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Case Details (Sorted by Vaccination Date)

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VAERS ID:167903 (history)  Vaccinated:2001-03-15
Age:2.0  Onset:2001-03-20, Days after vaccination: 5
Gender:Female  Submitted:2001-03-21, Days after onset: 1
Location:Iowa  Entered:2001-03-28, 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747271IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site reaction, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: The pt developed hives on 3/20/01 with a large area of erythema at the site of Prevnar injection.

VAERS ID:168164 (history)  Vaccinated:2001-03-15
Age:1.3  Onset:2001-03-15, Days after vaccination: 0
Gender:Male  Submitted:2001-03-26, Days after onset: 11
Location:Minnesota  Entered:2001-04-03, 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: ? early URI
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0049L2IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725542IMRL
Administered by: Private     Purchased by: Private
Symptoms: Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Fever and extreme fussiness 1 hr post immunizations

VAERS ID:168177 (history)  Vaccinated:2001-03-15
Age:2.0  Onset:2001-03-15, Days after vaccination: 0
Gender:Male  Submitted:2001-03-21, Days after onset: 6
Location:Virginia  Entered:2001-04-03, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: RAD which is ongoing but no wheezing that day
Preexisting Conditions: Seizure disorder ?; RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4706410IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS593453A0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01170IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1267J0IMRL
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: On 3/15/01, had DT Pediatric, Hib, IPV and MMR. Within 1 hours, post vax, had full body hives. He was treated with Benadryl and Ora Pred. Symptoms resolved on 3/19/01.

VAERS ID:168196 (history)  Vaccinated:2001-03-15
Age:4.0  Onset:2001-03-16, Days after vaccination: 1
Gender:Male  Submitted:2001-03-21, Days after onset: 5
Location:Massachusetts  Entered:2001-04-03, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0328BA IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T0394 SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0405K SCLA
Administered by: 0     Purchased by: 0
Symptoms: 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: Swelling, warmth, tenderness at injection site.

VAERS ID:169137 (history)  Vaccinated:2001-03-15
Age:25.0  Onset:2001-04-16, Days after vaccination: 32
Gender:Female  Submitted:2001-04-18, Days after onset: 2
Location:Wisconsin  Entered:2001-04-25, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1381K SC 
Administered by: Other     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: The pt had been instructed at the time of MMR administration to prevent/avoid pregnancy for 3 months after receiving the vaccine. The pt unintentionally became pregnant. LMP 3/12/01, MMR given on 3/15/01. The pt had a positive pregnancy test on 4/16/01. Pt unsure of plans regarding pregnancy. The pt did not have an adverse reaction.

VAERS ID:169258 (history)  Vaccinated:2001-03-15
Age:3.5  Onset:2001-03-16, Days after vaccination: 1
Gender:Male  Submitted:2001-03-19, Days after onset: 3
Location:Ohio  Entered:2001-04-30, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: OH0014
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAMA972A23IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T026622IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1383K0IMRL
Administered by: Public     Purchased by: 0
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: On 3/15/01, vaccines were given. On 3/16/01, left thigh was warm and red. On 3/17/01 and 3/18/01, leg continued to be red, despite mom''s efforts with Benadryl cream. She contacted physician. No other symptoms. On 3/17/01, brought back child to H D to show redness of approx. 5" in diameter to left thigh with slight warmth to area.

VAERS ID:172526 (history)  Vaccinated:2001-03-15
Age:49.0  Onset:2001-03-15, Days after vaccination: 0
Gender:Female  Submitted:2001-05-10, Days after onset: 55
Location:Ohio  Entered:2001-06-27, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: estrogen
Current Illness: NONE
Preexisting Conditions: penicillin allergy
Diagnostic Lab Data: NONE
CDC Split Type: OH0033
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0839K0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Anxiety, Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Thirty minutes after receiving vaccine the patient developed a pinpoint rash on bilateral forearms and tightness in the throat. The patient became anxious.

VAERS ID:187515 (history)  Vaccinated:2001-03-15
Age:  Onset:2001-04-28, Days after vaccination: 44
Gender:Male  Submitted:2002-05-30, Days after onset: 397
Location:Unknown  Entered:2002-07-15, Days after submission: 46
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: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01042849
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1268J   
Administered by: Unknown     Purchased by: Other
Symptoms: Parotid gland enlargement
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Information has been received from a physician concerning a male patient who on 0/15/02 was vaccinated with MMRII. On 04/28/01, the patient experienced swelling of the right parotid gland. No other other symptoms were noted. Unspecified medical attention was sought. Additional information has been requested

VAERS ID:167885 (history)  Vaccinated:2001-03-15
Age:  Onset:2001-03-15, Days after vaccination: 0
Gender:Unknown  Submitted:2001-03-23, Days after onset: 8
Location:Foreign  Entered:2001-03-28, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20010072591
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM 0IM 
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  SC 
Administered by: 0     Purchased by: 0
Symptoms: Coma, Pallor, Strabismus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: On 3/15/01, a few minutes, post vax, the vaccinee became pale and unresponsive to touch and the eyes deviated to the left for 30 seconds and then returned to normal. The reporter considered the events to be "Medically Significant" and states that it will affect the giving of future immunizations. The most recent information received on 3/21/01, reports the outcome of the pt as recovered on 3/15/01. No other details were given. No further information is expected.

VAERS ID:174551 (history)  Vaccinated:2001-03-15
Age:2.0  Onset:2001-03-15, Days after vaccination: 0
Gender:Male  Submitted:2001-08-20, Days after onset: 157
Location:Foreign  Entered:2001-08-22, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20010198281
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM  IM 
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS  IM 
Administered by: 0     Purchased by: 0
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: On 3/15/01, a dose of Infanrix was given. On the same day, post vax, the boy developed urticaria and a severe rash on his limbs. He was seen by a physician and was given Epinephrine, Promethazine and an unspecified antihistamine. He completely recovered. The events were considered "Medically Important" by the reporting physician.

VAERS ID:167407 (history)  Vaccinated:2001-03-16
Age:60.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-19, Days after onset: 3
Location:New Hampshire  Entered:2001-03-20, 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: estroderm patch, prometrium
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NH0110
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0376AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site mass, Oedema, Rash maculo-papular, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: The pt felt hot on the way home from the physicians office, then developed a macular papular rash on 3/17 and on the following day 3/18 experienced hives and swelling in the neck. The pt also experienced injection site redness, hardness and warmth to the touch. Saw physician on 3/18 and still had rash on arms, trunk and legs.

VAERS ID:167687 (history)  Vaccinated:2001-03-16
Age:1.7  Onset:2001-03-17, Days after vaccination: 1
Gender:Male  Submitted:2001-03-19, Days after onset: 2
Location:New York  Entered:2001-03-22, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: URI, rhinorrhea, nasal congestion, and fever
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733321IMRL
Administered by: Private     Purchased by: 0
Symptoms: Agitation, Crying, Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad)
Write-up: 20-25 minutes of unconsolable crying, uncontrolled crying, swelling, and slight redness.

VAERS ID:167823 (history)  Vaccinated:2001-03-16
Age:32.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-15, Days after onset: 1
Location:New York  Entered:2001-03-26, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0368AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Malaise, 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: Pain, swelling and redness 14 hours, post vax, followed by chills, fever and bad malaise on the next day. Symptoms started to resolve on the 3rd day.

VAERS ID:167852 (history)  Vaccinated:2001-03-16
Age:1.8  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-20, Days after onset: 4
Location:Georgia  Entered:2001-03-27, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS958A23IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1409K0IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4749550IMLA
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The pt broke out in a rash all over her body.

VAERS ID:167870 (history)  Vaccinated:2001-03-16
Age:1.5  Onset:2001-03-16, Days after vaccination: 0
Gender:Male  Submitted:2001-03-09, Days after onset: 7
Location:Florida  Entered:2001-03-27, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0176K0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1694J0SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Immediately following vaccination, the pt broke out in a red rash and whelps. The pt was treated with Benadryl.

VAERS ID:167899 (history)  Vaccinated:2001-03-16
Age:1.6  Onset:2001-03-17, Days after vaccination: 1
Gender:Male  Submitted:2001-03-20, Days after onset: 3
Location:California  Entered:2001-03-28, 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: epistaxis
Preexisting Conditions: small for gestational age
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725481IM 
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The pt experienced urticaria within 24 hours post vax. The pt also had the same reaction with the 1st dose.

VAERS ID:167955 (history)  Vaccinated:2001-03-16
Age:4.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-20, Days after onset: 4
Location:Minnesota  Entered:2001-03-28, 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESVO266BA4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T04723SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1160K1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: The CMA spoke with the mother of the patient on 03/21/01, the patient is doing fine. The CMA explained to the mother the need for the patient to receive DTaP at her 5 year visit.

VAERS ID:168162 (history)  Vaccinated:2001-03-16
Age:0.3  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-22, Days after onset: 6
Location:Wisconsin  Entered:2001-04-03, 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: none
Current Illness: none well baby check
Preexisting Conditions: none
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0357CA1IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1588K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T02661SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720451IMRL
Administered by: Private     Purchased by: Private
Symptoms: Irritability, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: Within 24 hrs onset of fever 101.5F, irritable, erythematous rash - seen by MD on 3/19/01. Fever subsided - rash faint per MD report.

VAERS ID:168176 (history)  Vaccinated:2001-03-16
Age:1.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Male  Submitted:2001-03-16, Days after onset: 0
Location:Texas  Entered:2001-04-03, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Sniffles
Preexisting Conditions: Child gets "sick" often.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA549AA3IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R148922IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1273K SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1146K SCLA
Administered by: Public     Purchased by: Other
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: Splotches on face and stomach about 2-3 hours, post vax.

VAERS ID:168207 (history)  Vaccinated:2001-03-16
Age:40.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-25, Days after onset: 9
Location:Maine  Entered:2001-04-03, 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: Paxil
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: ME01010
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3374A41 LA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt experienced left upper extremity pain with swelling into left hand persisting for 4 days. Pt also developed erythema at injection site.

VAERS ID:168278 (history)  Vaccinated:2001-03-16
Age:0.2  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-26, Days after onset: 10
Location:Tennessee  Entered:2001-04-04, 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: URI
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4734420IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1822K0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R142220 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733310IMLL
Administered by: Private     Purchased by: Private
Symptoms: Decreased appetite, Irritability, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: 2-3 hrs post vaccine had fever 103F, irritable increased sleeping and decreased appetite. Symptoms lasted 24-36 hrs told to go to ER, didn''t go because symptoms improved.

VAERS ID:168279 (history)  Vaccinated:2001-03-16
Age:0.6  Onset:2001-03-17, Days after vaccination: 1
Gender:Male  Submitted:2001-03-20, Days after onset: 3
Location:Florida  Entered:2001-04-04, 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: Lunde
Current Illness:
Preexisting Conditions: reactive airway
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747341IMRL
Administered by: Private     Purchased by: 0
Symptoms: Injection site erythema, Roseola
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Mom states area around vaccine red and broke out in rash all over body. appears to be roseola rash not reaction.

VAERS ID:168394 (history)  Vaccinated:2001-03-16
Age:29.0  Onset:0000-00-00
Gender:Male  Submitted:2001-04-03
Location:Minnesota  Entered:2001-04-06, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Pt reports flu-like symptoms
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3383A40IMRA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Joint swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Pt contacted clinic on 3/29/01 to report progressive arthralgia that began "soon after" the vaccination. He noted swelling and pain, first in his left knee, then his left ankle, then in his right leg and then his arms. He was unsure about fevers. His symptoms seem worse each day and are unrelieved by NSAIDS. He was encouraged to see a PCP soon for further evaluation and treatment. Follow up: Patient did not state the exact date/time. He reports his symptoms began "soon" after the vaccination given.

VAERS ID:168402 (history)  Vaccinated:2001-03-16
Age:13.0  Onset:2001-03-17, Days after vaccination: 1
Gender:Female  Submitted:2001-03-19, Days after onset: 2
Location:Wisconsin  Entered:2001-04-06, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal 50mg bid
Current Illness: NONE
Preexisting Conditions: Cerebral Palsy-dx''d at 10 months
Diagnostic Lab Data: Lamictal blood level drawn on 3/17/01
CDC Split Type: WI0116
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5166A21IMRA
Administered by: Other     Purchased by: Public
Symptoms: Grand mal convulsion, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: 13 year old sustained grand mal seizure about 24 hours, post vax of Hep-B #1. Had no illnesses prior to shot. Emesis all day on 3/17/01 until 17:00, then seemed fine.

VAERS ID:168508 (history)  Vaccinated:2001-03-16
Age:5.0  Onset:2001-03-17, Days after vaccination: 1
Gender:Male  Submitted:2001-03-19, Days after onset: 2
Location:Illinois  Entered:2001-04-10, 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:
Preexisting Conditions: Allergic to Rocephin
Diagnostic Lab Data:
CDC Split Type: IL01007
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0313BA4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T002523IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0163K1SCRA
Administered by: Public     Purchased by: 0
Symptoms: Erythema, Hypersensitivity, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Client awakened approx. midnight, post vax, complaining of itching legs, nausea and vomiting. Child''s body was very red, especially legs. Was taken to ER and was completely red on face, trunk, legs and arms. Treated with steroids for allergic reaction.

VAERS ID:168632 (history)  Vaccinated:2001-03-16
Age:1.8  Onset:2001-03-23, Days after vaccination: 7
Gender:Male  Submitted:2001-04-10, Days after onset: 17
Location:Kentucky  Entered:2001-04-12, 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: NONE
Current Illness:
Preexisting Conditions: stenosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0356AA3IMLL
HIBV: HIB (HIBTITER)PFIZER/WYETH622363A3IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1333H0IMRL
Administered by: Private     Purchased by: Public
Symptoms: Apnoea, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: The mother reported an apneic spell requiring stimulation. This happened twice. The pt experienced a hyporesponsive collapse. The pt is now on an apneic monitor and doing well with no further episodes and is scheduled to see a neurologist.

VAERS ID:168730 (history)  Vaccinated:2001-03-16
Age:1.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-27, Days after onset: 11
Location:California  Entered:2001-04-16, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: azithromycin
Current Illness: Serous Otitis Media
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA010028
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM961A23IMLA
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA522A3IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.040K0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1140K0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site reaction, Pyrexia, Rash papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Received vaccines on 3/16/01 and temperature rose to 103F but was relieved by Tylenol every 4 hours for 48 hours. Broke out in papules at injection site on right deltoid on 3/18/01 which became vesicular on 3/19/01.

VAERS ID:168769 (history)  Vaccinated:2001-03-16
Age:1.0  Onset:2001-03-22, Days after vaccination: 6
Gender:Female  Submitted:2001-03-29, Days after onset: 7
Location:Tennessee  Entered:2001-04-17, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TN01013
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1712J0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747262IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0925K0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous, Infection, Rash erythematous
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Six days post vax the pt broke out with chicken pox. Pt had over 100 lesions on 03/22/2001. As of 03/28/2001 the pt had chicken pox and a fine red raised rash.

VAERS ID:168789 (history)  Vaccinated:2001-03-16
Age:43.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-03-25, Days after onset: 9
Location:Washington  Entered:2001-04-17, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Celebrex, Flovent, Flonase.
Current Illness: NONE
Preexisting Conditions: Allergic to bee stings, some trees, cats, dust mites, and weeds.
Diagnostic Lab Data:
CDC Split Type: WA011745
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS596C60  
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Hypoaesthesia, Injection site warmth, Oedema, Pain, Tongue disorder, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: This patient''s arm had swelling, red, hot, tender to touch with multiple hives moving up her arm to her neck and across the chest. Tongue felt numb. Took Benadryl and put ice on her arm, the next day it was not noticeable.

VAERS ID:169106 (history)  Vaccinated:2001-03-16
Age:29.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-04-18, Days after onset: 32
Location:Florida  Entered:2001-04-26, 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:
Current Illness: NONE
Preexisting Conditions: Narcotics sensitivity, and aeroallergens.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA228AA1SC 
Administered by: Military     Purchased by: Military
Symptoms: Dyspnoea, Eye disorder, Flushing, Pruritus, Skin disorder
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (broad)
Write-up: This patient received yellow fever injection at 9:15 AM, symptoms occurred at 9:45 AM. The patient was sent to the ER with flushing, itching, dyspnea, nasal-ocular systems, burning skin.

VAERS ID:169407 (history)  Vaccinated:2001-03-16
Age:0.5  Onset:2001-03-16, Days after vaccination: 0
Gender:Male  Submitted:2001-04-18, Days after onset: 32
Location:Unknown  Entered:2001-05-04, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Unremarkable pregnancy; elective Cesarean section for breech presentation
Diagnostic Lab Data: CBC; Chem Panel; CT-all neg about 20 hours, post vax. EEG-pending. Neuro consult was normal on 4/18/01.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Musculoskeletal stiffness, Tic, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad)
Write-up: This child seemed to develope a tic (ear jerk to shoulder) 4 hours, post vax. It persisted for 1 week and gradually faded away over that week to 10 days. At 16 hours, post vax, he also had 3 brief episodes of about 10 seconds each, wherein he tensed and shook. But seemed conscious. My inference is that the child momentarily had tics; possible seizure.

VAERS ID:169814 (history)  Vaccinated:2001-03-16
Age:1.1  Onset:2001-03-17, Days after vaccination: 1
Gender:Male  Submitted:2001-03-21, Days after onset: 4
Location:Illinois  Entered:2001-05-15, Days after submission: 54
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: IL01010
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01202 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0827K0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747381IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1865J0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Bumps all over body.

VAERS ID:169839 (history)  Vaccinated:2001-03-16
Age:4.9  Onset:2001-03-17, Days after vaccination: 1
Gender:Female  Submitted:2001-03-19, Days after onset: 2
Location:Arkansas  Entered:2001-05-15, Days after submission: 56
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: AR0124
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM973A20IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.104720SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1507K1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Approx. 24 hours, post vax, pt developed temperature of 104F. Motrin given and temperature decreased to 100F. Mother states is giving every 4 to 6 hours. When Motrin wears off, temperature increases again. Has been going on X 4 days. Call to mother on 4/1/01, said pt ill X 2 days and temperature did not exceed 104.9F.

VAERS ID:170003 (history)  Vaccinated:2001-03-16
Age:6.0  Onset:2001-03-17, Days after vaccination: 1
Gender:Male  Submitted:2001-03-19, Days after onset: 2
Location:Pennsylvania  Entered:2001-05-18, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: PA0130
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS950A2  LA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1701K  RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1368K  LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1334K  RA
Administered by: Public     Purchased by: Public
Symptoms: Injection site inflammation, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This child was swollen, inflammed, tissue (warm to touch), at the site of the DTaP and MMR vaccination (left deltoid). Rx: Augmentin.

VAERS ID:170740 (history)  Vaccinated:2001-03-16
Age:4.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Male  Submitted:2001-05-30, Days after onset: 74
Location:New York  Entered:2001-06-01, 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:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES01032329
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1725J1SCRL
Administered by: Other     Purchased by: Other
Symptoms: Injection site swelling, Pruritus, Rash maculo-papular, 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: On 03/16/01, within 5-10 minutes of receiving the MMR, the child developed hives and a raised maculopapular rash on his face, legs, and spread all over his body. It was reported that the patient was immediately treated with epinephrine shot and was "reported as fine 20 minutes after the epinephrine". The child was given oral diphenhydramine for the weekend. On the date of the report, 03/19/01, the child was "seen in the clinic this morning and rash, itching, all gone". The report indicated that the first dose of MMR vaccine live was given at an unknown place and that it is unknown if the child had a reaction. Upon internal review, the patient''s experience was determined to be other medical event. Additional information is not expected.

VAERS ID:174262 (history)  Vaccinated:2001-03-16
Age:50.0  Onset:2001-03-19, Days after vaccination: 3
Gender:Male  Submitted:2001-07-30, Days after onset: 132
Location:Unknown  Entered:2001-08-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01033128
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1071K   
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction
SMQs:
Write-up: On 3/19/01, pt was seen for an injection site reaction. It was reported that no medication was ordered. Unspecified medical attention was sought. Another pt (WAES 01032345) who recvd same vax with same lot # had a similar experience. Addtl info has been requested.

VAERS ID:175058 (history)  Vaccinated:2001-03-16
Age:31.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-05-25, Days after onset: 69
Location:Indiana  Entered:2001-09-05, Days after submission: 103
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide, Prilosec
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ9760517APR2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4705920IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0381AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site induration, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: The evening of receiving vax the pt developed a fever, nausea and vomiting. She also developed induration at the site of Pnu-Imune-23 administration. She recovered. This is 1 of 2 pts from this facility who had an adverse experience following receipt of Pnu-Imune-23 lot 470-592. A copy of this report has been forwarded to Aventis Pasteur, manufacturer of Td vax.

VAERS ID:175404 (history)  Vaccinated:2001-03-16
Age:9.0  Onset:2001-06-16, Days after vaccination: 92
Gender:Male  Submitted:2001-09-06, Days after onset: 82
Location:Florida  Entered:2001-09-17, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins (unspecified)
Current Illness:
Preexisting Conditions: Otic infection; varicella
Diagnostic Lab Data: Diagnostic lab-dx''d with Graves disease; physical exam-nml except for impressive thyroid; body weight-98lbs on 10/00; TSH-0.1; HR elevated; Total serum thyroxine-5.7; SMAC-23 (nml); body weight-85lbs
CDC Split Type: WAES01082663
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1358L1IMLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IMRA
Administered by: Other     Purchased by: Other
Symptoms: Basedow's disease, Heart rate increased, Thirst, Thyroid disorder, Tremor, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Hypothyroidism (broad), Hyperthyroidism (narrow)
Write-up: On 03/16/2001, this child was vaccinated with a 2nd dose of pneumococcal vaccine 23 polyvalent. It was noted that on 06/02/00, the patient received a 1st dose of pneumococcal vaccine 23 polyvalent. On 06/16/01, three months after the 2nd vaccination, the patient was diagnosed with graves disease. Unspecified medical attention sought. Upon internal review, Graves Disease was considered an other important medical event. F/U info from the pt''s endocrinologist indicated that he did not think there was an association between the Graves disease and the pneumococcal vaccine (manufacturer unknown). Additional info has been requested. F/U states that information has been received from a consumer concerning her 10 year old son with no known drug allergies, a history of ear infections and varicella (1996) and a family history of thyroid diseases (dad, thyroiditis) who on 6/2/00 was vaccinated in the left leg with a 1st dose of pneumococcal vaccine 23 polyvalent (lot 469402 invalid lot for this product). The mother reported the vaccine to be "pneumococcal" vaccine and the physician calls it "23 valent pneumococcal vaccine". Medical records received stated that the dose given on 6/2/00 was Streptococcus pneumonia vaccine (Prevnar) (lot 469402). Concomitant medication included a dose in the right arm of Hep-B (lot 633866/1958J). There was no illness at the time of vax. On 3/15/01, the child was seen for a well visit. The physician reported that he had been encouraging the family to have the child lose some weight. On this visit, the child had reported that he had taken up 4 different sports and had a 10lb weight loss. The physician reported, and medical records confirmed, that on 3/16/01, the pt received a dose in the left arm of Prevnar (lot 474724), a dose in the left arm of Hep-A (lot 637331/1358L) and a tetanus shot in the right arm (lot U0375AA). It was reported that sometime in 10/00, the parents started noticing weight loss on the child. The weight loss continued until 5/01 when the child was looking ill. He had blood t

VAERS ID:220371 (history)  Vaccinated:2001-03-16
Age:4.0  Onset:2004-05-05, Days after vaccination: 1146
Gender:Male  Submitted:2004-05-07, Days after onset: 2
Location:South Dakota  Entered:2004-05-17, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1179K0SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4771711IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0930K0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Chicken pox diagnosed on 5-6-04 by doctor.

VAERS ID:238396 (history)  Vaccinated:2001-03-16
Age:5.0  Onset:2004-07-08, Days after vaccination: 1210
Gender:Female  Submitted:2005-05-16, Days after onset: 312
Location:Ohio  Entered:2005-05-27, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0407USA00746
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning a 5 year old female who on 3/16/01 was vaccinated SC with a 0.5ml dose of varicella virus vaccine live. On 7/8/04, it was reported to the physician''s office that the patient developed breakthrough varicella. Unspecified medical attention was sought. It was noted that therapy with varicella virus vaccine live was discontinued. A product quality complaint was not involved. No further information was available. The nurse also reported that the patient''s female sibling had a similar experience after therapy with varicella virus vaccine live (WAES0408USA00470).

VAERS ID:242525 (history)  Vaccinated:2001-03-16
Age:1.1  Onset:2005-03-09, Days after vaccination: 1454
Gender:Male  Submitted:2005-08-09, Days after onset: 152
Location:California  Entered:2005-08-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0787K2 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES1308K0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1245K3 RA
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous, Rash papular
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: Mild rash, possible chicken pox papule.

VAERS ID:251473 (history)  Vaccinated:2001-03-16
Age:5.0  Onset:2006-02-08, Days after vaccination: 1790
Gender:Female  Submitted:2006-02-13, Days after onset: 5
Location:Georgia  Entered:2006-02-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM981A24 LL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05063 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1273K1 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1469K0 RA
Administered by: Private     Purchased by: Public
Symptoms: Blister, Drug ineffective, Rash papular, Skin ulcer, Viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Hypersensitivity (broad)
Write-up: About 20 lesions, mostly on trunk, few on face. Vesicles, papules and scabbed papules. DX Varicella, TX Acyclovir.

VAERS ID:254434 (history)  Vaccinated:2001-03-16
Age:1.0  Onset:2006-04-18, Days after vaccination: 1859
Gender:Male  Submitted:2006-04-21, Days after onset: 3
Location:Virginia  Entered:2006-04-21
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
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0050L2IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747243IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1151K0SCRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash consistent with chickenpox.

VAERS ID:255849 (history)  Vaccinated:2001-03-16
Age:1.3  Onset:2005-04-12, Days after vaccination: 1488
Gender:Female  Submitted:2006-05-12, Days after onset: 395
Location:Unknown  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0504USA04336
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1142K SC 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Info has been received from a health professional concerning a 5 year old female with no known medical history or allergies who on 3/15/01, was vaccinated SC with a 0.5 ml dose of varicella virus vaccine live. There was no concomitant medication. On approximately, 4/12/05, the pt developed breakthrough chickenpox with lesions that lasted 24 hours on her back. On 4/12/05, the pt was seen in the office. Treatment included calamine lotion and Benadryl. On 4/18/05, the pt was seen in the office, her lesions had resolved. There was no product quality complaint involved. Additional info has been requested.

VAERS ID:271190 (history)  Vaccinated:2001-03-16
Age:2.0  Onset:2007-01-23, Days after vaccination: 2139
Gender:Female  Submitted:2007-01-25, Days after onset: 2
Location:Maryland  Entered:2007-01-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: ecezema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1606K0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Varicella
SMQs:
Write-up: developed varicella

VAERS ID:313948 (history)  Vaccinated:2001-03-16
Age:7.0  Onset:2007-09-12, Days after vaccination: 2371
Gender:Unknown  Submitted:2008-05-16, Days after onset: 247
Location:Unknown  Entered:2008-05-23, 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: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA01463
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.635459/0759K0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Information has been received from a physician''s assistant concerning a 7 year old patient with no pertinent medical history, drug reactions or allergies who on 16-MAR-2001 was vaccinated subcutaneously with a first dose of varicella virus vaccine live (Oka/Merck) (Lot # 635459/0759K). There was no concomitant medication. On 12-SEP-2007 the patient experienced varicella like rash covering entire body. Subsequently, the patient recovered. Medical attention was sought. There was no product quality complaint. There were no lab diagnostic studies performed. Additional information has been requested.

VAERS ID:168419 (history)  Vaccinated:2001-03-16
Age:2.0  Onset:2001-03-16, Days after vaccination: 0
Gender:Female  Submitted:2001-04-04, Days after onset: 18
Location:Foreign  Entered:2001-04-09, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: On 3/18/01 a full blood count was performed and retrieved normal values.
CDC Split Type: 20010080461
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM  IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: 0     Purchased by: 0
Symptoms: Cough, Oedema peripheral, Pyrexia, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 3/16/01, a 1st dose of Infanrix-Hib was given. The same day, post vax, this girl developed fever (38C) and cough. She was treated with Paracetamol and cough medicine NOS without any effect. During the night from 3/17/01 to 3/18/01, she developed fever up to 39.2C. She developed also an increased cough and swelling of arm and chest. Subsequently, she was brought to the ER. Apart from the swelling, she was reportedly in good condition. On 3/17/01, she was started on antihistamines NOS after which the swelling improved and the cough resolved. At a date as yet unknown, the fever had also resolved. As of 3/23/01, at the time of this report, the swelling of the chest and arm was ongoing. The reporting physician considered the events to be a "Significant Hazard", contraindication, side effect or precaution and definitely related to Infanrix-Hib.

VAERS ID:169053 (history)  Vaccinated:2001-03-16
Age:27.0  Onset:2001-03-21, Days after vaccination: 5
Gender:Female  Submitted:2001-04-19, Days after onset: 28
Location:Foreign  Entered:2001-04-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Allergies to erythromycin and penicillin
Diagnostic Lab Data: Sero-negative for measles antibodies
CDC Split Type: WAES01041000
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: 0     Purchased by: 0
Symptoms: Back pain, Drug ineffective, Muscle spasms, Torticollis
SMQs:, Lack of efficacy/effect (narrow), Retroperitoneal fibrosis (broad), Dystonia (narrow), Ocular motility disorders (broad)
Write-up: Information has been received from a health authority concerning a 27 year old female with a penicillin and erythromycin allergy who on 3/16/01 was vaccinated with MMRII. The vaccine was given as she had been in contact with severe cases of measles and was sero-negative for measles antibodies. On 3/21/01, the pt developed torticollis, back pain and muscle spasms. In March 2001, the pt experienced measles exposure. It was reported that the pt had been recovering from torticollis but had not recovered from back pain or muscle spasms. The health authority reported that the back pain, muscle spasms and torticollis were considered "Other Medical Events". No further information is available.

VAERS ID:167871 (history)  Vaccinated:2001-03-17
Age:1.1  Onset:2001-03-17, Days after vaccination: 0
Gender:Male  Submitted:2001-03-19, Days after onset: 2
Location:California  Entered:2001-03-27, 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: NONE
Current Illness: NONE
Preexisting Conditions: hx of previous febrile seizure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3141A21IM 
Administered by: Private     Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: The pt experienced a generalizes seizure on the same day as vax.

VAERS ID:169104 (history)  Vaccinated:2001-03-17
Age:1.6  Onset:2001-03-27, Days after vaccination: 10
Gender:Male  Submitted:2001-04-18, Days after onset: 21
Location:Virginia  Entered:2001-04-25, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.7276K0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Rash (red, papular rash) over face, chest and extremities. No treatment.

VAERS ID:197200 (history)  Vaccinated:2001-03-17
Age:27.0  Onset:2001-03-18, Days after vaccination: 1
Gender:Female  Submitted:2001-05-03, Days after onset: 45
Location:Maryland  Entered:2003-02-04, Days after submission: 642
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood and urine culture-negative
CDC Split Type: U200100530
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0368AA   
Administered by: Private     Purchased by: Private
Symptoms: Chills, Dizziness, Injection site hypersensitivity, Injection site oedema, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: It was reported that a 27-year-old female patient received a TD Adult vaccination on 3/17/01. Reportedly on 3/18/01, the patietn woke up at 4am with chills, fever 102F, generalized body aches, dizziness and nausea. Advised to go to emergency room per physician. Treated with IV fluids for dehydration. Antipyretics for fever. On 3/19/01 patient developed local reaction of redness and swelling of injection site with soreness, took Motrin. Also felt an enlarged lymph node. Physician instructed patient to continue on Motrin and to be evaluated if enlarged lymph node persists in 4 weeks. From additional correspondence received on 4/25/01, it was reported that the patient was treated symptomatically with analgesics, rest and IV fluids in the emergency room. Additional patient information was also provided.

VAERS ID:170327 (history)  Vaccinated:2001-03-18
Age:0.3  Onset:2001-05-18, Days after vaccination: 61
Gender:Female  Submitted:2001-05-21, Days after onset: 3
Location:New York  Entered:2001-05-29, 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:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0341BA2IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4753852IM 
Administered by: Public     Purchased by: 0
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Temperature up to 104F X 3 days.

VAERS ID:167726 (history)  Vaccinated:2001-03-19
Age:1.4  Onset:2001-03-19, Days after vaccination: 0
Gender:Female  Submitted:2001-03-21, Days after onset: 2
Location:California  Entered:2001-03-23, 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: Augmentin
Current Illness: Otitis media
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM972A23IMLA
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1409K2IMLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725451IMRA
Administered by: Other     Purchased by: Public
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: This child developed a fever, erythema and swelling developed on her left deltoid (6 x 7 cm) and a smaller area of erythema on the right deltoid.

VAERS ID:167791 (history)  Vaccinated:2001-03-19
Age:12.0  Onset:2001-03-19, Days after vaccination: 0
Gender:Female  Submitted:2001-03-22, Days after onset: 3
Location:New York  Entered:2001-03-26, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5173A22IMLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Broke out in hives, post vax. No breathing problems. Recommended OTC Benadryl and call office if any other problems. This was vaccine #3.

VAERS ID:167896 (history)  Vaccinated:2001-03-19
Age:0.8  Onset:2001-03-19, Days after vaccination: 0
Gender:Female  Submitted:2001-03-22, Days after onset: 3
Location:Unknown  Entered:2001-03-28, 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: Omnicef
Current Illness: bilateral otitis media
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 1IM 
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: The pt experienced a red rash and a splotchy head and face.

VAERS ID:167897 (history)  Vaccinated:2001-03-19
Age:4.0  Onset:2001-03-21, Days after vaccination: 2
Gender:Male  Submitted:2001-03-22, Days after onset: 1
Location:South Carolina  Entered:2001-03-28, 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: prematurity, umbilical hernia, allergy to PCN and Ceclor
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725550IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0932K0SCLL
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: The pt experienced a large 2 1/2 x 2 1/2 inch whelp that developed at site which was red and hard. Treated with warm compresses. No SOB or fever was noted.

VAERS ID:167900 (history)  Vaccinated:2001-03-19
Age:0.3  Onset:2001-03-20, Days after vaccination: 1
Gender:Female  Submitted:2001-03-20, Days after onset: 0
Location:Washington  Entered:2001-03-28, 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:
Current Illness: NONE
Preexisting Conditions: NOEN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS972A21IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA563AA1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R04441SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4749520IMRL
Administered by: Private     Purchased by: Public
Symptoms: Contusion, Dermatitis bullous, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypersensitivity (narrow)
Write-up: The pt experienced head to toes red bruised lesions. Almost chicken pox like in appearance. Onset was within 15 hours of administration. This was accompanied by a low grade fever.

VAERS ID:167905 (history)  Vaccinated:2001-03-19
Age:1.5  Onset:2001-03-20, Days after vaccination: 1
Gender:Male  Submitted:2001-03-21, Days after onset: 1
Location:Wisconsin  Entered:2001-03-28, 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: NONE
Current Illness: dog bite to face
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS978A23 RA
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.969K2IMRA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4753850IMRA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site oedema, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Approximately 1 day post vax, the pt had swelling in left arm with a reddened line below area of injection. Normal ROM, however guarding arm. No fever noted. The pt was seen by an MD.

VAERS ID:167920 (history)  Vaccinated:2001-03-19
Age:2.0  Onset:2001-03-19, Days after vaccination: 0
Gender:Female  Submitted:2001-03-21, Days after onset: 2
Location:Texas  Entered:2001-03-28, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS988A2 IMLL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES474714 IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.    
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The pt experienced erythema around the injection site, mild swelling, no other problems.

VAERS ID:167952 (history)  Vaccinated:2001-03-19
Age:72.0  Onset:2001-03-20, Days after vaccination: 1
Gender:Female  Submitted:2001-03-22, Days after onset: 2
Location:Massachusetts  Entered:2001-03-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD70  RA
Administered by: Private     Purchased by: Public
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: this patient has swelling on arm in 3" circles.

VAERS ID:168045 (history)  Vaccinated:2001-03-19
Age:1.5  Onset:2001-03-20, Days after vaccination: 1
Gender:Female  Submitted:2001-03-26, Days after onset: 6
Location:Wisconsin  Entered:2001-04-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS989A23IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Injection site swelling, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Right upper leg swollen, hot to touch, itchy and painful.

VAERS ID:168153 (history)  Vaccinated:2001-03-19
Age:0.3  Onset:2001-03-19, Days after vaccination: 0
Gender:Male  Submitted:2001-03-21, Days after onset: 2
Location:North Carolina  Entered:2001-04-03, Days after submission: 12
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 35 week gestation (prematurity)
Diagnostic Lab Data: NONE
CDC Split Type: NC01040
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0340AB0IMLL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES4747100IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05060SCRA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4753800IMRL
Administered by: Public     Purchased by: Public
Symptoms: Crying, Eye disorder, Hyperhidrosis, Hypertonia, Hypotonia, Pallor, Skin discolouration, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: The infant had an instant scream with administration of Prevnar (IPV 1st, Prevnar 2nd, Hib 3rd). The infant became pale, diaphoretic, hypotonic, hyporesponsive, turned bluish across the eyebrows with circumora.. His eyes deviated sharply to the upper right side held there about 30 secs. When his eyes returned to normal position he responded to painful stimuli to ear lobes then to mandibular joints. Cry resulted in color of skin normalization after 15:20. The patient was left clonic. The DTaP was administered to the infant he turned slightly pale, but quickly recovered with mother consoling. The infant firmly began to suck his bottle. The doctor Administered 0.4 ml of APAP med for fever precaution. The mother instructed in what to watch for in the infant behavior for immunization reaction and seeking emergency help. The mother expressed understanding via spanish interpretation. When the infant left the clinic he had good color and was sleeping in the infant seat about 4:50 pm. No oxygen was ever needed, as the infant was treated the doctor responded very quickly. The infant maintained respiratory and heart rate; CPR not needed.

VAERS ID:168168 (history)  Vaccinated:2001-03-19
Age:0.8  Onset:2001-03-20, Days after vaccination: 1
Gender:Male  Submitted:2001-03-25, Days after onset: 5
Location:North Carolina  Entered:2001-04-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NC01039
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES47204961010IMRL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Temp to 101F 36 hrs after

VAERS ID:168193 (history)  Vaccinated:2001-03-19
Age:53.0  Onset:2001-03-20, Days after vaccination: 1
Gender:Female  Submitted:2001-03-22, Days after onset: 2
Location:Illinois  Entered:2001-04-03, 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
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0367AA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Chills, Lethargy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Within 24 hrs my arm became very sore and I started to feel as though I was getting the flu. I became very lethargic and weak and later that evening very chilled, the chilled effect last most of the night and by morning it subsided. I still felt very weak the entire next day but by the third day I was feeling fine but still had a sore arm. I never remember having any reaction ever before with any vaccine.

VAERS ID:168197 (history)  Vaccinated:2001-03-19
Age:59.0  Onset:2001-03-26, Days after vaccination: 7
Gender:Female  Submitted:2001-03-27, Days after onset: 1
Location:Pennsylvania  Entered:2001-04-03, 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: Metformin, calcium,Lipitor, Cozaar, hctz, Claritin
Current Illness:
Preexisting Conditions: HTN, DM II, Hypercholesterolemia, osteoarthritis, allergic rhinitis
Diagnostic Lab Data: peak flow=250
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0368AA IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site induration, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 8 days post vaccine, pt presented with 1 day h/o wheezing and local induration at site of injection.

VAERS ID:168404 (history)  Vaccinated:2001-03-19
Age:0.2  Onset:2001-03-22, Days after vaccination: 3
Gender:Female  Submitted:2001-03-23, Days after onset: 1
Location:Nevada  Entered:2001-04-09, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT of the Head - Nml, EKG - Nml, CBC - Nml, Blood culture - pending.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS9078A20IMLL
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5167A20IMRL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES4733880IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T047220SCRL
Administered by: Private     Purchased by: Public
Symptoms: Coma, Hypotonia, Pallor
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Approximately 36 hours status post vaccination this infant suffered a 15 minute of hypotonia and pallor with unresponsiveness. Spontaneous resolution, no fever, no cough, no rhinorrhea.

VAERS ID:168464 (history)  Vaccinated:2001-03-19
Age:1.8  Onset:2001-03-20, Days after vaccination: 1
Gender:Male  Submitted:2001-03-26, Days after onset: 6
Location:New York  Entered:2001-04-10, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: cellulitis to face
Preexisting Conditions: insect bite
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)PFIZER/WYETH4753830 RL
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt experienced redness and swelling to right thigh. Treated with warm compresses, Benadryl and Augmentin.

VAERS ID:168482 (history)  Vaccinated:2001-03-19
Age:69.0  Onset:2001-03-20, Days after vaccination: 1
Gender:Female  Submitted:2001-03-22, Days after onset: 2
Location:Oklahoma  Entered:2001-04-10, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OK0113
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0944K1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: One day post vax the pt experienced redness, swelling and warm to touch to the right arm. The size of the redness was approximately the size of a hand. The pt returned to the health department. The pt was instructed to use heat and ice on arm. The pt then saw a PA and was put on Zyrtec for 8 days. On 3/22/01 the pt states that she is better and the symptoms are better.

VAERS ID:168573 (history)  Vaccinated:2001-03-19
Age:1.0  Onset:2001-03-28, Days after vaccination: 9
Gender:Male  Submitted:0000-00-00
Location:Colorado  Entered:2001-04-11
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
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1525K0IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1281K0SCLA
PPV: PNEUMO (PNU-IMUNE)PFIZER/WYETH4712262IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1149K0SCRA
Administered by: Other     Purchased by: Unknown
Symptoms: Febrile convulsion, Pyrexia, Rhinorrhoea, Upper respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: This infant had a fever of 102.6 on day # 10 after immunizations and had a febrile seizure (2nd time febrile seizure). The patient also had new rhinorrhea and URI sickness. The seizure lasted 30 secs.

VAERS ID:168749 (history)  Vaccinated:2001-03-19
Age:0.3  Onset:2001-03-21, Days after vaccination: 2
Gender:Female  Submitted:2001-04-04, Days after onset: 13
Location:Missouri  Entered:2001-04-17, Days after submission: 13
Life Threatening? No
Died? Yes
   Date died: 2001-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Cough-lung CTA
Preexisting Conditions: Otitis Media 2 1/2 weeks prior to immunizations
Diagnostic Lab Data:
CDC Split Type: MO2001021
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0356CA0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05060SCLL
Administered by: Public     Purchased by: Public
Symptoms: Road traffic accident
SMQs:, Accidents and injuries (narrow)
Write-up: No data obtained. Parents are awaiting final autopsy report and the death certificate. These will not be produced until a final toxicology report is obtained. All of this is per the coroner. Autopsy states cause of death as undetermined. Death certificate states cause of death due to cerebral laceration w/open skull fracture due to an automobile accident.

VAERS ID:168816 (history)  Vaccinated:2001-03-19
Age:11.0  Onset:2001-03-21, Days after vaccination: 2
Gender:Male  Submitted:2001-03-21, Days after onset: 0
Location:Arkansas  Entered:2001-04-17, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: chest x-ray, physical
CDC Split Type: AR0122
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1654K2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: The mother states the pt developed a low grade fever 24 hours post vax. 48 hours post vax, the pt developed a fever of 105. The pt was given Advil. Advised to call doctor if fever does not decrease. On 3/22/01, the pt was seen by PMD who states the pt had a "virus".

VAERS ID:168939 (history)  Vaccinated:2001-03-19
Age:1.0  Onset:2001-03-21, Days after vaccination: 2
Gender:Male  Submitted:2001-04-12, Days after onset: 21
Location:South Carolina  Entered:2001-04-20, 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:
Current Illness: 03/16/01 Viral enteritis with dehydration.
Preexisting Conditions: Atopic dermatitis.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1470K0 LL
Administered by: Military     Purchased by: Military
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: This infant was vaccinated on 03/19/01 with Varicella. The patient''s mother called the primary care physician on 03/21/01, with complaints of hive like rash all over his body. The mother treated with Benadryl and Calamine lotion. Some question of whether moms allergy to Neomycin carried over to the child.

VAERS ID:169295 (history)  Vaccinated:2001-03-19
Age:1.0  Onset:2001-04-01, Days after vaccination: 13
Gender:Female  Submitted:2001-04-23, Days after onset: 21
Location:Alabama  Entered:2001-05-01, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 0SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 3IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Private     Purchased by: Other
Symptoms: Joint swelling, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Rash in her face, legs, hands and stomach. Fever and swelling of joints. Treated with Motrin.

VAERS ID:169317 (history)  Vaccinated:2001-03-19
Age:9.8  Onset:2001-03-25, Days after vaccination: 6
Gender:Female  Submitted:2001-04-24, Days after onset: 29
Location:Oregon  Entered:2001-05-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1423K0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1241K/1464K0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Gave varivax on 3/19/01 and pt broke out in a vesicular rash on 3/25/01. Examined on 3/26/01 and had 30-40 vesicles on red base on arm, face and trunk. Went onto develop more than 400+ lesions by 4/3/01.

VAERS ID:169554 (history)  Vaccinated:2001-03-19
Age:0.2  Onset:2001-03-19, Days after vaccination: 0
Gender:Male  Submitted:2001-03-21, Days after onset: 2
Location:Idaho  Entered:2001-05-08, Days after submission: 47
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: ID01020
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS978A20IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1586K0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T048430SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747220IMRL
Administered by: Public     Purchased by: Public
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: The pt experienced a "scream" type cry for greater than 3 hours.

VAERS ID:169896 (history)  Vaccinated:2001-03-19
Age:11.0  Onset:2001-03-19, Days after vaccination: 0
Gender:Female  Submitted:2001-04-30, Days after onset: 41
Location:Missouri  Entered:2001-05-16, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: MO2001027
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5168A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Rash erythematous
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Post vax, pt had small red lumps on inner forearm (L) and 1 bump on (R) inner forearm. She complained of problem breathing, about 1 hour, post vax.

VAERS ID:170113 (history)  Vaccinated:2001-03-19
Age:2.0  Onset:2001-03-21, Days after vaccination: 2
Gender:Female  Submitted:2001-05-10, Days after onset: 49
Location:Ohio  Entered:2001-05-22, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Post vax, given a 7 day course of Bactrim on 3/26/01; Zyrtec on 4/7/01 and Atarax on 4/18/01.
Current Illness: NONE
Preexisting Conditions: Medicine allergies to Zithromax, Amoxicillin, Benadryl, Ceftin
Diagnostic Lab Data: Blood test showed an allergic reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1012J0SCLL
Administered by: Private     Purchased by: Other
Symptoms: Diarrhoea, Hypersensitivity, Nausea, Pruritus, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: 2 days, post vax, she had a temperature of 102F, followed by vomiting and diarrhea (severe) for 5 days. After antibiotic treatment for 7 days, rash on face. She has suffered since with severe itching, etc. We have since gone to the hospital and they are now treating for extreme car sickness from extreme stress to system.

VAERS ID:170190 (history)  Vaccinated:2001-03-19
Age:0.2  Onset:2001-03-19, Days after vaccination: 0
Gender:Male  Submitted:2001-05-16, Days after onset: 57
Location:Nebraska  Entered:2001-05-23, 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: fussy baby, milk protein intolerance
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0371AB0IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1522K0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T06970IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725540IMLL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Opisthotonus
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: The night of the vaccines, the pt fell asleep and when mom put child in crib, the baby arched back and head repeatedly over 10-15 seconds. Unknown if any color changes or if eyes opened or rolled back. No fever. Mom concerned if this may have been a seizure.

VAERS ID:170538 (history)  Vaccinated:2001-03-19
Age:3.0  Onset:2001-03-20, Days after vaccination: 1
Gender:Unknown  Submitted:2001-05-23, Days after onset: 63
Location:Unknown  Entered:2001-05-31, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01033059
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis contact, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 3 year old patient who on approximately 03/19/01 was vaccinated with Hepatitis A vaccine inactivated. On approximately 03/20/01, the patient developed a fine (slight bumps) non-pruritic rash above and below the site of the injection. The rash appeared within 36 hours post injection and "now" lasted into day four post injection. The reporting physician did not feel that this was a hypersensitivity reaction to the vaccine, but she thought it was most likely a contact dermatitis to the alcohol swab. As of 03/23/01, the patient had no other symptoms. The patient sought unspecified medical attention. No further information is available.

VAERS ID:170486 (history)  Vaccinated:2001-03-19
Age:17.0  Onset:2001-03-27, Days after vaccination: 8
Gender:Female  Submitted:2001-03-30, Days after onset: 3
Location:Michigan  Entered:2001-06-01, Days after submission: 62
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: MI2001040
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM244O80IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site reaction, Pharyngolaryngeal pain, Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (broad)
Write-up: On 3/27/01, pt c/o sore throat, brown circle around site where vax given 3/19. Pt denies swelling, redness, inflammation or fever. 3/28/01 left message on machine re: reactions to look for. Pt never returned calls 3/28 or 3/30/01.

VAERS ID:171032 (history)  Vaccinated:2001-03-19
Age:0.5  Onset:2001-03-21, Days after vaccination: 2
Gender:Male  Submitted:2001-04-18, Days after onset: 27
Location:Florida  Entered:2001-06-12, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: peaches,
Diagnostic Lab Data: blood culture, chest x-ray, urine cultures
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS989A22IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747241IMRL
Administered by: Private     Purchased by: Private
Symptoms: Lethargy, Pyrexia, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (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), Hypersensitivity (narrow)
Write-up: This patient had generalized hives, fever of 105 for 24 hours after his shots. He was vomiting. He was very lethargic and the rash continued. Because of the severity of the reaction the pt was hospitalized. He was observed for 48 hours and then subsequently discharged and he never had any problem. In the past he has never had any adverse reactions to immunizing agents.

VAERS ID:171412 (history)  Vaccinated:2001-03-19
Age:1.1  Onset:2001-03-28, Days after vaccination: 9
Gender:Male  Submitted:2001-06-07, Days after onset: 70
Location:Nevada  Entered:2001-06-14, 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: Tylenol
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.0172K0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1242K0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Convulsion, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), 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), Hypersensitivity (narrow)
Write-up: 9 days post vax, the pt developed a fever of 104.5 and had a seizure. The next day developed a rash. Seen at the ER.

VAERS ID:172440 (history)  Vaccinated:2001-03-19
Age:15.0  Onset:2001-03-19, Days after vaccination: 0
Gender:Female  Submitted:2001-03-20, Days after onset: 1
Location:Washington  Entered:2001-06-26, Days after submission: 97
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WA011753
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS173A2 IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05052  LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1379K SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0330AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Headache, Injection site pain, Ocular hyperaemia, Pain, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Vestibular disorders (broad)
Write-up: Onset, 1 hours, post vax. Chief complaints, headache, dizziness, body aches, sore arms, red eyes and slept most of the day of immunization; did not go to school on 3/20/01. Mother had to feed because arms hurt. Gave Tylenol X 1, ice to arms.

VAERS ID:172598 (history)  Vaccinated:2001-03-19
Age:1.0  Onset:2001-03-20, Days after vaccination: 1
Gender:Female  Submitted:2001-06-23, Days after onset: 94
Location:Connecticut  Entered:2001-06-29, 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: Amoxicillin. Ventolin
Current Illness: Resolving URI, bronchitis
Preexisting Conditions: NONE
Diagnostic Lab Data: Urinalysis - neg
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R133122IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747371IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1468K0SC 
Administered by: Private     Purchased by: Private
Symptoms: Erythema multiforme, Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Urticaria/erythema multiforme. Progressive despite stopping Amoxicillin; swelling of hands and feet - started on po steroids with resolution.

VAERS ID:172679 (history)  Vaccinated:2001-03-19
Age:0.5  Onset:2001-03-20, Days after vaccination: 1
Gender:Female  Submitted:2001-05-09, Days after onset: 49
Location:North Carolina  Entered:2001-07-02, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diarrhea
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ8688321MAR2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM978A2 IM 
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURERT05062   
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.474710   
PNC: PNEUMO (PREVNAR)PFIZER/WYETH4725520IMLL
Administered by: Military     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: One day after being vaccinated the pt developed a 1 cm-1.5 cm area of induration at the site of the Prevnar injection. She also developed a streak of erythema that extended from the area of induration.

VAERS ID:172804 (history)  Vaccinated:2001-03-19
Age:1.3  Onset:2001-03-20, Days after vaccination: 1
Gender:Male  Submitted:2001-03-21, Days after onset: 1
Location:Texas  Entered:2001-07-03, Days after submission: 103
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NON SPECIFIED
Diagnostic Lab Data:
CDC Split Type: TX01044
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU03218A4IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1427K2IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA512AB4IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733451IMRL
Administered by: Public     Purchased by: 0
Symptoms: Injection site induration, Skin irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Noticed this AM, whelps on R leg diameter 130mm L leg @ site of Hep B & Prevnar. R leg local irritation 42mm. Child is walking w/o problems. Afebrile. Noted some hardness @ injection sites. Band Aids were left on $g 24hrs. Advised warm moist compresses. Tylenol/motrin. Call in 2 days if whelps still present.

VAERS ID:176334 (history)  Vaccinated:2001-03-19
Age:1.1  Onset:2001-10-04, Days after vaccination: 199
Gender:Male  Submitted:2001-10-09, Days after onset: 5
Location:Kansas  Entered:2001-10-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Varicella zoster, still very fussy. Still recovering.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0401K SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733513IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0526K SCRL
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection, Irritability, Pruritus
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (broad)
Write-up: Varicella vaccine given 03/19/2001. Developed vesicular rash on pt lower extremity 10/04/2001. Pt very fussy with it and was scratch in it. Seen at urgent care 10/07/2001 and diagnosed varicella and given Acyclovir and Benadryl. On 10/09/2001 has excoriated vesicular rash confined to pt thigh, primarily anterior knee and one spot on pt lower back near spine.

VAERS ID:177885 (history)  Vaccinated:2001-03-19
Age:  Onset:2001-03-20, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Georgia  Entered:2001-11-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: triaminic, tanafed, Albuterol
Current Illness: Asthma
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM981A23IMRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5101A22IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1413K3IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05322SCLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site mass, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Given 3/19/2001 - seen in office 3/21/01 R thigh red, swollen, lump local reaction only - walking on leg ok no infection noted.

VAERS ID:187933 (history)  Vaccinated:2001-03-19
Age:1.4  Onset:0000-00-00
Gender:Female  Submitted:2002-05-30
Location:Unknown  Entered:2002-07-23, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levsin
Current Illness:
Preexisting Conditions: Dairy allergy; Antibiotic allergy
Diagnostic Lab Data: Body temp 6/01-105F
CDC Split Type: WAES0112USA01833
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Insomnia, Irritability, Otitis media, Pyrexia, Rash morbilliform
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a consumer concerning her 17 month old daughter with no past medical history, a dairy allergy and an antibiotic allergy who on 3/19/01 was vaccinated with MMRII (lot 00150-invalid lot). Concomitant therapy included hyoscyamine (Levsin). In approx. 3/01, the pt developed a fever of 105F, a rash, an ear infection, irritability and insomnia. It was noted that the rash looked like measles and rubella. She went on antibiotics and the effects disappeared within 2 weeks. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:195309 (history)  Vaccinated:2001-03-19
Age:1.0  Onset:2001-12-03, Days after vaccination: 259
Gender:Male  Submitted:2003-03-06, Days after onset: 458
Location:Tennessee  Entered:2002-12-23, Days after submission: 73
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: Blood culture positive for streptococcus pneumoniae (intermediate resistance); Blood culture positive for streptococcus pneumoniae (penicillin sensitive; serotype pending)
CDC Split Type: HQ4165511SEP2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT05622 RA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747243IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1469K0 LA
Administered by: Private     Purchased by: Other
Symptoms: Bacterial infection, Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Follow up information received 10/14/02 from physician contained dates of Prevnar immunization and complete vaccination record of patient. A physician reported that a 2 year old male child received a 4th dose of Prevnar (pneumococcal 7-valent conjugate vaccine), 1st dose of Varivax, 3rd dose of Polio vaccine on 3/19/01, when he was 12 months old. On 8/23/02, the child''s blood culture was positive for Streptotoccal pneumoniae. He was treated with IM ceftriaxone sodium and high doses of amoxicillin. The organism was penicillin sensitive. A serotype is pending. The patient''s experience was considered to be life-threatening. On 12/3/01, the patient also had positive blood cultures for Streptococcal pneumoniae. See case HQ4203613SEP2002. No additional information was available as of the date of this report. Follow-up information received 04Mar2003 from physician stated that serotyping was not done following child''s first episode of invasive pneumococcal disease. Serotyping performed by CDC following second episode of invasive pneumococcal disease identified serotype 23B (not a Prevnar serotype. Follow-up received 02Dec2002 contained quality control results (satisfactory) for Prevnar lot numbers. Follow-up information received 14Oct2002 from physician contained dates of Prevnar immunization and complete vaccine record of patient.

VAERS ID:200629 (history)  Vaccinated:2001-03-19
Age:1.3  Onset:2002-11-08, Days after vaccination: 599
Gender:Female  Submitted:2002-12-31, Days after onset: 53
Location:Texas  Entered:2003-04-01, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Congenital cystic kidney disease; Epidermal naevus
Diagnostic Lab Data: Blood culture positive for streptococcus pneumoniae; CSF culture positive for streptococcus pneumoniae
CDC Split Type: HQ5970730DEC2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 1  
Administered by: Other     Purchased by: Other
Symptoms: Bacterial infection, Drug ineffective, Meningism
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow)
Write-up: An MD reported that a 15 mt old female received her 2nd dose of Prevnar on 3/19/01. Her medical history included polycystic kidney disease and epidermal nevus system. On 11/8/02, at 35 mts of age, she developed Pneumococcal meningitis. On 11/9/02, she was hospitalized. Blood and cerebrospinal fluid cultures were positive for Streptococcus pneumoniae. No further info was available at the date of this report.

VAERS ID:207463 (history)  Vaccinated:2001-03-19
Age:4.0  Onset:2001-04-01, Days after vaccination: 13
Gender:Male  Submitted:2003-08-05, Days after onset: 855
Location:Pennsylvania  Entered:2003-08-05
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: MRI,Blood work to be done August 7th for pyruvate and lactate reading. some blood work done with his nuerologist prior to MRI.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (DITANRIX)SMITHKLINE BEECHAM921A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R02363IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1326J3IMRA
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER 0IDLA
Administered by: Public     Purchased by: Unknown
Symptoms: Asthenia, Autism, Balance disorder, Coordination abnormal, Demyelination, Encephalopathy, Gait disturbance, Hypotonia, Multiple sclerosis, Paralysis flaccid, Vascular anomaly
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad)
Write-up: roughly 2 weeks after his immunizations he became, fatigued, weak, and unsteady; he kept falling. I finally took him to a neurologist, and an MRI was reformed; result found were: MS,Demyelinating Encephalopathy,Post Vaccination Reaction, also diagnoised with Hypotonia, gait disturbance/Ataxia.In PT and OT at Easter Seals. Suffers also from: asthma, allergies, AD, fatigue and weakness. In continious treatment now. The medical record states congenital atonia, attention deficit disorder, and R frontal venous angioma.

VAERS ID:211659 (history)  Vaccinated:2001-03-19
Age:48.0  Onset:2001-06-07, Days after vaccination: 80
Gender:Male  Submitted:2003-10-27, Days after onset: 872
Location:Wisconsin  Entered:2003-11-04, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: E-rays, MRI
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS   LA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Difficulty in walking, Neurological symptom
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Severe pain in all joints, difficulty walking, have numerous anti-inflammatory meds trials with no help. Experiencing neuro problems in right leg. Symptoms started 3 to 4 months after last vaccination.

VAERS ID:217302 (history)  Vaccinated:2001-03-19
Age:1.1  Onset:2003-12-12, Days after vaccination: 998
Gender:Male  Submitted:2004-03-04, Days after onset: 83
Location:Arizona  Entered:2004-03-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNKNOWN
Preexisting Conditions: AUTISM, S/P HYDRONEPHOSIS, GERD, CHRONIC LUNG DISEASE, ASD, RAD.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1339K0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Herpes zoster, Viral infection
SMQs:
Write-up: CHILD BROKE OUT WITH SHINGLES APPROXIMATELY 12-12-2003. CHILD WAS SEEN IN OFFICE ON 2-17-2004 BECAUSE SHINGLES WERE NOT IMPROVING AND SPREADING. SPOKE WITH MOM ON 02-27-2003 STATES SHINGLES IMPROVING. USING BENADRYL AND CALOMINE LOTION AS NEEDED. CHILD DOES HAVE DIAGNOSIS OF AUTISM.

VAERS ID:223027 (history)  Vaccinated:2001-03-19
Age:  Onset:2001-03-19, Days after vaccination: 0
Gender:Female  Submitted:2004-05-28, Days after onset: 1165
Location:Unknown  Entered:2004-06-22, Days after submission: 25
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: diagnostic laboratory: 03/19/2001 and 12/19/2002: titer after MMR vaccination patient failed to seroconvert.
CDC Split Type: WAES0304USA01176
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug ineffective, Laboratory test abnormal
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a registered nurse concerning a female patient who on 19MAR2001 was vaccinated with a dose of measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation). ON 19DEC2002 the patient received a second dose of measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation). It was reported that a titer was drawn after each dose and the pt failed to seroconvert each time. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:256280 (history)  Vaccinated:2001-03-19
Age:1.1  Onset:2005-05-30, Days after vaccination: 1533
Gender:Unknown  Submitted:2006-05-12, Days after onset: 347
Location:Massachusetts  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Body temp 100.3
CDC Split Type: WAES0506USA03799
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1153K  UN
Administered by: Other     Purchased by: Other
Symptoms: Dermatitis bullous, Pyrexia, Skin ulcer, Viral infection
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 5 year old patient who on 3/19/2001 was vaccinated with a dose of varicella virus vaccine live (lot 635607/1153K). On 5/30/2005 the patient developed a rash. On 5/31/2005 the physician diagnosed the patient with breakthrough varicella with 50-249 lesions. The patient had a fever of 100.3 that lasted 1 day. There were no complications. The patients diagnosis was not confirmed by the lab. The patient had no prior history of chickenpox. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information is not expected.

VAERS ID:169243 (history)  Vaccinated:2001-03-19
Age:1.0  Onset:2001-03-22, Days after vaccination: 3
Gender:Female  Submitted:2001-04-24, Days after onset: 32
Location:Foreign  Entered:2001-04-30, 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: paracetamol, acetaminophen
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES01041235
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Febrile convulsion, Upper respiratory tract infection
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a health authority concerning a 12 month old female who on 3/19/01 was vaccinated with MMRII. Concomitant medication included paracetamol. On 3/22/01, the pt experienced 2 febrile convulsions. It was noted that there was no family history of convulsions, febrile or otherwise. The clinical examination was unremarkable other than a red throat with enlarged tonsils but no cough. A questionable viral upper respiratory infections or "MMR reaction" was also noted. It was reported that the pt recovered. The reporter considered the experiences "Other Medical Events". Additional information is not expected.

VAERS ID:170254 (history)  Vaccinated:2001-03-19
Age:2.0  Onset:2001-03-22, Days after vaccination: 3
Gender:Male  Submitted:2001-05-18, Days after onset: 56
Location:Foreign  Entered:2001-05-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20010118291
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0IM 
Administered by: 0     Purchased by: 0
Symptoms: Kawasaki's disease, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vasculitis (narrow)
Write-up: All previous vaccinations with other vaccines were well tolerated. On 3/19/01, the pt received the 1st dose of Havrix K (Hep-A vaccine). Approx. 3 days, post vax, on 3/22/01, the vaccinee experienced Kawasaki Syndrome with fever $g 39C. On 3/29/01, the pt was hospitalized. The most recent information received on 5/14/01, reports the outcome of the pt as not yet recovered. The reporter considered that the event was possibly related to vaccination with Havrix K. Other serious criteria term (Vasculitis Allergic).

VAERS ID:211330 (history)  Vaccinated:2001-03-19
Age:0.3  Onset:0000-00-00
Gender:Female  Submitted:2003-10-29
Location:Foreign  Entered:2003-10-31, Days after submission: 2
Life Threatening? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: She received the previous study vaccine on 2/17/01.
Diagnostic Lab Data:
CDC Split Type: 200302633
Vaccination
Manufacturer
Lot
Dose
Route
Site
BCG: BCG (NO BRAND NAME)UNKNOWN MANUFACTURER    
DTPHIB: DTP + HIB (DTP + ACTHIB)AVENTIS PASTEUR  IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oral intake reduced, Pharyngitis, Pyrexia, Respiratory rate increased, Rhinitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow)
Write-up: This case has been reported after completion of a clinical study. This study was conducted between 1998 and 2002. it was a randomized, controlled, double-blind trial comparing pneumonia and meningitis outcomes among children <2 years of age who were immunized according to schedule with DTP or DTP PRP T vaccine. The primary outcome was radiologically confirmed alveolar infiltrate based on standard criteria. Preliminary results: 55.073 children were enrolled. DTP PRP T had a large effect on meningitis outcomes but prevented a small proportion, if any, of measured pneumonia outcomes. More data on mortality rates are awaited. Case history: Cold, cough for 3 days, didn''t want breast feeding, high temperature for 4 days, fast breathing for 1 day. Baby died at home without being examined by a physician. Comments from study physician: Death due to unknown cause 3 days post vaccination with multiple vaccines. Symptoms began before vaccination and suggest pneumonia. Unblinding of the clinical trial: the patient has been exposed to study vaccine: DTP HIB. The principal investigator stated that the deaths were not related to vaccination and that infant mortality rate before the study was 100/1000.

VAERS ID:175925 (history)  Vaccinated:2001-03-20
Age:1.3  Onset:0000-00-00
Gender:Male  Submitted:2001-09-26
Location:Foreign  Entered:2001-10-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Normal physical examinations, body temperature was 36.5C and thee were no signs of an infection. Lab test includes: 03/28/01 hemoglobin 10.3 g/dL, hematocrit 31.4 %, white blood cell count 9900 /mcL, platelets 7000 /mcL; 03/30/01 Hemoglobin
CDC Split Type: WAES01052599
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1394J SC 
Administered by: 0     Purchased by: 0
Symptoms: Laboratory test abnormal, Petechiae, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: A 15 month old male who on 03/20/01 was vaccinated IM with a 1st dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live. On 03/28/01, the patient presented with petechia, but was in good general state with normal physical examinations, body temperature was 36.5C and thee were no signs of an infection. The diagnosis was "immunothrombocytopenic purpura after MMR vaccination with anemia ". The patient received treatment with IV steroids and immunoglobulins and recovered. At discharge, on 04/10/01, he was still on low-dose oral steroids.

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