15 seconds after epi given. Sent to the ER. Appeared to be a seizure.

VAERS ID:175440 (history)  Vaccinated:2001-08-28
Age:0.5  Onset:2001-08-29, Days after vaccination: 1
Gender:Female  Submitted:2001-09-10, Days after onset: 12
Location:Ohio  Entered:2001-09-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough and congestion for 2 days
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 2IMRL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 2SCLL
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site mass, Injection site warmth, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Received call from mother, saying child had raised area on left VL approx. 2cm-4cm, warm to the touch with redness. No increased temperature. (+) TTP.

VAERS ID:175474 (history)  Vaccinated:2001-08-28
Age:1.6  Onset:2001-08-29, Days after vaccination: 1
Gender:Female  Submitted:2001-09-06, Days after onset: 8
Location:Indiana  Entered:2001-09-18, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;UNK. DTAP;3;.50;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU01311EA3IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1482H2IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13902SCRL
Administered by: Public     Purchased by: Public
Symptoms: Abasia, Injection site mass, Injection site pain, Injection site reaction, Injection site swelling, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 8/29/01, on awakening at 07:00, the child would not stand on left leg and cried with pain upon trying to stand. Her left leg is swollen, 2" in diameter, warm to touch, with a "knot", but no redness noted. Mom used Advil for low-grade temperature and pain. She used a cool wash rag to area and mom massaged leg. On 8/30/01, the pt is back walking without complaint of pain, swelling is gone, "knot remains palpable per mom in left leg.

VAERS ID:175479 (history)  Vaccinated:2001-08-28
Age:1.5  Onset:2001-08-28, Days after vaccination: 0
Gender:Male  Submitted:2001-08-30, Days after onset: 2
Location:Texas  Entered:2001-09-18, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU03532C (B)0IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESU03532C (A)0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T12732 LL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt developed hives all of his body. Injection site was swollen and pink. The symptoms are resolving.

VAERS ID:175539 (history)  Vaccinated:2001-08-28
Age:42.0  Onset:2001-08-31, Days after vaccination: 3
Gender:Female  Submitted:2001-09-10, Days after onset: 10
Location:Oklahoma  Entered:2001-09-19, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid, Topamax, Vivactyl, Loestrin.
Current Illness: Severe abdominal pain, nausea, and vomiting.
Preexisting Conditions: Allergic to trees, grass, dust, mold. Possible multiple sclerosis.
Diagnostic Lab Data: Blood tests (abnormal), UA (normal), HIDA Scan (Nml).
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Blood bilirubin increased, Enzyme abnormality, Laboratory test abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Severe abdominal pain 3 days following, elevated liver enzymes and bilirubin, continuing for 3 weeks, (so far).

VAERS ID:175553 (history)  Vaccinated:2001-08-28
Age:9.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-09-11, Days after onset: 14
Location:Utah  Entered:2001-09-20, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: hayfever
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMRA
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
Administered by: Private     Purchased by: 0
Symptoms: Abdominal pain, Anorexia, Arthralgia, Fatigue, Flushing, Headache, Influenza like illness, Injection site pain, Malaise, Pain, Pruritus, Pyrexia, Vertigo, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypersensitivity (broad), Arthritis (broad)
Write-up: The pt experienced a 103 degree fever, anorexia, fatigue, headache, malaise, nausea, vomiting, pain, vertigo, abdominal cramps, diarrhea, arthralgia, chills, flu-like symptoms, flushing, itching chin, and pain at injection site.

VAERS ID:175568 (history)  Vaccinated:2001-08-28
Age:2.9  Onset:2001-08-30, Days after vaccination: 2
Gender:Male  Submitted:2001-08-30, Days after onset: 0
Location:California  Entered:2001-09-21, Days after submission: 22
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': CA010096
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM697A20IMLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747280IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt developed a red induration on left arm.

VAERS ID:175583 (history)  Vaccinated:2001-08-28
Age:71.0  Onset:2001-08-29, Days after vaccination: 1
Gender:Female  Submitted:2001-09-04, Days after onset: 6
Location:Nevada  Entered:2001-09-21, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Nose drops, Premarin
Current Illness: feeling tired
Preexisting Conditions: asthma, sinus problems, allergy to PCN
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0523L1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Face oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The pt complained of swelling of the upper lip only 1 day post vax. the swelling resolved 1-2 days after it appeared. No other symptoms.

VAERS ID:175625 (history)  Vaccinated:2001-08-28
Age:1.3  Onset:2001-08-29, Days after vaccination: 1
Gender:Male  Submitted:2001-08-29, Days after onset: 0
Location:Oregon  Entered:2001-09-24, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl; Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': OR200134
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0310AA3IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5194A22IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0159L0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733461IMRL
Administered by: Public     Purchased by: Other
Symptoms: Cold sweat, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: This child woke up on 8/29/01 with a rash or hives on his left trunk. Skin was cool to touch. No vomiting or other symptoms. Reported to PMD for evaluation and he recommended Tylenol and Benadryl if hives persist. On 8/31/01, telephone call to mother and she reported that hives had increased to full body but now are resolving. Temperature went to 101F (axillary) but now resolved.

VAERS ID:175706 (history)  Vaccinated:2001-08-28
Age:4.0  Onset:2001-09-07, Days after vaccination: 10
Gender:Female  Submitted:2001-09-19, Days after onset: 12
Location:Ohio  Entered:2001-09-25, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Familial hand tremor.
Diagnostic Lab Data: Had blood work, MRI and urine sample is being tested for a possible genetic problem.
CDC 'Split Type': OH0051
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS997A23IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1885D0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Fall
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: On 9/7/01 between 1:15 to 1:30, patient was observed having grand mal seizure after getting off the tricycle at preschool. Patient does not remember getting off tricycle and starting to walk. She fell foward, hitting her forehead as a result of the seizure.

VAERS ID:175896 (history)  Vaccinated:2001-08-28
Age:0.2  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-09-06, Days after onset: 9
Location:New Jersey  Entered:2001-10-01, Days after submission: 25
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': HQ5436631AUG2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM  IM 
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES  IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.    
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 0IMRL
Administered by: Private     Purchased by: Other
Symptoms: Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (broad)
Write-up: A nurse reported that a 2 month old female received injections of Prevnar (1st dose), Infanrix, IPV and Act-Hib on 8/28/01. Several hours, post vax, both of the pt''s legs turned purple from the hips to toes. This lasted over 20 minutes. The responsible physician did not believe the reaction was due to the vaccination, but a different physician felt there was indeed a causal relationship.

VAERS ID:175977 (history)  Vaccinated:2001-08-28
Age:2.8  Onset:2001-08-30, Days after vaccination: 2
Gender:Female  Submitted:2001-09-09, Days after onset: 10
Location:Kentucky  Entered:2001-10-02, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': KY2001067
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4730043IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 2 days post vax, the child broke out in large red welts and hives on face, neck, trunk and arms, legs and back. Seen by MD and was instructed to give Benadryl every 4-6 hours. The pt also experienced slight occasional itching.

VAERS ID:176181 (history)  Vaccinated:2001-08-28
Age:15.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-08-28, Days after onset: 0
Location:Michigan  Entered:2001-10-10, Days after submission: 43
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: Pulse taken after 15 minutes at 64-68 BPM RR 16-18/min.
CDC 'Split Type': MI2001077
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5189A20IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0602L1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Hypoacusis
SMQs:, Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)
Write-up: Dizziness and loss of hearing about 1 month. Observed for 20 minutes.

VAERS ID:176328 (history)  Vaccinated:2001-08-28
Age:4.0  Onset:2001-08-29, Days after vaccination: 1
Gender:Male  Submitted:2001-09-04, Days after onset: 6
Location:Texas  Entered:2001-10-16, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD/Mantoux Skin Test/Aventis-Pasteur/C063AA/ID/LA/1 previously
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC; Chem 7 done in hospital
CDC 'Split Type': TX01135
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM997A24IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T06972 SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1282K1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad)
Write-up: The child received immunizations on 8/28/01 PM and did fine. Mother noticed that child was irritable on 8/29/01 and later in the day, about 19:00, pt went outside to play X 15-20 minutes and mother noticed area was red. Mother brought child to clinic on 8/30/01 for comfort measures. Reviewed with instructions to see LMD if problems persisted or worsened. Diagnosed with cellulitis.

VAERS ID:176391 (history)  Vaccinated:2001-08-28
Age:1.0  Onset:2001-09-10, Days after vaccination: 13
Gender:Male  Submitted:2001-09-19, Days after onset: 9
Location:Wisconsin  Entered:2001-10-17, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAMA978AZ3IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0288K3IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES480907 IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0235L SCRL
Administered by: Public     Purchased by: Private
Symptoms: Convulsion, Dyspnoea, Eye movement disorder, Loss of consciousness, Pyrexia, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt began to run fever at midnight, temperature of 103. rolled eyes back, began to tremble, seizure lasted 1 minute. Child unconscious, very purple lips, and difficulty breathing. Mom breathed in his mouth. Called 911, taken to hospital, given Tylenol and released after 2 hours.

VAERS ID:176525 (history)  Vaccinated:2001-08-28
Age:0.3  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-10-09, Days after onset: 42
Location:Pennsylvania  Entered:2001-10-22, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: Seen by pediatric neurologist.
CDC 'Split Type': PA0157
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0299AB1IMRA
HBHEPB: HIB + HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4774510IMLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: The patient had two seizures in the car on the way home from the clinic approximately 35 minutes after receiving vaccine.

VAERS ID:176560 (history)  Vaccinated:2001-08-28
Age:83.0  Onset:2001-08-30, Days after vaccination: 2
Gender:Male  Submitted:2001-10-16, Days after onset: 47
Location:Minnesota  Entered:2001-10-22, 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: MVT, Minerals
Current Illness: NONE
Preexisting Conditions: Eczema with history of skin cancer.
Diagnostic Lab Data: Temp 35.9C/Chem 8-WNL/Sed Rate above 46
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1197K1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Application site reaction, Cellulitis, Injection site reaction
SMQs:
Write-up: Patient complained via telephone on 08/30/2001, of a "large local reaction". The patient was advised to treat with an ice pack. The patient went to the ER on 09/02/2001 and was diagnosed with cellulitis. Augmentin was prescribed.

VAERS ID:177635 (history)  Vaccinated:2001-08-28
Age:0.3  Onset:2001-08-28, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Oklahoma  Entered:2001-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM984A21IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1641K1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T08161SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809771IMLL
Administered by: Private     Purchased by: Private
Symptoms: Choking, Rash maculo-papular, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: On 8-28/01, at night time she acted like she was choking with her secretions. Her skin got splotchy. Acted as if she couldn''t breath. Mucous from the mouth lasted 1 hour.

VAERS ID:177637 (history)  Vaccinated:2001-08-28
Age:0.2  Onset:2001-08-28, Days after vaccination: 0
Gender:Male  Submitted:2001-11-05, Days after onset: 69
Location:Minnesota  Entered:2001-11-12, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM997A21IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1762K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T084121IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4797871IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Golf ball size swelling at shot sight of vaccines-right leg.

VAERS ID:179907 (history)  Vaccinated:2001-08-28
Age:0.2  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-11-29, Days after onset: 93
Location:New Jersey  Entered:2002-01-14, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ8725426NOV2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM 0IM 
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES 0IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEUR 0  
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Crying, Cyanosis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: A nurse reported that a infant rec''d her 1st dose of Prevnar, Infanrix (GSK), Act-HIB (Aventis Pasteur SA) and IPOL (Aventis Pasteur SA) vaccines on 8/28/01. That same day, the infant experienced cyanosis of her legs and she screamed. The cyanosis resolved within 10 minutes. She was seen by the reporter and recovered. This report was rec''d from Glaxo Smith Kline (ref. #2001021044-1).

VAERS ID:180208 (history)  Vaccinated:2001-08-28
Age:4.0  Onset:2001-08-29, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Arkansas  Entered:2002-01-22
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': AR024
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM988AZ4IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT08412SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1574K1SCRA
Administered by: 0     Purchased by: 0
Symptoms: Cellulitis
SMQs:
Write-up: Cellulitis right arm due to 3 injections given in same arm. Has been given 2 antibiotic PO for cellulitis.

VAERS ID:180742 (history)  Vaccinated:2001-08-28
Age:24.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2002-01-22, Days after onset: 147
Location:Texas  Entered:2002-01-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': TX02015
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1047L0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Injection site erythema, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 3 hours injection given, broke out into a red rash from upper chest to stomach. Rash was also at injection site. Rash lasted three days. Did not miss any work and no other reaction.

VAERS ID:181520 (history)  Vaccinated:2001-08-28
Age:0.6  Onset:2001-08-28, Days after vaccination: 0
Gender:Male  Submitted:2002-02-07, Days after onset: 163
Location:Arkansas  Entered:2002-02-20, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, motrin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': AR0209
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM505A22IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0409L2IMLL
HIBV: HIB (ACTHIB)AVENTIS PASTEUR592AA2IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747282IMRL
Administered by: Public     Purchased by: Other
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: On 08/28/2001, 3 hrs after immunizations given, child developed a fever of 103.8 degrees F. and mom said "she could not get it down all the rest of the day with Tylenol and Motrin so she took him to the clinic the next morning on 08/29/2001."

VAERS ID:182409 (history)  Vaccinated:2001-08-28
Age:12.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2002-03-07, Days after onset: 191
Location:Unknown  Entered:2002-03-13, 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:
Preexisting Conditions: asthma
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES01083179
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0410L0  
Administered by: Other     Purchased by: Other
Symptoms: Headache, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a pharmacist concerning a 12 year old female, with a history of asthma and no known allergies, who on 08/28/2001 was vaccinated with the first dose of hep b vaccine recombinant. There was no concomitant medication. Immediately after vaccination, on 08/28/2001, the pt passed out and experienced a severe headache, that lasted a few minutes, at the same time. The pt sought unspecified medical attention. Additional info has been requested.

VAERS ID:185470 (history)  Vaccinated:2001-08-28
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:2002-05-15
Location:Unknown  Entered:2002-05-28, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01091393
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site reaction, Pruritus, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician''s assistant concerning a 1 year old male who on 08/28/01 was vaccinated with varicella virus vaccine live. Concomitant vaccination 08/28/01 included streptococcus pneumoniae vaccine (Prevnar). The physician''s assistant reported that both vaccinations were received in one leg. Subsequently, the pt developed an injection site reaction; itching, scratched lesions and scabbing. The pt was seen on 09/07/2001. In FOLLOW UP, the physician reported that the ''local vesicular reaction " were ''not atypical or adverse" and that "this was not a reportable event", therefore the physician indicated "we didn''t pursue it"

VAERS ID:185483 (history)  Vaccinated:2001-08-28
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:2002-05-15
Location:Unknown  Entered:2002-05-28, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01092070
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Rash, Rash papular, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician''s assistant and physician concerning a 1 year old male who on 08/28/01 was vaccinated with varicella virus vaccine live. Concomitant vaccination on 08/28/2001 included streptococcus pneumonia vaccine (Prevnar). The physician''s assistant reported the both vaccinations were received in one leg. Subsequently, the patient developed an injection site reaction: rash, papular lesion. The patient was seen on 09/07/2001. In follow-up, the physician reported that the "local vesicular reactions " were ''not atypical or adverse". It was noted that two other patients (WAES010192071 & 01091393) had similar experiences following exposure to varicella virus vaccine live. No further information is available.

VAERS ID:185484 (history)  Vaccinated:2001-08-28
Age:1.0  Onset:2001-09-07, Days after vaccination: 10
Gender:Male  Submitted:2002-05-15, Days after onset: 250
Location:Unknown  Entered:2002-05-28, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01092071
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Rash pustular
SMQs:, Hypersensitivity (narrow)
Write-up: Information has been received from a physician''s assistant concerning a 1 year old male who on 08/28/2001 was vaccinated with varicella vaccine. Concomitant vaccination on 08/28/2001 included Prevnar. The physician''s assistant reported that both vaccinations were received in one leg. Subsequently, the pt developed an injection site reaction described as a knob with a pustule. The pt was seen in the physician''s office on 09/07/2001. In follow-up, a physician reported that the "local vesicular reactions" were "not atypical or adverse." It was noted that two other pts had similar experienced following exposure to varicella vaccine. No further info is available.

VAERS ID:185486 (history)  Vaccinated:2001-08-28
Age:  Onset:0000-00-00
Gender:Male  Submitted:2002-05-15
Location:Unknown  Entered:2002-05-28, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES01092093
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0582L   
Administered by: Other     Purchased by: Other
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Information has been received from a health professional concerning a male who on 08/28/2001 was vaccinated with one dose of varicella vaccine. Concomitant therapy included Prevnar. On an unspecified date, the pt developed a varicella-like rash with papular and vesicular reaction. It was noted that prescription drug treatment was not required. Subsequently, the pt recovered. Additional info has been requested.

VAERS ID:185487 (history)  Vaccinated:2001-08-28
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:2002-05-15
Location:Unknown  Entered:2002-05-28, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES01092095
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0582L   
Administered by: Other     Purchased by: Other
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Information has been received from a health professional concerning an approximately 12 month old male who on 08/28/2001 was vaccinated with one dose of varicella vaccine administered in the leg. Concomitant therapy included one dose of Prevnar, administered in the same leg. On an unspecified date, in approximately August 2001, the pt experienced "itching/scratching" and "scabbing due to abrasion/scatching." It was noted that no prescription drug treatment was required. Subsequently, the pt recovered. Additional info has been requested.

VAERS ID:185488 (history)  Vaccinated:2001-08-28
Age:1.1  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:Unknown  Entered:2002-05-28
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: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES01092096
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0582L   
Administered by: Other     Purchased by: Other
Symptoms: Injection site induration, Rash pustular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a health professional concerning an approximately 13 month old pt who on 08/28/2001 was vaccinated with one dose of varicella vaccine administered in the left. Concomitant therapy included one dose of Prevnar administered in the same leg. On an unspecified date, in approximately August 2001, the pt developed a local reaction of a knot on the leg and a non-tender pustule. It was noted that no prescription drug treatment was needed. Subsequently, the pt recovered. Additional info has been requested.

VAERS ID:185506 (history)  Vaccinated:2001-08-28
Age:8.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2002-05-15, Days after onset: 260
Location:Massachusetts  Entered:2002-05-28, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness:
Preexisting Conditions: Asthma; allergic to cats and feathers
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES01100021
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0466L0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Muscle twitching, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a consumer concerning her 8 year old daughter, with allergies to cats and feathers and a mild case of asthma, who on 08/28/2001 was vaccinated SC in the left arm with the first dose of varicella vaccine. Concomitant therapy included albuterol. One minute post-vaccination, the pt passed out and experienced twitching in her right arm. On an unspecified date, the pt developed a three inch red spot at the injection site. Follow-up info received from a registered nurse indicated that the pt appeared anxious before administration of the vaccine. The nurse reported that the pt was pale and sweaty during the syncopal episode. Her pulse remained strong, but no nausea was noted. The pt and her mother remained in the office until the pt recovered. No medical attention was sought. No further info is available.

VAERS ID:187573 (history)  Vaccinated:2001-08-28
Age:5.0  Onset:2001-08-29, Days after vaccination: 1
Gender:Female  Submitted:2002-05-30, Days after onset: 274
Location:Washington  Entered:2002-07-15, 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: Multi-vitamins and supplements (NOS)
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01083161
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1SC 
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from an RN concerning a 5 year old female with no known allergies and who recently has a physical for special education on 8/28/01 was vaccinated with a dose of MMRII. Concomitant therapy included multi-vitamins and supplements. On 8/29/01, the pt''s mother reported that her "child broke out in rash on her chest". There were no other symptoms reported (no fever, no cough, no lethargy and no swelling). The pt sought unspecified medical attention. Follow-up information from the reporter stated that the adverse event was unlikely vaccine related. The reporter spoke with the mother again and the child was improving. It was reported that the pt recovered. No further information in expected.

VAERS ID:195607 (history)  Vaccinated:2001-08-28
Age:1.1  Onset:2001-09-04, Days after vaccination: 7
Gender:Male  Submitted:2002-12-20, Days after onset: 472
Location:Colorado  Entered:2002-12-30, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diarrhea two preceding days
Preexisting Conditions: NONE
Diagnostic Lab Data: Spinal fluid with low glucose
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0733L0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0495L0 LA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Meningitis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Four generalized clonic-tonic seizures 7 days after administration of MMR II and Varivax.

VAERS ID:197227 (history)  Vaccinated:2001-08-28
Age:18.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2001-09-12, Days after onset: 15
Location:Connecticut  Entered:2003-02-04, Days after submission: 510
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': U200100972
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0361AA  LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: From phone contact w/PT''s parent, was stated that an 18 y.o. female PT received a TD adult vaccination, lot #U0361AA exp. 10/12/02 on 8/28/01. The PT developed fever 104 deg F, chills, a sore arm and leg- muscular, as well as a headache. PT was seen in MD''s office.

VAERS ID:198862 (history)  Vaccinated:2001-08-28
Age:18.0  Onset:2001-08-28, Days after vaccination: 0
Gender:Female  Submitted:2002-02-05, Days after onset: 161
Location:Maryland  Entered:2003-03-05, Days after submission: 393
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Scoliosis
Diagnostic Lab Data: Temp 98.1 deg F
CDC 'Split Type': U200200057
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUA413AA0SCLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: It was reported that an 18 year old female pt received a Menomune vaccination (UA413AA) administered SC in the left arm on 8/28/01. Reportedly that same day the pt experienced pain at the injection site, "feels tender and hurts, six on a scale of 1-10" per pt. Feels slightly warm to touch. Does not appear red or swollen. Ice pack applied. Pt states will take Tylenol. Campus physician examined pt and states, "not a problem."

VAERS ID:249880 (history)  Vaccinated:2001-08-28
Age:3.0  Onset:2005-11-01, Days after vaccination: 1526
Gender:Male  Submitted:2005-12-20, Days after onset: 49
Location:Missouri  Entered:2005-12-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER04672  UN
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: Developed rash symptoms typical of varicella in out break situation.

VAERS ID:348088 (history)  Vaccinated:2001-08-28
Age:1.1  Onset:2001-08-28, Days after vaccination: 0
Gender:Male  Submitted:2009-05-15, Days after onset: 2817
Location:New Jersey  Entered:2009-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0804USA05960
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.  UNUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0560L0IMUN
Administered by: Private     Purchased by: Other
Symptoms: Herpes zoster, Incorrect route of drug administration
SMQs:
Write-up: Information has been received from a registered nurse concerning a 4 year old male with no pertinent medical history and no known drug reactions/allergies who on 28-AUG-2001 was vaccinated intramuscularly (previously reported as subcutaneously) in his left leg with a 0.5 ml initial dose of VARIVAX (Oka/Merck) (Lot# 638907/0560L). On the same day, the patient was also vaccinated with PEDVAX HIB (MSD) and MMR II (MSD). Concomitant therapy included DTP (manufacturer unknown). There was no illness at time of vaccination. On 20-JUN-2005 the patient got shingles, he never had chickenpox (as previously reported). Subsequently, the patient recovered from shingles. The patient did not require any medical treatment. The patient sought medical attention at the office visit. There was not product quality complaint. A hospital vaccine specialist advised this patient to receive the VARIVAX (Oka/Merck) again. Additional information is not expected.

VAERS ID:174878 (history)  Vaccinated:2001-08-29
Age:33.0  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-08-30, Days after onset: 0
Location:Oklahoma  Entered:2001-08-31, 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: Levoxyl, Pepcid, Benadryl.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: X-ray
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Public     Purchased by: Unknown
Symptoms: Balance disorder, Dizziness, Dyspnoea, Headache, Heart rate increased, Lymphadenopathy, Musculoskeletal stiffness, Nausea, Odynophagia, Pharyngeal oedema, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: This patient had an injection at 2:00 PM on 08/29/2001. She felt funny all afternoon, off balance. She went back to bed, awoke a 3:00 AM having difficulty breathing. Glands, throat all swollen. Tingly fingers and toes. No fever. Stiff neck, headache, queasy stomach, heart beating fast, sore throat when she swallows (hard to swollow), also feels spacey and dizzy.

VAERS ID:174876 (history)  Vaccinated:2001-08-29
Age:0.3  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-08-31, Days after onset: 1
Location:Massachusetts  Entered:2001-09-04, 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:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0515AA1IM 
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4758271IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T06241SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4797971IM 
Administered by: Private     Purchased by: Public
Symptoms: Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Received Dtap, Ipv, Hib, Prevnar 8-29-01 Developed fever to 103.6 R w/in 24 hrs some irritablility

VAERS ID:174934 (history)  Vaccinated:2001-08-29
Age:31.0  Onset:2001-08-29, Days after vaccination: 0
Gender:Male  Submitted:2001-08-29, Days after onset: 0
Location:Unknown  Entered:2001-09-05, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hx of sewage exposure
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM670D6   
Administered by: 0     Purchased by: 0
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: After this patient received Hep A immunization approximately 1 hour later returned complaining of slight difficulty in breathing and throat tightening. Patient given Benadryl with good results.

VAERS ID:175104 (history)  Vaccinated:2001-08-29
Age:4.0  Onset:0000-00-00
Gender:Female  Submitted:2001-08-29
Location:Massachusetts  Entered:2001-09-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: CBC sent 8/29/01
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES403218A4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R069224 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0405K1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt developed a 7 x 9.5 cm area of erythema, induration, warmth and swelling on 8/29/01.

VAERS ID:175106 (history)  Vaccinated:2001-08-29
Age:27.0  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-09-05, Days after onset: 6
Location:Virginia  Entered:2001-09-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM698D6 IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESUO463AA IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESR12304 IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt developed an 8 cm diameter local area of redness and swelling.

VAERS ID:175185 (history)  Vaccinated:2001-08-29
Age:5.0  Onset:2001-08-31, Days after vaccination: 2
Gender:Male  Submitted:2001-08-31, Days after onset: 0
Location:Unknown  Entered:2001-09-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM992A2 IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt developed a 4cm X 6cm erythema and edema at injection site.

VAERS ID:175202 (history)  Vaccinated:2001-08-29
Age:1.0  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-08-31, Days after onset: 1
Location:Pennsylvania  Entered:2001-09-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1388K0SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809070IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1905K0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt developed a red area about 80mm X 40mm on leg, that was warm to touch and slightly tender to touch. Site of problem area Rt leg.

VAERS ID:175228 (history)  Vaccinated:2001-08-29
Age:0.7  Onset:2001-08-30, Days after vaccination: 1
Gender:Male  Submitted:2001-08-30, Days after onset: 0
Location:Utah  Entered:2001-09-11, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM983A22IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1190K2IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05332SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4749471IMLL
Administered by: Public     Purchased by: Public
Symptoms: Injection site mass, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt''s right thigh was swollen by 24 hours, post vax. DTAP given in right upper thigh. Left thigh was a little swollen, also. Prevnar given in left upper thigh. On 9/3/01, follow-up call; there are 2 lumps or knots, one in each upper thigh.

VAERS ID:175252 (history)  Vaccinated:2001-08-29
Age:1.8  Onset:2001-08-30, Days after vaccination: 1
Gender:Male  Submitted:2001-08-31, Days after onset: 1
Location:Pennsylvania  Entered:2001-09-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergies to Augmentin and Cefzil
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0513DB3IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA603AA3IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T1310 SCRL
Administered by: Private     Purchased by: Private
Symptoms: Abasia, Injection site pain, Injection site swelling, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt had marked swelling with wheal and 8cm circle and warm to touch. Refusing to walk and cries when area is touched.

VAERS ID:175314 (history)  Vaccinated:2001-08-29
Age:1.5  Onset:2001-08-30, Days after vaccination: 1
Gender:Male  Submitted:2001-08-31, Days after onset: 1
Location:Pennsylvania  Entered:2001-09-14, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES0513DB3IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES603AA3IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.13102SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815562IMRL
Administered by: Private     Purchased by: Private
Symptoms: Gait disturbance, Injection site swelling, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt developed a marked swelling and wheal (10cm circle), warm to touch and a noticeable limp.

VAERS ID:175315 (history)  Vaccinated:2001-08-29
Age:0.8  Onset:2001-08-29, Days after vaccination: 0
Gender:Male  Submitted:2001-08-30, Days after onset: 1
Location:Michigan  Entered:2001-09-14, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0513AA1IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA571AA1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13101IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815561IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site swelling, Screaming, Skin discolouration
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt developed acute swelling and discoloration of entire portion of both legs. He also had extended crying the entire day.

VAERS ID:175369 (history)  Vaccinated:2001-08-29
Age:12.0  Onset:2001-09-04, Days after vaccination: 6
Gender:Male  Submitted:2001-09-06, Days after onset: 2
Location:New York  Entered:2001-09-14, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Temperature and nausea.;UNK. HEPATITIS B;1;.00;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5208A22IMLA
Administered by: Private     Purchased by: Private
Symptoms: Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: This child had a temperature of 100 - 103 with nausea. One week after Hep B # 3 on 08/29/01. Per mom similar symptoms occurred after Hep B #1 09/23/93, # 2 12/16/93. Parents very anxious, they feel this is an adverse reaction. The physician feel illness is concurrent with viral illness in community.

VAERS ID:175429 (history)  Vaccinated:2001-08-29
Age:1.3  Onset:2001-08-29, Days after vaccination: 0
Gender:Male  Submitted:2001-08-31, Days after onset: 2
Location:Michigan  Entered:2001-09-17, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Also had IPV, Connaught, lot # T07852, SC, left arm on 08/29/2001.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO3532C3IMRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5176A21IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUO3532C3IMRL
MER: MEASLES + RUBELLA (MR-VAX II)MERCK & CO. INC.1280K0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0567L0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Difficulty in walking, Injection site erythema, Injection site induration, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Local reaction (erythema and induration 1 1/2" in diameter causing pain and difficulty walking) on left thigh. Treated with acetaminophen initially followed by Ibuprophen after calling LHD.

VAERS ID:175433 (history)  Vaccinated:2001-08-29
Age:0.8  Onset:2001-08-30, Days after vaccination: 1
Gender:Male  Submitted:2001-08-31, Days after onset: 1
Location:Michigan  Entered:2001-09-17, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Hypotonia
Preexisting Conditions: Hypotonia
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: This infant had a rash on his body with out fever.

VAERS ID:175448 (history)  Vaccinated:2001-08-29
Age:0.3  Onset:2001-08-29, Days after vaccination: 0
Gender:Female  Submitted:2001-09-06, Days after onset: 8
Location:Indiana  Entered:2001-09-18, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Digoxin; Lasix; Reglan; generic Aldactone; Zantac; Infant Tylenol
Current Illness: NONE
Preexisting Conditions: Down''s; Atrial and Ventricular Septal Defect; Congenital Heart
Diagnostic Lab Data: WBC-23.8 (high);Differential-% neutrophils-55% (high); % lumphocytes-26% (low)
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0311EA1IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1638K1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13901SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4792381IMLL
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Diarrhoea, Injection site erythema, Injection site swelling, Lymphopenia, Oral intake reduced, Pyrexia, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)
Write-up: Per mom, post vax, at approx. 11:00, the pt took 1 oz of formula and fell asleep. She was awakened at approx. 16:00 and she refused to eat. She started crying non-stop at 17:30 to 19:30, and then fell asleep at 19:45. At some time this evening, her temperature climbed to 103.2F and she was taken to ER. In ER she was vomiting and was given suppositories at ER. On 8/30/01, she was taken to a pediatric doctor and blood and urine samples were taken. She was given a shot of Rocephin at this time. Both legs were red and swollen at injection sties. On 8/31/01, she was taken back to the doctor because of continued diarrhea and vomiting. Another shot was given; mom is not sure what it was but she thinks it was Rocephin. On 9/1/01, mom states she took some Pedialyte but pushed nipple back on formula. She had less diarrhea and vomiting today. On 9/2/01, the baby took 12 oz of formula today. No Pedialyte offered. but less diarrhea and vomiting than yesterday per mom. On 9/3/01, mom felt she was "turning around" for the better by today. The way the baby acted, ate and slept, she was better. On 9/5/01, she was seen again by the doctor for a check-up. Baby was back to "normal" per the doctor and the mom.

VAERS ID:175453 (history)  Vaccinated:2001-08-29
Age:0.3  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-09-06, Days after onset: 7
Location:Indiana  Entered:2001-09-18, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Occasional cough
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0311EA1IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1638K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13901SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809001IMRL
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea, Injection site erythema, Injection site mass, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)
Write-up: Per mom; noticed redness, swelling and 99F temperature on 8/30/01 at 08:00. Tylenol was given at that time. On 8/31/01, redness/swelling was gone but there was a "knot" palpable. No loss of appetite; breast feeding. One "looser" than normal stool noted by mom during the episode.

VAERS ID:175470 (history)  Vaccinated:2001-08-29
Age:4.0  Onset:2001-09-10, Days after vaccination: 12
Gender:Female  Submitted:2001-09-11, Days after onset: 1
Location:Pennsylvania  Entered:2001-09-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO378AA3IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T114822SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1501J0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1610K0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The mother states small red bumps developed on child''s torso and chin, mild itching. No fever present. 09/11 rash fading.

VAERS ID:175471 (history)  Vaccinated:2001-08-29
Age:1.3  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-09-06, Days after onset: 7
Location:Indiana  Entered:2001-09-18, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Diarrhea, no fever.
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO311EA3IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1638K2IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13902SCLL
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Per mom - symptoms started on 08/30/01 at 8 am, redness size 3 inches in diameter (left leg) with complaints of pain. Tylenol given Thursday and Friday 2 times both days. Mom says "spot" is pin point size since 09/01/01, no "knot".

VAERS ID:175472 (history)  Vaccinated:2001-08-29
Age:1.4  Onset:2001-08-29, Days after vaccination: 0
Gender:Male  Submitted:2001-09-06, Days after onset: 8
Location:Indiana  Entered:2001-09-18, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO311EA1IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1638K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13901SCLL
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Per mother''s friend, symptoms started Wed., 08/29/01, in the evening, complained of redness, swelling, and soreness in the left leg. Tylenol was given for treatment of symptoms. Friend brought baby for shots with permission by mom.

VAERS ID:175473 (history)  Vaccinated:2001-08-29
Age:1.3  Onset:2001-08-29, Days after vaccination: 0
Gender:Female  Submitted:2001-09-06, Days after onset: 8
Location:Indiana  Entered:2001-09-18, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Indigestion night before.
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1482H2IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13902SCLL
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESUO311EA3IMLL
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oral intake reduced, Screaming
SMQs:, Anaphylactic reaction (broad), Hostility/aggression (broad), Hypersensitivity (broad)
Write-up: Symptoms started approximately 4 hors after injections. Didn''t want to eat supper. Screamed when she stood up. Cried "alot" between 5:30 pm and bed time at 8:30 pm. Mom says redness size of nickel, no "knot". On Thursday, 08/30/01, symptoms continued per mom so appt was made at the doctors for 3 pm and taken to the appt. The doctor ordered amoxicillin. The parent gave the child Tylenol thru Thursday and it was not needed on Friday.

VAERS ID:175476 (history)  Vaccinated:2001-08-29
Age:4.0  Onset:2001-08-31, Days after vaccination: 2
Gender:Female  Submitted:2001-08-31, Days after onset: 0
Location:Missouri  Entered:2001-09-18, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MO2001048
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM981A24IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T08163SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0252L1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0223L0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt had a 3" radius of redness, puffy and hot on RVL where DTAP was given.

VAERS ID:175489 (history)  Vaccinated:2001-08-29
Age:4.0  Onset:2001-09-10, Days after vaccination: 12
Gender:Female  Submitted:2001-09-15, Days after onset: 5
Location:Pennsylvania  Entered:2001-09-18, 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
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0378AA3IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T114822SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1501J0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1610K0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Hypersensitivity, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Mom states pt developed small, red bumps on torso and chin with mild itching. No fever was present. Mom took child to the doctor and was dx''d as a vaccine reaction. On 9/11/01, rash is fading.

VAERS ID:175516 (history)  Vaccinated:2001-08-29
Age:1.0  Onset:2001-08-29, Days after vaccination: 0
Gender:Female  Submitted:2001-09-10, Days after onset: 12
Location:Louisiana  Entered:2001-09-19, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Strabismus; Hemangioma on back
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T127322IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0592L0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0229L0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt developed urticarial lesions, 6 to 8 hours, post vax. Pt was afebrile and not sick looking. Treatment was Benadryl Elixir.

VAERS ID:175579 (history)  Vaccinated:2001-08-29
Age:5.0  Onset:2001-09-05, Days after vaccination: 7
Gender:Female  Submitted:2001-09-12, Days after onset: 7
Location:South Dakota  Entered:2001-09-21, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES514EA4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T112823UNRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0166C1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.058210SCLA
Administered by: Private     Purchased by: Public
Symptoms: Dermatitis bullous, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: The pt received vax''s on 8/27/01. On 9/5/01 the child''s mother called on symptoms child was experiencing. The child experienced a fever and rash on trunk characterized pox-like eruptions. Upon follow up the pox began to scab over and dry up. Pox were on trunk only.

VAERS ID:175586 (history)  Vaccinated:2001-08-29
Age:11.0  Onset:2001-08-29, Days after vaccination: 0
Gender:Male  Submitted:2001-08-31, Days after onset: 2
Location:Virginia  Entered:2001-09-21, Days after submission: 21
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: vital signs, EKG - wnl, Blood glucose level - low
CDC 'Split Type': VA01029
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0424K0IM 
Administered by: Public     Purchased by: Other
Symptoms: Cold sweat, Coma, Feeling hot, Malaise, Musculoskeletal stiffness, Pallor, Stomach discomfort
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: After receiving the vax, the pt returned to waiting room. He sat down in there and reported feeling sick to his stomach the his body stiffened and his eye rolled back. He was lowered to the floor near the waiting room. Mother reported the child was unresponsive for several seconds. The skin was warm, moist and pale in color.

VAERS ID:175726 (history)  Vaccinated:2001-08-29
Age:4.0  Onset:2001-08-31, Days after vaccination: 2
Gender:Male  Submitted:2001-09-19, Days after onset: 19
Location:Kentucky  Entered:2001-09-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM513A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T10983 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0696L1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0562L0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt''s left arm was severely swollen from elbow to shoulder with redness in this entire area.

VAERS ID:175805 (history)  Vaccinated:2001-08-29
Age:2.3  Onset:2001-08-30, Days after vaccination: 1
Gender:Male  Submitted:2001-09-18, Days after onset: 19
Location:North Carolina  Entered:2001-09-28, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': NC01084
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM507A21IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0006L2IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4773931IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T09091 RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1811K0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Elevated temperature by mom''s report. Wheals to abdomen, legs and arms which was observed by this nurse.

VAERS ID:176008 (history)  Vaccinated:2001-08-29
Age:0.2  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-09-12, Days after onset: 13
Location:Illinois  Entered:2001-10-03, Days after submission: 21
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: UA - nml, CBC - wnl, urine culture - neg, blood culture - neg
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM508A20IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0480L0IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809770IMLL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: The pt experienced an onset of a fever up to 103.5, which occurred approximately 36 hours post vax. The pt was taken to the ER and was treated with antibiotics for 48 hours and the had improved.

VAERS ID:176065 (history)  Vaccinated:2001-08-29
Age:0.3  Onset:2001-08-29, Days after vaccination: 0
Gender:Female  Submitted:2001-08-29, Days after onset: 0
Location:Kansas  Entered:2001-10-05, Days after submission: 37
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: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM997A21IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1527K2IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13101SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4808981IMLL
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: Pt immunization card was checked. Child was given immunizations. When mom was given immunization information sheets (VIS) mom said her child should not have gotten Hep-B as she got 1st one at birth and 2nd one on 6/29/01 and the nurse failed to write it into the Pink Immunization. So the 3rd Hep-B given in Hib/Hep (Comvax) at 15:45. Discovered this at 17:50 on 8/29/01. The child had no apparent reaction from this and no evidence seen of reaction after 15 minutes.

VAERS ID:176268 (history)  Vaccinated:2001-08-29
Age:4.3  Onset:2001-08-30, Days after vaccination: 1
Gender:Male  Submitted:2001-09-04, Days after onset: 5
Location:Oklahoma  Entered:2001-10-12, Days after submission: 38
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergy to Amoxil
Diagnostic Lab Data:
CDC 'Split Type': OK0145
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809000IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site inflammation, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Pt''s entire upper arm became inflamed, red and hot to touch. Pt complained of itching in affected area.

VAERS ID:176844 (history)  Vaccinated:2001-08-29
Age:1.0  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-09-04, Days after onset: 5
Location:South Carolina  Entered:2001-10-30, Days after submission: 56
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': SC0147
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0252L0SCRA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4797903IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0223L0SCLA
Administered by: Public     Purchased by: 0
Symptoms: Anorexia, Listless, Pallor
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: The patient''s mother describes the patient as pale, listless and refusing food. Mother was instructed to take the patient to her M.D.

VAERS ID:180515 (history)  Vaccinated:2001-08-29
Age:1.0  Onset:2001-08-29, Days after vaccination: 0
Gender:Female  Submitted:2001-11-21, Days after onset: 84
Location:Illinois  Entered:2002-01-24, Days after submission: 64
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC; CXR; UA; Blood Cultures-all neg
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1525K2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0105K0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Eye movement disorder, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Ocular motility disorders (narrow)
Write-up: The pt developed a fever that evening followed by eyes rolling and shaking. In ER, fever was 104.8F.

VAERS ID:185398 (history)  Vaccinated:2001-08-29
Age:  Onset:2001-08-31, Days after vaccination: 2
Gender:Unknown  Submitted:2002-05-15, Days after onset: 257
Location:Unknown  Entered:2002-05-24, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01090049
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: Information has been received from a school nurse concerning a child who on approximately 08/29/2001 was vaccinated with a dose of varicella vaccine. On approximately 08/31/2001, the pt developed chicken pox. Additional info has been requested.

VAERS ID:185410 (history)  Vaccinated:2001-08-29
Age:4.0  Onset:2001-08-29, Days after vaccination: 0
Gender:Female  Submitted:2002-05-15, Days after onset: 259
Location:Unknown  Entered:2002-05-24, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: body temperature-08/31/01/-101.6 deg F
CDC 'Split Type': WAES01090918
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Pyrexia, Rash vesicular, Skin irritation, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a consumer concerning her 4 year old female relative who on 08/29/01 was vaccinated with a dose of varicella virus vaccine live (site unknown). On 08/29/01, the pt vomited "all the way home". The child was reportedly "upset the rest of the day". On 08/31/01, the pt had spots and ran a temperature of 101.6 deg F. The following day the child had more spots on the face and neck. On 09/02/01, the pt had impertigo on her hand for which she was being treated with oral and topical antibiotics. The physician saw the pt on 09/03/01 and agreed that she agreed that she thought that the child had chicken pox. The pt had a total of about 10 spots on the back of both shoulders. The pt was still breaking out on 09/07/01. It was reported on 09/07/01 that the physician reported w/in the last few days that " the number of lesions are 12 now". On 09/07/01, the physician stated that the pt was asymptomatic.

VAERS ID:185897 (history)  Vaccinated:2001-08-29
Age:5.0  Onset:2001-08-29, Days after vaccination: 0
Gender:Unknown  Submitted:2002-05-16, Days after onset: 260
Location:Colorado  Entered:2002-05-31, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0352349A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM507A2 IMLL
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Injection site oedema, Injection site reaction, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Report 2001021437-1 describes cellulitis at the injection site of a five year old male who received Infanrix. Medical history, concurrent conditions, and concurrent medications were not specified. On 08/29/2001, the child received an injection of Infanrix. The reporter indicated that the child had received previous injections of Infanrix, but the number of previous injections was not provided. On 08/29/2001, an unspecified time post-immunization, the injection site became red, swollen and hot. The child was seen by the physician, who made a diagnosis of cellulitis and prescribed Benadryl every four hours. The cellulitis resolved on 09/01/2001. The reporter considered the cellulitis to be mild in intensity and related to Infanrix administration.

VAERS ID:186674 (history)  Vaccinated:2001-08-29
Age:1.8  Onset:2002-06-09, Days after vaccination: 284
Gender:Female  Submitted:2002-06-11, Days after onset: 2
Location:California  Entered:2002-06-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Vesicles-back spread then legs and neck. Benadryl.

VAERS ID:196780 (history)  Vaccinated:2001-08-29
Age:0.2  Onset:2001-09-15, Days after vaccination: 17
Gender:Male  Submitted:2003-01-18, Days after onset: 490
Location:Maryland  Entered:2003-01-27, Days after submission: 9
Life Threatening? No
Died? Yes
   Date died: 2001-09-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bleeding in eye
Preexisting Conditions: NONE
Diagnostic Lab Data: Autopsy-shaken baby syndrome
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM989A2   
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA563AC   
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT0909   
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES489542   
Administered by: Private     Purchased by: Other
Symptoms: Agitation, Apnoea, Cardiac arrest, Central nervous system neoplasm, Crying, Diarrhoea, Injury, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Tumours of unspecified malignancy (narrow), Noninfectious diarrhoea (narrow)
Write-up: After administration of shots on 8/29/01, pt experienced high fever, diarrhea, high-pitched screaming. 9/15/01-stopped breathing, cardiac arrest. 9/25/01-life support terminated. Pt died.

VAERS ID:401337 (history)  Vaccinated:2001-08-29
Age:1.2  Onset:2010-09-21, Days after vaccination: 3310
Gender:Male  Submitted:2010-09-30, Days after onset: 9
Location:Maine  Entered:2010-09-30
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: Varicella-Zoster virus DNA
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0153L0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0466L0SCLL
Administered by: Private     Purchased by: Unknown
Symptoms: Varicella post vaccine, Varicella virus test positive
SMQs:
Write-up: Patient tested (+) for Varicella on 9/21/10. He had received (1) dose of VARIVAX on 8/29/2001. No treatment needed.

VAERS ID:176440 (history)  Vaccinated:2001-08-29
Age:  Onset:2001-09-01, Days after vaccination: 3
Gender:Female  Submitted:2001-10-15, Days after onset: 44
Location:Foreign  Entered:2001-10-18, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: On 9/2/01; ALAT-2664; ASAT-1502; Alkaline phosphatase-292; ESR-#1 8 mm; ESR-#2-14; Gamma Glutamyl Transferase-128; Total Bilirubin-4.85. On 9/5/01; ALAT-1400; ASAT-521; Total Bilirubin-12.
CDC 'Split Type': 20010241661
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  IM 
Administered by: 0     Purchased by: 0
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood bilirubin increased, Fatigue, Gastrointestinal disorder, Hepatic enzyme increased, Hepatitis, Jaundice, Leukopenia, Pruritus, Rash
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Hypersensitivity (narrow)
Write-up: On 8/29/01, pt received Engerix-B. Four days, post vax, on 9/1/01, the pt was dx''d with Hepatitis experiencing fever of 38.5C, fatigue, gastrointestinal symptoms and scleral icterus (detected on 9/2/01). Additionally, the pt experienced an itching exanthema and leukopenia. Hepatic enzymes were elevated (ALAT 2664, ASAT 1502) on 9/2/01 but were dropping fast (ALAT 1400, ASAT 2001). The most recent information received on 10/11/01, did not report the outcome of the pt. The reporter considered that the event was possibly related to treatment with Engerix-B. Additional information has been requested.

VAERS ID:253567 (history)  Vaccinated:2001-08-29
Age:73.0  Onset:2005-05-15, Days after vaccination: 1355
Gender:Unknown  Submitted:2006-03-30, Days after onset: 319
Location:Foreign  Entered:2006-04-03, 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:
Preexisting Conditions:
Diagnostic Lab Data: Blood culture: streptococcus pneumonia serotype 6B
CDC 'Split Type': WAES0603AUS00174
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.   UN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bacterial infection, Drug ineffective, Pneumonia, Sepsis, Viral infection
SMQs:, Agranulocytosis (broad), Lack of efficacy/effect (narrow), Eosinophilic pneumonia (broad)
Write-up: Information was obtained on request by the company from the agency via a case line listing and public case detail form concerning a 73 year old patient who on 8/29/2001 was vaccinated with Pneumococcal 23v polysaccharide vaccine. On 5/15/2005 the patient developed pneumococcal infection and vaccination failure, treated with IV antibiotics unspecified and was hospitalized. The patient was admitted with invasive pneumococcal disease manifesting as pneumonia. Streptococcus pneumonia serotype 6B was isolated on blood cultures. At the time of reporting to the agency on 10/27/2005, the patient had recovered from the pneumococcal infection and vaccination failure with a recovery date of 5/24/2005. The agency considered the pneumococcal infection and vaccination failure were certainly related to therapy with Pneumococcal 23v polysaccharide vaccine. The original reporting source was not provided. Additional information is not expected.

VAERS ID:174846 (history)  Vaccinated:2001-08-30
Age:20.0  Onset:2001-08-30, Days after vaccination: 0
Gender:Male  Submitted:2001-08-30, Days after onset: 0
Location:North Dakota  Entered:2001-08-31, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA939AA0SCRA
Administered by: Military     Purchased by: Military
Symptoms: Chest discomfort, Erythema, Eye oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Slight chest tightness, redness and swelling around the eyes, at 08:45, 0.5ml EPI 1:1000 given.

VAERS ID:175211 (history)  Vaccinated:2001-08-30
Age:28.0  Onset:2001-08-30, Days after vaccination: 0
Gender:Female  Submitted:2001-09-04, Days after onset: 5
Location:New York  Entered:2001-09-10, 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: Allergy to eggs
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5236A40IMLA
Administered by: Other     Purchased by: 0
Symptoms: Chills, Dizziness, Hyperhidrosis, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt complaining of dizziness, diaphoresis about 8 hours, post vax. Complained of chills, 24 hours, post vax with dizziness. Afebrile. Seen by PMD, 24 hours, post vax. Per employee, pain medication given and note written for 2 days off. Employee has weekend scheduled off; no lost time.

VAERS ID:175378 (history)  Vaccinated:2001-08-30
Age:18.0  Onset:2001-08-30, Days after vaccination: 0
Gender:Female  Submitted:2001-09-06, Days after onset: 7
Location:Ohio  Entered:2001-09-14, 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: Metronidazole (flagyl)
Current Illness: Trichomonas Vaginitis
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5173A22 LA
Administered by: Public     Purchased by: Public
Symptoms: Ageusia, Eye disorder, Facial palsy, Nervous system disorder
SMQs:, Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: The patient is an 18 year old who originally got a TB shot and a Hepatitis B shot a couple of days ago and since then she has had loss of taste on half of her tongue and her eyes are not closing right. Her face is all twisted and her mouth is twisted. The patient shows classic signs of Bell''s Palsy on the right side of her face, loss of taste on half of her tongue and a seventh nerve distribution.

VAERS ID:175618 (history)  Vaccinated:2001-08-30
Age:0.2  Onset:2001-09-01, Days after vaccination: 2
Gender:Female  Submitted:2001-09-19, Days after onset: 18
Location:California  Entered:2001-09-24, Days after submission: 5
Life Threatening? No
Died? Yes
   Date died: 2001-09-01
   Days after onset: 0
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: No report from the coroner.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM992A20IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1528K0IMLL
Administered by: Private     Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)
Write-up: Received a letter from an RN, PHN 09/19/01, saying that this infant died on 09/01/01 with preliminary diagnosis of Sudden Infant Death Syndrome. Did not know of patient death prior to the letter. Death certificate states cause of death as "pending" and autopsy performed.

VAERS ID:176347 (history)  Vaccinated:2001-08-30
Age:14.0  Onset:2001-08-30, Days after vaccination: 0
Gender:Female  Submitted:2001-09-15, Days after onset: 16
Location:Texas  Entered:2001-10-16, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TB Test
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': TX01133
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0106L IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0476L IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0822K SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Chest pain, Dizziness, Heart rate decreased, Pallor
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Immediately after administrated Immunization,pt check out dizziness, noticed very pale. Ammonia inhaler place nostrils, elevated legs,epic nephrite, 3 cc administered Pulse was weak, chest pain.

VAERS ID:177844 (history)  Vaccinated:2001-08-30
Age:7.0  Onset:2001-09-01, Days after vaccination: 2
Gender:Female  Submitted:2001-10-29, Days after onset: 58
Location:California  Entered:2001-11-16, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: NONE
Preexisting Conditions: Type I diabetes mellitus.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809010IMLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Hyperglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Two days post vax the patient experienced an increase in blood glucose, received a mildly increased insulin dose. The next day the patient had a seizure associated with the blood glucose in the 50''s. The seizure was generalized and brief. On arrival to the ER the patient''s blood glucose was 88. No further problems or treatment.

VAERS ID:181148 (history)  Vaccinated:2001-08-30
Age:0.9  Onset:2001-08-30, Days after vaccination: 0
Gender:Female  Submitted:2002-01-28, Days after onset: 151
Location:California  Entered:2002-02-11, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': C002002
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM970AZ1IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1290K1IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT07871IMRL
Administered by: Public     Purchased by: Public
Symptoms: Torticollis
SMQs:, Dystonia (narrow), Ocular motility disorders (broad)
Write-up: Head twitched to the right several times in each episode--several episodes each day. Lasts about 3 days after immunization. Then goes away and child is fine. None after that.

VAERS ID:181792 (history)  Vaccinated:2001-08-30
Age:1.4  Onset:2001-12-19, Days after vaccination: 111
Gender:Male  Submitted:2002-02-20, Days after onset: 63
Location:Ohio  Entered:2002-02-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol PCN
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data: DFA + herpes zoster
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1637K2IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0606L0SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841313IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1893K0SCRL
Administered by: Private     Purchased by: Other
Symptoms: Herpes zoster, Rash papular, Rash vesicular, Skin ulcer
SMQs:, Hypersensitivity (narrow)
Write-up: On the day of vaccination, noticed impetiginous lesions on left buttock. Nine days after vaccine seen macular non vesicular rash all over body. By October 29th seen afain for rash that began 3 days prior as papular on trunk, buttocks, legs and arms. December 14th seen for maculopapular rash on left buttock. On Dec 19th, seen for rash and DFA + zoster. Rash reoccured Jan 22nd and given a course of acyclonir.

VAERS ID:190444 (history)  Vaccinated:2001-08-30
Age:0.9  Onset:2002-09-03, Days after vaccination: 369
Gender:Female  Submitted:2002-09-15, Days after onset: 12
Location:Massachusetts  Entered:2002-09-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Recent hx L leg twitching
Preexisting Conditions: Food allergies, dx allergic colitis
Diagnostic Lab Data: MRI brain, EEG N, CBC N, urine drug-neg
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES4823703IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU082422SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0548M0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Coordination abnormal, Gait disturbance, Hypotonia, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Ataxia, falling, repeated loss of tone of lower limbs, broad based gait, hyperlordotiz stance from 4 d after vax till ~5-6 d later (duration < 1wk).

VAERS ID:255838 (history)  Vaccinated:2001-08-30
Age:1.0  Onset:2005-04-20, Days after vaccination: 1329
Gender:Male  Submitted:2006-05-12, Days after onset: 387
Location:Unknown  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0504USA04016
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Info has been received from an LPN concerning a 4 year old male with no medical history or allergies who on 8/30/01 was vaccinated with a dose of varicella virus vaccine live. There was no concomitant therapy. There was no illness at the time of vaccination. The LPN reported that on 4/20/05, the pt developed breakthrough characterized by a rash consisting of 50 lesions. No fever or other symptoms were noted. The pt was seen on 4/21/05, but no lab/diagnostic tests were performed. Subsequently, the pt recovered. Additional info is not expected.

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