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Found 459176 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:179784 (history)  Vaccinated:2002-01-03
Age:1.0  Onset:2002-01-03, Days after vaccination: 0
Gender:Female  Submitted:2002-01-07, Days after onset: 4
Location:California  Entered:2002-01-09, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0817L2 LL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4828733 RL
Administered by: Private     Purchased by: Private
Symptoms: Dehydration, Lethargy, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Began vomiting 1 hour after administration of vaccines as well as being lethargic. Hospitalized for dehydration.

VAERS ID:179816 (history)  Vaccinated:2002-01-03
Age:65.0  Onset:2002-01-04, Days after vaccination: 1
Gender:Male  Submitted:2002-01-04, Days after onset: 0
Location:Wisconsin  Entered:2002-01-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ-ASA; ibuprofen
Current Illness:
Preexisting Conditions: Intolerance to Flu shot; HTN
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1449K0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Post vax, the pt developed a local redness, swelling and pain (8cm diameter). NSAIDS

VAERS ID:179821 (history)  Vaccinated:2002-01-03
Age:1.5  Onset:2002-01-05, Days after vaccination: 2
Gender:Male  Submitted:2002-01-07, Days after onset: 2
Location:Tennessee  Entered:2002-01-09, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Croup
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0537DA3IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEUR 2IMLL
Administered by: Private     Purchased by: Private
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: The pt developed erythema multiforme within 48 hours, post vax.

VAERS ID:179822 (history)  Vaccinated:2002-01-03
Age:47.0  Onset:2002-01-04, Days after vaccination: 1
Gender:Female  Submitted:2002-01-07, Days after onset: 3
Location:Florida  Entered:2002-01-09, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abrasions to left leg
Preexisting Conditions: Allergy to PCN and sulfa
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0539AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The pt''s right deltoid was swollen, hot, red and extremely painful lasting 2-3 days.

VAERS ID:179834 (history)  Vaccinated:2002-01-03
Age:12.0  Onset:2002-01-03, Days after vaccination: 0
Gender:Female  Submitted:2002-01-04, Days after onset: 1
Location:New York  Entered:2002-01-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5209A90 LA
Administered by: Private     Purchased by: 0
Symptoms: Dizziness, Fatigue, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Twenty minutes after vaccine complained of overwhelming fatigue, weakness, lightheadedness, nausea. Fatigue persisted into next day.

VAERS ID:179872 (history)  Vaccinated:2002-01-03
Age:0.2  Onset:2002-01-03, Days after vaccination: 0
Gender:Female  Submitted:2002-01-07, Days after onset: 4
Location:New York  Entered:2002-01-11, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM996A20IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1523K0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT07600IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4823770IMLL
Administered by: Private     Purchased by: Public
Symptoms: Crying
SMQs:, Depression (excl suicide and self injury) (broad)
Write-up: Two hours after vaccines patient began crying inconsolably and refused to breastfeed. This episode lasted from 10:30 to 7:00 am the following day.

VAERS ID:180041 (history)  Vaccinated:2002-01-03
Age:1.0  Onset:2002-01-05, Days after vaccination: 2
Gender:Unknown  Submitted:2002-01-08, Days after onset: 3
Location:Michigan  Entered:2002-01-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM576A25IMLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Localized erythema at site of DTaP 2 cm with firm induration managed conservatively with observation

VAERS ID:180046 (history)  Vaccinated:2002-01-03
Age:2.2  Onset:0000-00-00
Gender:Female  Submitted:2002-01-08
Location:Washington  Entered:2002-01-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEUR 2IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC. 1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT14462SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SCRL
Administered by: Private     Purchased by: 0
Symptoms: Injection site erythema, Injection site swelling, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: tender swelling slighty red increased in size @ 4 days post immunizations swelling @ site of hib/heb b vaccine

VAERS ID:180349 (history)  Vaccinated:2002-01-03
Age:1.3  Onset:2002-01-12, Days after vaccination: 9
Gender:Male  Submitted:2002-01-14, Days after onset: 2
Location:Pennsylvania  Entered:2002-01-23, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness: URI & OM- left ear.
Preexisting Conditions: History of idiopathic urticaria
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0734L0IMLL
Administered by: Private     Purchased by: Private
Symptoms: Otitis media, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: MMR given 1-3-02 Fever and rash began to 1-12-02 pt. seen 1-14-02, low grade temperature unresolved. O M still noted. Patient was on amoxicillin. Rash appeared to be measles and not drug eruptions.

VAERS ID:180497 (history)  Vaccinated:2002-01-03
Age:20.0  Onset:0000-00-00
Gender:Female  Submitted:2002-01-11
Location:Virginia  Entered:2002-01-24, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline; Proventil; Ovicon 35
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0630SC 
Administered by: Other     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: A poison-like rash on hands, feet and back of neck.

VAERS ID:180636 (history)  Vaccinated:2002-01-03
Age:0.3  Onset:2002-01-03, Days after vaccination: 0
Gender:Male  Submitted:2002-01-24, Days after onset: 21
Location:Pennsylvania  Entered:2002-01-29, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synagis/Med-Immune-IM-1-12/3/01, Synagis/Med-Immune-IM-2-12/31/01
Current Illness: NONE
Preexisting Conditions: NKA, extracorporeal membrane oxygenation X 9 days after birth
Diagnostic Lab Data: allergy skin testing following 2 mo vaccines, had some reactions @ 2mo all results neg.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM524A21IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0950L1IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU04261SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4831641IMLL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Pt received vaccines @ 9am 1/3/02, onset of urticaria, fever 101-103F 6pm through 1/4/02. Symptoms resolved 1/5/02am. 2nd episode diffuse hives day of vaccines.

VAERS ID:180666 (history)  Vaccinated:2002-01-03
Age:1.0  Onset:2002-01-11, Days after vaccination: 8
Gender:Female  Submitted:2002-01-22, Days after onset: 11
Location:Oregon  Entered:2002-01-29, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 200202
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0537CA2IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT13102IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0943L0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0985L0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Mom verbalizes client started with a fever on 01/11/02 then developed a rash on 01/12/02 but no fever. Client developed a generalized rash to stomach and back a couple of spots on face, arm pits and a spot on the right side of the forehead and a spot to the right leg. (Fever on 01/11/2002 was 101 degrees F.) Rashes gone on 01/16/2002.

VAERS ID:181044 (history)  Vaccinated:2002-01-03
Age:0.6  Onset:2002-01-04, Days after vaccination: 1
Gender:Female  Submitted:2002-01-25, Days after onset: 21
Location:California  Entered:2002-02-07, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': 42860
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0540CA2IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4831762IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site inflammation, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Site of injection was inflamed and it was very swollen at Prevnar site. R thing.

VAERS ID:181077 (history)  Vaccinated:2002-01-03
Age:1.3  Onset:2002-01-04, Days after vaccination: 1
Gender:Male  Submitted:2002-01-28, Days after onset: 24
Location:Maine  Entered:2002-02-07, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Otitis
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM517A23IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT13902IMRL
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Marked redness and swelling at thigh. Pt taken to ER on 01/04/2002 at 6:30pm seen in clinic on 01/05/2002 and the next day, also.

VAERS ID:181122 (history)  Vaccinated:2002-01-03
Age:1.6  Onset:2002-01-04, Days after vaccination: 1
Gender:Male  Submitted:2002-01-07, Days after onset: 3
Location:California  Entered:2002-02-08, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness: otitis media
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': CA020003
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS514A23IMLL
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA6800AA3IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841423IMRL
Administered by: Private     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash-bilat. upper thighs with pruritis.

VAERS ID:181449 (history)  Vaccinated:2002-01-03
Age:29.0  Onset:2002-01-23, Days after vaccination: 20
Gender:Male  Submitted:2002-01-25, Days after onset: 2
Location:D.C.  Entered:2002-02-15, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline 100mg twice a day
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0630SCLA
Administered by: Other     Purchased by: Unknown
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Developed "bump" on left side of nose near left brow/eye that developed surrounding swelling on 23 Jan 02. No fever, chills, nausea, vomiting, malaise or other systemic symptoms reported. Seen in ER and treated with one dose of unknown IV antibiotics. Advised to follow-up as outpatient and received 2nd dose 24 hours later.

VAERS ID:181588 (history)  Vaccinated:2002-01-03
Age:61.0  Onset:2002-01-03, Days after vaccination: 0
Gender:Male  Submitted:2002-02-14, Days after onset: 42
Location:California  Entered:2002-02-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;Tetanus Toxoid (Mfr not specified);;10.00;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0699AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Back pain, Myalgia, Nasal congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: Six hours, post vax, I came down with a light case of flu symptoms (nasal congestion and muscle pains), which increased over several days in severity. No temperature. Muscle pain increased in severity and started first in the lower back and now has moved to the arm, legs and hip joints. It took about 1 1/2 weeks for the nasal congestion to abate. The pain severity has slightly decreased, but is still persistent after 6 weeks, making it just bearable to rise from an automobile seat. Exercise helps, but rising after sitting in one place for any length of time is painful. Ibuprofen and aspirin have little effect.

VAERS ID:181854 (history)  Vaccinated:2002-01-03
Age:0.3  Onset:2002-01-03, Days after vaccination: 0
Gender:Female  Submitted:2002-01-03, Days after onset: 0
Location:Tennessee  Entered:2002-03-01, Days after submission: 57
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM522A21 LL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0774L1 LL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURU03441 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4831741 RL
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Rash macular, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow)
Write-up: On both lower extremities only, scattered erythematous, 3 mm-10mm macules with central clearing. lesions arose within fifteen minutes of vaccinations (pt was asleep within 5 minutes of administration and experienced. No labored breathing, cyanosis, or swelling of mucous membrane.

VAERS ID:182498 (history)  Vaccinated:2002-01-03
Age:13.0  Onset:2002-01-03, Days after vaccination: 0
Gender:Male  Submitted:2003-03-07, Days after onset: 428
Location:New York  Entered:2002-03-14, Days after submission: 358
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0201USA00341
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1230L1  
Administered by: Private     Purchased by: Private
Symptoms: Face oedema, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a physicians assistant concerning a 13 year old male with no known drug allergies who on 03-Jan-2002 was vaccinated with the second dose of hepatitis B vaccine recombinant (yeast). There was no concomitant medications. On 04-Jan-2002, the patient seen in the emergency room with a hive-like rash on his trunk, arms and neck and was also noted to have some facial edema At the time of this report, the outcome of the events was unknown. Additional information has been requested. The pt was treated with Benadryl. Follow up info was received from the physician''s assistant on 2/22/02. It was determined that the rash was "probably not related to the vaccine." The pt was referred to his primary care physician. Additional info has been requested.

VAERS ID:182772 (history)  Vaccinated:2002-01-03
Age:0.2  Onset:2002-01-03, Days after vaccination: 0
Gender:Male  Submitted:2002-03-21, Days after onset: 77
Location:New York  Entered:2002-03-25, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: GERD
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ1399620MAR2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES 1IM 
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES 1IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEUR 1SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES  IM 
Administered by: Private     Purchased by: Private
Symptoms: Aspiration, Condition aggravated, Gastrooesophageal reflux disease, Pneumonia aspiration
SMQs:, Gastrointestinal nonspecific dysfunction (narrow)
Write-up: A mother reported that her 2 month old son, with a history of "reflux problems", received Prevnar, DTAP, Hib and IPV vaccines on 1/3/02. That same day, the infant developed an "increase in reflux which led to aspiration". Subsequently, the child was hospitalized with a dx of pneumonia. He was treated with amoxicillin. The mother stated that the physician feels the "reactions may be the result of an allergy to ingredients in any of the vaccines". Information regarding this event has been forwarded. The pt developed an aggravation of reflux and aspiration following receipt of a subsequent dose of Prevnar; see (HQ1403920MAR2002).

VAERS ID:184345 (history)  Vaccinated:2002-01-03
Age:80.0  Onset:2002-01-29, Days after vaccination: 26
Gender:Female  Submitted:0000-00-00
Location:Wisconsin  Entered:2002-05-09
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure medication, Prilosec, Zyrtec, Cardizem
Current Illness: Arm and legs all swollen for weeks
Preexisting Conditions: Infectious diseases, hypoglycemia, hyperlipidemia, hypertension
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.105261IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Abasia, Dyspnoea, Fluid retention, Hypotension, Injection site infection, Laboratory test abnormal, Nausea, Oral intake reduced, Serum sickness, Weight decreased
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Received pneumonia shot. On 1/21/02, I was home for about 2 weeks sick. On 2/6/02, was in the hospital so sick that I was all swollen and could not walk and filled with fluids. I thought I was going to die and could not hardly breathe. My brother took me to another doctor. 6 pills I was on and so sick and couldn''t barely eat. I still only weight 120 lbs. The doctor said I got the 1 in a thousand that was infected in pneumonia site. The discharge summary states serum sickness, hypotension, and elevated lab values. The annual follow up states "I went to doctor one year and in 6 months I see him again that pneumonia shot poisoned your whole system I was never sick in my life and this poison''s your system, not much of a apposite I weigh 117 pounds my face sure got the wrinkles. I felt better before this shot I had never again will I have it. I am thinning and my arms have the veins showing. Large veins on my legs and my hands the veins get red at times.

VAERS ID:186417 (history)  Vaccinated:2002-01-03
Age:1.1  Onset:2002-01-28, Days after vaccination: 25
Gender:Male  Submitted:2002-05-15, Days after onset: 106
Location:Unknown  Entered:2002-06-12, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Congenital abnormality NOS; neurological disorder NOS; respiratory disorder NOS
Diagnostic Lab Data: Deoxyribonucleic acid-VZV+ (PCR analysis; Oka/Vaccine) 02/14/02
CDC 'Split Type': WAES0201USA03390
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster
SMQs:
Write-up: Information has been received from a physician concerning a 13 month old male with numerous "chronic neurologic and pulmonary conditions" and multiple congenital anomalies who on 01/03/2002 was vaccinated with a dose of varicella virus vaccine live. The reporter stated that, to his knowledge, the pt was not immunosupressed. It was noted that the child is currently hospitalized and on a ventilator and that the reporter was not sure if the child was hospitalized at the time of vaccination or afterward. It was also reported that the pt was hospitalized due to his pre-existing chronic medical condition and it was, in no way, related to vaccination with varicella virus vaccine live. On 01/28/2002 the pt began to develop a rash. He had approximately 12 lesions described as very large juicy vesicles. It was also described as "typical varicella." It was noted that there were 150 vesicular lesions on his trunk, face and extremities that occurred 27 days post vacicnation. His max temp was 101 deg. It was noted that the child had no chickenpox until now and that he had no known exposure to varicella. However, three weeks ago, there was a pt in the hospital who had a case of chickenpox. To the reporter''s knowledge there was no contact between that case and this pt. The physician collected a swab specimen from a vesicular lesion on 01/10/2002 the physician and it was sent for PCR analysis. It was reported that the pt recovered. Another pt (WAES0201USA03220) experienced herpes zoster following vaccination with varicella virus vaccine live. Follow-up info indicated that preliminary results showed the specimen was VZV + and that the specimen would be typed in the next week or so. Additional follow-up reported that the swab from the vesicular lesion was VZV+ and that the PCR analysis identified the presence of Oka/Vaccine strain. The pt is at home and has recovered. It was reported that, to the doctor''s knowledge, the pt was not on steroids for his other underlying conditions and he was "surprised that the child''s rash looked lik

VAERS ID:227861 (history)  Vaccinated:2002-01-03
Age:1.0  Onset:2004-10-07, Days after vaccination: 1008
Gender:Male  Submitted:2004-10-08, Days after onset: 1
Location:Pennsylvania  Entered:2004-10-18, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash

VAERS ID:252714 (history)  Vaccinated:2002-01-03
Age:1.3  Onset:0000-00-00
Gender:Female  Submitted:2006-03-13
Location:California  Entered:2006-03-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Viral infection
SMQs:
Write-up: Child had the chicken pox shot on 1/3/02 from previous Dr. Child had reaction on chickenpox.

VAERS ID:381504 (history)  Vaccinated:2002-01-03
Age:20.0  Onset:2002-01-04, Days after vaccination: 1
Gender:Female  Submitted:2010-02-02, Days after onset: 2951
Location:Unknown  Entered:2010-02-25, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DOXYCYCLINE; OVICON 35; PROVENTIL
Current Illness: Unknown
Preexisting Conditions: Asthma
Diagnostic Lab Data: Exam see note
CDC 'Split Type': 09AV00003OT
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV063 UNUN
Administered by: Other     Purchased by: Other
Symptoms: Oedema peripheral, Rash, Rash macular
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: A poison like rash on hands, feet, and back of neck. Macular rash hands neck. Sl edema of hands. VS stable (see note).

VAERS ID:388850 (history)  Vaccinated:2002-01-03
Age:3.0  Onset:2009-12-04, Days after vaccination: 2892
Gender:Female  Submitted:2010-05-14, Days after onset: 160
Location:Unknown  Entered:2010-05-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: serum immunoglobulin M, 12/07/09, <1:10; serum immunoglobulin G, 12/07/09, 7.3; serum amylase test, 12/07/09, 316; body temp, 101.2 F
CDC 'Split Type': WAES1001USA02146
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Blood amylase increased, Blood immunoglobulin G, Blood immunoglobulin M, Body temperature increased, Mumps, Parotitis, Pyrexia, Vaccine breakthrough infection
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow)
Write-up: Information has been received from a physician concerning a 11 year old female who on 03-JAN-2002 was vaccinated with a dose of MMR II (route, site, dose and lot number not reported). On an unknown date, the patient was vaccinated with a second dose of MMR II (route, site, dose and lot number not reported). On 29-NOV-2009, the patient was vaccinated with a third dose of MMR II (lot number 664886/0776Y) (route, site, dose and lot number not reported). On 04-DEC-2009 the patient experienced mumps. (the date of diagnosis was reported as 06-DEC-2009). The patient had fever of 101.2 F and left parotitis. On 07-DEC-2009, the patient had the following lab tests: serum IgM <1:10, serum IgG 7.3 and serum amylase was 316. The patient was exposed to others with mumps and there were other reported cases in the same household. The outcome for mumps was not reported. No further information is available.

VAERS ID:179783 (history)  Vaccinated:2002-01-04
Age:0.2  Onset:2002-01-04, Days after vaccination: 0
Gender:Female  Submitted:2002-01-07, Days after onset: 3
Location:New Mexico  Entered:2002-01-09, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 50 mg
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS522A20IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.095160IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT14640SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841460IMRL
Administered by: Other     Purchased by: Public
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow)
Write-up: Within 20-30 minutes of being immunized infant had an apneic episode.

VAERS ID:180052 (history)  Vaccinated:2002-01-04
Age:1.3  Onset:2002-01-04, Days after vaccination: 0
Gender:Female  Submitted:2002-01-07, Days after onset: 3
Location:Illinois  Entered:2002-01-16, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPH: DTAP + HIB (TRIHIBIT)AVENTIS PASTEUR0933L0IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT139L2IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4828733IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site reaction
SMQs:
Write-up: 6 x 7 cm localized reaction from injection site on left thigh from diptheria, tetanus and pertussis vaccine.

VAERS ID:180055 (history)  Vaccinated:2002-01-04
Age:1.3  Onset:2002-01-05, Days after vaccination: 1
Gender:Female  Submitted:2002-01-09, Days after onset: 4
Location:California  Entered:2002-01-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1133L   
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0165L   
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES481551   
Administered by: Private     Purchased by: Public
Symptoms: Injection site induration, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen firm painful lamp R $gL lasted at least 6 days.

VAERS ID:180146 (history)  Vaccinated:2002-01-04
Age:58.0  Onset:2002-01-05, Days after vaccination: 1
Gender:Male  Submitted:2002-01-08, Days after onset: 3
Location:Texas  Entered:2002-01-18, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0154AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: On 1/8/02, the client reported that on 1/5/02, he noted swelling and redness under his left arm. Advised client to see doctor and he declined.

VAERS ID:180356 (history)  Vaccinated:2002-01-04
Age:4.0  Onset:2002-01-05, Days after vaccination: 1
Gender:Female  Submitted:2002-01-07, Days after onset: 2
Location:Wisconsin  Entered:2002-01-23, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair
Current Illness: Resolving pneumonia
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM521A24IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT13702SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1374L1IMLA
Administered by: Private     Purchased by: Other
Symptoms: Blister, Erythema, Pain, Swelling
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 1/4/02 Received DTaP injection Right upper arm 1/5/02 right arm red swollen, tendser at injection site 1/6/02 blisters develop @ injection site, increased swelling & pain. Child seen in emergency room, started on cephalaxin antibiotic. 1/7/02 seen at our clinic-Rx pedrapred zyrtec 1.9.02 F/u visit-blisters healed, minimal redness, swelling, no pain 1/14/2002 Resolved

VAERS ID:180549 (history)  Vaccinated:2002-01-04
Age:1.6  Onset:2002-01-06, Days after vaccination: 2
Gender:Female  Submitted:2002-01-11, Days after onset: 5
Location:New Jersey  Entered:2002-01-25, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Heart murmur
Diagnostic Lab Data: Saw a neurologist went back to ER.
CDC 'Split Type': NJ20023
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM521A23IMLA
HIBV: HIB (ACTHIB)AVENTIS PASTEUR563AA3IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT090922 LA
Administered by: Public     Purchased by: Public
Symptoms: Coma, Convulsion, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow)
Write-up: On 01/09/2002, received a call from the pt''s mother stating that the child had seizure lasting 20 mins of unresponsiveness and was taken to the ER. Mom also stated that the child has been taking tempertanitrums since birth with periods of unresponsiveness. Physician told mom that the episode was not feel that it was vaccine related. Patient had a seizure 15-20 minutes unresponsive. ER then days after she had severe hives.

VAERS ID:180591 (history)  Vaccinated:2002-01-04
Age:1.1  Onset:2002-01-04, Days after vaccination: 0
Gender:Male  Submitted:2002-01-18, Days after onset: 14
Location:Wisconsin  Entered:2002-01-28, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Diarrhea, fever over 101 deg.
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood cultures negative; chest x-ray normal
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0674L2IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0904L0IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1149L0IMLL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Pyrexia
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)
Write-up: Low grade fever and loose stools on day of immunization prior to immunizations. Within 6 hrs of receiving immunizations, pt developed fever of 103-104 degrees F. and had generalized tonic/clonic seizure lasting 90 sec. On 01/12/2002 again, the pt had fever and generalized seizure. No history of seizures before 01/04/2002

VAERS ID:180921 (history)  Vaccinated:2002-01-04
Age:50.0  Onset:2002-01-06, Days after vaccination: 2
Gender:Female  Submitted:2002-01-11, Days after onset: 5
Location:Michigan  Entered:2002-02-05, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthyroid
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Diagnostic Lab Data:
CDC 'Split Type': MI2002006
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUB077AA0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: On 1-5-02, patient "bumped" area in evening. On 1-6-02, patient woke up and noticed left arm had 1-2 inch area that was red, bumpy and itchy. Area "improved" between 1-7-02 and 1-10-02. On 1-10-02, patient reports "bumping" area again and area is "red, slightly bumpy, and some itching on 1-11-02. No treatment.

VAERS ID:181025 (history)  Vaccinated:2002-01-04
Age:5.0  Onset:2002-01-04, Days after vaccination: 0
Gender:Male  Submitted:2002-01-31, Days after onset: 27
Location:Maryland  Entered:2002-02-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Had allergy testing (milk and mildew allergy); Immunosupressed
Diagnostic Lab Data: Blood tests; X-rays
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.135110IMLA
Administered by: Public     Purchased by: 0
Symptoms: Abdominal pain upper, Dehydration, Pneumonia, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Four hours, post vax, the pt developed a temperature of 103.7F. He developed a 4 X 4 red rash on 1/5/02 and had bad stomach pains. He was hospitalized on 1/23/02 with dehydration and pneumonia (overnight stay). Treated with antibiotics; Keflex IM and then Zithromax Keflex po.

VAERS ID:181241 (history)  Vaccinated:2002-01-04
Age:0.3  Onset:2002-01-04, Days after vaccination: 0
Gender:Male  Submitted:2002-02-01, Days after onset: 28
Location:Ohio  Entered:2002-02-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA648AA0IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841490IMRL
Administered by: Private     Purchased by: 0
Symptoms: Pallor, Staring
SMQs:, Hypotonic-hyporesponsive episode (broad)
Write-up: Several hours after receiving the vaccinations he seemed very pale and dazed.

VAERS ID:181247 (history)  Vaccinated:2002-01-04
Age:16.0  Onset:2002-01-05, Days after vaccination: 1
Gender:Female  Submitted:2002-01-29, Days after onset: 24
Location:Michigan  Entered:2002-02-12, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Antibacterial cream for skin infection
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': MI2002008
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4018053 IMRA
Administered by: Public     Purchased by: 0
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: Rash on bilateral arms and shoulders. Rash noticed by client on 1/5/02 around the injection site and spread across shoulders and other arm. Pt denies itching, difficulty breathing, shortness of breath or rash anywhere else on her body. PHN referred pt to PP. Follow-up call to parent on 1/10/02 finds that rash is still present but is "doing fine". On 1/29/02, telephone call to parent who stated that the rash persisted until 1/21/02 (approx). The rash was never red but was raised; only on the upper body, shoulders and back primarily and somewhat itchy (but not intense). Other factors discussed; the pt had been treated and recovered from scabies but still had some lingering lesions. The pt was never taken to a doctor for care during this time. Recommended discussing this reaction with the pt''s doctor and to consider checking prior to receiving future vaccines.

VAERS ID:181261 (history)  Vaccinated:2002-01-04
Age:58.0  Onset:2002-01-11, Days after vaccination: 7
Gender:Male  Submitted:2002-02-01, Days after onset: 21
Location:Idaho  Entered:2002-02-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: flu/4018054/IM/RD/0
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID02005
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS217A40IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT1464 IMLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0138BA IMLA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURT1229Z0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0228L0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Malaise, Pharyngolaryngeal pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Generalized malaise, sore throat, rash on body starting 7 days after vaccines given. Lasting 1 week +.

VAERS ID:181376 (history)  Vaccinated:2002-01-04
Age:12.0  Onset:2002-01-15, Days after vaccination: 11
Gender:Male  Submitted:2002-02-06, Days after onset: 22
Location:New York  Entered:2002-02-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: dust allergies and Latex
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: 0
Symptoms: Pityriasis rosea, Skin ulcer
SMQs:
Write-up: Herald lesion on right arm discovered 1/15/02-Hep B shot given on 1/4/02-several lesions on torso 1/5/02-Pityriasis Rosea diagnosed.

VAERS ID:181537 (history)  Vaccinated:2002-01-04
Age:4.0  Onset:2002-01-05, Days after vaccination: 1
Gender:Female  Submitted:2002-01-07, Days after onset: 2
Location:Georga  Entered:2002-02-20, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': GA02006
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM984A24IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEUR09093SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1384K1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site reaction, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Mom stated child''s left arm was red and swollen with some itching. She gave the child Tylenol and put ice pack on arm, also applied Benadryl. Mom stated child was afebrile, which she was told to bring the child in if she felt that her arm needed to be looked at. Mom called back on 01/08/2002 and said that the child is doing much better.

VAERS ID:181795 (history)  Vaccinated:2002-01-04
Age:3.0  Onset:2002-01-04, Days after vaccination: 0
Gender:Female  Submitted:2002-02-18, Days after onset: 45
Location:California  Entered:2002-02-27, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONe
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Hyperhidrosis, Inflammation, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Very high fever; skin clammy, hot and red; shot was hard in center didn''t end for 24 hrs.

VAERS ID:181887 (history)  Vaccinated:2002-01-04
Age:1.0  Onset:2002-01-10, Days after vaccination: 6
Gender:Female  Submitted:2002-01-15, Days after onset: 5
Location:Illinois  Entered:2002-03-04, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT head; Chemistry panel; EEG
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0376L0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0575L0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Convulsion, Dyskinesia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt developed jerking seizure lasting about 3-4 minutes and was taken to ER per EMT. Parent left ER after labs, CT and urine taken; pt was signed out AMA. Had 2nd seizure which occurred at home. Pt was taken to ER by EMT and admitted. Had 3rd seizure on 1/11/02 while in the hospital.

VAERS ID:182437 (history)  Vaccinated:2002-01-04
Age:0.5  Onset:0000-00-00
Gender:Male  Submitted:2002-03-04
Location:Michigan  Entered:2002-03-14, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM505A21IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0554K IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT09015 SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES480897 IMRL
Administered by: Private     Purchased by: 0
Symptoms: Injection site induration, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Localized swelling and tenderness persisted. Now, 2 months later, induration and tenderness continue.

VAERS ID:183079 (history)  Vaccinated:2002-01-04
Age:0.5  Onset:2002-01-07, Days after vaccination: 3
Gender:Male  Submitted:2002-03-22, Days after onset: 74
Location:Kansas  Entered:2002-04-02, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM542A21IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0950L0IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURU03441SCLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large amount of redness and swelling of the right thigh.

VAERS ID:185227 (history)  Vaccinated:2002-01-04
Age:36.0  Onset:2002-01-07, Days after vaccination: 3
Gender:Male  Submitted:2002-05-22, Days after onset: 134
Location:Unknown  Entered:2002-05-23, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine hydrochloride (Prozac) 20mg daily; Diazepam 5mg 3 X daily
Current Illness: UNK
Preexisting Conditions: Allergic Rhinitis; Anxiety; Bipolar Affective Disorder 1998; Dyspepsia 1985
Diagnostic Lab Data: CBC revealed elevated WBC, neutrophil and monocyte counts; lymphocyte count was decreased; ESR-37mm/hr (H); Parvovirus B19 IgG-(+); WBC-11,900/uL (H)
CDC 'Split Type': A0357443A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Lymphopenia, Monocytosis, Pain, Pyrexia, Rash, Red blood cell sedimentation rate increased, Viral infection, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: The pt received his 1st injection of Twinrix on 1/4/02. On 1/7/02, 3 days post vax, he began to experience muscle aches, body aches, joint pain and rash. On 1/9/02, 5 days post vax, he began to experience fever that ranged from 101F to 103F. He presented for medical attention on 1/12/02. In the physician''s office, his temperature was 102.1F.

VAERS ID:190585 (history)  Vaccinated:2002-01-04
Age:0.2  Onset:2002-01-04, Days after vaccination: 0
Gender:Female  Submitted:2002-09-19, Days after onset: 257
Location:Unknown  Entered:2002-09-25, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES0203USA00995
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM522A20IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC. 0IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT14540SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841460IMRL
Administered by: Other     Purchased by: Other
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow)
Write-up: Information has been received concerning a 2 month old female who on 1/4/02 was vaccinated with the first dose of Haemophilus B conjugate vaccine, hepatitis B vaccine recombinant (yeast) IM in the right leg (lot #09516-invalid). Concomitant therapy that same day included the first dose of diphtheria toxoid/pertussis vaccine/tetanus toxoid (INFANRIX) IM in the left leg (lot #522A2), the first dose of poliovirus vaccine (IPOL) SC in the left leg (lot #T1454), the first dose of Streptococcus pneumoniae vaccine (PREVNAR) IM in the right leg (lot #484146). Other concomitant therapy included acetaminophen (TYLENOL) (PARACETAMOL). Within 20-35 minutes post-vaccination, the patient experienced an apneic episode and was hospitalized for 2 days. This was originally reported by a health professional. Follow up information was received from manufacturer on 9/4/02. No further medically significant information was provided. No further information is available.

VAERS ID:198985 (history)  Vaccinated:2002-01-04
Age:6.0  Onset:2002-01-07, Days after vaccination: 3
Gender:Female  Submitted:2003-03-06, Days after onset: 423
Location:California  Entered:2003-03-07, Days after submission: 1
Life Threatening? No
Died? Yes
   Date died: 2002-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM05206A2 IMLA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM706A2 IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.07422 SCLA
Administered by: Public     Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.

VAERS ID:199498 (history)  Vaccinated:2002-01-04
Age:  Onset:2002-01-04, Days after vaccination: 0
Gender:Unknown  Submitted:2003-03-07, Days after onset: 427
Location:Unknown  Entered:2003-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES0201USA01081
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2IM 
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from an RN concerning a child who on 1/4/02 was vaccinated with the 3rd dose of Hep-B vaccine recombinant (yeast). It was reported that the child subsequently developed hives. Unspecified medical attention was sought. No further info was provided at the time of this report. Conflicting follow-up from the RN stated that the child did not experience an adverse reaction. No further info is expected.

VAERS ID:199519 (history)  Vaccinated:2002-01-04
Age:38.0  Onset:0000-00-00
Gender:Female  Submitted:2003-03-07
Location:Michigan  Entered:2003-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Dynacin
Current Illness:
Preexisting Conditions: Acne, NOS
Diagnostic Lab Data: Serum alanine, ? 2002, value - 123, elevated; Serum aspartate, ? 2002, value - 70, elevated; Serum LDH, ? 2002, value - 263, elevated;
CDC 'Split Type': WAES0205USA01153
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1336L1  
Administered by: Public     Purchased by: Other
Symptoms: Hepatitis, Liver function test abnormal
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow)
Write-up: Info. has been received from a registered nurse from an employee health department concerning a 38 y.o. female financial analyst employee w/acne who was vax''d w/her first and 2nd dose of Hep B vax recombinant on 12/3/01 at 8 a.m. and 1/4/02 at 8:00, respectively. Concomitant therapy included one dose of MMRII on 1/11/02 and minocycline HCl (Dynacin), for treatment of her acne. The nurse reported that on an unknown date in 2002 the PT alleged that she had elevated liver enzymes and verbal reports of Lab results from the PT herself revealed elevated serum alanine aminotransferase of 123, elevated serum aspartate aminotransferase of 70, and elevated serum lactate dehydrogenase of 263. The nurse also reported that the "doctor felt she had hepatitis." It was not known why the PT had her liver enzymes tested but it was known that she has had the test done previously related to therapy w/minocycline HCl (Dynacin). The nurse further reported that there was no proof of the elevated liver enzymes at her facility, that the PT was no longer employed there, and that attempts to have follow-up have failed. The PT sought unspecified medical attention. Add''l info is not expected.

VAERS ID:204694 (history)  Vaccinated:2002-01-04
Age:3.0  Onset:2003-06-04, Days after vaccination: 516
Gender:Female  Submitted:2003-06-05, Days after onset: 1
Location:California  Entered:2003-06-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1145L0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Rash papular
SMQs:
Write-up: Varicella: Findings: Chest with fine pink papules right leg with vessicles. Treatment: Aveeno baths and Benadryl.

VAERS ID:281591 (history)  Vaccinated:2002-01-04
Age:1.1  Onset:2006-10-02, Days after vaccination: 1732
Gender:Female  Submitted:2007-05-16, Days after onset: 226
Location:Maine  Entered:2007-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Diagnostic laboratory test, 10/02?/06, "tested the lesions" - verified as wild type varicella.
CDC 'Split Type': WAES0610USA05039
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Skin lesion, Varicella, Varicella post vaccine, Varicella zoster virus serology positive
SMQs:
Write-up: Information has been received from a physician concerning a 5 year old female with no allergies or medical history who on 04-JAN-2002 was vaccinated SC with a 0.5 mL dose of Varivax (lot # "MSD18931-1"). There was no concomitant medication. On 02-OCT-2006, the patient was found to have six lesions located on the face, torso, and back. The lesions were tested and verified that it was wild type varicella. Unspecified medical attention was sought. The patient was given Benadryl. A product quality complaint was not involved. Varicella was determined to be an other important medical event by the physician. Additional information has been requested.

VAERS ID:308655 (history)  Vaccinated:2002-01-04
Age:1.1  Onset:2008-03-22, Days after vaccination: 2269
Gender:Male  Submitted:2008-03-31, Days after onset: 9
Location:Texas  Entered:2008-03-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: Immunosuppression work-up underway
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)PFIZER/WYETH484198 IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0793L0IMRL
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Blister, Herpes zoster, Immunology test
SMQs:, Severe cutaneous adverse reactions (broad), Retroperitoneal fibrosis (broad), Hypersensitivity (broad)
Write-up: Pt does not have known case of Varicella and had Varicella Vaccine on 1/4/02. On 3/22, developed back pain on R, then erupted in violaceous patches of vesicles along R T1. Seen by 3 physicians-all confirming shingles. Responded to acyclovir.

VAERS ID:182548 (history)  Vaccinated:2002-01-04
Age:23.0  Onset:2002-01-04, Days after vaccination: 0
Gender:Female  Submitted:2002-03-11, Days after onset: 66
Location:Foreign  Entered:2002-03-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': U200200174
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS 0IM 
RAB: RABIES (NO BRAND NAME)UNKNOWN MANUFACTURER    
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEUR  IM 
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (broad)
Write-up: It was reported that a 23 year old female pt was concomitantly vaccinated on 1/4/02 with a dose of Typhoid vaccine, a 1st dose of Hep-A and B vaccine (Twinrix), a dose of Rabies and Virus Encephalitis Tick Borne vaccine (both unknown manufacturers). On the same day, the pt experienced chest tightness (very mild reaction). The pt recovered on an unspecified date. On 1/11/02, the pt was administered a 2nd dose of Hep-A and B vaccine. Two hours later, the pt presented with chest tightness, which lasted for 2 days. The reporter considered the reaction to be serious as it was a "Medically Significant Event" and the 3rd dose of Hep-A and B vaccine was not given. Twinrix was indicated by the reporter as the suspect vaccine. No more information is expected. The case is closed. From follow-up it was reported that this case is a duplicate of the non-serious cas UK021112 that had also been reported through the UK Health Authorities on 3/11/02. The two cases have merged, which retains the ADROIT merged number 439249. Additional information from case Uk021112 is as follows: On 1/4/02, the patient experienced brochospasm described by the reporter on follow-up as very mild chest tightness. Bronchospams is also reported to have occurred between 1/11/02 - 1/13/02. The case is closed.

VAERS ID:180029 (history)  Vaccinated:2002-01-05
Age:1.3  Onset:2002-01-05, Days after vaccination: 0
Gender:Male  Submitted:2002-01-08, Days after onset: 3
Location:Ohio  Entered:2002-01-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Phenergan VC syrup
Current Illness: Upper airway congestion; nasal drainage
Preexisting Conditions:
Diagnostic Lab Data: MRI; EEG, LP-all neg
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA648AA3IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1084L0IMLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4848622IMLL
Administered by: Private     Purchased by: Private
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: The pt developed a fever and a seizure about 12 hours, post vax. He needed valium to "break". Dx: Atypical febrile seizure

VAERS ID:181380 (history)  Vaccinated:2002-01-05
Age:62.0  Onset:2002-01-16, Days after vaccination: 11
Gender:Male  Submitted:2002-02-04, Days after onset: 19
Location:Ohio  Entered:2002-02-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COPD
Preexisting Conditions: Sulfa
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0996L1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Influenza, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: sore arm during day of vaccination. twenty-four hours after vaccination, arm swollen and slightly reddened, lasted 1 1/2 -2 days. Pt also felt like had mild case of flu

VAERS ID:184289 (history)  Vaccinated:2002-01-05
Age:46.0  Onset:2002-01-12, Days after vaccination: 7
Gender:Male  Submitted:0000-00-00
Location:New Jersey  Entered:2002-05-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~Anthrax (Biothrax)~6~37.00~Patient
Other Medications: Glidizide
Current Illness: Depression
Preexisting Conditions: diabetes
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0636SC 
Administered by: Other     Purchased by: Public
Symptoms: Back pain, Chest pain, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Headache, leg and chest pain, fever

VAERS ID:187150 (history)  Vaccinated:2002-01-05
Age:0.2  Onset:2002-02-02, Days after vaccination: 28
Gender:Female  Submitted:2002-03-14, Days after onset: 40
Location:Michigan  Entered:2002-07-02, Days after submission: 109
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Lumbar puncture - postivie for streptococcal pneumonia organism
CDC 'Split Type': HQ1246711MAR2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM522A20IM 
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA629AA0IM 
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT14640IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841970IM 
Administered by: Other     Purchased by: Other
Symptoms: Bacterial infection, Drug ineffective, Sepsis
SMQs:, Agranulocytosis (broad), Lack of efficacy/effect (narrow)
Write-up: A registered nurse reported that a 2 month old female received a 1st dose of Prevnar, Infanrix, Polio vaccine, and ActHIB vaccines on 01/05/2002. The pt developed meningitis 4 weeks after receiving her first Prevnar immunization. The child was hospitalized. A spinal tab revealed a "streptococcal pneumonia organism" that is now being studied to determine the serotype involved. No additional info was available as of the date of this report.

VAERS ID:207243 (history)  Vaccinated:2002-01-05
Age:24.0  Onset:2002-10-07, Days after vaccination: 275
Gender:Female  Submitted:2003-07-30, Days after onset: 296
Location:Pennsylvania  Entered:2003-08-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0211USA01563
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0165M0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Injection site oedema, Malaise, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Info has been received from a physician concerning a 24 year old female teacher with no known allergies or prior medical history who on 01/05/2002 was vaccinated with a 1st dose of pneumococcal vaccine 23 polyvalent (Lot #642722/0165M), intramuscularly in her right deltoid. The pt had no illness at the time of vaccination. On 10/07/2002, the pt developed urticaria with tender wheals and edema at the injection site followed by malaise and chills. The pt was treated with prednisone. The physician reported that no diagnostic or laboratory tests were performed. On 11/07/2002, the pt recovered. The pt sought medical attention from the reporting physician. Additional info is not expected.

VAERS ID:213036 (history)  Vaccinated:2002-01-05
Age:1.1  Onset:2002-01-05, Days after vaccination: 0
Gender:Male  Submitted:2002-09-18, Days after onset: 255
Location:Unknown  Entered:2003-11-25, Days after submission: 433
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Nasopharyngitis
Diagnostic Lab Data: Electroencephalogram negative; Lumbar puncture negative; Nuclear magnetic resonance imaging negative.
CDC 'Split Type': u200200193
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)AVENTIS PASTEUR  IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1084L IMLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES484862 IMLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, Febrile convulsion
SMQs:, Anaphylactic reaction (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: A 15 month old male received injections of Prevnar (third dose), MMR II, and ActHIB on 1/5/02. The infant had pre-existing upper airway congestion and nasal drainage. Concomitant therapy included Phenergan VC syrup. Approximately 12 hours post vaccination, the infant developed fever and a seizure. He needed valium to breathe. Magnetic resonance imaging, electroencephalogram and lumbar puncture results were negative. The infant was hospitalized for 3 days. The diagnosis was atypical febrile seizure. From additional correspondence received on 9/4/02, no further medically significant information provided. Case is closed.

VAERS ID:180491 (history)  Vaccinated:2002-01-06
Age:39.0  Onset:2002-01-10, Days after vaccination: 4
Gender:Male  Submitted:2002-01-15, Days after onset: 5
Location:Wisconsin  Entered:2002-01-24, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU0674AA IMLA
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIESUA444AA SCLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0464AA IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESR0826 IMRA
Administered by: Military     Purchased by: Military
Symptoms: Lymphoedema
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 4 day, post vax, I noticed a large lump in my left armpit. After taking Naprosyn, it died down, after 4 days.

VAERS ID:197883 (history)  Vaccinated:2002-01-06
Age:2.0  Onset:2002-01-06, Days after vaccination: 0
Gender:Male  Submitted:2003-01-07, Days after onset: 366
Location:Idaho  Entered:2003-02-19, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': ID03002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS755A20IMLL
Administered by: Public     Purchased by: Public
Symptoms: Cough, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Mom states that child started having hives a few hours after Hepatitis A vaccine received. Mom gave child Benadryl. Mom stats that child still have a few on his back and his ears the next day. Mom also states that child starting coughing too.

VAERS ID:179836 (history)  Vaccinated:2002-01-07
Age:0.5  Onset:2002-01-07, Days after vaccination: 0
Gender:Male  Submitted:2002-01-08, Days after onset: 1
Location:North Carolina  Entered:2002-01-10, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xopenex
Current Illness: Recovering from RSV
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSA522A2 IMLL
HBPV: HIB POLYSACCHARIDE (HIBIMUNE)LEDERLE LABORATORIES4803194F IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM52528A IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES480898 IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad)
Write-up: Fever up to 101F, irritability and erythema at the site.

VAERS ID:179853 (history)  Vaccinated:2002-01-07
Age:36.0  Onset:2002-01-07, Days after vaccination: 0
Gender:Female  Submitted:2002-01-08, Days after onset: 1
Location:New Jersey  Entered:2002-01-10, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0706L0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Blood pressure increased, Chest pain, Heart rate increased, Lacrimation increased, Lethargy, Pruritus, Throat tightness, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Hypersensitivity (broad)
Write-up: At 16:00, the pt displayed symptoms of itchy throat, watery eyes, lethargic, PR-110, R-20, BP-140/80 and complained of mid-sternal chest pain and wheezing. O2 via mask was given at 3L/minute IV, NS, Epinephrine .3mg SC. EMS called and responded. Pt taken to ER; alert and responsive with decreased chest pain.

VAERS ID:179984 (history)  Vaccinated:2002-01-07
Age:1.4  Onset:2002-01-08, Days after vaccination: 1
Gender:Male  Submitted:2002-01-09, Days after onset: 1
Location:Louisiana  Entered:2002-01-15, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Rapid Strep-neg
CDC 'Split Type': LA020202
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM527A22IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1133L2IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT14462SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4831712IMRL
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: The pt developed a temperature of 104.a (axillary). The temperature decreases to 102F with Tylenol; no relief with Motrin. Went to ER on 1/8/02 and MD found no problems.

VAERS ID:179997 (history)  Vaccinated:2002-01-07
Age:4.0  Onset:0000-00-00
Gender:Female  Submitted:2002-01-10
Location:North Carolina  Entered:2002-01-15, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albudrol daily
Current Illness: NONE
Preexisting Conditions: allergies
Diagnostic Lab Data:
CDC 'Split Type': NC02001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM514824 LA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT09093SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.M0154L1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Mom tells PNN small amount of edema on 01/08/02 but has increased largely since yesterday per mom. On 1-9-02 left arm red and edematous 3 quarters way to elbow . PHN learned on 1-10-02 that MD ordered Motrin and cold compresses

VAERS ID:180044 (history)  Vaccinated:2002-01-07
Age:5.0  Onset:2002-01-09, Days after vaccination: 2
Gender:Female  Submitted:2002-01-10, Days after onset: 1
Location:New Mexico  Entered:2002-01-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0536BA4IMRA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM706A20IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT11283SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1090L1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash, red, raised difused, warm to touch on cheeks, fore arms, to a lesser degree on upper arms and legs, does not itch. No fever or other symptoms.

VAERS ID:180080 (history)  Vaccinated:2002-01-07
Age:54.0  Onset:2002-01-08, Days after vaccination: 1
Gender:Male  Submitted:2002-01-11, Days after onset: 3
Location:Vermont  Entered:2002-01-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0912L0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Joint swelling, Neck pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: About 24 hours, post vax of 1st injection, the pt complains of neck pain. About 12 hours later, he complained of fever and bilateral knee pain and swelling. He contacted his private MD who has prescribed Celebrex.

VAERS ID:180087 (history)  Vaccinated:2002-01-07
Age:0.5  Onset:2002-01-08, Days after vaccination: 1
Gender:Male  Submitted:2002-01-08, Days after onset: 0
Location:Texas  Entered:2002-01-17, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM521A22IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA621AA2IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT13902SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4831741IMRL
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt with parent complaining of hot, red and swollen injection site on left thigh. Rx''d Benadryl po and cold compresses to area per doctor.

VAERS ID:180341 (history)  Vaccinated:2002-01-07
Age:13.0  Onset:2002-01-07, Days after vaccination: 0
Gender:Male  Submitted:2002-01-14, Days after onset: 7
Location:Missouri  Entered:2002-01-23, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol; Singulair
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: Liver panel; ESR; CBC-all wnl; Mean WBC-2.5
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5209C91IMLA
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Headache, Hyperhidrosis, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad)
Write-up: The pt was seen in the doctor''s office on 1/11/02 for complaints of joint pain, general malaise, fever and sweats since 1/7/02. Pt also had a headache. Dx''d with serum sickness due to Hep-B injection.

VAERS ID:180345 (history)  Vaccinated:2002-01-07
Age:33.0  Onset:2002-01-08, Days after vaccination: 1
Gender:Female  Submitted:2002-01-09, Days after onset: 1
Location:Idaho  Entered:2002-01-23, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0372L1 LL
Administered by: Private     Purchased by: 0
Symptoms: Myalgia, Pain, Rash, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Local reaction to MMR. left arm swelling erythema, pain, tenderness & rash. Ice pack applied. taking Advil. Local reaction resolved 1-14-02

VAERS ID:180469 (history)  Vaccinated:2002-01-07
Age:3.0  Onset:2002-01-08, Days after vaccination: 1
Gender:Female  Submitted:2002-01-14, Days after onset: 6
Location:South Dakota  Entered:2002-01-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal; Tomax
Current Illness: UNK
Preexisting Conditions: Moderately abnormal EEG 8/2001. Child has elevated liver enzymes from seizure medication. Petit mal seizures since 10 months of age related to left mesial temporal sclerosis.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40180291IMRL
Administered by: Public     Purchased by: Public
Symptoms: Grand mal convulsion, Injection site pain
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt had her first influenza injection December 5th. On January 7th the child was brought in for the second immunization and the mother reported that the site "got a little sore the last time." On 01/08/2002 the child was seen at the medical clinic and was admitted to the hospital with grand mal seizures and transferred to a different hospital a later that day.

VAERS ID:180512 (history)  Vaccinated:2002-01-07
Age:1.3  Onset:2002-01-14, Days after vaccination: 7
Gender:Male  Submitted:2001-10-16, Days after onset: 90
Location:Washington  Entered:2002-01-24, Days after submission: 100
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA596AC3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0741L0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash macular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Fever of 103.2F, pinpoint macular rash on the chin, neck, upper chest and back.

VAERS ID:180513 (history)  Vaccinated:2002-01-07
Age:1.5  Onset:0000-00-00
Gender:Male  Submitted:2002-01-16
Location:Illinois  Entered:2002-01-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild nasal congestion
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS522A23 LL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES4774003 LL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT07872 RL
Administered by: Unknown     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 1/8/02 seen with reaction locally; swelling and erythema left thigh 4cmx8cm. No fever. Completely resolved in 5 days.

VAERS ID:180596 (history)  Vaccinated:2002-01-07
Age:0.6  Onset:2002-01-08, Days after vaccination: 1
Gender:Male  Submitted:2002-01-22, Days after onset: 14
Location:Virginia  Entered:2002-01-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0518L2IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT10982SCLL
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis contact
SMQs:, Hypersensitivity (narrow)
Write-up: On 1/8/02, the pt broke out in a rash similar in appearance to a contact dermatitis (per PMD), non-pruritic. The pt is breast fed.

VAERS ID:180722 (history)  Vaccinated:2002-01-07
Age:1.0  Onset:2002-01-07, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Rhode Island  Entered:2002-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0595L0SC 
Administered by: Military     Purchased by: Military
Symptoms: Unevaluable event
SMQs:
Write-up: Pt given dose of MMR that had been out of temperature range

VAERS ID:180764 (history)  Vaccinated:2002-01-07
Age:1.0  Onset:2002-01-09, Days after vaccination: 2
Gender:Female  Submitted:2002-01-10, Days after onset: 1
Location:Tennessee  Entered:2002-01-31, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergy to milk product
Diagnostic Lab Data:
CDC 'Split Type': TN02002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1638K2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1513K0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0570L0SCLL
Administered by: Public     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash on chest and arms, Referred to PCP.

VAERS ID:180771 (history)  Vaccinated:2002-01-07
Age:20.0  Onset:2002-01-08, Days after vaccination: 1
Gender:Female  Submitted:2002-01-21, Days after onset: 13
Location:Maryland  Entered:2002-01-31, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD0160441A0PO 
Administered by: Private     Purchased by: 0
Symptoms: Abdominal pain, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: The pt had nausea and abdominal cramping beginning on 1/8/02 and continuing through 1/14/02. No treatment.

VAERS ID:180800 (history)  Vaccinated:2002-01-07
Age:1.5  Onset:2002-01-08, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2002-02-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pediagole 1/7/02-1/11/02
Current Illness:
Preexisting Conditions: Bronchrolitis
Diagnostic Lab Data: blood culture (-); CXR-(-); Echo (-); electrolytes (-); UA (-); 3.7 $g11.7/35.8 < 196K, 0 p, 57 l, 30 atl, 5m,
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0536BA IM 
Administered by: 0     Purchased by: 0
Symptoms: Neutropenia, Petechiae, Purpura, Pyrexia
SMQs:, Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Petechiae/ purpura, fever, neutropenia

VAERS ID:180807 (history)  Vaccinated:2002-01-07
Age:41.0  Onset:2002-01-10, Days after vaccination: 3
Gender:Female  Submitted:2002-01-22, Days after onset: 12
Location:Washington  Entered:2002-02-01, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol 25mg, Klonopren 7mg
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0343AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 5 cm diameter indurated area left deltoid, emanating from the deep tissue. It is slightly tender. No erythema and full range of motion of shoulder, no lymphadenopathy.

VAERS ID:181091 (history)  Vaccinated:2002-01-07
Age:1.0  Onset:2002-01-11, Days after vaccination: 4
Gender:Male  Submitted:2002-01-17, Days after onset: 6
Location:North Carolina  Entered:2002-02-07, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Possible allergy to milk (not tested yet)
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0154L SCLA
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 4 days after receiving vaccine he began having a red rash on his face and shoulders. On day 8 after receiving the shot he broke out with hives and a red rash on legs then began a temperature. Rash, hives, and temp continued for 4 more days. First began treating with Benadryl for the hives and Motrin for his temperature. His temperature fluctuated between 101.5F- 99F. After 4 days with little improvement, the doctor prescribed Hydroxide liquid and after 2 days symptoms improved.

VAERS ID:181259 (history)  Vaccinated:2002-01-07
Age:1.0  Onset:2002-01-13, Days after vaccination: 6
Gender:Male  Submitted:2002-01-29, Days after onset: 16
Location:Texas  Entered:2002-02-12, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': TX02018
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0537DA3IMLL
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA620AA3IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0738L0SCLL
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash morbilliform
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Per Dr symptoms fever, rash (measles) symptom occur 6 days after immunization.

VAERS ID:181263 (history)  Vaccinated:2002-01-07
Age:17.0  Onset:2002-01-07, Days after vaccination: 0
Gender:Female  Submitted:2002-01-14, Days after onset: 7
Location:Idaho  Entered:2002-02-12, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;DTaP (unknown mfr);1;0;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': ID02002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5208A20IMLA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM706A20IMRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Chest pain, Dizziness, Eye irritation, Eye pain, Pyrexia, Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Pt complained of dizziness 20 minutes after injections. 2 hrs later hives appeared and pt complained of heaviness in chest, like someone sitting on chest. Pt sent to ER - later that day @ 4pm Pt again went to ER with heaviness in chest. Next day complained of fever 101F, thick swollen tongue, itchy eyes that hurt and joint aches.

VAERS ID:181271 (history)  Vaccinated:2002-01-07
Age:5.0  Onset:2002-01-07, Days after vaccination: 0
Gender:Female  Submitted:2002-01-14, Days after onset: 7
Location:Nebraska  Entered:2002-02-12, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': NE021
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM975A24IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT02664IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1390K1SCRL
Administered by: Public     Purchased by: Public
Symptoms: Bradycardia, Coma, Hyperventilation, Hypotonia, Hypoventilation, Pallor
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Just got done with shots and became heavy in foster mom''s arms; head went down, color was very pale, breathing very shallow and unresponsive. Layed down and 30 seconds later, she came around. P-68. At 18:17, P-92 and R-32. Skin still clammy at 18:35. Called PA for MD. Pt stayed around until 19:13. Foster mom visited with PA at 19:30 and took her home.

VAERS ID:181362 (history)  Vaccinated:2002-01-07
Age:33.0  Onset:2002-01-08, Days after vaccination: 1
Gender:Male  Submitted:2002-02-06, Days after onset: 29
Location:Unknown  Entered:2002-02-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline 100 po BID times 4 days
Current Illness:
Preexisting Conditions: Diabetes Mellitus II
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV063 SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Back pain, Chills, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt had chills times 1 day, N&V times 4 days and L extremity pain dorsum post vaccination. Sought medical care 3 days post vax with treatment with LMD with otc analgesic and anti-emesis. All conditions resolved with no further problems noted.

VAERS ID:181476 (history)  Vaccinated:2002-01-07
Age:15.0  Onset:2002-01-16, Days after vaccination: 9
Gender:Female  Submitted:2002-01-23, Days after onset: 7
Location:Illinois  Entered:2002-02-19, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness: NONE
Preexisting Conditions: PCN, Amoxicillin
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPH: DTAP + HIB (TRIHIBIT)AVENTIS PASTEURUA531AA3IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT07862SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0162K0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Temp 1-16-02@ 102 degree F, 1-17-02@ 104.5-104.7, 1-18-02 rash saw dr., temp was down, rash on abd, gave Tylenol (day 10), Day 2 gave Motrin

VAERS ID:181519 (history)  Vaccinated:2002-01-07
Age:0.2  Onset:2002-01-07, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:2002-02-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0537DA0IMRL
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA625AP/U8091AA0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT14500SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841960IMLL
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER0958L0IMLL
Administered by: Private     Purchased by: Private
Symptoms: Heart rate irregular, Pallor, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt. developed pallor, thready pulses, tachycardia about 10 mins. after injection. Resolved with treatment in 15 min.

VAERS ID:181534 (history)  Vaccinated:2002-01-07
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:2002-02-06
Location:Minnesota  Entered:2002-02-20, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, CRP, ESR
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0776L2 RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0904L0 LL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841972 RL
Administered by: Private     Purchased by: Private
Symptoms: Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Persistent fever x 5-7days, MMR on 01/17-01/24. Swelling at injection site for 5 days, Prevnar on 01/08-01/13.

VAERS ID:181570 (history)  Vaccinated:2002-01-07
Age:0.5  Onset:2002-01-21, Days after vaccination: 14
Gender:Male  Submitted:2002-01-25, Days after onset: 4
Location:Michigan  Entered:2002-02-20, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM527A22IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1825K2IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEUR9040302SCLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Mass palpated in right thigh, noted 2 weeks after IZ given in right thigh. No treatment. Will have pt follow-up to document resolution.

VAERS ID:181777 (history)  Vaccinated:2002-01-07
Age:0.6  Onset:2002-01-21, Days after vaccination: 14
Gender:Male  Submitted:2002-05-30, Days after onset: 128
Location:Illinois  Entered:2002-02-27, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Blood culture-(+) Streptococcus pneumonia, serology 19F; CBC-results not reported
CDC 'Split Type': WAES0202USA01910
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0540CA2IM 
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1409K2IM 
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1375K IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815432IMRL
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Irritability, Pneumonia, Pyrexia, Sepsis, Vomiting
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad)
Write-up: Information has been received concerning a 7 month old male who on 1/7/02 was vaccinated with 1 dose of Hep-B vaccine recombinant (yeast) (lot 637547/1375K), a 3rd dose IM in the right thigh of PREVNAR (lot 481543), a 3rd dose of HIB conjugate Hep-B (lot 637764/1409K) and a 3rd dose of TRIPEDIA (lot 40540CA). On 1/21/02, the infant was seen by a physician for fever, vomiting and irritability. A blood culture on 1/21/02 was (+) for Streptococcus pneumonia, serology 19F. The infant received unspecified treatment. Vaccination failure was also reported. Streptococcal septicemia was considered to be an "Other Important Medical Event". This report was originally received from a physician. No further information is available. Follow up info from the physician noted that the pt was doing well and had recovered from all of his experiences. No further info is available. It has been determined that WAES0202USA02894 is a duplicate of WAES0202USA01910. Therefore, WAES0202USA02894 is being deleted from our files and the reports consolidated into WAES0202USA01910. WAES0202USA02894 was previously submitted to the FDA on 3/7/02. Additional follow up info from the physician indicated that there was "no concern about the above stated vaccine in this given pt." No further info is available.

VAERS ID:181844 (history)  Vaccinated:2002-01-07
Age:0.6  Onset:2002-01-31, Days after vaccination: 24
Gender:Male  Submitted:2002-02-26, Days after onset: 26
Location:Unknown  Entered:2002-03-01, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Blood culture-(+) streptococcus pneumoniae, serotype 19F; CBC-results not reported
CDC 'Split Type': U200200140
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEUR 2IM 
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.  IM 
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 2IMRL
Administered by: 0     Purchased by: 0
Symptoms: Bacterial infection, Irritability, Pneumonia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad)
Write-up: A physician reported that a 7 month old male received his 3rd dose of Prevnar along with Tripedia, Comvax, and Recombivax-HB vaccines on 01/07/2002. On 01/31/2002, the infant was seen by a physician for fever, vomiting and irritability. A blood culture was positive for streptococcus pneumoniae, serotype 19F. A CBC was performed; however, results were not reported. The infant received unspecified treatment. Streptococcal septicemia is considered medically important.

VAERS ID:181853 (history)  Vaccinated:2002-01-07
Age:47.0  Onset:2002-01-08, Days after vaccination: 1
Gender:Female  Submitted:2002-01-15, Days after onset: 7
Location:Washington  Entered:2002-03-01, Days after submission: 45
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: localized reaction/fever;DTaP (Certiva);;10.00;In Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4722090IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 1-8-02, Local swelling and redness Left deltoid 7 cm diameter around injection site. Pt reports '';low grade" fever and chills. No other symptoms reported. Swelling completely resolved by 1/12/02

VAERS ID:183482 (history)  Vaccinated:2002-01-07
Age:47.0  Onset:2002-01-07, Days after vaccination: 0
Gender:Female  Submitted:2002-04-04, Days after onset: 87
Location:New York  Entered:2002-04-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM524A21IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Moderate swelling on the left arm from the elbow to the shoulder. Pain in the erythematous area. Reaction after 8 hours and lasted for 8 days. No fever or discharge at the injection site.

VAERS ID:183536 (history)  Vaccinated:2002-01-07
Age:2.2  Onset:2002-01-18, Days after vaccination: 11
Gender:Male  Submitted:2002-02-06, Days after onset: 19
Location:Alaska  Entered:2002-04-16, Days after submission: 68
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: OMNISEF
Current Illness: NONE
Preexisting Conditions: Ear infection
Diagnostic Lab Data:
CDC 'Split Type': AK200209
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1149L0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Hypersensitivity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Mother called to let a nurse know that 11 days after receiving varicella, pt had an allergic reaction. Client had also been on "OMNISEF" for an ear infection. Parent took the child to the ER because hands, ears and feet became swollen. MD unsure if it''s related to vaccine or antibiotic.

VAERS ID:184540 (history)  Vaccinated:2002-01-07
Age:1.5  Onset:2002-01-20, Days after vaccination: 13
Gender:Female  Submitted:2002-01-22, Days after onset: 2
Location:Washington  Entered:2002-05-14, Days after submission: 111
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': WA021817
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0296AC0IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The pt developed hard "lump" at injection site.

VAERS ID:186010 (history)  Vaccinated:2002-01-07
Age:0.8  Onset:2002-02-25, Days after vaccination: 49
Gender:Male  Submitted:2002-05-06, Days after onset: 69
Location:Pennsylvania  Entered:2002-06-04, Days after submission: 29
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CSF positive for Streptococcus pneumoniae type 19A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURU04262SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4831763 LL
Administered by: Private     Purchased by: Private
Symptoms: Bacterial infection, Infection, Lethargy, Meningitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Presented to office with overnight fever, lethargy, vomiting, nonspecific exam. Admitted to hospital and had positive spinal tap for Streptococcus pneumoniae type 19A.

VAERS ID:197233 (history)  Vaccinated:2002-01-07
Age:15.0  Onset:2002-01-07, Days after vaccination: 0
Gender:Male  Submitted:2002-01-14, Days after onset: 7
Location:Colorado  Entered:2003-02-04, Days after submission: 386
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': U200200008
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0376AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash maculo-papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: It was reported that a 15 y.o. male PT received a TD adult vaccination administered on 1/7/02 at 10 a.m. At approximately 3:30 that same day the PT developed blotchy, itchy rash on his face. PT was given Benadryl 50 mg po. The PT''s recovery status is unknown.

VAERS ID:199232 (history)  Vaccinated:2002-01-07
Age:0.4  Onset:2002-01-22, Days after vaccination: 15
Gender:Male  Submitted:2002-10-31, Days after onset: 282
Location:Iowa  Entered:2003-03-11, Days after submission: 131
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PT experienced 2-3 lumps in both legs w/in the first few wks after receiving the first set of immunizations (Infanrix, Comvax, and IPV) on 10/29/01.
Diagnostic Lab Data: Nodules were drained and the cultures revealed sterile abscess. The pathology report on the biopsy material obtained from the PT shows that an inflammatory granuloma consisting of lymphohistocytic reaction and eosinophils.
CDC 'Split Type': U200200474
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS9891 RL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1822K1 LL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT07871 LL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES483175   
Administered by: Other     Purchased by: Other
Symptoms: Granuloma, Hypersensitivity, Injection site mass, Injection site reaction
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Info has been received on 6/27/02 from a health care prof''l concerning a 5 mt old male PT who was vax''d with the first dose of Infanrix, Comvax, and IPV on 10/29/01. PT presented w/2-3 lumps in both legs w/in the first few wks after receiving the first set of immunizations. On 6/7/02, PT was also vax''d with Infanrix, Comvax, IPV, and Prevnar. On 1/22/02, PT''s mother called the MD''s office to report that PT''s left leg was infected. PT developed nodules to inject sites. Nodules were drained and the cultures revealed sterile abscess. On 2/5/02, new lumps also presented and recheck showed 4-5 mm area that will scar. PT was referred to a local dermatologist at that time. He was evaluated for nodular areas on 3/27/02 at a local university. It was determined that the lumps were due to an aluminum allergic reaction. At the present, PT is doing some follow-up w/the local university. His last visits were on 5/16/02 and 6/14/02. According to the MD''s report received on 6/1/02, PT presented w/a palpable subcutaneous nodule of unknown origin in the middle of his right anterior thigh, which is a typical reactionary nodule that develops after vax''s which contain aluminum. The pathology report on the biopsy material obtained from the PT shows an inflammatory granuloma consisting of lymphohistocytic reaction and eosinophils was observed, which is consistent w/a vax reaction.

VAERS ID:234766 (history)  Vaccinated:2002-01-07
Age:1.3  Onset:2005-02-28, Days after vaccination: 1148
Gender:Male  Submitted:2005-03-02, Days after onset: 2
Location:Pennsylvania  Entered:2005-03-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin
Current Illness: under treatment for ear infection diagnosed 01/02/2003
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1230L2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1091L SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0965L SCLA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Pruritus, Pyrexia, Rash erythematous, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Vaccine Breakthrough. Seen in our office 03/01/2005 with fever and rash. Onset 02/28/2005. Had 10-12 lesions on trunk. Erythematous with central vesicle and few crusted. Itchy. Had varicella vaccine 01/07/2002. DX''d with varicella by Dr. on 03/01/2005.

VAERS ID:248423 (history)  Vaccinated:2002-01-07
Age:1.0  Onset:2005-11-20, Days after vaccination: 1413
Gender:Female  Submitted:2005-11-21, Days after onset: 1
Location:Ohio  Entered:2005-11-29, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Febrile;30 lesions
Preexisting Conditions: Amoxicillin
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURU042V2 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1210L  RA
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Temp 102 on 11/21 and rash on head, body, arms plus multiple lesions.

VAERS ID:271038 (history)  Vaccinated:2002-01-07
Age:1.0  Onset:2007-01-18, Days after vaccination: 1837
Gender:Female  Submitted:2007-01-18, Days after onset: 0
Location:North Carolina  Entered:2007-01-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: Clinical observation.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER 3 UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 2 UN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 0 UN
Administered by: Other     Purchased by: Other
Symptoms: Acne, Blister, Medical observation
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Multiple vesicles, papules.

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