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Found 596268 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:128128 (history)  Vaccinated:1999-08-31
Age:21.0  Onset:1999-09-01, Days after vaccination: 1
Gender:Female  Submitted:1999-09-03, Days after onset: 2
Location:Maryland  Entered:1999-09-08, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 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.0956H1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Anorexia, Headache, Migraine, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt started w/fever next morning & h/a, fever of 103;took APAP w/relief-temp WNL; c/o loss appetite, went to infirmary @ school;migraine;

VAERS ID:128220 (history)  Vaccinated:1999-08-31
Age:1.3  Onset:1999-09-04, Days after vaccination: 4
Gender:Male  Submitted:1999-09-08, Days after onset: 4
Location:Illinois  Entered:1999-09-13, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Diagnostic Lab Data: none
CDC Split Type: IL99056
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM910A23IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0699J0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax began breaking out with rash & mom called had & stated pt had numerous lesions on face which were draining;

VAERS ID:128319 (history)  Vaccinated:1999-08-31
Age:1.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:1999-09-03, Days after onset: 3
Location:North Carolina  Entered:1999-09-16, 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: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: NC99066
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES10014603IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1239H3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1973H0SCRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4660172PO 
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt exp oblong white welt approx 4cm longx1/2cm wide c/redness around edges;pt not allergic to eggs; applied cold compresses; rxn to MMR

VAERS ID:128322 (history)  Vaccinated:1999-08-31
Age:6.0  Onset:1999-09-03, Days after vaccination: 3
Gender:Female  Submitted:1999-09-14, Days after onset: 11
Location:Washington  Entered:1999-09-16, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: inhaler
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7172CB4 RA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0800E3PO 
Administered by: Other     Purchased by: Public
Symptoms: Face oedema, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt devel rash all over body; swelled face; T99.3; rx: benadryl; tylenol; MD advise via telephone

VAERS ID:128328 (history)  Vaccinated:1999-08-31
Age:9.0  Onset:1999-09-07, Days after vaccination: 7
Gender:Unknown  Submitted:0000-00-00
Location:California  Entered:1999-09-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 7/20/99-hepB #1-#1400H & varicella-#0314J
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1400H1  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.13524   
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Pruritus
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 6 weeks p/vax pt exp vesicles & itching

VAERS ID:128355 (history)  Vaccinated:1999-08-31
Age:1.4  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:1999-09-07, Days after onset: 7
Location:Texas  Entered:1999-09-17, 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
HIBV: HIB (HIBTITER)PFIZER/WYETH520253A3IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site inflammation, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: p/vax pt rt thigh red; inflamed; warm to touch; spread from mid thigh to knee; applied cold packs & given tylenol/advil

VAERS ID:128481 (history)  Vaccinated:1999-08-31
Age:0.5  Onset:1999-09-01, Days after vaccination: 1
Gender:Male  Submitted:1999-09-15, Days after onset: 14
Location:Florida  Entered:1999-09-27, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: tylenol; phenergan supp
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)PFIZER/WYETH4623141IMLL
HIBV: HIB (HIBTITER)PFIZER/WYETH410303A1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N02911SCLL
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Crying, Diarrhoea, Meningitis, Sepsis, Vomiting
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: p/vax pt devel vomiting & diarrhea (mild); but associated w/extreme irritability & high pitched scream; hosp to R/O meningitis, sepsis, etc

VAERS ID:128532 (history)  Vaccinated:1999-08-31
Age:1.3  Onset:1999-09-01, Days after vaccination: 1
Gender:Male  Submitted:1999-09-08, Days after onset: 7
Location:Delaware  Entered:1999-09-27, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4643033IMLA
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS460103A3IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0921J0SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4642522PO 
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: erythema & edema extending from above the shoulder to the elbow of the lt arm developing 24hr p/vax;tx w/cool compresses & DPH;sx resolved w/in 72hr;

VAERS ID:128538 (history)  Vaccinated:1999-08-31
Age:1.1  Onset:1999-09-06, Days after vaccination: 6
Gender:Female  Submitted:1999-09-10, Days after onset: 4
Location:Minnesota  Entered:1999-09-27, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UA-negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0119J0IMLL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: febrile illness began early AM on 9/6/99;9/799 T105.5;very faint rash-mostly on face 9/8/99;

VAERS ID:128571 (history)  Vaccinated:1999-08-31
Age:5.0  Onset:1999-09-02, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:New Jersey  Entered:1999-09-27
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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4623554IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0919J1SCRL
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0799A3PO 
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: large hive top of lt thigh-large red lump followed by small hives on both legs-circular rings, itchy;DPH given did not disappear until 5 days later;

VAERS ID:128598 (history)  Vaccinated:1999-08-31
Age:60.0  Onset:1999-09-06, Days after vaccination: 6
Gender:Female  Submitted:1999-09-07, Days after onset: 1
Location:Georgia  Entered:1999-09-27, Days after submission: 20
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: HTN, codeine, cephalexin
Diagnostic Lab Data: NONE
CDC Split Type: GA99109
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM598A60IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7031BA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypertonia, Injection site hypersensitivity, Injection site oedema, Myalgia, Pain, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: lt arm w/redness, swelling & warm to touch;denies fever;arm is stiff & sore;has been applying warm compresses, alcohol & taking aleve for the soreness;

VAERS ID:128604 (history)  Vaccinated:1999-08-31
Age:1.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:1999-09-15, Days after onset: 15
Location:Minnesota  Entered:1999-09-27, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0531J0 LL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash & fever a week p/vax;

VAERS ID:128615 (history)  Vaccinated:1999-08-31
Age:15.0  Onset:1999-09-16, Days after vaccination: 16
Gender:Female  Submitted:1999-09-18, Days after onset: 2
Location:Illinois  Entered:1999-09-27, 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:
Current Illness: NONE
Preexisting Conditions: allergy to amoxicillin, ery-ped, PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1668H1 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0447J0 RA
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Headache, Neck pain, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt devel low grade temp, rash on face;1-2cm plain erythematous lesions on forehead, cheeks;h/a;9/17//99 neck pain w/flexion;more vesicular lesions;9/18.99 moderate neck pain w/flexion;about 30 vesicular lesions scattered;

VAERS ID:128620 (history)  Vaccinated:1999-08-31
Age:4.0  Onset:1999-09-03, Days after vaccination: 3
Gender:Male  Submitted:1999-09-13, Days after onset: 10
Location:Illinois  Entered:1999-09-27, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pt exp behavior changes & tempertantrums, irritability w/ampicillin;
Diagnostic Lab Data:
CDC Split Type: IL99061
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 4  
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER 3  
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Personality disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)
Write-up: p/vax major behavior changes 9/3-9/6/99;no fever, etc;temper tantrums, extreme, irritability;

VAERS ID:128626 (history)  Vaccinated:1999-08-31
Age:12.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:1999-09-02, Days after onset: 2
Location:Minnesota  Entered:1999-09-27, 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: none
Diagnostic Lab Data:
CDC Split Type: MN99015
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0847J2 LA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Injection site hypersensitivity, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt exp funny felling; like could faint; that evening itchy feeling where shot given; in AM has 4'''' red rash area w/itching where shot given; c/o upper arm hurting

VAERS ID:128633 (history)  Vaccinated:1999-08-31
Age:4.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:1999-09-03, Days after onset: 3
Location:Oregon  Entered:1999-09-27, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: u/a: + ketones; tr blood; tr levlkocytes strep A -
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER0962260 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Coordination abnormal, Haematuria, Nausea, Pyrexia, Urine analysis abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: p/vax pt exp nausea & vomiting; fever 101-102; mild ataxia

VAERS ID:128729 (history)  Vaccinated:1999-08-31
Age:13.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:1999-09-20, Days after onset: 20
Location:New York  Entered:1999-09-28, 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: allergy immune therapy 8/27/99
Current Illness: NONE
Preexisting Conditions: D. Farinae, dust mie, cat, house dust, molds, ragweed, mixed weeds, grass,t tree
Diagnostic Lab Data: EKG-nl;EEG-nl;CBC w/differential-nl;complete profile-nl;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.181440 LA
Administered by: Private     Purchased by: Public
Symptoms: Hypertonia, Hypotension, Hypotonia, Hypoventilation, Lacrimal disorder, Muscle twitching, Stupor, Urinary incontinence
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Lacrimal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)
Write-up: p/vax 5min starring, listing to rt, eyes fluttering, then drooling began;facial nerve noted shortly p/drooling;responsive @ that time;child moved to floor VS note 60/38, 66, 10;

VAERS ID:128769 (history)  Vaccinated:1999-08-31
Age:5.0  Onset:1999-09-01, Days after vaccination: 1
Gender:Female  Submitted:1999-09-08, Days after onset: 7
Location:New Hampshire  Entered:1999-09-30, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PRN proventil;Prelone
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data: NONE
CDC Split Type: NH9919
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAMA911A24IMLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES 3PO 
Administered by: Private     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 1" hard area, pale center w/#" irregular red area, APAP PRN; used 1/2" needle;

VAERS ID:128996 (history)  Vaccinated:1999-08-31
Age:0.2  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:1999-09-03, Days after onset: 3
Location:Michigan  Entered:1999-10-07, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP p/vax
Current Illness: no illness
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type: MI99090
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM911A20 LL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.N10611 RL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0587J0 RL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N10610 RL
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Insomnia, Malaise, Muscle twitching, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: p/vax pt has not slept through noc;screams @ night;listless during daytime not self;lo grade temp 99/6 ax;body jerks;

VAERS ID:128997 (history)  Vaccinated:1999-08-31
Age:5.0  Onset:1999-09-06, Days after vaccination: 6
Gender:Male  Submitted:1999-09-10, Days after onset: 4
Location:Michigan  Entered:1999-10-07, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA or medical conditions
Diagnostic Lab Data: NA
CDC Split Type: MI99092
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7389AA4IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N10613SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0117J1SCLL
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt got red rash on legs, upper inner aspect of arms, abd, c/o itchy;no other sx;mom called MD who said to observe & bring child to office if gets worse;

VAERS ID:129186 (history)  Vaccinated:1999-08-31
Age:0.2  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:1999-09-23, Days after onset: 23
Location:Georgia  Entered:1999-10-12, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp rxn @ 2mo w/DTAP dose 1;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EEG
CDC Split Type: GA9911
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM910A20IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2937A21IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1617H0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N05970SCLL
Administered by: Public     Purchased by: Public
Symptoms: Muscle spasms, Somnolence, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)
Write-up: p/vax pt w/lethargy & sl tremors of extremities;dx by ER MD infantile spasms cause unk;adm to hosp then transferred -in ped neuro x 24hr;EEG;dx DTP immun rxn;

VAERS ID:129189 (history)  Vaccinated:1999-08-31
Age:42.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:1999-10-06, Days after onset: 36
Location:New York  Entered:1999-10-12, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness:
Preexisting Conditions: had meningitis in past called MD on 9/1/99;
Diagnostic Lab Data: blood work;
CDC Split Type: NYS99030
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1010H0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Hyperacusis, Photosensitivity reaction, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: h/a commenced 3hr p/vax;fever of 101 sound & photosensitivity;fever x 2 or 3 days;stiff neck occurred;

VAERS ID:129463 (history)  Vaccinated:1999-08-31
Age:1.3  Onset:1999-09-01, Days after vaccination: 1
Gender:Female  Submitted:1999-10-13, Days after onset: 42
Location:Kentucky  Entered:1999-10-18, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4623543 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0508H0 RL
Administered by: Public     Purchased by: Public
Symptoms: Muscle twitching, Pyrexia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: p/vax pt was sitting in high chair & had a staring spell;child pulled out of high chair & body began to jerk & twitch;mom reports child T to 104;child rushed to ER;MD could find no signs of infect & no reason for having sz;

VAERS ID:129545 (history)  Vaccinated:1999-08-31
Age:5.0  Onset:1999-09-01, Days after vaccination: 1
Gender:Male  Submitted:1999-09-02, Days after onset: 1
Location:Washington  Entered:1999-10-19, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: denies
Other Medications: denies
Current Illness: denies
Preexisting Conditions: denies
Diagnostic Lab Data: NONE
CDC Split Type: WA991592
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6916BC4IMLA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1189H1IMRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES797F44PO 
Administered by: Public     Purchased by: Public
Symptoms: Headache, Myalgia, Pyrexia, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fever 102-18hr p/vax;h/a x 24hr;legs ache 18hr p/vax;runny nose started 9/2/99;

VAERS ID:129607 (history)  Vaccinated:1999-08-31
Age:0.2  Onset:0000-00-00
Gender:Female  Submitted:1999-10-08
Location:California  Entered:1999-10-20, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp rxn @ 4mo w/DTP dose 2;
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7316BB0 RL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESP1333AA0 LL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P01670 LL
Administered by: Private     Purchased by: Private
Symptoms: Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)
Write-up: excessively sleepy x 6 days;

VAERS ID:129613 (history)  Vaccinated:1999-08-31
Age:18.0  Onset:1999-09-18, Days after vaccination: 18
Gender:Female  Submitted:1999-10-18, Days after onset: 30
Location:New York  Entered:1999-10-21, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: No relevant Data
Other Medications: NONE
Current Illness:
Preexisting Conditions: pregnancy (LPM 8/1/99);
Diagnostic Lab Data:
CDC Split Type: WAES99090478
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: pt recv vax when was in gestational week four (LMP 8/1/99);pt began bleeding on 9/18/99 & had a spontaneous abortion;9/20/99 pt was seen by MD who reported pt denied any sexual activity prior to vax;

VAERS ID:129837 (history)  Vaccinated:1999-08-31
Age:0.2  Onset:1999-09-02, Days after vaccination: 2
Gender:Male  Submitted:1999-10-20, Days after onset: 48
Location:Nevada  Entered:1999-10-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 2 EEG''s, 1 MRI, 2 CAT Scans all came back nl;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER    
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Apnoea, Convulsion, Dyspnoea, Encephalitis, Infection, Unevaluable event
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: p/vax pt found in crib almost dead, barely breathing in hosp 2 days later had 6 sz;was on phenobarb x 6wk;had encephalitis, sz;

VAERS ID:129896 (history)  Vaccinated:1999-08-31
Age:0.2  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Maine  Entered:1999-10-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM902A2 IMRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2909A2 IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0874J IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N0491 SCLL
Administered by: Private     Purchased by: Public
Symptoms: Crying, Screaming
SMQs:, Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: p/vax pt had excessive cry & screaming x 36-48hr;

VAERS ID:131049 (history)  Vaccinated:1999-08-31
Age:52.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:1999-11-09, Days after onset: 70
Location:Colorado  Entered:1999-11-23, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp pain & discomfort w/#1 hep b vax;
Other Medications:
Current Illness:
Preexisting Conditions: arthritis;smokes 1/2 ppd; allergies: Lidocaine (x/ preservative free), lanolin, glycerin & PCN (rash as a child);
Diagnostic Lab Data: EMG;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM507382 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, Insomnia, Pain, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)
Write-up: p/vax pt devel numbness in lt hand (middle fingers);progressed up arm to neck/back shoulder blade;tx pred, cortisone;insomnia, SOB;vicodin;cont pain

VAERS ID:132320 (history)  Vaccinated:1999-08-31
Age:0.6  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:1999-08-31, Days after onset: 0
Location:South Carolina  Entered:1999-12-28, Days after submission: 119
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: SC99075
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES09622602IMRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3068A22IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESN0813AA2IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Skin discolouration, Vasodilatation
SMQs:, Hypotonic-hyporesponsive episode (broad)
Write-up: 2 mins. after shots, skin from both knees up, around diaper area and halfway up middle of abd & back, turned a bright red/mottled color. Pt. given Benadryl 50mg/cc, given IM in (l) lateral thigh.

VAERS ID:133042 (history)  Vaccinated:1999-08-31
Age:11.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:1999-11-18, Days after onset: 79
Location:California  Entered:2000-01-05, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, Electroly. Studies, CT SCAN of the head.
CDC Split Type: 990155
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Agitation, Stupor, Thrombocytopenia
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Altered level of consciousness and agitation. Symptoms cont for approx 3 hrs after hosp admission. 6 mos after vax, pt seen multiple times for recurrent abdominal pain and thrombocytopenia.

VAERS ID:134691 (history)  Vaccinated:1999-08-31
Age:34.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:2000-03-01, Days after onset: 183
Location:Hawaii  Entered:2000-03-10, 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: Hay fever
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0411SCRA
Administered by: Other     Purchased by: Other
Symptoms: Chest pain, Hypokinesia, Injection site pain, Myasthenic syndrome
SMQs:, Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Local soreness at R/shoulder that became decreased in strength to R/arm over period of 1 week, then had decreased fine motor skills/dexterity/writing to R/hand. Had chest pain in first 24 hrs. to R/chest.

VAERS ID:150581 (history)  Vaccinated:1999-08-31
Age:57.0  Onset:1999-09-01, Days after vaccination: 1
Gender:Female  Submitted:2000-01-19, Days after onset: 140
Location:Pennsylvania  Entered:2000-03-29, Days after submission: 70
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19990297451
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0  
Administered by: Other     Purchased by: Other
Symptoms: Alopecia
SMQs:
Write-up: On 8/31/99 the pt received the first dose of Lymerix. In September, 99, the pt noticed a large amount of hair loss. On 10/6/99 the pt received the second dose of Lymerix. the pts hair loss has worsened in the last two weeks. The most recent information, received on 11/8/99 reports the condition of the pt is ongoing.

VAERS ID:152600 (history)  Vaccinated:1999-08-31
Age:46.0  Onset:1999-09-04, Days after vaccination: 4
Gender:Male  Submitted:2000-07-20, Days after onset: 320
Location:New York  Entered:2000-06-01, Days after submission: 49
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:
CDC Split Type: 899250106A
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)PFIZER/WYETH49980620SC 
Administered by: Public     Purchased by: Public
Symptoms: Hypoacusis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Next day post vax, the pt developed a fever. He recovered. On 9/4/99, he experienced a feeling of hearing loss as though his right ear was clogged. .

VAERS ID:152613 (history)  Vaccinated:1999-08-31
Age:52.0  Onset:1999-09-04, Days after vaccination: 4
Gender:Female  Submitted:0000-00-00
Location:New York  Entered:2000-06-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 899260104L
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)PFIZER/WYETH49980620SC 
Administered by: Private     Purchased by: Private
Symptoms: Hypoacusis
SMQs:, Hearing impairment (narrow)
Write-up: On 9/4/99, the pt experienced a feeling of hearing loss, as though her ear was clogged.

VAERS ID:153242 (history)  Vaccinated:1999-08-31
Age:1.4  Onset:0000-00-00
Gender:Male  Submitted:2000-05-05
Location:California  Entered:2000-06-08, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Rash
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4643062IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:155573 (history)  Vaccinated:1999-08-31
Age:27.0  Onset:1999-09-01, Days after vaccination: 1
Gender:Female  Submitted:2000-03-09, Days after onset: 190
Location:Pennsylvania  Entered:2000-06-28, Days after submission: 110
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: U1999006260
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7258BA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Reportedly on 9/1/99, the pt experienced redness and hardness at the injection site on her left arm. The pt reportedly recovered from this experience.

VAERS ID:155576 (history)  Vaccinated:1999-08-31
Age:  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:1999-09-10, Days after onset: 10
Location:Delaware  Entered:2000-06-28, Days after submission: 292
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: U1999006520
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7308AB IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: It was reported that a female pt received a TD Adult vaccine on 8/31/99. Reportedly, within 24 hours, the pt experienced swelling from shoulder to hand which was also red, hot and painful.

VAERS ID:156598 (history)  Vaccinated:1999-08-31
Age:1.25  Onset:1999-09-01, Days after vaccination: 1
Gender:Male  Submitted:1999-11-12, Days after onset: 72
Location:California  Entered:2000-07-13, Days after submission: 243
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: U1999007150
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0008AA3IMLA
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESU0008AA3IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site mass, Injection site oedema, Injection site pain, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Two days post vax pt presented with red, swollen, slightly firm area on left upper arm, 10 X 7.5 cm in size and warm to the touch. Parent stated it was worse one day post vax with some discomfort and itching.

VAERS ID:159488 (history)  Vaccinated:1999-08-31
Age:33.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:2000-08-28, Days after onset: 363
Location:Unknown  Entered:2000-09-08, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0383SC 
Administered by: Military     Purchased by: Military
Symptoms: Headache, Influenza like illness
SMQs:
Write-up: Post vax, the pt experienced flu-like symptoms for a couple of days. After this time, the headaches that had developed never went away. They slowly got less severe but never gone. Now they are there everyday in a low grade level.

VAERS ID:163239 (history)  Vaccinated:1999-08-31
Age:40.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:1999-09-02, Days after onset: 2
Location:Virginia  Entered:2000-11-14, Days after submission: 439
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: Purified Protein Derivative Test - 08/31/1999
CDC Split Type: 19990227021
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3023A20 LA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Dizziness, Fatigue, Malaise, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: On the day of vax, the pt experienced exhaustion, achiness and malaise. The next day the pt experienced nausea, abdominal pain and dizziness. No treatment was given. The most recent information received reports the symptoms are ongoing.

VAERS ID:163370 (history)  Vaccinated:1999-08-31
Age:15.0  Onset:1999-09-22, Days after vaccination: 22
Gender:Female  Submitted:2000-04-10, Days after onset: 201
Location:Ohio  Entered:2000-11-14, Days after submission: 218
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prednisone
Current Illness:
Preexisting Conditions: acne
Diagnostic Lab Data: CBC, SGOT, EBV, CMV, hepatitis A profile, ANA-positive
CDC Split Type: 20000095611
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3075A21IM 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Antinuclear antibody positive, Arthralgia, Asthenia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 9/22/99, the pt went to her pediatrician with complaints of fevers, aches, and decreased energy. She had joint pain. She had reportedly pain in her knee, foot, and wrist. She was seen by an orthopedist and during this examination it was thought that the pt''s complaints were not from an orthopedic injury. The reporter indicated that it was the impression of the pt''s physician that the adverse events were a rheumatic illness with a lupus-like presentation. Autoimmune hepatitis is also currently being ruled out. Treatment of the adverse events was not specified. No other details were provided.

VAERS ID:165287 (history)  Vaccinated:1999-08-31
Age:2.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Louisiana  Entered:2001-01-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES01010934
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4643040IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD. 2IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: Private     Purchased by: Other
Symptoms: Headache, Musculoskeletal stiffness, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient''s mother reported that the patient received Acel-Imune, MMR (Merck), and IPV (Aventis Pasteur SA) vaccines on 8/31/99. Subsequently the patient began crying and screaming that lasted for hours. Later that evening, the patient developed a low-grade fever and stiffening of both legs. The stiffening of her legs caused her to awaken that night screaming. The low-grade fever and leg stiffness resolved within 5 days. On 9/5/99, the patient developed head pain. Copies of this report have been forwarded to Merck and Aventis Pasteur, manufacturers of the concomitantly administered vaccines.

VAERS ID:186865 (history)  Vaccinated:1999-08-31
Age:31.0  Onset:1999-09-01, Days after vaccination: 1
Gender:Male  Submitted:1999-09-03, Days after onset: 2
Location:Virginia  Entered:2002-06-24, Days after submission: 1025
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
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0441SCRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Large local reaction (45mm x 10mm), tingling hands/feet, left ant thigh.

VAERS ID:217231 (history)  Vaccinated:1999-08-31
Age:1.0  Onset:2004-03-01, Days after vaccination: 1644
Gender:Female  Submitted:2004-03-03, Days after onset: 2
Location:Georgia  Entered:2004-03-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0929J0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0699J0 LA
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Several days of itching, scattered red lesions on chest, neck and face. Diagnosis: Chickenpox may return to school after crusting begins.

VAERS ID:217640 (history)  Vaccinated:1999-08-31
Age:5.5  Onset:2004-03-03, Days after vaccination: 1646
Gender:Male  Submitted:0000-00-00
Location:Virginia  Entered:2004-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0921J0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0710J0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Drug ineffective, Infection, Pyrexia, Rash papular, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: "Lesions all over body starting 3-3-04 fever for 12 hours few days ago" 75-100 red lesions with papules, pustules and scabs- torso, arms, legs.

VAERS ID:233816 (history)  Vaccinated:1999-08-31
Age:3.0  Onset:2005-02-03, Days after vaccination: 1983
Gender:Male  Submitted:2005-02-14, Days after onset: 11
Location:Pennsylvania  Entered:2005-02-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS888A2  RA
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)LEDERLE LABORATORIES4632832PO 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0843H0 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Blister, Cough, Erythema, Pyrexia, Rash papular
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: redness and cough for 2 days with fever followed by papules transformed into blisters, trunk, face and eruption in that order of appearance.

VAERS ID:254719 (history)  Vaccinated:1999-08-31
Age:7.0  Onset:2006-04-25, Days after vaccination: 2429
Gender:Female  Submitted:2006-04-25, Days after onset: 0
Location:Maine  Entered:2006-04-27, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0541J1SCLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0382AA4IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0444J0SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Blister, Drug ineffective, Viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Hypersensitivity (broad)
Write-up: Pt developed varicella disease after vaccination mild case <30 vesicles.

VAERS ID:256641 (history)  Vaccinated:1999-08-31
Age:3.58  Onset:1999-09-02, Days after vaccination: 2
Gender:Male  Submitted:2006-05-12, Days after onset: 2444
Location:Virginia  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: body temp - 09/02/1999 - 103
CDC Split Type: WAES0509USA02763
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.630675/0424J0 UN
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Skin ulcer
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has bee received from a physician concerning a 43-month old white male with no allergies or medical conditions who on 31-Aug-1999 was vaccinated in the left arm with a first dose of varicella virus vaccine live. There was no illness at the time of vaccination. VARICELLA, PYREXIA Two days after vaccination on 02-Sep - 1999 at "one year of age" the patient experienced a fever of 103 degrees. Subsequently, the patient recovered. On 20-Jun-2005 the patient developed a varicella illness with diffuse lesions on the face, neck, scalp, trunk, and thighs. No diagnostic tests were performed. Subsequently, the patient recovered. Additional information is not expected.

VAERS ID:279754 (history)  Vaccinated:1999-08-31
Age:10.0  Onset:2006-03-24, Days after vaccination: 2397
Gender:Unknown  Submitted:2007-05-16, Days after onset: 417
Location:Unknown  Entered:2007-05-24, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0603USA04045
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Varicella
SMQs:
Write-up: Information has been received from a physician concerning a 10 year old patient who on 31-AUG-1999 was vaccinated with Varivax, 0.5 mL single dose, subcutaneous. On 24-MAR-2006 the patient developed a breakthrough case of chickenpox lesions. The patient''s outcome was not reported. Additional information is not expected.

VAERS ID:450996 (history)  Vaccinated:1999-08-31
Age:10.0  Onset:2000-03-21, Days after vaccination: 203
Gender:Male  Submitted:2012-03-02, Days after onset: 4364
Location:Massachusetts  Entered:2012-03-02
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0444J0UNLA
Administered by: Public     Purchased by: Other
Symptoms: Rash, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling of face and "rash" very close to eye.

VAERS ID:128062 (history)  Vaccinated:1999-08-31
Age:4.0  Onset:1999-08-31, Days after vaccination: 0
Gender:Male  Submitted:1999-09-03, Days after onset: 3
Location:Foreign  Entered:1999-09-07, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 1999022805
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypotension, Mydriasis, Pallor, Shock, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: p/vax pt became very pale & fainted; mydriasis; Dx shock; to hosp; on arrival pt already recovering & BP nl; p/2hr disch;MD felt rxn poss r/t vax but could be unidentified stress status;

VAERS ID:129438 (history)  Vaccinated:1999-08-31
Age:11.0  Onset:1999-09-01, Days after vaccination: 1
Gender:Female  Submitted:1999-10-11, Days after onset: 40
Location:Foreign  Entered:1999-10-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lindane lotion;
Current Illness:
Preexisting Conditions: pediculosis capitis
Diagnostic Lab Data: unk
CDC Split Type: WAES99091439
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cardiovascular disorder, Nausea, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt exp generalized urticaria, severe pruritus, nausea & circulatory disability & hosp;

VAERS ID:130536 (history)  Vaccinated:1999-08-31
Age:1.1  Onset:1999-09-07, Days after vaccination: 7
Gender:Male  Submitted:1999-10-22, Days after onset: 45
Location:Foreign  Entered:1999-10-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: spinal tap;computed axial tomography;electroencephalography;EBV antibodies-negative;WBC count-negative;serum C-reactive protein-nl;toxoplasam antibody screen-negative;Lonogram-nl;fundus oculi-nl;
CDC Split Type: WAES99090676
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Febrile convulsion, Hypotonia
SMQs:, Peripheral neuropathy (broad), Convulsions (narrow), 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: p/vax pt exp a gen sz during 15min in a feb context (39C) & hosp;lP performed showing 7 cells (other data not reported);on exam nl & pt temp fell (38C);EEG planned;pt w/hyperthermia;hypotonia;

VAERS ID:130281 (history)  Vaccinated:1999-08-31
Age:20.0  Onset:1999-09-02, Days after vaccination: 2
Gender:Male  Submitted:1999-11-03, Days after onset: 62
Location:Foreign  Entered:1999-11-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 1999028294
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Pancreatitis
SMQs:, Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt exp abd pain;pt devel severe effusion & was also not noticed;dx pancreatitis;pt recovered w/o sequelae;

VAERS ID:132229 (history)  Vaccinated:1999-08-31
Age:76.0  Onset:1999-09-06, Days after vaccination: 6
Gender:Female  Submitted:1999-11-30, Days after onset: 85
Location:Foreign  Entered:1999-12-07, Days after submission: 7
Life Threatening? No
Died? Yes
   Date died: 1999-09-16
   Days after onset: 10
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: myocardial infarction;cardiac pacemaker device placement;CAD;hyperlipdemia;
Diagnostic Lab Data: blood culture-+ for staphylococcus;CXR-infiltrations in upper lobe;coloscopy;sonography;CT
CDC Split Type: WAES99111580
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Infection, Leukocytosis, Pyrexia, Renal failure, Sepsis, Shock, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: p/vax pt devel a high grade fever & was adm to hosp;9/16/99 pt died;dx was staphylococcemia;COD was bacterial sepsis;MD felt fever & sepsis were not r/t vax;pt also had thrombocytopenia, leukocytosis.Pt died because of final circulatory &

VAERS ID:133233 (history)  Vaccinated:1999-08-31
Age:11.0  Onset:1999-09-01, Days after vaccination: 1
Gender:Female  Submitted:2000-01-06, Days after onset: 127
Location:Foreign  Entered:2000-01-12, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19990334761
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dysphagia, Headache, Paraesthesia, Paralysis
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: Pt rcvd vaccine 8/31/99, on 9/1/99 pt developed cephalgia, 9/2/99 pt experienced dysphagia, 9/3/99 pt developed r/upper limb paresis, paresthesia was also noticed. 10/1/99 pt rcvd 2nd dose and paresis reoccured.

VAERS ID:183444 (history)  Vaccinated:1999-08-31
Age:42.0  Onset:1999-11-18, Days after vaccination: 79
Gender:Female  Submitted:2002-04-09, Days after onset: 872
Location:Foreign  Entered:2002-04-15, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: Synovial cyst in her knee which was removed in 1965 and mother has osteo-arthritis.
Diagnostic Lab Data: Rheumatoid factor 4/7/00 (+)
CDC Split Type: B0257462A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS2489B41IMLA
Administered by: Other     Purchased by: Other
Symptoms: Difficulty in walking, Dizziness, Fatigue, Hypothyroidism, Joint stiffness, Pain, Pharyngolaryngeal pain, Rheumatoid arthritis, Viral infection, Visual disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypothyroidism (narrow), Vestibular disorders (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: On 7/13/99, the pt received her 1st dose of Engerix-B vaccine. On 8/31/99, the pt received a 2nd dose after which, there were no immediate reactions. Approx. 5 weeks, post vax, on 10/5/99, the pt developed a sore throat, fatigue, visual disturbances and had dizzy spells. She was dx''d as having a viral infection and recovered within a few weeks. On 11/18/99, approx. 3 months, after the 2nd dose, the pt developed joint symptoms of stiffness in fingers, painful feet and had difficulty in walking. On 2/2/00, she was dx''d as having a mild under-active thyroid and was treated with thyroxine. On 4/7/00, the pt was dx''d with rheumatoid arthritis. The most recent information received on 3/28/02, reports the outcome of the pt as not yet recovered. No other details were given. No further information is expected.

VAERS ID:128211 (history)  Vaccinated:1999-09-01
Age:1.0  Onset:1999-09-02, Days after vaccination: 1
Gender:Male  Submitted:1999-09-02, Days after onset: 0
Location:Michigan  Entered:1999-09-13, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no
Other Medications: tylenol or dimetapp
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: no tests or lab done: Dx: viral infect
CDC Split Type: MI99087
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1550H0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Hyperhidrosis, Hypothermia, Infection, Insomnia, Pallor, Rhinitis, Somnolence, Tooth disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: p/vax pt woke x2 during night due to teething; very pale; clear nasal drainage; T97; diaphoretic; slept all day;

VAERS ID:128234 (history)  Vaccinated:1999-09-01
Age:  Onset:1999-09-01, Days after vaccination: 0
Gender:Male  Submitted:1999-09-07, Days after onset: 6
Location:Arizona  Entered:1999-09-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: na
Other Medications: triamcinolone topical
Current Illness: eczena-facial
Preexisting Conditions: egg allergy; per allergist; eczema
Diagnostic Lab Data: na
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES10014603 LL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1919H1 RL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P004022SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1783H0SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: p/vax pt had welt (wheal + flare) at inj site; faded by 30 minutes;

VAERS ID:128352 (history)  Vaccinated:1999-09-01
Age:76.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:1999-09-10, Days after onset: 9
Location:Ohio  Entered:1999-09-17, 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: aricept
Current Illness: rectal pain
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES459560 IMLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7341BA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Hypothermia, Injection site hypersensitivity, Injection site oedema, Injection site pain, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt office visit lt upper arm redness; swelling & pain; T97.5; symptoms worse in AM; redness; swelling below inj site; ER PM; rx not filled; Dx: cellulitis from ER MD

VAERS ID:128586 (history)  Vaccinated:1999-09-01
Age:30.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:1999-09-21, Days after onset: 20
Location:California  Entered:1999-09-27, 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: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESV0063AA SCLA
Administered by: Private     Purchased by: Private
Symptoms: Myalgia, Pain, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: lt arm pain & soreness, small amount of redness;

VAERS ID:128630 (history)  Vaccinated:1999-09-01
Age:1.5  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Georgia  Entered:1999-09-27
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 (ACEL-IMUNE)LEDERLE LABORATORIES4643053IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: p/vax pt exp 8x6cm area induration & erythema below inj site rt leg

VAERS ID:128641 (history)  Vaccinated:1999-09-01
Age:33.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:1999-09-10, Days after onset: 9
Location:Pennsylvania  Entered:1999-09-27, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)PFIZER/WYETH4978252  RA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Headache, Hypertonia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt exp arm spasms; ache in legs/arms; chills; low grade fever & h/a

VAERS ID:129526 (history)  Vaccinated:1999-09-01
Age:6.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Washington  Entered:1999-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WA991595
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4577924IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0352J1SCLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0802B4PO 
Administered by: Public     Purchased by: Public
Symptoms: Injury, Speech disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: p/vax pt walked to door & pitched forward hitting face & shoulder;color good, eyes open making contact, did not speak for 10min but nodded appropriately to questions;vasovagal response;referred to ER for eval;

VAERS ID:130644 (history)  Vaccinated:1999-09-01
Age:71.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:1999-10-20, Days after onset: 49
Location:California  Entered:1999-10-25, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Celecoxib;Hydrochlorothiazide
Current Illness: unk
Preexisting Conditions: drug hypersensitivity;hypercholesterolaemia;HTN NOS;osteoarthritis NOS;
Diagnostic Lab Data: unk
CDC Split Type: 2264413OCT199
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Epidermal necrosis
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt recv Pravachol for tx of hypercholesterolemia;10 day later pt devel toxic epidermal necrolysis;pt hosp;

VAERS ID:130152 (history)  Vaccinated:1999-09-01
Age:5.0  Onset:1999-09-17, Days after vaccination: 16
Gender:Female  Submitted:1999-09-23, Days after onset: 6
Location:Oklahoma  Entered:1999-11-02, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: tooth cavity-x-rays head 9/20/99 no prlblems found
Diagnostic Lab Data: 9/20/99 mumps titer;Md dx vaccine induced rxn MMR;
CDC Split Type: OK9947
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (CERTIVA)NORTH AMERICAN VACCINESC0104 LA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1148J0 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0541J1SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0799C3PO 
Administered by: Public     Purchased by: Other
Symptoms: Dental caries, Ear pain, Infection, Lymphadenopathy, Vasodilatation
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: c/o rt ear hurting & redness;swelling behind rt ear;to ER swelling & pain; next day swelling worse;swelling over rt jaw to behind rt pinna;mom states swelling down onto neck;tenderness to even light palpation;dental caries on rt side;viral

VAERS ID:132727 (history)  Vaccinated:1999-09-01
Age:33.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:1999-12-20, Days after onset: 110
Location:Michigan  Entered:1999-12-21, 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: OTC vitamins, Dexadrine
Current Illness: NONE
Preexisting Conditions: Hypoglycemia, vasiculitis
Diagnostic Lab Data: BP, Liver Profile, Diabetic Profile
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3001A41IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anxiety, Asthenia, Dizziness, Dyspnoea, Hypoglycaemia, Rash, Tachycardia, Vasodilatation
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow)
Write-up: 9/99 - Recd HepB - 1 week later pt experienced SOB, weakness, tachycardia, flushing, dizziness. ER visit - (BP 186/96). 10/16/99 rcvd 2nd dose - same sx, rash, hypoglycemic reaction. Dr dx anxiety attack also. (See original for more info.)

VAERS ID:133611 (history)  Vaccinated:1999-09-01
Age:12.0  Onset:1999-11-10, Days after vaccination: 70
Gender:Female  Submitted:2000-01-24, Days after onset: 75
Location:D.C.  Entered:2000-02-02, 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:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Military     Purchased by: Unknown
Symptoms: Alopecia
SMQs:
Write-up: 4-6 weeks post vaccination, pt developed alopecia areata. Diagnosed by family MD, confirmed by Dermatologist.

VAERS ID:133829 (history)  Vaccinated:1999-09-01
Age:30.0  Onset:1999-11-01, Days after vaccination: 61
Gender:Female  Submitted:2000-02-01, Days after onset: 92
Location:Unknown  Entered:2000-02-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: Pregancy: fetus age 7 days
Diagnostic Lab Data: UNK
CDC Split Type: 1054101OCT
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES454971 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Stillbirth
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: Intra-uterine death. Pt was 7 days pregnant when rcv''d vax. Add info rcv''d indicated that, in Nov, fetus died in utero. Hospitalized for delivery of dead fetus. Dx of fetal death due to genetic extra chromosome was made.

VAERS ID:150032 (history)  Vaccinated:1999-09-01
Age:16.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:2000-03-08, Days after onset: 189
Location:Pennsylvania  Entered:2000-03-14, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Red dye allergy.
Diagnostic Lab Data:
CDC Split Type: WAES00030322
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Public     Purchased by: Other
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Information has been received from the mother of the pt, who, subsequently, who experienced seizures and convulsions

VAERS ID:150560 (history)  Vaccinated:1999-09-01
Age:30.0  Onset:0000-00-00
Gender:Female  Submitted:2000-01-19
Location:New Jersey  Entered:2000-03-29, Days after submission: 70
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: 19990259461
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: In September, 1999, the pt received her first dose of Lymerix. The next day, she experienced flu-like symptoms and fever. No treatment was given. The most recent information, received on 9/25/99, reports that the condition of the pt is recovered.

VAERS ID:150588 (history)  Vaccinated:1999-09-01
Age:  Onset:0000-00-00
Gender:Female  Submitted:2000-01-19
Location:Massachusetts  Entered:2000-03-29, Days after submission: 70
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: 19990321321
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: In September, 1999 the pt received her first dose of Lymerix, subsequently , she experienced arm pain which "is getting worse". In November, 1999, the pt received her second dose of Lymerix, subsequently, she experienced arm pain again and is "getting worse". The pain started at the vaccination site and has progressed to both of her arms. The most recent information received on 12/7/99, reports the condition of the pt as getting worse.

VAERS ID:150786 (history)  Vaccinated:1999-09-01
Age:19.0  Onset:2000-03-27, Days after vaccination: 208
Gender:Male  Submitted:2000-04-04, Days after onset: 7
Location:New Jersey  Entered:2000-04-06, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI, Cat Scan of Brain.
CDC Split Type: 20000094131
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Demyelination, Dizziness, Nervous system disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Demyelination (narrow), Vestibular disorders (broad)
Write-up: In 8/99, the pt received his first injection of Lymerix with no adverse events. In 9/99, he received the second dose of Lymerix. 3/27/00 he experienced dizziness, nausea and vomiting. He was diagnosed with demyelination of the white matter of his brain and was hospitalized. Information received on 3/30/00 reports that symptoms are ongoing and the patient remains in the hospital. Additional information has been requested.

VAERS ID:151885 (history)  Vaccinated:1999-09-01
Age:53.0  Onset:2000-01-01, Days after vaccination: 122
Gender:Male  Submitted:2000-04-21, Days after onset: 110
Location:Pennsylvania  Entered:2000-05-12, Days after submission: 21
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: Pt had a prior history of Lyme disease about 4 years ago but had been asymptomatic for about 2 years prior to vaccination.
Diagnostic Lab Data:
CDC Split Type: 20000055181
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Pain
SMQs:, Arthritis (broad)
Write-up: In September, October and November, 1999, the pt received Lymerix vaccines. Immediately, after each injection (exact date not provided), he had pain which resolved. Then in January, 2000, he experienced a severe flare-up of pain in his knees and his thighs. The most recent information received on 2/17/2000, indicates the outcome of the symptoms as unknown. Additional information has been requested. 1

VAERS ID:152253 (history)  Vaccinated:1999-09-01
Age:10.0  Onset:1999-09-02, Days after vaccination: 1
Gender:Male  Submitted:2000-03-07, Days after onset: 187
Location:Virginia  Entered:2000-05-23, Days after submission: 76
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: WAES99090501
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a health care professional concerning a 10 year old male who on 9/1/99 was vaccinated with the first dose of Hep B. On 9/2/99, the pt experienced fever of 102 and chills and achiness. On 9/3/99, the pt''s mother phoned the physician''s office and noted that the child''s temperature was 99. The pt sought unspecified medical treatment. Additional information has been requested.

VAERS ID:152273 (history)  Vaccinated:1999-09-01
Age:47.0  Onset:1999-09-08, Days after vaccination: 7
Gender:Female  Submitted:2000-03-07, Days after onset: 181
Location:Pennsylvania  Entered:2000-05-23, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99092221
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2IM 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Eyelid oedema, Facial palsy, Injection site pain, Injury, Pruritus, Skin discolouration, Tinnitus, Visual disturbance
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Periorbital and eyelid disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: On 9/8/99, the pt experienced a mosquito bite on her left forearm which swelled to 3/4 the circumference of her forearm. The bite was red and hot to the touch. After the bug bite, the pt experienced joint aches and Bell''s palsy-like symptoms which left the pt''s eyelids swollen, slightly itchy, and at times impairs her vision. Additionally, the pt noted a gurgling sound in her left ear and she noticed that her skin color was shallow. The pt reported that the inflammation has subsided but she noticed that the injection site is still tender to the touch. The pt noted normally react to mosquito bites but never to this extent before.

VAERS ID:154822 (history)  Vaccinated:1999-09-01
Age:  Onset:1999-09-01, Days after vaccination: 0
Gender:Unknown  Submitted:1999-10-28, Days after onset: 57
Location:New York  Entered:2000-06-20, Days after submission: 236
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ0860529SEP1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4998237 IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: A physician reported that approximately 40 to 50% of 25 pts experienced an injection site reaction described as either redness or swelling following the receipt of Flu-Shield in September of 1999.

VAERS ID:155276 (history)  Vaccinated:1999-09-01
Age:1.25  Onset:1999-09-03, Days after vaccination: 2
Gender:Female  Submitted:2000-05-24, Days after onset: 264
Location:Colorado  Entered:2000-06-22, Days after submission: 29
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: WAES99090519
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 9/3/99, post vax, the pt experienced diarrhea, fever of 101-102F and red spots on the face. At the time of the report, the pt''s symptoms were resolving and the red spots on her face had scabbed over. No further information is available.

VAERS ID:155278 (history)  Vaccinated:1999-09-01
Age:1.0  Onset:1999-09-06, Days after vaccination: 5
Gender:Male  Submitted:2000-05-24, Days after onset: 261
Location:Pennsylvania  Entered:2000-06-22, Days after submission: 29
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: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99090621
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Private     Purchased by: Private
Symptoms: Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 12 month old white male who on 9/1/99 was vaccinated with MMR and Varicella. On 9/6/99, the pt experienced "an unusual total body rash characterized by fine, raised bumps which began on the arms and legs and spread to the trunk and cheeks." The pt sought unspecified medical treatment. On an unspecified date, the pt recovered. No further information is available.

VAERS ID:155939 (history)  Vaccinated:1999-09-01
Age:1.25  Onset:1999-11-30, Days after vaccination: 90
Gender:Unknown  Submitted:2000-05-16, Days after onset: 167
Location:Illinois  Entered:2000-07-03, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99120548
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: On 11/30/99, the pt developed chickenpox. The pt sought unspecified medical attention. No further information is available.

VAERS ID:156156 (history)  Vaccinated:1999-09-01
Age:  Onset:1999-09-14, Days after vaccination: 13
Gender:Female  Submitted:2000-05-16, Days after onset: 245
Location:Texas  Entered:2000-07-10, Days after submission: 55
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: PCN allergy
Diagnostic Lab Data:
CDC Split Type: WAES99091063
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Injection site rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt experienced joint aches. On 9/15/99, the pt also experienced 5" lesion rash around injection site. The lesions were red, non-itchy welts in a circle around the injection site. "The pt sought unspecified medical treatment. Additional information has been requested.

VAERS ID:156181 (history)  Vaccinated:1999-09-01
Age:2.0  Onset:1999-09-19, Days after vaccination: 18
Gender:Female  Submitted:2000-05-16, Days after onset: 240
Location:Pennsylvania  Entered:2000-07-10, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;VARIVAX;2;11.00;In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99091689
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SCGM
Administered by: Other     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: Approximately two weeks post vax pt developed and outbreak of chickenpox.

VAERS ID:156234 (history)  Vaccinated:1999-09-01
Age:1.0  Onset:1999-10-04, Days after vaccination: 33
Gender:Female  Submitted:2000-05-16, Days after onset: 225
Location:Virginia  Entered:2000-07-10, Days after submission: 55
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: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99100633
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Infection, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt experienced fever. Approximately 7 days later the pt developed varicella with less than 10 lesions.

VAERS ID:156248 (history)  Vaccinated:1999-09-01
Age:2.0  Onset:1999-10-01, Days after vaccination: 30
Gender:Female  Submitted:2000-05-16, Days after onset: 228
Location:Colorado  Entered:2000-07-10, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: chest x-ray 10/1999
CDC Split Type: WAES99100812
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Pt developed positive TB results. All family contacts were negative. Chest x-ray was negative.

VAERS ID:156568 (history)  Vaccinated:1999-09-01
Age:1.08  Onset:0000-00-00
Gender:Female  Submitted:2000-05-16
Location:Ohio  Entered:2000-07-13, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99101783
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Subsequent to receiving one dose of varicella virus vaccine live, the pt experienced a varicella like rash with 2-3 lesions at a time at random sites on the body. The lesions resolved and reappeared elsewhere. They were relatively dry and were not weeping. The pts rash persists.

VAERS ID:333128 (history)  Vaccinated:1999-09-01
Age:56.0  Onset:0000-00-00
Gender:Male  Submitted:2008-11-24
Location:Unknown  Entered:2008-11-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthmatic bronchitis; High Cholesterol, Hypertension; Nocturia; Recurrent Bronchitis
Preexisting Conditions: Elbow surgery; Fracture of Elbow; Gout; Ruptured Achilles Tendon
Diagnostic Lab Data: Diagnostic tests: 17 April 2001: HLA B27 not detected. HLA DR typing 1 loci result: DR8, typing loci 2 results: DR11. 07 November 2001: Lyme ELISA titer IgG less than 80 (normal); Lyme IgG and IgM Western Blot, and IgG Mardx and Immunetics
CDC Split Type: A0600187A
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Amnesia, Arthralgia, Asthenia, Borrelia burgdorferi serology, Borrelia burgdorferi serology positive, Cardiac electrophysiologic study abnormal, Cognitive disorder, Confusional state, Disturbance in attention, Dizziness, Electromyogram abnormal, Fatigue, Feeling hot, Fluid retention, HLA marker study, Headache, Hypoaesthesia, Immunology test, Influenza like illness, Joint stiffness, Joint swelling, Lyme disease, Musculoskeletal pain, Musculoskeletal stiffness, Myalgia, Neck pain, Nerve conduction studies abnormal, Nodule, Oedema peripheral, Pain, Pain in extremity, Paraesthesia, Polyneuropathy, Pyrexia, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: This case was reported by a lawyer and described the occurrence of stiffness in hands in a male subject of unspecified age who was vaccinated with LYMERIX. A physician or other health care professional has not verified this report. On an unspecified date the subject received unspecified dose of LYMERIX (unknown). At an unspecified time after vaccination with LYMERIX, the subject experienced stiffness in his hands, pain in legs and shoulders, lightheadedness, diffuse joint pain and swelling, tingling and numbness in his hands and lower arms, cognitive dysfunction, arthralgias, aches and pains in neck, wrist pains, swelling in hands, fatigue, loss of concentration, short term memory problems, headaches, morning stiffness in arms, possible neurological injuries, and decreased activities of daily life. At the time of reporting the outcome of the events were unspecified. This information was received via a Statement of Injuries. Follow up information was received on 07 November 2008 via an interview between lawyers and the subject. The subject received the first dose of LYMERIX on 01 September 1999. Two to three weeks after vaccination he experienced hand pain, shoulder pain, joint pain, and joint swelling. Five to six weeks after vaccination, he experienced leg pain, weakness, lack of concentration, fatigue, tingling, wrist pain, numbness of the lower arms and wrists, and short term memory loss. In 2001 he developed headaches. Treatment included unspecified pain medications. The events were unresolved at the time of reporting. Follow up information was received on 19 November 2008 via medical records. A note dated 04 August 1999 indicated that the subject "may sign up for Lyme clinic". The subject was vaccinated with LYMERIX in September 1999, and approximately four weeks later reportedly developed stiffness of the hands which resolved. On 22 November 1999, the subject reported hand swelling, wrist pain, joint pain and heat (hands, shoulders, knees), and fatigue. On 15 December 1999, the subject was evaluated for joi

VAERS ID:336466 (history)  Vaccinated:1999-09-01
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2009-01-05
Location:New York  Entered:2009-01-05
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diverticulosis; Gastroesophageal Reflux Disease; Hiatal Hernia
Preexisting Conditions: Broken nose; Cat scratch fever, Ex-smoker; The subject smoked one and a half packs of cigarettes per day since age 15, stopped in approximately 1992. Family history of arthritis (mother).
Diagnostic Lab Data: Diagnostic results: 05 May 2000: B. burgdorferi Ab (IgG and IgM) by Western Blot negative. B. burgdorferi Ab screen 2.43; positive. 10 May 2000: Lyme ELISA positive, Western Blot negative. 23 May 2000: X-rays of right and left hands and wri
CDC Split Type: A0759678A
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Angiotensin converting enzyme increased, Arthralgia, Autoimmune disorder, Blepharospasm, Blister, Borrelia burgdorferi serology positive, Chest pain, Cognitive disorder, Costochondritis, Cough, Echocardiogram normal, Episcleritis, Fatigue, Gastrooesophageal reflux disease, HLA marker study, Immunology test, Immunology test abnormal, Leukocytosis, Musculoskeletal pain, Musculoskeletal stiffness, Neurological symptom, Nuclear magnetic resonance imaging brain abnormal, Ocular hyperaemia, Pain, Pain in extremity, Paraesthesia, Rhinitis allergic, Sarcoidosis, Stress echocardiogram, Synovitis, Temperature intolerance, Tinnitus, Upper respiratory tract infection, Viral infection, X-ray limb normal
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Hypertension (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Periorbital and eyelid disorders (narrow), Scleral disorders (narrow), Ocular motility disorders (narrow), Hypersensitivity (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified age who was vaccinated with LYMERIX (GlaxoSmithKline). A physician or other health care professional has not verified this report. On an unspecified date the subject received unspecified dose of LYMERIX (unknown). At an unspecified time after vaccination with LYMERIX, the subject experienced severe joint pain of the hands, feet, shins, knees, shoulders, elbows, wrists, and palms, eye redness, blisters in the corner of the eye, cough, pin in the foot, pain with walking, tinnitus, stiffness, fatigue, reflux symptoms (nos), chest pain, eye twitching, cold intolerance, and activities of daily living impaired. The statement further alleged that the subject experienced "rheumatologic, neurologic, and/or cognitive sequella of an autoimmune, immune-mediated, or other biological mechanism, all caused by vaccination with LYMERIX, including but not limited to those symptoms set forth above". At the time of reporting the outcome of the events was unspecified. Follow up information was received on 05 January 2009 via medical records. The subject received her first LYMERIX vaccine on 26 April 1999. She received her second LYMERIX vaccine in approximately September 1999 or October 1999, along with an influenza vaccine (unknown manufacturer). In March 2000, she developed episcerlitis with eye redness. On 05 May 2000, she complained of arthralgias and ongoing episcleritis. On 23 May 2000, she was evaluated for complaints of hand pain. A progress note dated 25 May 2000 indicated that the subject was diagnosed with sarcoidosis secondary to Lyme vaccine. Treatment included VIOXX. On 02 October 2000, she was evaluated for a five-day history of dry cough, aches, and fatigue, in addition to the sarcoid affecting her eye. Impression included upper respiratory infection, most likely viral. On 31 January 2002, she was seen by an allergy specialist who diagnosed cough and allergic rhinitis. According to a physician''s note dated

VAERS ID:388688 (history)  Vaccinated:1999-09-01
Age:4.0  Onset:2009-11-22, Days after vaccination: 3735
Gender:Female  Submitted:2010-05-14, Days after onset: 172
Location:New York  Entered:2010-05-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Serum immunoglobulin M, 11/23/09, <1: IgM; serum immunoglobulin G, 11/23/09, 7.11 IgM; serum amylase test, 11/23/09, 381
CDC Split Type: WAES1001USA02034
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood amylase increased, Blood immunoglobulin G, Blood immunoglobulin M, Mumps, Oropharyngeal pain, Parotitis, Vaccine breakthrough infection
SMQs:, Acute pancreatitis (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 14 year old female patient who in April 1996, was vaccinated with the first dose of MMR II. On 01-SEP-1999, the patient received the second dose of MMR II. On 29-DEC2009, the patient experienced mumps (date of diagnosed was reported to be on 25-DEC-2009). The patient was afebrile and had parotitis. The outcome of the patient was not reported. Follow up information has been received reporting that on 22-NOV-2009 (previously reported as 25-DEC-2009) the patient experienced mumps. Mumps was diagnosed on 23-NOV-2009 (previously reported as 25-DEC-2009). The patient developed a sore throat and left parotitis. On 23-NOV-2009 the first blood work was performed, the results were: IgM (<1:10) : <1:10, IgG ($g1.10): 7.11 and serum amylase: 381. At the time of the report, the patient''s outcome was unknown. This is one of several cases from the same source. Additional information has been requested.

VAERS ID:567541 (history)  Vaccinated:1999-09-01
Age:38.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Female  Submitted:2015-02-28, Days after onset: 5659
Location:Virginia  Entered:2015-02-28
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Hypersensitivity, Hypoaesthesia oral, Hypotension
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Lips numb, hypotension with dizziness. Placed as allergy in medical record.

VAERS ID:684269 (history)  Vaccinated:1999-09-01
Age:1.17  Onset:0000-00-00
Gender:Male  Submitted:2017-03-01
Location:Colorado  Entered:2017-03-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Absolute neutrophil count decreased; Langerhans cell histiocytosis; White blood cell count low
Preexisting Conditions:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: Lab result: 104 F
CDC Split Type: US0095075131702USA011487
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Unknown
Symptoms: Conjunctivitis, Fine motor skill dysfunction, Measles, Memory impairment, Nervous system disorder, Pneumonia, Pyrexia, Rash, Sensory processing disorder
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This spontaneous report as received from a registered nurse refers to her son, a currently 18 year old male patient with no drug reactions or allergies. The patient''s concurrent conditions included Langerhans cell histiocytosis with a low absolute neutrophil count and a low overall white blood cell count. Information regarding concomitant medications was not reported. In approximately September 1999 (reported as "at 15 months of age"), the patient was vaccinated with M-M-R II (therapy type, dose, route of administration, lot # and expiration date were not reported) as routine vaccination. On an unknown date, the patient developed a measles rash, conjunctivitis, pneumonia and a fever of 104 Fahrenheit degrees "for over a week". The reporter stated that her son had multiple visits with the pediatrician following development of these symptoms, and he received acetaminophen (manufacturer unknown) and ibuprofen "altering every 2 hours around the clock". He was also prescribed unspecified antibiotics during this period of time. She stated that the pediatrician said this was the second time they had seen this in 25 years of practice. On unknown dates, the patient also suffered long-term neurological damage from the events described above, and he had sensory-processing issues, difficulty with memorization and fine-motor control issues. The outcome of the events was unknown. The relatedness between the events and M-M-R II was not reported. Upon internal review, the events of measles and pneumonia were considered to be medically significant. Additional information has been requested.

VAERS ID:128742 (history)  Vaccinated:1999-09-01
Age:11.0  Onset:1999-09-01, Days after vaccination: 0
Gender:Male  Submitted:1999-09-24, Days after onset: 23
Location:Foreign  Entered:1999-09-29, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: WAES99091583
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.P078110IM 
MEA: MEASLES (MORATEN)BERNA BIOTECH, LTD    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Eye disorder, Hypertonia, Stupor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: p/vax pt exp hypertonia w/loss of consciousness for a few minutes & ocular revulsion followed by asthenia & torpor; pt hosp & treated w/venous infusion; one day p/onset pt recovered & disch;

VAERS ID:133235 (history)  Vaccinated:1999-09-01
Age:39.0  Onset:1999-09-30, Days after vaccination: 29
Gender:Male  Submitted:2000-01-06, Days after onset: 98
Location:Foreign  Entered:2000-01-12, Days after submission: 6
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: GOT-290;GPT-1400,GGT-389;AP-248;mild leukopenia;serology showed titer for Hep A
CDC Split Type: 19990267032
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Chest pain, Gamma-glutamyltransferase increased, Headache, Hepatitis, Leukopenia, Malaise, Pain, Pharyngitis
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Oropharyngeal infections (narrow), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt recv''d Havrix vax in early Sept 1999. 4 wks later the pt experienced abdominal pain,sensation of chest pressure,headache,limb pain,malaise,& sore throat.Dxed w/ acute hepatitis.Pt recv''d no medical tx.

VAERS ID:158084 (history)  Vaccinated:1999-09-01
Age:0.2  Onset:1999-09-27, Days after vaccination: 26
Gender:Female  Submitted:2000-07-26, Days after onset: 303
Location:Foreign  Entered:2000-07-28, Days after submission: 2
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Sleep study-nml, Hypothermia (35C)
CDC Split Type: 20000223531
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM24880C9C0IM 
HIBV: HIB (HIBTITER)PFIZER/WYETH 0IM 
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Apnoea, Cyanosis, Hypothermia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Accidents and injuries (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)
Write-up: 09/27/99, twenty-five days post vax, this 2-month-old baby girl was admitted to the hospital due to hypothermia (temperature of 35 C) and apnea. On a date unknown, she was discharged from the hospital with apnea monitor. On 10/08, thirty-seven days post vax, she was again admitted to the hospital; she was blue around her lips but attentive when startled. There was no apnea on admission and no decrease in oxygen saturation. On 12/02, a sleep study showed no abnormalities. As of 07/24/00, at the time of this report, the outcome is unknown. Further information has been requested. On a date unknown, she completely recovered per follow-up dated 8/21/00. On 6/21/00 a 2nd dose of Polio Sabin was given. Follow-up states the physician states possibly related to Infanrix and/or Polio Sabin.

VAERS ID:161102 (history)  Vaccinated:1999-09-01
Age:34.0  Onset:1999-11-01, Days after vaccination: 61
Gender:Female  Submitted:2000-10-27, Days after onset: 360
Location:Foreign  Entered:2000-10-31, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen, Lisino, Mobec, paracetamol
Current Illness:
Preexisting Conditions: allergy to pollen and grass, prolapse of intervertebral disk, lumbo-ischialgia
Diagnostic Lab Data: NMR tomography of cervical spine and thoracic spine-left-sided lesion of vertebral body D1, a small lesion of vertebral body D6, and mild degenerative changes in the area of the middle and lower thoracic spine; liquor analysis-increased lev
CDC Split Type: 20000308811
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Hyperhidrosis, Hypertonia, Laboratory test abnormal, Nausea, Pain, Paraesthesia, Tachycardia, Tremor, Trigeminal neuralgia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: In November 1999, the vaccinee experienced pressing pain in the left half of the body and the area of the face and neck and a four weeks-lasting paresthesia in the left arm. Afterwards the paresthesia improved, but the pain in the whole left half of the body remained. The vaccinee''s complaints markedly increased a few days before she was hospitalized on 2/3/00. At this time the paresthesia occurred in the whole left half of the body and the vaccinee developed hypertonia. The gait was not impaired. On 2/3/00, the vaccinee suffered from marked nausea, tachycardia, hypertonia, dizziness, increased sweating, and temporal tremor. The ER physician suspected a transitory ischemic attack. Therefore the vaccinee was hospitalized on the same day. A hospital record is available. The following dx were made: left-sided hemidysaesthesia without evident organic correlative and relapsing syndrome of cervical and thoracic spine. The vaccinee was treated for the events with non-steroidal antirheumatics and Tolperison. The hypokalemia was compensated. Despite the continuing left-sided hemidysaesthesia the vaccinee was discharged on 3/8/00. At this time the vaccinee was able to work. In August 2000, the vaccinee was suspected of having a trigeminal neuralgia.

VAERS ID:163514 (history)  Vaccinated:1999-09-01
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:2000-12-04
Location:Foreign  Entered:2000-12-11, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES00112018
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.HH67480 IM 
Administered by: Other     Purchased by: Other
Symptoms: Autism, Viral infection
SMQs:
Write-up: Information has been received from a health authority concerning a 1 year old male pt who on 9/1/99 was vaccinated IM with 1 dose of MMR II. Development of autistic spectrum disorder was reported in 9/99. Additionally, the pt experienced recurrent viral-like illnesses, shortly after vaccination. The reporter considered the pt''s experiences to be "Other Medical Events". As of 11/22/00, the outcome was unknown. No further information is available.

VAERS ID:164283 (history)  Vaccinated:1999-09-01
Age:1.0  Onset:1999-10-08, Days after vaccination: 37
Gender:Female  Submitted:2000-12-27, Days after onset: 446
Location:Foreign  Entered:2000-12-29, Days after submission: 2
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Temperature-35C; Sleep study-nml
CDC Split Type: HQ4994718DEC2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM  IM 
HIBV: HIB (HIBTITER)PFIZER/WYETH  IM 
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER  PO 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cyanosis, Hypothermia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Accidents and injuries (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: A 1 year old female received Hib-Titer, Infanrix and poliomyelitis virus vaccines on 9/1/99 and subsequently developed hypothermia. Her temperature was 35C. On 10/8/99, her apnea monitor went off and she was blue around the lips. A sleep study test performed on 12/2/99 was normal. She recovered. The reporter considered this event life-threatening and "possibly" related to vaccine administration.

VAERS ID:223816 (history)  Vaccinated:1999-09-01
Age:  Onset:1999-12-01, Days after vaccination: 91
Gender:Female  Submitted:2004-07-09, Days after onset: 1681
Location:Foreign  Entered:2004-07-12, 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: UNK
Preexisting Conditions: Rheumatoid polyarthritis;
Diagnostic Lab Data: UNK
CDC Split Type: B0337986A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Panniculitis, Rash macular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This case was reported by a foreign regulatory authority and described the occurrence of injection site lupic panniculitis in a female subject (unknown age) who received an injection of hepatitis B vaccine for prophylaxis. Concurrent medical condition included rheumatoid polyarthritis. In August and September 199, the subject received the first and second injection of unspecified hepatitis B vaccine. Three months after the second injection, the subject presented with two blotches at both injection sites. A dermatologist made the diagnosis of lupic panniculitis. At the time of the reporting, the lupic panniculitis was currently healing. The reporter''s causality assessment was unknown. This case has been considered as serious (OMIC). Follow up: The reporter considered the events to be possibly related to vaccinations with Engerix B. This case has been considered as serious by GSK algorithm but non serious by the french regulatory authority.

VAERS ID:386139 (history)  Vaccinated:1999-09-01
Age:3.0  Onset:0000-00-00
Gender:Male  Submitted:2010-04-27
Location:Foreign  Entered:2010-04-28, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Laboratory test, 4.2, hair sample: mercury level
CDC Split Type: WAES1004USA03647
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Allergy test, Antimicrobial susceptibility test, Autism, Bacterial test, Blood count, Blood test, Cytogenetic analysis, Disability, Fungal test, Hair metal test abnormal, Urine analysis
SMQs:
Write-up: Initial information received on 26-OCT-2009, this case is not medically confirmed. This case is linked with case E2010-01528 and is related to general claim against a foreign Ministry of Health related to all products containing thiomersal. The claim contains 65 cases among which 41 are related to vaccines. Furthermore, this case is also linked with 2 cases related to patients who dropped their complaints. The claim is not against Sanofi Pasteur MSD, this latter is only a third party. Therefore some of the cases are poorly documented. Current case concerns an about 36 months old male patient. The patient was received the following vaccines: 4 doses of a diphtheria toxoid (+) poliovirus vaccine inactivated (unspecified) (+) tetanus toxoid (manufacturer unknown, batch number, route and site of administration not reported) on 03-JUL-19943, 30-SEP-1993, 07-DEC-1993 and 07-JUN-1994. 4 doses of a Hib conj vaccine (manufacturer unknown, batch number, route and site of administration not reported) on 03-JUL-1993, 30-SEP-1993, 07-DEC-1993 and 07-JUN-1994. 1 dose of a MMR (manufacturer unknown, batch number, route and site of administration not reported) on 15-MAR-1994. 3 doses of a hepatitis B virus vaccine (manufacturer unknown, batch number, route and site of administration not reported) on 2004 (exact dates reported). 3 doses of a meningococcal C vaccine (manufacturer unknown, batch number, route and site of administration not reported) on 03-JUL-1993, 30-SEP-1993 and 07-DEC-1993. 1 dose of a diphtheria-tetanus-pertussis vaccine (manufacturer unknown, batch number, route and site of administration not reported) in September 1999, exact date not reported. 1 dose of a diphtheria-tetanus vaccine (manufacturer unknown, batch number, route and site of administration not reported) in May 2007, exact date not reported. According to the report, the patient was diagnosed with autism in 1997, exact date not reported, had a disability grade of 33% which was evaluated on the 22-MAR-2000. A test performed in a hair sample (dates not reported) showed that the patient had a mercury level of 4.2 (units not reported). According to the form received from the claimant, the following statements were included: Urinary analysis, Hair test, Blood count, Blood test, Food allergies test, Genetic test, Bacterial and yeast susceptibilities. It was written in the form received from the claimant "Medical report: Yes" but we hadn''t received it yet. Other business partner numbers included E2010-01888. No further information is available.

VAERS ID:676542 (history)  Vaccinated:1999-09-01
Age:0.17  Onset:1999-09-01, Days after vaccination: 0
Gender:Male  Submitted:2016-11-24, Days after onset: 6294
Location:Foreign  Entered:2016-11-24
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Nutritional supplementation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1611NZL010676
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Cardiovascular disorder, Developmental delay, Hypotonia, Pyrexia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Information was obtained on a request by the company from the agency via a Case Line Listing concerning a 3 month old male patient. Information regarding patient''s recent surgery, transfusion, X-ray with contrast media, other chemicals, nutritional supplements, and familiar allergy were unknown. There were no pre-existing renal/hepatic disease, known allergy and other medical conditions. Patient''s concurrent condition included nutritional supplementation. Approximately in September 1999, the patient was vaccinated with one dose of M-M-R II (therapy type:HSA) via subcutaneous route. Within the same duration, the patient also received hepatitis B virus vaccine(unspecified) (Manufacturer unknown). At an unspecified time after vaccination, the patient developed following events: hypotonia, cardiovascular disorders, developmental delay, pyrexia and tremor, which were not severe. Outcome of the events were reported as not recovered (dechallenge: unknown). Reporting agency considered all the events to be serious due to persisting disability. The original reporting source was not provided. Additional information is not expected from the Agency as follow up information cannot be obtained.

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