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Case Details (Sorted by Vaccination Date)

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VAERS ID: 118617 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: Montana  
Vaccinated:1999-01-28
Onset:1999-01-28
   Days after vaccination:0
Submitted: 1999-02-04
   Days after onset:7
Entered: 1999-02-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2565A4 / 2 RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Inhaler, Premarin, Progesterin, Synthroid
Current Illness: UNK
Preexisting Conditions: Asthma, Hypothyroidism, Hypoglycemia; Allergic to Morphine & Demerol
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Pt recv vax on 1/28/99; 3 hr post vax pt exp general body aches & swollen glands in neck


VAERS ID: 118853 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: California  
Vaccinated:1999-01-28
Onset:1999-01-29
   Days after vaccination:1
Submitted: 1999-02-04
   Days after onset:6
Entered: 1999-02-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 989580 / 6 LA / -

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

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

Write-up: Pt recv vax on 1/28/99; on 1/29/99 pt exp LA swelling, red- to elbow


VAERS ID: 118856 (history)  
Form: Version 1.0  
Age: 65.0  
Gender: Female  
Location: Maryland  
Vaccinated:1999-01-28
Onset:1999-01-28
   Days after vaccination:0
Submitted: 1999-01-29
   Days after onset:1
Entered: 1999-02-10
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1585H / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: MD99004

Write-up: Pt recv vax on 1/28/99; on same day pt exp left arm & shoulder swollen&painful, malaise


VAERS ID: 118901 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Oregon  
Vaccinated:1999-01-28
Onset:1999-02-01
   Days after vaccination:4
Submitted: 1999-02-03
   Days after onset:2
Entered: 1999-02-11
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TTOX: TETANUS TOXOID (NO BRAND NAME) / CONNAUGHT LABORATORIES 0918080 / 6 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Headache, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Zoloft, arm. thyroid, OCP''s Trycyclene
Current Illness: NONE
Preexisting Conditions: Hypothyroid, Depression
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt recv vax on 1/28/99; on 2/1/99 pt exp headache, bilateral jaw pain & base of skull pain


VAERS ID: 118913 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Female  
Location: North Carolina  
Vaccinated:1999-01-28
Onset:1999-02-04
   Days after vaccination:7
Submitted: 1999-02-09
   Days after onset:5
Entered: 1999-02-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 360753A / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1187H / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0795F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Chills, Convulsion, Febrile convulsion, Pyrexia, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: results unk;CAT scan, spinal tap, EEG, bloodwork all nl dx viral infect;
CDC Split Type:

Write-up: 1wk post vax pt devel temp, staring spell, sz lasting 25-30min, T103.6, chills;rx phenobarb to control sz;


VAERS ID: 118922 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Female  
Location: California  
Vaccinated:1999-01-28
Onset:0000-00-00
Submitted: 1999-02-04
Entered: 1999-02-12
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0998410 / 1 LA / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0998390 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0796A / 1 MO / PO

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

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

Write-up: Pt recv vax on 1/28/99; post vax pt exp swollen upper LA, urticaria, warmth to area; tx=Benadryl IM & Benadryl PO


VAERS ID: 119027 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Illinois  
Vaccinated:1999-01-28
Onset:1999-01-28
   Days after vaccination:0
Submitted: 1999-01-29
   Days after onset:1
Entered: 1999-02-16
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 2547A2 / 1 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 0576H / 2 LA / -

Administered by: Other       Purchased by: Other
Symptoms: Conjunctivitis, Face oedema, Rhinitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt recv vax on 1/28/99; 15 min post vax pt exp stuffy right nostril, runny nose, sclerae red, eyelids puffy


VAERS ID: 119211 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Female  
Location: Michigan  
Vaccinated:1999-01-28
Onset:1999-01-30
   Days after vaccination:2
Submitted: 1999-02-03
   Days after onset:4
Entered: 1999-02-22
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 0956H / 3 LA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1262H / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MI99019

Write-up: Pt recv vax on 1/28/99; on 1/30/99 pt exp fever (102-104); tx=Ibuprofen, Amoxicillin; pt im 2/1/99


VAERS ID: 119253 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: New York  
Vaccinated:1999-01-28
Onset:1999-02-07
   Days after vaccination:10
Submitted: 1999-02-20
   Days after onset:13
Entered: 1999-02-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 458590 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 456917 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: right external ear deformity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: seizures;


VAERS ID: 119278 (history)  
Form: Version 1.0  
Age: 52.0  
Gender: Female  
Location: Kentucky  
Vaccinated:1999-01-28
Onset:1999-01-28
   Days after vaccination:0
Submitted: 1999-02-01
   Days after onset:4
Entered: 1999-02-23
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Anorexia, Arthralgia, Asthenia, Chills, Dysphagia, Influenza, Malaise
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Arthritis (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aricept-Zestoretic; Prem-pro
Current Illness: Dog bite
Preexisting Conditions: Alzheimers disease; high BP
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe pain in joints p/about 2hr of getting shot;felt like onset of bad flu;chills-no appetite for several days;very draggy & weak;some choking feeling;still having pain in joints. 12/2000. Non-Serious Case which did not require f/u now updated per telephone call from patient. She states that this reaction to TD injection has persisted in that pain in shoulders and back "never stopped". Has seen a specilaist who suggested pt may have carpal tunnel on L side. Patient would like this information place in VAERS record.


VAERS ID: 119438 (history)  
Form: Version 1.0  
Age: 1.1  
Gender: Male  
Location: Texas  
Vaccinated:1999-01-28
Onset:1999-01-28
   Days after vaccination:0
Submitted: 1999-02-01
   Days after onset:4
Entered: 1999-02-26
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451500 / 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402253A / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 1178H / 1 RL / -

Administered by: Private       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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 99TX13

Write-up: Pt recv vax on 1/28/99; on same day pt exp swollen left thigh w/redness


VAERS ID: 119447 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Washington  
Vaccinated:1999-01-28
Onset:1999-01-29
   Days after vaccination:1
Submitted: 1999-02-19
   Days after onset:21
Entered: 1999-02-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0983H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10701 / 1 LL / -

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

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

Write-up: Pt recv vax on 1/28/99; on 1/29/99 pt exp lump on left thigh


VAERS ID: 119456 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: South Carolina  
Vaccinated:1999-01-28
Onset:1999-02-01
   Days after vaccination:4
Submitted: 1999-02-25
   Days after onset:24
Entered: 1999-03-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0925880 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 1010H / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 2120192 / 4 MO / PO

Administered by: Private       Purchased by: Public
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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: 1/28/99: PPD, 248611,Connaught; Atuss DM
Current Illness: Upper respiratory infection
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt recv vax on 1/28/99; on 2/1/99 pt exp rash, bumps on legs, fever (101.3); tx=Zithromax


VAERS ID: 119457 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: South Carolina  
Vaccinated:1999-01-28
Onset:1999-02-01
   Days after vaccination:4
Submitted: 1999-02-25
   Days after onset:24
Entered: 1999-03-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 09258800 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 1010H / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 2120192 / 4 MO / PO

Administered by: Private       Purchased by: Public
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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: 1/28/99: PPD,Connaught, 248611; Atuss DM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Pt recv vax on 1/28/99; on 2/1/99 pt exp rash, bumps on legs, fever (100.8); tx=Zithromax


VAERS ID: 119481 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: California  
Vaccinated:1999-01-28
Onset:1999-01-30
   Days after vaccination:2
Submitted: 1999-02-11
   Days after onset:12
Entered: 1999-03-01
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402203A / 4 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Ecchymosis, Injection site hypersensitivity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)

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

Write-up: 2" rash & bruise @ site;


VAERS ID: 119765 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Male  
Location: Arizona  
Vaccinated:1999-01-28
Onset:1999-02-15
   Days after vaccination:18
Submitted: 1999-02-17
   Days after onset:2
Entered: 1999-03-05
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE x/for PCn Ibuprofen
Current Illness: NONE child ahd fever on 22JAN99;
Preexisting Conditions: mom reported child had possible hearing loss d/t repeated ear infect;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AZ9904

Write-up: pt recv vax 28JAn99 & on 15FEB99 when child awoke mom saw a rash on child stomach & in the diaper area;16FEB99 the rash had spread to the child''s back & arms;late in the afternoon of 16FEB, rash spread to child neck & face;


VAERS ID: 120348 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:1999-01-28
Onset:1999-01-29
   Days after vaccination:1
Submitted: 1999-02-22
   Days after onset:24
Entered: 1999-03-15
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Public       Purchased by: Public
Symptoms: Dermatitis exfoliative, Dry skin, Pruritus, Pyrexia, Somnolence, Vomiting
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK992

Write-up: high fever, projective vomiting, skin on back rough dry, itchy, lethargic;APAP & advil dec temp;no MD visit but mom c/o skin on back remaining rough& scaly;


VAERS ID: 120778 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: Virgin Islands  
Vaccinated:1999-01-28
Onset:1999-01-28
   Days after vaccination:0
Submitted: 1999-03-16
   Days after onset:47
Entered: 1999-03-30
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Private
Symptoms: Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: pt recv vax 28JAN99 & exp pain from upper arm, to elbow particularly painful to forearm & numbness in hand; eg. painful twisting cap off tooth paste & lifting anything;


VAERS ID: 121861 (history)  
Form: Version 1.0  
Age: 51.0  
Gender: Female  
Location: Nevada  
Vaccinated:1999-01-28
Onset:1999-01-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1999-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Hypokinesia, Myalgia, Myasthenic syndrome, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99020458

Write-up: pt recv vax 28JAN99 & 31JAN99 pt exp muscle aches & weakness & pain when trying to lift the arm;


VAERS ID: 121954 (history)  
Form: Version 1.0  
Age: 67.0  
Gender: Female  
Location: New York  
Vaccinated:1999-01-28
Onset:1999-01-28
   Days after vaccination:0
Submitted: 1999-01-29
   Days after onset:1
Entered: 1999-05-06
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988234 / UNK - / IM A
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 454386 / 2 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Chills, Injection site hypersensitivity, Injection site mass, Injection site oedema, Injection site pain, Pyrexia, Tremor, Vasodilatation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: Lopressor;Diovan;Zocor;Premarin;Ecotrin;Vitamins;
Current Illness: NONE
Preexisting Conditions: HTN, hyperlipidemia & allergic to ticlid & percocet;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 899048001L

Write-up: pt recv vax & devel a small area of redness @ one of the inj sites;the next day devel a 15 to 17cm area of warmth, swelling, pain & induration @ one of the sites & a fever of 102.2 w/shaking chills;


VAERS ID: 122370 (history)  
Form: Version 1.0  
Age: 70.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1999-01-28
Onset:0000-00-00
Submitted: 1999-03-08
Entered: 1999-05-21
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 457829 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XALATAN; PREMARIN; COSOPT
Current Illness: none
Preexisting Conditions: unspecified eye disorder
Allergies:
Diagnostic Lab Data: none
CDC Split Type: 899068115A

Write-up: A physician reported that a 70-year-old female received an injection TD absorbed on 28-JAN-1999 and subsequently reported that she developed an injection site reaction characterized by a 3-incg area of redness and soreness. Four days post-immunization, the patient reported that the redness had "moved down" her arm and that the injection site was warm and " 1 5 inches raised".


VAERS ID: 124581 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Female  
Location: Colorado  
Vaccinated:1999-01-28
Onset:1999-02-13
   Days after vaccination:16
Submitted: 1999-05-14
   Days after onset:89
Entered: 1999-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Dermatitis bullous, Infection, Pyrexia, Rash maculo-papular
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: methotrexate, naproxen, prednisone
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 2/20/99, polymerase chain react, pos for varicella
CDC Split Type: WAES99021756

Write-up: 14days p/vax pt devel 4-5 papular lesions, on 17feb pt had 20-40 lesions & was dx as having chickenpox, treated w/acyclovir. pt eventually devel 100-200 lesion & temp 104f. addl info requested


VAERS ID: 123000 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Male  
Location: Connecticut  
Vaccinated:1999-01-28
Onset:1999-02-20
   Days after vaccination:23
Submitted: 1999-05-24
   Days after onset:92
Entered: 1999-05-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 626886/1247H / 1 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~0.00~Patient
Other Medications: Prolastin;Prolixin;Winrho Sd;Lithium;Pred;Artane;Immune Globulin on 2/11/99 Citrate;Pred;Artane;
Current Illness: thrombocytopenia
Preexisting Conditions: bipolar disorder;COPD;depression;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99051024

Write-up: Information has been received from a registered nurse concerning a 42 year old male with a history of bipolor disorder and drug induced thrombocytopenia who on 28-JAN-1999 was vaccinated with PNEUMOVAX 23. On 11-FEB-1999 the patient was administered immune globulin human and meningitis vaccine. Concomitant therapy included prednisone, lithium citrate, PROLASTIN, and ARTANE. On 28-FEB-1999 the patient was diagnosed with BELL'' Palsy and was hospitalized. No further information is available.


VAERS ID: 123016 (history)  
Form: Version 1.0  
Age: 33.0  
Gender: Female  
Location: Illinois  
Vaccinated:1999-01-28
Onset:1999-02-28
   Days after vaccination:31
Submitted: 1999-05-14
   Days after onset:74
Entered: 1999-05-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2724A4 / 2 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Arthralgia, Immune system disorder, Oedema, Pyrexia, Vasculitis, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vasculitis (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Orthonovcum, synthroid;pt recv hep b dose 1 10AUG98;
Current Illness: NONE
Preexisting Conditions: hypothyroid, hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL99025

Write-up: about a month p/2nd dose of hep b pt devel joint pain, swelling, redness, vasculitis on both legs;persistent fever between 99-100 for 3 months;dx autoimmune system disorder;


VAERS ID: 154183 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: California  
Vaccinated:1999-01-28
Onset:1999-02-01
   Days after vaccination:4
Submitted: 2000-06-04
   Days after onset:488
Entered: 2000-06-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Dyspnoea, Laboratory test abnormal, Pruritus, Rash erythematous, Scar, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin, Benadryl, chronic ear infections
Allergies:
Diagnostic Lab Data: Mom states that I had 1 injection of MMR at age 5. Screening test came up negative so doctor would not release me from hospital unless I had another injection.
CDC Split Type:

Write-up: Pt. experienced difficulty breathing, hives, red swollen bumps over entire body, severe itching, loss of appetite for a 2-1/2 weeks duration. Permanent scar where injection was given.


VAERS ID: 154610 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Female  
Location: Illinois  
Vaccinated:1999-01-28
Onset:1999-02-01
   Days after vaccination:4
Submitted: 1999-11-22
   Days after onset:294
Entered: 2000-06-19
   Days after submission:209
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RUB: RUBELLA (MERUVAX II) / MERCK & CO. INC. - / 2 - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Pregnancy
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99031277

Write-up: Pt experienced a "red face". No further information is available.


VAERS ID: 416134 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Michigan  
Vaccinated:1999-01-28
Onset:1999-01-28
   Days after vaccination:0
Submitted: 2011-02-03
   Days after onset:4389
Entered: 2011-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -

Administered by: Public       Purchased by: Other
Symptoms: Arthralgia, Chills, Dizziness, Nausea, Restlessness, Sleep disorder, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: nausea, vomiting, lightheaded, syncope, chills, restlessness, joint pain, change in sleep patterns


VAERS ID: 192148 (history)  
Form: Version 1.0  
Age: 0.7  
Gender: Male  
Location: Foreign  
Vaccinated:1999-01-28
Onset:0000-00-00
Submitted: 2002-11-18
Entered: 2002-10-30
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 1487309A / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Autism, Diarrhoea, Infection, Otitis media
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: B0282938A

Write-up: This report received from a foreign institute of public health describes the occurrence of otitis in a boy of unknown age receiving diphtheria tetanus acellular pertussis vaccine for prophylaxis. Concurrent drugs included MMR vaccine (other manufacturer). On 1/28/99, a 3rd dose of Infanrix was given. On 9/1/99, a dose of MMR was given. On a date as yet unknown, after vaccinations, the boy developed otitis and diarrhea which were considered to be serious. He also developed language discontinuation: the words he already knew disappeared. Over the next 3 weeks, he became distant. Then, he developed his 1st ear infection with antibiotic treatment. Since he got several ear infection with 9 antibiotic treatment during the next 13 months. In July 1999, he had competely recovered from being distant. As of 10/16/02, at the time of this report, the outcome was reported as unresolved. The reporting physician considered the events to be unlikely related to Infanrix. Additional information has been requested but will unlikely be available. The follow ups tates from November 1999 till May 2000, he was constantly il. In May 2000 he developed strong features of autism. In December 2000 he was diagnosed with childhood autism. As of 11/4/02, at the time of the follow-up report, the outcome was unknown. The reporting physician cosniderred the events to be unlikely related to Infanrix. Additional info has been requested but will unlikely be available.


VAERS ID: 118566 (history)  
Form: Version 1.0  
Age: 0.1  
Gender: Female  
Location: Illinois  
Vaccinated:1999-01-29
Onset:1999-01-29
   Days after vaccination:0
Submitted: 1999-02-03
   Days after onset:5
Entered: 1999-02-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Abdominal distension, Conjunctivitis, Constipation, Hypotonia, Infection, Pallor, Pyrexia, Stupor, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), 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), Conjunctival disorders (narrow), Ocular infections (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: N/A~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: exposure to beta strep via vaginal delivery
Allergies:
Diagnostic Lab Data: csf culture neg, meningitis panel suggestive of viral infect, UA & blood cultures neg
CDC Split Type: 19990027621

Write-up: Pt recv vax on 1/29/99; on same day pt exp unresponsiveness, pale, limp; tx= antibiotics & IV fluids


VAERS ID: 118708 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Indiana  
Vaccinated:1999-01-29
Onset:1999-01-29
   Days after vaccination:0
Submitted: 1999-01-30
   Days after onset:1
Entered: 1999-02-09
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456057 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 2 RL / IM

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

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

Write-up: leg (thigh) swollen-red, tender, general body for approx 10-15min-occurred x2 few hr p/vax;? allerg rxn;


VAERS ID: 118770 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-01-29
Onset:1999-01-29
   Days after vaccination:0
Submitted: 1999-02-02
   Days after onset:4
Entered: 1999-02-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0962260 / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0597 / 3 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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)

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

Write-up: fever & irritability;T101-102 ax;


VAERS ID: 118772 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Minnesota  
Vaccinated:1999-01-29
Onset:1999-01-30
   Days after vaccination:1
Submitted: 1999-02-01
   Days after onset:2
Entered: 1999-02-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0939790 / 3 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2597A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402253A / 3 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 45626S / 3 MO / PO

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

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

Write-up: seizure x 3;2x 30JAN99;1 x 31JAN99;


VAERS ID: 118858 (history)  
Form: Version 1.0  
Age: 77.0  
Gender: Female  
Location: Maryland  
Vaccinated:1999-01-29
Onset:1999-01-30
   Days after vaccination:1
Submitted: 1999-02-01
   Days after onset:2
Entered: 1999-02-10
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1585H / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Tricor, Cozaar, Fosamax, Beta pace
Current Illness: NONE
Preexisting Conditions: High blood pressure, irregular heartbeat, Breast cancer in 1995
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: MD99005

Write-up: Pt recv vax on 1/29/99; on 1/30/99 pt exp vax site sore, swollen, red


VAERS ID: 118859 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: Utah  
Vaccinated:1999-01-29
Onset:1999-01-29
   Days after vaccination:0
Submitted: 1999-02-01
   Days after onset:3
Entered: 1999-02-10
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0963390 / UNK LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Injection site oedema, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt has had similar rx to prior vaccines~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: UT991802

Write-up: Pt recv vax on 1/29/99; on same day pt exp fever, body aches, vax site sore & inflamed


VAERS ID: 118924 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Michigan  
Vaccinated:1999-01-29
Onset:1999-02-06
   Days after vaccination:8
Submitted: 1999-02-10
   Days after onset:4
Entered: 1999-02-12
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 90707 / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Cough, Pyrexia, Rash, Rhinitis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt recv vax on 1/29/99; on 2/6/99 pt exp fever, runny nose, cough, rash x 3 day; dx=measles


VAERS ID: 119204 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: Texas  
Vaccinated:1999-01-29
Onset:1999-02-09
   Days after vaccination:11
Submitted: 1999-02-16
   Days after onset:7
Entered: 1999-02-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0944770 / 3 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0895H / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1001H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0795H / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1323H / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Anaemia, Condition aggravated, Leukopenia, Oral candidiasis, Otitis media, Petechiae, Pneumonia, Pyrexia, Rash maculo-papular, Thrombocytopenia
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Fer-in-Sol iron supplement
Current Illness: UNK
Preexisting Conditions: developmental delays (global), Fe deficiency anemia, 3Jan99 hosp for pneumonia
Allergies:
Diagnostic Lab Data: low platelet count 102,000;low WBC count 3.9;low neutrophile count 156;
CDC Split Type:

Write-up: 11-12 days p/vax onset of morbilliform rash w/fever to 101;progressive to petechial rash & irritability required complete w/u;blood/urea/CSF analysis & cult & hosp;dx BOM, pneumonia, anemia, thrombocytopenia, neutropenia, oral candidiasis


VAERS ID: 119741 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: Maryland  
Vaccinated:1999-01-29
Onset:1999-02-11
   Days after vaccination:13
Submitted: 1999-02-24
   Days after onset:13
Entered: 1999-03-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0932110 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1656H / 1 RL / -

Administered by: Public       Purchased by: Other
Symptoms: Injection site oedema, Skin discolouration
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Pt recv vax on 1/29/99; on 2/11/99 pt exp swelling/ discoloration at vax site; tx=Keflex


VAERS ID: 120161 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Male  
Location: New Jersey  
Vaccinated:1999-01-29
Onset:1999-02-09
   Days after vaccination:11
Submitted: 1999-03-05
   Days after onset:24
Entered: 1999-03-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 410303A / 4 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1580H / 1 RA / SC

Administered by: Private       Purchased by: Other
Symptoms: Blood urea normal, Febrile convulsion, Lymphocyte count decreased, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~0.00~In Patient
Other Medications: Albuterol
Current Illness: stable RAD
Preexisting Conditions: otic infection
Allergies:
Diagnostic Lab Data: lymphocyte count, 17 %, Low; blood urea nitrogen, 21 MG/DL, High; total serum carbon, 19 NEQ/L, Low; WBC count, 21.5 K, High
CDC Split Type: WAES99031242

Write-up: 9FEB99 pt devel a high fever & then began to seize;pt was taken to hosp where blood & urine testing were done on IV ATB & therapy started;pt was discharged same day. This is in follow-up to report(s) previously submitted on 5/21/99. Information has been received from a physician concerning a 16-month-old Caucasian male with stable reactive airway disease and a history of otic infection. Who on 29-JAN-1999 was vaccinated SC in the right arm with first dose of MMR II; concomitant vaccine that same day included PEDVAXHIB. On 09-FEB-1999 the patient developed high fever and then began to experience seizures and was taken to the emergency room. He was placed on IV antibiotic therapy, several laboratory testing were performed. Laboratory tests reveal the following results: CO2 = 19.0 NEQ/L; WBC = 21.5 K; LYMPH = 17.0 %. The reporter also noted that the patient was kept in the emergency room for duration of 12 hours. Upon medicail review, it was determined that febrile seizure was an important medical event. The patient recovered from all the symptoms on 09-FEB-1999. No further information is available.


VAERS ID: 120955 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Texas  
Vaccinated:1999-01-29
Onset:1999-02-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 7B91655 / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1361H / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1345H / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX99033

Write-up: measles resulting from vaccine;


VAERS ID: 121095 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: South Carolina  
Vaccinated:1999-01-29
Onset:1999-01-31
   Days after vaccination:2
Submitted: 1999-02-23
   Days after onset:23
Entered: 1999-04-12
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2566B9 / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0950740 / 1 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Chest pain, Hypersensitivity, Injection site reaction, Lymphadenopathy, Oedema, Oedema peripheral, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC99010

Write-up: c/o soreness in lt arm 30JAN99;PM sunday 31JAN99 had fever 100, swelling in lt arm, underarm & chest;1FEB99 child saw MD recv Prelone in tapering doses;hurt into chest;swelling of lt upper extremity;allerg rxn;


VAERS ID: 121306 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Florida  
Vaccinated:1999-01-29
Onset:1999-02-10
   Days after vaccination:12
Submitted: 1999-04-12
   Days after onset:60
Entered: 1999-04-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0600 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Hypokinesia, Multiple sclerosis, Speech disorder, Tongue disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 9/97 rt face weakness/hypesthesia; dx w/acute disseminated myelitis; recuperated;
Allergies:
Diagnostic Lab Data: MRI-lesion brain;CSF w/oligoclonal bands;
CDC Split Type:

Write-up: pt recv vax 26JAN99 & on 10FEB99 had diff in walking, slow speech, uncoordination, dysarthria dx w/MS on 3SEP97; had sx of rt facial weakness, hypesthesia rt face;dx w/disseminated encephalomyelitis;


VAERS ID: 121697 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Nevada  
Vaccinated:1999-01-29
Onset:1999-02-06
   Days after vaccination:8
Submitted: 1999-03-11
   Days after onset:33
Entered: 1999-04-29
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0791H / 2 RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0978770 / 6 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Dizziness, Hyperhidrosis, Myasthenic syndrome, Nausea, Pallor, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ATB for acne
Current Illness: NONE
Preexisting Conditions: acne, hayfever
Allergies:
Diagnostic Lab Data: several blood tests-for autoimmune disease, sed rate, CBC, blood glucose, CXR, EKG;saw aneurologist for f/u-no abnormal findings;
CDC Split Type: NV99007

Write-up: 7 days p/vax pt had tingling rt hand little finger, numbness on underside of arm, dizziness & nausea & weakness in legs w/paleness & clamminess;went to ER & blood work done then lt side (arm & leg) began quivering;dizzy, clammy w/tingling;


VAERS ID: 125584 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: South Carolina  
Vaccinated:1999-01-29
Onset:1999-01-29
   Days after vaccination:0
Submitted: 1999-03-15
   Days after onset:45
Entered: 1999-07-12
   Days after submission:118
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0958460 / UNK LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0961050 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789M / UNK MO / PO
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4978319 / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199900152

Write-up: p/vax pt was fussy;


VAERS ID: 125775 (history)  
Form: Version 1.0  
Age: 0.18  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-01-29
Onset:1999-02-04
   Days after vaccination:6
Submitted: 1999-04-26
   Days after onset:80
Entered: 1999-07-13
   Days after submission:78
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462312 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1614H / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. H0957 / 1 LA / IM
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4974308 / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Diarrhoea, Gastrointestinal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt devel loose stools containing blood tinged mucus 5 days p/ next set of vax~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 899118013A

Write-up: 5 days p/recv vax pt devel loose stools containing blood-tinged mucus; seen by MD & changed formula; pt recovered


VAERS ID: 128196 (history)  
Form: Version 1.0  
Age: 42.0  
Gender: Male  
Location: Unknown  
Vaccinated:1999-01-29
Onset:1999-02-05
   Days after vaccination:7
Submitted: 1999-08-27
   Days after onset:202
Entered: 1999-09-13
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV017 / 3 - / SC
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 553A6 / 2 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Arthritis, Headache, Pain, Pyrexia, Rheumatoid arthritis
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 10/1 & 10/15/98-/anthrax-bioport-#FAV017;12/97-HepatitisA-smithKline-#VHA549B6;
Current Illness: recvovering from hernia surgery
Preexisting Conditions: cluster h/a; sinusitis; temporo-mandibular disease; sulfa allergy; smoker
Allergies:
Diagnostic Lab Data: 8/17/99 ANA, rheumatoid factor, ESR all neg; chemistry; CBC, TSH, DNA double strand, cholesterol all nl;
CDC Split Type:

Write-up: 2/5/99-rt inguinal pain, prescription inc; 5/11/99 rt hip pain; 5/24/99-dx: osteoarthritis bilat; 6/15/99 h/a; 8/17/99- swollen joints; fevers; pain in hands, elbows, shoulder, knees; poss rheumatoid arthritis;dx cluster h/a;


VAERS ID: 132814 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Male  
Location: Unknown  
Vaccinated:1999-01-29
Onset:1999-01-29
   Days after vaccination:0
Submitted: 1999-08-18
   Days after onset:200
Entered: 1999-12-31
   Days after submission:135
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH - / 3 - / SC

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

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

Write-up: No rxn to 1st vax. 2nd dose exp urticaria. 1/29/99 3rd dose - fever, gen erythemia, prolonged urticaria. 8/18/99 pt seen at hosp urticaria spreads all over body. Fever and gen erythemia. Prescribed Hydroxyzine 10mg PO tabs PRN.


VAERS ID: 171418 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: California  
Vaccinated:1999-01-29
Onset:2000-05-24
   Days after vaccination:481
Submitted: 2001-05-15
   Days after onset:356
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1326H / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Infection, Pyrexia, Skin ulcer
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Concurrent Conditions: Varicella exposure
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES00060217

Write-up: Impetigo, Fever - Information has been received from a physician''s office concerning a 2 year old Spanish female patient with wild type varicella exposure who on 29 Jan 1999 was vaccianted with a first dose of varicella virus vaccine live in the left thigh. On 24 May 2000, the patient developed a really bady case with infected lesions, a couple on her face about 3 cm around her mouth, nostrils, ears, and all over her body. she had a fever last week, but on 31 May 2000 at the office visit, she did not. The patient was treated with topical antibiotics. Follow up information from a physician''s office indicated that on 31 May 2000, the patient presented with large lesions on her right earlobe and around her mouth and nostrils. The lesions wore 3 cm and became infectious. The patient was diagnosed with impetigo and treated with amoxicillin triphydrate (+) clavalanate potassium (Augmentin) 400 mg and mupirocin (Bactroban) ointment. On 07 Jun 2000 the patient recovered.


VAERS ID: 172949 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Ohio  
Vaccinated:1999-01-29
Onset:1999-01-29
   Days after vaccination:0
Submitted: 2000-01-26
   Days after onset:362
Entered: 2001-07-05
   Days after submission:525
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457788 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402203A / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0826 / 2 LA / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4978319 / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Diarrhoea, Infection
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: U199901056

Write-up: Diarrhea - A report was received from Wyeth (8-99130-003A) regarding events in Ohio. A territory representative reported that an infant received the first dose of Rota Shield and, later that evening, developed mild diarrhea which resolved the same evening. Follow-up information received from the infant''s mother indicated that her 4 month old son received Roth Shield, DTaP (Wyeth-Lederle), Hib (Wyeth-Lederle) and IPV (PMC France) vaccines in January 1999. Within 24 hours, the infant developed diarrhea. He recovered. No additional information was provided with correspondence returned to Aventis Pasteur US on 19 Jan 2000. From follow up #2 correspondene received on 12/10/01 it was reported that the pt received the vaccinations on 1/29/99. No treatment was required. The pt recovered from this experience and is healthy. The lot numbers and the route/site info for the products were also provided. No further info is expected, this case is closed.


VAERS ID: 193040 (history)  
Form: Version 1.0  
Age: 2.7  
Gender: Female  
Location: Maine  
Vaccinated:1999-01-29
Onset:2002-10-28
   Days after vaccination:1368
Submitted: 2002-11-12
   Days after onset:15
Entered: 2002-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1243H / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: ME02006

Write-up: No fever, itching at 10/21. Rashes 10/22 ~ 30 lesions on trunk.


VAERS ID: 193041 (history)  
Form: Version 1.0  
Age: 5.2  
Gender: Male  
Location: Maine  
Vaccinated:1999-01-29
Onset:2002-10-23
   Days after vaccination:1363
Submitted: 2002-11-12
   Days after onset:20
Entered: 2002-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 86282 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1683E / UNK RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / UNK MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1155H / UNK LA / -

Administered by: Private       Purchased by: Public
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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to sulfur
Allergies:
Diagnostic Lab Data:
CDC Split Type: ME02005

Write-up: 10/23 rashes ~ 100, low fever cover all body.


VAERS ID: 216573 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Female  
Location: Texas  
Vaccinated:1999-01-29
Onset:2004-01-27
   Days after vaccination:1824
Submitted: 2004-02-17
   Days after onset:21
Entered: 2004-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0054H / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dermatitis bullous, Drug ineffective
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient had a case of varicella. Onset 1-27-04.


VAERS ID: 218274 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Male  
Location: Texas  
Vaccinated:1999-01-29
Onset:2004-03-28
   Days after vaccination:1885
Submitted: 2004-03-29
   Days after onset:1
Entered: 2004-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1538H / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1072H / 1 RL / SC

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

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

Write-up: PATIENT RECIEVED VARIVAX ON 01-29-99. NOW HAS CHICKEN POX.


VAERS ID: 159017 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Foreign  
Vaccinated:1999-01-29
Onset:1999-01-29
   Days after vaccination:0
Submitted: 2000-08-21
   Days after onset:569
Entered: 2000-08-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPIPV: DTP + IPV (NO BRAND NAME) / BERNA BIOTECH, LTD - / UNK - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Deafness, Pyrexia, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hearing impairment (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U2000006420

Write-up: On the same day as the vax, the pt experienced a fever and deafness. He recovered with sequelae. The duration was not reported. The reporter''s assessment is unlikely for deafness and probable for fever. Follow-up states the pt developed respiratory distress and was taking antibiotics for suspected infection.


VAERS ID: 165667 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Unknown  
Location: Foreign  
Vaccinated:1999-01-29
Onset:1999-03-26
   Days after vaccination:56
Submitted: 2001-02-06
   Days after onset:683
Entered: 2001-02-08
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER E83059A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The pt had a chromosomal anomaly. First vaccination (P1) with Act-Hib DTP (lot #P5106) on 11/20/1998. P1 lot # and name to be verified.
Allergies:
Diagnostic Lab Data:
CDC Split Type: U2001003730

Write-up: On 3/26/99, the baby developed a Haemophilus type b bacteremia and subsequently died. To be noticed that the pt had a chromosomal anomaly.


VAERS ID: 118848 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: Alabama  
Vaccinated:1999-01-30
Onset:1999-01-31
   Days after vaccination:1
Submitted: 1999-02-03
   Days after onset:3
Entered: 1999-02-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 456816 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 393103A / 3 RL / -

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

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

Write-up: Pt recv vax on 1/30/99; on 1/31/99 pt exp swollen, inflamed nodule on right thigh


VAERS ID: 119209 (history)  
Form: Version 1.0  
Age: 48.0  
Gender: Female  
Location: Arkansas  
Vaccinated:1999-01-30
Onset:1999-01-31
   Days after vaccination:1
Submitted: 1999-02-04
   Days after onset:4
Entered: 1999-02-22
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0944780 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AR995

Write-up: Pt recv vax on 1/30/99; on 1/31/99 pt exp swelling, firm area, redness, sore vax site; dx=cellulitis; tx=Keflex


VAERS ID: 119255 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Female  
Location: California  
Vaccinated:1999-01-30
Onset:1999-01-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1999-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0989580 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dyspnoea, Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: pt recv vax 30JAN99 & pt exp localized redness w/vesicles, pruritus down arm, hand, chest area;SOB w/chest tightness 24hr p/vax;


VAERS ID: 123266 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Female  
Location: Alaska  
Vaccinated:1999-01-30
Onset:1999-01-30
   Days after vaccination:0
Submitted: 1999-02-04
   Days after onset:5
Entered: 1999-06-02
   Days after submission:117
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: pt rpt sore/swollen @ rt arm since vax, seen @clinic w/bruising, slight swelling @ rt arm, full rom rt shoulder/arm.


VAERS ID: 152069 (history)  
Form: Version 1.0  
Age: 31.0  
Gender: Female  
Location: Kentucky  
Vaccinated:1999-01-30
Onset:1999-02-13
   Days after vaccination:14
Submitted: 2000-03-07
   Days after onset:388
Entered: 2000-05-18
   Days after submission:71
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1584E / 3 - / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Muscle atrophy, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Hepatitis C
Allergies:
Diagnostic Lab Data: skin biopsy-results not available
CDC Split Type: WAES99031088

Write-up: On 2/13/99, two weeks post vax, with the third dose, the pt experienced soreness, redness, and slight itching near the injection site. Shortly thereafter, an indentation appeared approximately 2.5 inches below the injection site on her upper right arm. The indentation gradually manifested as muscular atrophy. The pt was seen by a dermatologist and a biopsy was performed. The was dx with morphea scarring of the tissue and therapy with doxycycline and calcipotreine topical ointment was initiated.The MD was not certain of the cause of the incident, and was not sure if the incident was vaccine related. At the time of the report, the pt had not recovered from the experience. No further information is available.


VAERS ID: 256375 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Unknown  
Vaccinated:1999-01-30
Onset:0000-00-00
Submitted: 2006-05-12
Entered: 2006-05-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Laboratory test abnormal
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Negative titer
CDC Split Type: WAES0507USA02082

Write-up: Information has been received from a health professional concerning a 28 year old healthy female who on 12/11/1998 and on 1/30/1999 was vaccinated with varicella virus vaccine live. It was reported that the patient had a negative titer for varicella. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 315832 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Unknown  
Location: Ohio  
Vaccinated:1999-01-30
Onset:2007-05-04
   Days after vaccination:3016
Submitted: 2008-05-16
   Days after onset:378
Entered: 2008-05-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1547H / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1663H / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Skin lesion
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pruritus~Varicella (no brand name)~~11.00~In Sibling
Other Medications:
Current Illness: Seasonal allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA03993

Write-up: Information has been received from a registered nurse concerning a 9 year old patient with seasonal allergies who on 30-JAN-1999 was vaccinated SC on right thigh with a first dose of varicella virus vaccine live (Oka/Merck) (Lot # 628694/1663H). Concomitant therapy included a SC first dose on left thigh with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (MSD) (Lot # 628901/1547H). At the time of vaccination, the patient did not have any illness. It was reported that on 04-MAY-2007 the patient developed less than 50 lesions for 5 days. The patient did not experience any problems and not itching. On 08-MAY-2007, the patient recovered. No medical attention was sought and no diagnostic laboratory tests were undertaken. It was also noted that the patient did not have any adverse events following prior vaccination. No further information is expected. This is one of several reports received from the same source. It was also reported that the patient''s sister had a similar experience after therapy with varicella virus vaccine live (Oka/Merck) (WAES # 0705USA03994).


VAERS ID: 118619 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: New Hampshire  
Vaccinated:1999-02-01
Onset:1999-02-01
   Days after vaccination:0
Submitted: 1999-02-04
   Days after onset:3
Entered: 1999-02-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402253A / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO7263 / 2 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)

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

Write-up: Pt recv vax on 2/1/99; on same day pt exp raised rash at both vax sites


VAERS ID: 119034 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Male  
Location: Ohio  
Vaccinated:1999-02-01
Onset:1999-02-02
   Days after vaccination:1
Submitted: 1999-02-04
   Days after onset:2
Entered: 1999-02-16
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 1681E / 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0950740 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: OH99010

Write-up: Pt recv vax on 2/1/99; on 2/2/99 pt exp red, blotchy rash w/ itching on left thigh vax site; tx=Benadryl;Annual follow-up dated 08/29/00 provided no addtional data.


VAERS ID: 119055 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-02-01
Onset:1999-02-04
   Days after vaccination:3
Submitted: 1999-02-11
   Days after onset:7
Entered: 1999-02-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361503A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0491 / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Pneumonia, Sepsis, Sudden infant death syndrome
SMQs:, Agranulocytosis (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-02-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: SIDS event 72hr p/vax;


VAERS ID: 119067 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-02-01
Onset:1999-02-01
   Days after vaccination:0
Submitted: 1999-02-10
   Days after onset:9
Entered: 1999-02-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 453847 / 4 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 2120192D10 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Malaise, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: w/in 1/2hr of vax pt exp high fever (101 axillary) & listlessness;pt seen in office later in day T102 ax, pt lethargic;neck supple, no sz activity;


VAERS ID: 119078 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: California  
Vaccinated:1999-02-01
Onset:1999-02-03
   Days after vaccination:2
Submitted: 1999-02-10
   Days after onset:7
Entered: 1999-02-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0967100 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CA990011

Write-up: hive reaction <2hr 48hr p/vax;pt was @ school rash resolved by time of afternoon appointment;


VAERS ID: 119081 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:1999-02-01
Onset:1999-02-02
   Days after vaccination:1
Submitted: 1999-02-10
   Days after onset:8
Entered: 1999-02-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1480H / 3 RA / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER 1444H / 2 LA / -

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

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

Write-up: p/24hr inflammation (soreness/swelling) in lt deltoid;pt mom instructed to use warm then cold packs & anti-inflammatory for soreness;no reaction to prev immun;


VAERS ID: 119235 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Arkansas  
Vaccinated:1999-02-01
Onset:1999-02-02
   Days after vaccination:1
Submitted: 1999-02-09
   Days after onset:7
Entered: 1999-02-22
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1237H / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 1172H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H12 / 3 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Ecchymosis, Injection site hypersensitivity, Injection site mass
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Malformation corpus collosum
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AR998

Write-up: Pt recv vax on 2/1/99; on 2/2/99 pt exp red knot on LA vax site, reddish-purple color


VAERS ID: 119270 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Connecticut  
Vaccinated:1999-02-01
Onset:1999-02-12
   Days after vaccination:11
Submitted: 1999-02-17
   Days after onset:5
Entered: 1999-02-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0235H / UNK - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 453226 / 3 MO / PO

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

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

Write-up: coryza;macular-papular rash on face, trunk, proximal areas;


VAERS ID: 119274 (history)  
Form: Version 1.0  
Age: 65.0  
Gender: Female  
Location: Texas  
Vaccinated:1999-02-01
Onset:1999-02-05
   Days after vaccination:4
Submitted: 1999-02-12
   Days after onset:7
Entered: 1999-02-23
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0994610 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Keflex;Ibuprofen;ASA;Magnesium;Doxycycline
Current Illness: sinusitis
Preexisting Conditions: PCN, codeine, valium, elavir, premarin, iodine, paramicorciden, naroxin, iron, MSG, magnesium sulfate, sulfa, demerol, seldane, zantac, DHEA, nystatin, anesthesia;
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: lt deltoid w/erythema & induration of 3.7 x 2.5cm p/vax 4 days prior;tx DPH & warm compresses;


VAERS ID: 119342 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Missouri  
Vaccinated:1999-02-01
Onset:1999-02-19
   Days after vaccination:18
Submitted: 1999-02-20
   Days after onset:1
Entered: 1999-02-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0944770 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1944H / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 1001340 / 3 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Hypertonia, Hypotonia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: 36hr p/vax 4 episodes of ?clonic activity inside of 10min;no fever w/irritability;asymptomatic next AM;


VAERS ID: 120151 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Virginia  
Vaccinated:1999-02-01
Onset:1999-02-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 1999-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0034H / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0795D / 1 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1244H / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA99012

Write-up: 9FEB99 fever 103 R, rash generalized;12FEB99 fever 103, vasculitis-covered w/typical measles rash was seen by MD;enlarged lymph nodes;


VAERS ID: 120152 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Virginia  
Vaccinated:1999-02-01
Onset:1999-02-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 1999-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0034H / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0795D / 1 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1244H / 1 LL / -

Administered by: Public       Purchased by: Public
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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt sibling exp fever, rash, vasculitis, measles rash, enlarged lymph nodes w/MMR~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VA99011

Write-up: 10FEB fever 100R, rash on forehead, body;


VAERS ID: 120154 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: California  
Vaccinated:1999-02-01
Onset:1999-02-01
   Days after vaccination:0
Submitted: 1999-02-25
   Days after onset:24
Entered: 1999-03-10
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 09844 / 1 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Asthma, Chest pain, Condition aggravated, Myalgia, Pruritus, Pyrexia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, DPH PCN for asthma
Current Illness: NONE
Preexisting Conditions: theophylline, alupent, peanuts, IVP dye;hx asthma;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: CA990015

Write-up: facial hives w/itching, chest tightness w/wheezing, low grade fever (99) & generalized body aches;pt didn''t seek medical attention treated self w/DPH & albuterol inhaler;pt has hx of asthma stats took 2 days for sx to subside;has pvt allerg


VAERS ID: 121340 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Arkansas  
Vaccinated:1999-02-01
Onset:1999-02-10
   Days after vaccination:9
Submitted: 1999-02-11
   Days after onset:1
Entered: 1999-04-20
   Days after submission:67
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0982H / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 0775H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 074211 / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 16574 / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash maculo-papular, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: AR9912

Write-up: Pt recv vax on 2/1/99; on 2/10/99 pt exp vomiting, fever, fine/ pinpoint/ red rash on face then back


VAERS ID: 121862 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: New Jersey  
Vaccinated:1999-02-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1999-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Erythema multiforme, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: u
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99030088

Write-up: pt recv vax FEB99 & exp body rash;pt sought unspecified medical treatment;


VAERS ID: 122297 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Female  
Location: Indiana  
Vaccinated:1999-02-01
Onset:1999-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1999-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2235A2 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Anorexia, Arthralgia, Osteoarthritis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: crying, irritable, joints aching & sl swollen, fever up to 103.2, poor appetite w/vomiting of APAP;began 12hr p/vax cont 5 days;child missed 5 days of school during this episode;tx w/APAP & children''s motrin;


VAERS ID: 124569 (history)  
Form: Version 1.0  
Age: 41.0  
Gender: Male  
Location: California  
Vaccinated:1999-02-01
Onset:1999-02-20
   Days after vaccination:19
Submitted: 1999-05-14
   Days after onset:82
Entered: 1999-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99021558

Write-up: 19 days p/vax pt exp varicella w/less than 50 lesions & vesicles. no further info avail


VAERS ID: 124586 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Female  
Location: New York  
Vaccinated:1999-02-01
Onset:1999-02-23
   Days after vaccination:22
Submitted: 1999-05-14
   Days after onset:79
Entered: 1999-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho tri cyclen
Current Illness:
Preexisting Conditions: Contraception
Allergies:
Diagnostic Lab Data: Skin biopsy, results pending; Deoxyribonucleic acid, PCR results pending
CDC Split Type: WAES99030038

Write-up: Information has been received from a physician concerning a 29 year old female patient who in February 1999 was vaccinated with one dose of varicella. Concomitant therapy included birth control pills. On 23-FEB-1999 the patient experienced approximately 25 to 30 erythematous papules throughout her body. She had no fever and the papules did not vesiculate or crust, and there was no necrosis. The patient sought unspecified medical attention. PCR analysis results are pending. A skin biopsy was also performed with results pending. No further information is available.


VAERS ID: 124605 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-02-01
Onset:1999-02-01
   Days after vaccination:0
Submitted: 1999-05-14
   Days after onset:101
Entered: 1999-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant Data~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99030280

Write-up: p/vax pt exp local rxn of 4x6cm area of swelling & redness;


VAERS ID: 124647 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Alabama  
Vaccinated:1999-02-01
Onset:1999-02-01
   Days after vaccination:0
Submitted: 1999-05-14
   Days after onset:101
Entered: 1999-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No Relevant Data~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: 2/99 serum varicella zoster virus varicella antibody test negative p/2 doses;
CDC Split Type: WAES99030805

Write-up: p/vax pt lab eval revealed a lack of response;


VAERS ID: 122655 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Unknown  
Location: Utah  
Vaccinated:1999-02-01
Onset:0000-00-00
Submitted: 1999-05-21
Entered: 1999-05-24
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1553H / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective, Infection, Rash maculo-papular
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99030788

Write-up: it was rpt fr person in MD ofc concerning pt who was vax & subsequently pt exp measles w/small bumps all over lasting 2-3 days.


VAERS ID: 132801 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Idaho  
Vaccinated:1999-02-01
Onset:1999-02-02
   Days after vaccination:1
Submitted: 1999-02-03
   Days after onset:1
Entered: 1999-12-28
   Days after submission:328
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2612AZ / 1 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 594A9 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER 0149831A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID99047

Write-up: Pain left upper quarter 2/2/99 p.m. - 1st oral typhoid 2/1/99.


VAERS ID: 132802 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Male  
Location: Idaho  
Vaccinated:1999-02-01
Onset:1999-02-03
   Days after vaccination:2
Submitted: 1999-02-09
   Days after onset:6
Entered: 1999-12-28
   Days after submission:322
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2612AZ / 1 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 594A9 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER 01499Z01B / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: ID99046

Write-up: 2/3/99 - very nauseated took one dose oral typhoid on 2/1/99.


VAERS ID: 151908 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Male  
Location: Idaho  
Vaccinated:1999-02-01
Onset:1999-02-01
   Days after vaccination:0
Submitted: 2000-04-21
   Days after onset:444
Entered: 2000-05-12
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Headache, Influenza, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000072601

Write-up: At the end of February, 99, the pt received his first injection with Lymerix. Sometime thereafter, the pt experienced a "full blown flu", headache, severe body aches, general lack of energy, and a low fever. No treatment was given, and the symptoms resolved after one week. In late March, 99, the pt received the second dose of Lymerix with no ill effects.


VAERS ID: 152356 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Oregon  
Vaccinated:1999-02-01
Onset:0000-00-00
Submitted: 2000-03-07
Entered: 2000-05-25
   Days after submission:78
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: allergic reaction
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99120918

Write-up: The pt experienced a rash all over her body. It was reported that the first two doses of the vaccine were Hep B vaccine and that the pt had developed a reaction following each dose. Unspecified medical attention was sought. It was reported that the rash resolved within several days. Additional information has been requested.


VAERS ID: 154604 (history)  
Form: Version 1.0  
Age: 49.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1999-02-01
Onset:1999-02-14
   Days after vaccination:13
Submitted: 1999-11-22
   Days after onset:281
Entered: 2000-06-19
   Days after submission:209
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RUB: RUBELLA (MERUVAX II) / MERCK & CO. INC. - / UNK - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99021071

Write-up: 2 weeks post vax, pt developed a flat rash on face and neck and a large node behind ear. There was no fever. A couple of days later the rash was all over body.


VAERS ID: 155082 (history)  
Form: Version 1.0  
Age: 0.7  
Gender: Male  
Location: Colorado  
Vaccinated:1999-02-01
Onset:0000-00-00
Submitted: 2000-02-18
Entered: 2000-06-21
   Days after submission:123
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Skin disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99070426

Write-up: Post vax, the pt experienced dimpling of skin.


VAERS ID: 156682 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Male  
Location: New York  
Vaccinated:1999-02-01
Onset:1999-02-13
   Days after vaccination:12
Submitted: 2000-05-16
   Days after onset:457
Entered: 2000-07-14
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol; Rexan; Acyclovir; Beconase; Claritin
Current Illness:
Preexisting Conditions: spondylitis; ankylosis; cat allergy; seasonal allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99032268

Write-up: Approximately 2 weeks post vax the pt experienced a severe case of varicella. The pt was very sick with a fever of 103F and full blown chickenpox with lesions all over his body.


VAERS ID: 165373 (history)  
Form: Version 1.0  
Age: 0.14  
Gender: Female  
Location: Georgia  
Vaccinated:1999-02-01
Onset:1999-02-03
   Days after vaccination:2
Submitted: 2000-09-21
   Days after onset:595
Entered: 2001-01-24
   Days after submission:125
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 4890A2 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. H0957 / UNK - / SC

Administered by: Private       Purchased by: Private
Symptoms: Hypotonia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood cultures
CDC Split Type: HQ0050421AUG2000

Write-up: Mother reported that the patient received her first dose of DTaP in February, 1999, and 48 hours later, she developed a "hypotonic reaction." The patient was seen by the pediatrician. Her symptoms resolved within 8 hours.


VAERS ID: 172113 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: Unknown  
Vaccinated:1999-02-01
Onset:0000-00-00
Submitted: 2001-05-15
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Viral infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES01020202

Write-up: Information has been received from a medical assistant concerning 3 children who in February 1999 were vaccinated with varicella virus vaccine live. Subsequently the children developed varicella. No further information is expected.


VAERS ID: 172272 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-02-01
Onset:1999-10-04
   Days after vaccination:245
Submitted: 2001-05-15
   Days after onset:589
Entered: 2001-06-01
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Cervix disorder, Foetal disorder
SMQs:, Foetal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamins
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Amniocentesis -05/2081999- normal screening ; ultrasound results-short cervix
CDC Split Type: WAES99040276

Write-up: A 25 year old female pt who was vaccinated with a first and second dose of varicella virus vaccine live in January and February of 1999. It was known the pt was definitely pregnant when receiving the second dose. This report is part of the pregnancy registry. Follow Up information reported the pt never returned to the Dr''s office after her initial visit and the Dr had no information about the outcome of the pt pregnancy. Follow up information from the Dr''s office indicated the on 04-OCT-1999, the pt delivered via C-section and the baby was breech. The pt was also noted that during her pregnancy had several ultrasounds which revealed a short cervix. She also had an amniocentesis done which was normal. The pt was taking prenatal vitamins. The pt had a scheduled C-section because of the breech presentation. The pt gave birth tom a healthy 8 lb 2 oz male infant. Physical exam of the infant showed mild respiratory distress requiring suctioning and oxygen. Occasional rales were heard. On 04-OCT-1999, the infant''s Coomb''s test was negative. On 05-OCT-1999 the infant was feeding poorly from the breast. On 05-OCT-1999, the hemoglobin screen was abnormal with infant having sickle cell trait. The infant had several bilirubin tests and it was noted that the infant''s appetite improved with bottle supplementation. On 09-OCT-1999 the infant was discharged to his mother, his lungs clear, perfusion was good and the mild jaundice had significantly improved. Family testing and genetic counseling was suggested for the child''s parents regarding sickle cell trait.


VAERS ID: 180175 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: Virginia  
Vaccinated:1999-02-01
Onset:2002-01-11
   Days after vaccination:1075
Submitted: 2002-01-12
   Days after onset:1
Entered: 2002-01-22
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1362H / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1327H / 1 - / SC

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

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

Write-up: The pt got chickenpox after having had Varivax on 2/1/99.


VAERS ID: 184733 (history)  
Form: Version 1.0  
Age: 23.0  
Gender: Female  
Location: Unknown  
Vaccinated:1999-02-01
Onset:2001-04-01
   Days after vaccination:790
Submitted: 2002-05-15
   Days after onset:408
Entered: 2002-05-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Serum varicella zoster-weakly positive
CDC Split Type: WAES01041051

Write-up: Information has been received from a licensed visiting nurse concerning a 23 year old female who was vaccinated with two doses of varicella vaccine in January 1999 and February 1999. In September 1999, a serum varicella virus antibody test was "weakly positive." In approximately April 2001, the serum varicella virus antibody test revealed "no seroconversion." No further info is expected.


VAERS ID: 194862 (history)  
Form: Version 1.0  
Age: 44.0  
Gender: Female  
Location: New York  
Vaccinated:1999-02-01
Onset:0000-00-00
Submitted: 2002-12-05
Entered: 2002-12-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / GLAXOSMITHKLINE BIOLOGICALS 120B9 / UNK LA / -

Administered by: Private       Purchased by: Other
Symptoms: Asthenia, Myalgia, Pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Numerous blood test, spinal tap, bone scan, brain MRI, Ct Scan, EMG''s EEG
CDC Split Type:

Write-up: Pt was diagnosed with Lyme in Jan 1997 and treated with numerous antibiotics. Aching muscles continued. Received 2 Lyme vaccines in Feb and Mar 1999. Aching muscles, tingling, constant leg pain and weakness got worse since vaccines. Pt suffer these symptoms everyday- constantly. No treatment or doctors has been able to help at all.


VAERS ID: 204861 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Unknown  
Vaccinated:1999-02-01
Onset:1999-02-01
   Days after vaccination:0
Submitted: 2003-06-10
   Days after onset:1589
Entered: 2003-06-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Abortion, Multiple pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Live birth; Miscarriage; Pregnancy; HIV test positive
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0306USA00329

Write-up: It was reported in a published article that a female patient, who is HIV positive and who has a history of three pregnancies and 1 live birth (a son with autism) who in early February 1999, was vaccinated with a dose of MMR (second generation). The patient had become pregnant in January 1999. Two fetal heartbeats were identified earlier in the pregnancy but later, one was lost, and the mother was told that one of the twins had vanished. On 10/2/99 she delivered a boy who was still normal at age 12 weeks. The author noted that vaccination of women around conception may lead to stillbirths, premature delivery and vanishing twins. It was unknown if medical attention was sought.


VAERS ID: 213971 (history)  
Form: Version 1.0  
Age: 59.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1999-02-01
Onset:0000-00-00
Submitted: 2003-12-13
Entered: 2003-12-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Arthritis, Autoimmune disorder
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin; Levoxyl; Vioxx; Hydrochlorothiazide;
Current Illness: NONE
Preexisting Conditions: Osteoarthritis; Hypertension; Hypothyroid; Post-Lyme disease
Allergies:
Diagnostic Lab Data: DR4
CDC Split Type:

Write-up: Auto immune syndrome-Auto immune osteoarthritis-Vioxx and Praquenil


VAERS ID: 221611 (history)  
Form: Version 1.0  
Age: 6.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-02-01
Onset:0000-00-00
Submitted: 2004-05-17
Entered: 2004-05-25
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: About 200-240 pox marks, very itchy.


VAERS ID: 221807 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Louisiana  
Vaccinated:1999-02-01
Onset:2004-01-27
   Days after vaccination:1821
Submitted: 2004-05-14
   Days after onset:107
Entered: 2004-05-25
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1358H / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1659H / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Pyrexia, Viral infection
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Upper respiratory tract infection.
Preexisting Conditions: Otitis
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0401USA02097

Write-up: Information has been received from a health professional concerning a 5 year old female with no known allergies and a history of otitis and no other pertinent medical history who on 2/1/99 was vaccinated SC with a 0.5ml dose of varicella virus vaccine live (lot # 628248/1659H). On 1/27/04 the patient developed breakthrough chicken pox. She presented to the clinic with fever and 300 chicken pox. It was noted that the chicken pox were on both legs and torso. Treatment was recommended with calamine (+) camphor (+) pramoxine hydrochloride, diphenhydramine hydrochloride, and calamine lotion. It was reported that the patient had not yet recovered from the chicken pox. There was no product quality complaint involved. Additional information has been requested. Follow up information indicated that on Jan 26 2004, the patient developed a fever and vesicles all over her body. On 01/27/2004, the patient was diagnosed with varicella and over 100 lesions were noted throughout. The patient was treated with calamine (-) camphor (+) pramoxine hydrochloride (Aveeno), diphenhydramine hydrochloride (Benadryl) and calamine lotion. No ASA and Isolate. There were no lab test performed. On 02/03/2004 the patient recovered. No further information is expected.


VAERS ID: 251500 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1999-02-01
Onset:2003-12-01
   Days after vaccination:1764
Submitted: 2006-02-14
   Days after onset:806
Entered: 2006-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV030 / 1 RA / ID

Administered by: Military       Purchased by: Military
Symptoms: Influenza like illness, Nasal congestion
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, Lung Xray, Cat Scan, Lung Biopsy, Bronchioscope
CDC Split Type:

Write-up: 12/2003 Flu like symptoms. Chest congestion. Self medicated with over the counter cold medicine. 1/2003 Symptoms became worse. Primary Doctor began treatment for Bronchitis. 3/2003 suspected Asthma. Treated with numerous inhalers. 8/2003 referred to Pulmonologist. Have been under his care to date. All test are negative. Symptoms persist.


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