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Found 593491 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:128437 (history)  Vaccinated:1999-09-20
Age:0.5  Onset:1999-09-21, Days after vaccination: 1
Gender:Male  Submitted:1999-09-22, Days after onset: 1
Location:Georgia  Entered:1999-09-23, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: well child check
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES09960802 LL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P04742 LL
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: child devel redness, warmth, swelling & tenderness @ vax site w/in 24hr of vax;sx c/w cellulitis;

VAERS ID:128582 (history)  Vaccinated:1999-09-20
Age:1.6  Onset:1999-09-21, Days after vaccination: 1
Gender:Male  Submitted:1999-09-21, Days after onset: 0
Location:Florida  Entered:1999-09-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: PPD by Parke Davis lot# 03708P given 9/20/99;
Current Illness: NONE
Preexisting Conditions: environmental allergies;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7388AA3IMLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt lt arm swollen next morning by afternoon deltoid, upper arm lt side chest were red & swollen;seen by ARNP;instructed to observe;if s/s inc to ED/PMD;mom stated took pt to ED on 9/21/99 area looked worse;

VAERS ID:128716 (history)  Vaccinated:1999-09-20
Age:27.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Female  Submitted:1999-09-24, Days after onset: 4
Location:Arizona  Entered:1999-09-28, 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:
Preexisting Conditions: allergies to air borne pariticles
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7301BA0 LA
Administered by: Public     Purchased by: Unknown
Symptoms: Abdominal pain, Headache, Myasthenic syndrome, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Malignancy related conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt exp large red bullseye rash & hot to the touch; legs were shaky & would go numb all day; severe h/a & stomach ache

VAERS ID:128754 (history)  Vaccinated:1999-09-20
Age:19.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Female  Submitted:1999-09-22, Days after onset: 2
Location:New York  Entered:1999-09-29, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI-common cold
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type: WA991597
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: p/vax pt exp local 8x6cm pink indurated area at inj site; pt recovering

VAERS ID:128776 (history)  Vaccinated:1999-09-20
Age:23.0  Onset:1999-09-21, Days after vaccination: 1
Gender:Female  Submitted:1999-09-21, Days after onset: 0
Location:Oregon  Entered:1999-09-30, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DPH, Proventil;Allegra;
Current Illness: NONE
Preexisting Conditions: PCN & allergic rhinitis, asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1784H SCLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09973900IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt devel urticaria 24hr p/vax;pt not having any SOB, wheezing, swelling, hypotension;BP stable;hives on legs, arms abd;pt placed on allegra;

VAERS ID:128883 (history)  Vaccinated:1999-09-20
Age:31.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Female  Submitted:1999-09-27, Days after onset: 7
Location:Alaska  Entered:1999-10-04, 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: special 1/1000 for allergies
Current Illness: NONE
Preexisting Conditions: allergic to animal dander, grasses, pollens;
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982090 RA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: rt deltoid swollen w/erythema measuring 3" circumference;no other problems;

VAERS ID:128884 (history)  Vaccinated:1999-09-20
Age:0.4  Onset:1999-09-21, Days after vaccination: 1
Gender:Male  Submitted:1999-09-21, Days after onset: 0
Location:California  Entered:1999-10-04, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA990101
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7389AA1 RL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0104J1 LL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P01671 LL
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: diffuse rash on extremities, trunk, no drainage;no resp distress;no fever;

VAERS ID:128922 (history)  Vaccinated:1999-09-20
Age:1.3  Onset:1999-09-21, Days after vaccination: 1
Gender:Male  Submitted:1999-09-21, Days after onset: 0
Location:Illinois  Entered:1999-10-05, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergic to cefzil
Diagnostic Lab Data:
CDC Split Type: IL99059
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4623163IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS460103A2IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1781H SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4596022PO 
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: mom reports pt had very light, fine rash on chest, arms, feet & face;rash was not raised;mom noticed this rash 830AM the morning p/vax given;rash lasted 1 day;mom gave 1 dose of DPH per MD;

VAERS ID:128935 (history)  Vaccinated:1999-09-20
Age:8.0  Onset:1999-09-21, Days after vaccination: 1
Gender:Male  Submitted:1999-09-21, Days after onset: 0
Location:Illinois  Entered:1999-10-05, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: IL99058
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3080D91 LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dyspnoea, Laryngitis, Pyrexia, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt started having trouble breathing-sounded like cramp only deeper;had T102.3 lasting on & off for approx 24hr;went to MD given decadron;mom reported pt had raised rash on trunk front & back;

VAERS ID:128944 (history)  Vaccinated:1999-09-20
Age:1.2  Onset:1999-09-28, Days after vaccination: 8
Gender:Female  Submitted:1999-09-30, Days after onset: 2
Location:Washington  Entered:1999-10-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7172BA3IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESM0973AA3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1749H0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0730J0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Dermatitis bullous, Pyrexia, Rash maculo-papular, Skin nodule
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: lump devel about 7-8hr in lt leg p/inj;broke out in rash resembling chickenpox as it''s first breaking out;fever 1-2 days of 101-102;faintly colored papular rash everywhere;

VAERS ID:128960 (history)  Vaccinated:1999-09-20
Age:48.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Female  Submitted:1999-09-28, Days after onset: 8
Location:Florida  Entered:1999-10-06, 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: clindamycin 4 days prior
Current Illness: NONE
Preexisting Conditions: PCN, MVP
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3023A23IMLA
Administered by: Public     Purchased by: Private
Symptoms: Oedema, Pain, Petechiae, Pruritus, Vasculitis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vasculitis (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: w/in 12hr of vax pt devel burning & itching of feet;progressed to edema & petechia;dx w/vasculitis secondary to reaction by HBV by both allergist & vascular surgeon;steroid rx is responding well;

VAERS ID:128965 (history)  Vaccinated:1999-09-20
Age:0.2  Onset:1999-09-22, Days after vaccination: 2
Gender:Male  Submitted:1999-09-30, Days after onset: 8
Location:Tennessee  Entered:1999-10-06, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: colic;congested w/nl PE
Preexisting Conditions: colic;LGA;OM
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)PFIZER/WYETH4623560IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1192J0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P05520SCLL
Administered by: Private     Purchased by: Private
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: high pitched screaming for several hours 2 days p/vax;difficult to console;no fever;

VAERS ID:128980 (history)  Vaccinated:1999-09-20
Age:18.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Male  Submitted:1999-09-20, Days after onset: 0
Location:Louisiana  Entered:1999-10-07, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: prev hx 6-7 years old;epilepsy & sz;
Diagnostic Lab Data:
CDC Split Type: LA991001
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2944A21IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0917J1SCRA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4653080IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Asthenia, Hypertension, Hypertonia, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: pt verbalized weakness, fainted, hands & feet turned inward towards body & knees upward toward chest, pale skin,became able to speak;BP 130/80, pulse 72;

VAERS ID:129178 (history)  Vaccinated:1999-09-20
Age:4.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Female  Submitted:1999-09-21, Days after onset: 1
Location:Georgia  Entered:1999-10-12, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC Split Type: GA99107
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM910A24IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1357H1SCRA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0798D3PO 
Administered by: Public     Purchased by: Public
Symptoms: Face oedema, Oedema, Oedema peripheral, Pruritus, Urticaria, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt started scratching face, arms & neck;mom brought child back for nurses to see rash, hive like rash, reddened & sl swollen note on face, neck, upper chest & arms;child scratching badly;no diff breathing;

VAERS ID:129192 (history)  Vaccinated:1999-09-20
Age:4.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Pennsylvania  Entered:1999-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type: PA9963
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM597A20IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0721J0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash (wheals on lt arm, one leg, & on feet);

VAERS ID:129296 (history)  Vaccinated:1999-09-20
Age:1.4  Onset:1999-09-20, Days after vaccination: 0
Gender:Male  Submitted:1999-09-24, Days after onset: 4
Location:Minnesota  Entered:1999-10-13, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: CXR done @ ER
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)PFIZER/WYETH4623173IMLL
HIBV: HIB (HIBTITER)PFIZER/WYETH450253A3IMRL
Administered by: Private     Purchased by: Public
Symptoms: Condition aggravated, Dyspnoea, Febrile convulsion, Gaze palsy, Hypersensitivity, Hypertonia, Hyperventilation, Hypotonia, Pyrexia, Stupor, Tachycardia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: fever, resp distress, sz, diff breathing;T102,7, rapid heart rate;some resp difficulty w/eyes rolled back in head;R26;pupils were no reactive & was having gross tonic clonic sz;resp rapid w/great effort;sz poss d/t fever;allerg rxn

VAERS ID:129491 (history)  Vaccinated:1999-09-20
Age:1.7  Onset:1999-09-20, Days after vaccination: 0
Gender:Male  Submitted:1999-09-22, Days after onset: 2
Location:Oklahoma  Entered:1999-10-18, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OK9945
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU00465C1 LL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0211J2 RL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESU00465C1 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0934J0SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0443J0SC 
Administered by: Public     Purchased by: Public
Symptoms: Ecchymosis, Injection site hypersensitivity, Injection site mass, Vasodilatation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: rt anterior thigh 4", circular, red, warm to touch, itching, dimple area @ site of inj, blue darkened are @ site of inj;no fever;no temp for past 48hr;not tender to touch;no voiced complaints noted yesterday but inc in size today;given DPH

VAERS ID:129769 (history)  Vaccinated:1999-09-20
Age:10.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Georgia  Entered:1999-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Diagnostic Lab Data: CXR, EKG-nl;CBC, chem, monospot-nl;blood pressure-nl;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1823H0IM 
Administered by: Military     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: syncopal episode 1min p/vax then again 1hr later;then 1 wk later had 2 more episodes of syncope for 30sec;afterwards pt was awake & alert, responsive;

VAERS ID:130147 (history)  Vaccinated:1999-09-20
Age:28.0  Onset:1999-09-23, Days after vaccination: 3
Gender:Male  Submitted:1999-09-23, Days after onset: 0
Location:Texas  Entered:1999-11-02, Days after submission: 40
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: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0444SCLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site oedema, Oedema, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt w/some edema;edema inc distal lt upper arm to lt elbow;some pruritus;given pred;

VAERS ID:130824 (history)  Vaccinated:1999-09-20
Age:53.0  Onset:1999-09-22, Days after vaccination: 2
Gender:Male  Submitted:1999-11-02, Days after onset: 41
Location:Minnesota  Entered:1999-11-15, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: GERD, migraine h/a;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU001DAA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypertonia, Injection site hypersensitivity, Injection site oedema, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: p/vax whole body very sore & stiff day 2-3 p/vax;day 5 pt 1st noticed a sl swollen 2" red area;stated did not have redness prior to this day;sore & stiff body gone p/2 days;

VAERS ID:131590 (history)  Vaccinated:1999-09-20
Age:1.2  Onset:1999-09-28, Days after vaccination: 8
Gender:Male  Submitted:1999-10-25, Days after onset: 27
Location:Oregon  Entered:1999-11-30, Days after submission: 36
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: OR9928
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0538J0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: rash diffuse over body reported by mom 9/30/99 sen by MD same day;sx started 9/29/99 w/fever to 100.2;rash started around face & ears;

VAERS ID:132318 (history)  Vaccinated:1999-09-20
Age:14.0  Onset:1999-09-20, Days after vaccination: 0
Gender:Female  Submitted:1999-10-21, Days after onset: 31
Location:South Carolina  Entered:1999-12-28, Days after submission: 68
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: SC99076
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAMENG3092A91IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Face oedema, Headache, Oedema, Tongue oedema, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling of entire body including face & tongue.Also, hives,headache,& dizziness.Tx w/ prednisone.

VAERS ID:132933 (history)  Vaccinated:1999-09-20
Age:46.0  Onset:1999-09-25, Days after vaccination: 5
Gender:Female  Submitted:1999-12-23, Days after onset: 89
Location:Ohio  Entered:1999-12-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone,Methotrexate, Leucovorin
Current Illness:
Preexisting Conditions: hx of SLE since 1986
Diagnostic Lab Data: MRI, spinal tap was nml.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982310IMA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Erythema nodosum, Hepatocellular damage, Hyperhidrosis, Nausea, Paraesthesia, Peroneal nerve palsy, Systemic lupus erythematosus, Tachycardia
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: First had erythema nodosom on both knees, 5 days after vax. Tx''d with prednisone and ? other med. and they subsided. On 10/23 developed nausea,sweating and weakness and told by MD she had a flu virus. These symptoms continued and then she

VAERS ID:134628 (history)  Vaccinated:1999-09-20
Age:1.8  Onset:1999-10-16, Days after vaccination: 26
Gender:Female  Submitted:2000-02-28, Days after onset: 135
Location:Arkansas  Entered:2000-03-08, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT/MRI-nml, EEG-nml
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 
Administered by: Public     Purchased by: Private
Symptoms: Adverse drug reaction, Autism, Convulsion, Furuncle, Mental retardation severity unspecified, Rash, Speech disorder
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Boils on arm, rash on face and neck, petit-mal seizure, loss of speech and development skill, autistic.

VAERS ID:134690 (history)  Vaccinated:1999-09-20
Age:23.0  Onset:1999-10-28, Days after vaccination: 38
Gender:Female  Submitted:2000-03-03, Days after onset: 127
Location:Alaska  Entered:2000-03-10, 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: ortho-tricyclen
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0372  
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982341  
Administered by: Military     Purchased by: Military
Symptoms: Abdominal pain, Headache, Injection site hypersensitivity, Injection site oedema, Injection site pain, Insomnia, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (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), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Headaches, sleep deprivation, stomach pain (daily), arm swollen, red & sore, muscle aches and nausea. Pt partially recoverd - headaches, muscle and joint aches not as often as in the past. Pt missed 4 work days due to this event. At time of evaluations I wasn''t sure it was ANTHRAX. Pt did not received any furtheer ANTHRAX shots since the reported event Per follow-up: 7/25/00 1601 - 1st attempt to reach pt - message left on answering machine requesting a call back. 7/26/00 1520 - 2nd attempt to reach pt - message left on answering machine requesting a call back. 7/27/00 1355 - Call back from pt - she continues to have severe heaaches and has been seen by doctors - Consent form sent for medical records.

VAERS ID:152297 (history)  Vaccinated:1999-09-20
Age:34.0  Onset:1999-09-27, Days after vaccination: 7
Gender:Female  Submitted:2000-03-07, Days after onset: 162
Location:Nebraska  Entered:2000-05-23, Days after submission: 76
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99102113
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0904J0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a health care professional concerning a 34 year old female who on 9/20/99 was vaccinated IM in the left deltoid with the first dose of Hep B vaccine. Subsequently, the pt experienced a rash in the elbow vicinity of the injection arm. The rash began approximately 7 days post vax. The pt sought unspecified medical treatment. On an unspecified date the pt recovered. No additional information is available.

VAERS ID:155644 (history)  Vaccinated:1999-09-20
Age:51.0  Onset:1999-09-21, Days after vaccination: 1
Gender:Male  Submitted:2000-04-06, Days after onset: 198
Location:Minnesota  Entered:2000-06-28, Days after submission: 83
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: GERD
Diagnostic Lab Data:
CDC Split Type: U1999006980
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES40010AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hyperhidrosis, Injection site erythema, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: It was reported that a 51 year old male received a TD on 9/20/99. On 9/21/99, the pt experienced a fever, achiness and a local reaction of redness and soreness at the site along with sweats. Pt was told to take Benadryl and apply ice to the site. From correspondence received on 10/4/99, it was reported that the pt recovered from this experience.

VAERS ID:156199 (history)  Vaccinated:1999-09-20
Age:8.0  Onset:1999-09-23, Days after vaccination: 3
Gender:Female  Submitted:2000-05-16, Days after onset: 236
Location:Montana  Entered:2000-07-10, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES99092122
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash vesicular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Three days post vax, pt developed greater than 100 generalized vesicular rash with high fever. The scabs were crusting and the fever had resolved at the time of this report.

VAERS ID:156439 (history)  Vaccinated:1999-09-20
Age:20.0  Onset:1999-11-10, Days after vaccination: 51
Gender:Female  Submitted:2000-05-16, Days after onset: 187
Location:New York  Entered:2000-07-13, Days after submission: 58
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: serum varicella zoster 11/10/1999 - failed to seroconvert after two doses
CDC Split Type: WAES99111119
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0715J1SC 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Subsequent to receiving two doses of varicella virus vaccine live the pt''s laboratory evaluation revealed negative titer. It was noted that the pt has indeterminate antibodies of varicella.

VAERS ID:132672 (history)  Vaccinated:1999-09-20
Age:66.0  Onset:0000-00-00
Gender:Male  Submitted:1999-12-16
Location:Foreign  Entered:1999-12-21, Days after submission: 5
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: arrhythmia,chronic bronchitis,COPD,cirrhosis,DM,sick sinus syndrome
Diagnostic Lab Data: CSF-no increase in protein contents
CDC Split Type: WAES99120245
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Guillain-Barre syndrome, Paralysis, Respiratory disorder
SMQs:, Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad)
Write-up: 9/20/99:Pt. vaccinated w/ pneumococcal vacc.In 1999, pt. developed progressive paralysis necessitating mechanical vent.Dxed with Guillin-Barre Synd.

VAERS ID:157870 (history)  Vaccinated:1999-09-20
Age:1.0  Onset:1999-09-21, Days after vaccination: 1
Gender:Female  Submitted:2000-07-22, Days after onset: 305
Location:Foreign  Entered:2000-07-24, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Gastric echography was negative.
CDC Split Type: 20000216661
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM16733A91IM 
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER16733A91IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER16733A91IM 
Administered by: Other     Purchased by: Other
Symptoms: Hypotonia, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic 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), Hypoglycaemia (broad)
Write-up: The child received the second dose of Infanrix, Hep B and Imovax polio. On 9/21/99, unknown time after the vax, the child experienced hypotonia and hyporesponsiveness. The child was hospitalized and recovered after an unknown time. Treatment with anti pertussis and anti hepatitis b vaccine has been stopped. Causality assessment has been coded, by the reporting physician, as suspected for both Infanrix, Hep B and Imovax. 15-day follow up dated 9/6/00 states the pt was discharged ruing the same day as she was hospitalized. She was seen by a neurologist and a cardiologist. Her conditions were normal. She received the third dose uneventfully. Pertussis and hep B were not given. Follow-up dated 9/11/00 provided no additional data.

VAERS ID:157874 (history)  Vaccinated:1999-09-20
Age:0.5  Onset:1999-09-21, Days after vaccination: 1
Gender:Female  Submitted:2000-07-20, Days after onset: 303
Location:Foreign  Entered:2000-07-24, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U2000005690
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM16733A9 IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R012610 IM 
Administered by: Other     Purchased by: Other
Symptoms: Hypotonia, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic 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), Hypoglycaemia (broad)
Write-up: The day after on 9/21/99, she experienced a hypotonic hyporesponsive episode. The same day, she was hospitalized and then discharged. She was visited by a neurologist and by a cardiologist; her conditions were normal. A gastric echography was performed because of the hypothesis of reflux and the result negative. The baby finally recovered. After this single episode, she did not experience other HHE. The physician, who performed previous vaccinations, decided for the third dose to inject the inactivated Polio and to suspend acellular Pertussis and Hep B. No reactions/events after the third dose were reported.

VAERS ID:256593 (history)  Vaccinated:1999-09-20
Age:52.0  Onset:1999-12-01, Days after vaccination: 72
Gender:Female  Submitted:2006-05-25, Days after onset: 2366
Location:Foreign  Entered:2006-05-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Anticardiolipin antibodies 3/23/2000 negative, cerebrospinal fluid protein 3/15/2000 0.30g/l, Kaolin cephalin clotting time 6/2002 increased. Lumbar puncture 3/15/2000 normal, Lupus anticoagulant 6/2002 Positive, MRI brain 3/13/2000 abnormal, MRI brain 3/31/2000 abnormal 6/2002 abnormal, Scan brain 3/21/2000 normal, Ultrasound Doppler 3/21/2000 normal. On 3/13/2000 MRI brain showed hypersignal of left optic nerve. On 3/15/2000 a lumbar puncture was performed. Electrophoresis of cerebrospinal fluid CSF was normal and CSF contained 6 elements and 30 red blood cells. On 3/21/2000 ultrasound Doppler of vessels of the neck was normal. On 3/31/2000 MRI showed bilateral subdural hematoma and thrombophlebitis of superior longitudinal sinus and righ
CDC Split Type: B0424575A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS  IMUN
Administered by: Other     Purchased by: Other
Symptoms: Coagulation time prolonged, Difficulty in walking, Eye disorder, Eye pain, Headache, Hemiparesis, Influenza like illness, Laboratory test abnormal, Optic neuritis, Pain, Sensory disturbance, Subdural haematoma, Thrombophlebitis
SMQs:, Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Corneal disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Ocular infections (broad), Hypoglycaemia (broad)
Write-up: This case was reported by regulatory authority and described the occurrence of optic neuritis in a 52 year old female subject who was vaccinated with hepatitis A inactivated and hepatitis B recombinant vaccine (Twinrix adult) for prophylaxis. Past vaccination included one dose of typhoid vaccine (Typhim) given on 7/12/1999 and a first dose of Twinrix and a booster of Tetanus, poliomyelitis vaccine unknown manufacturer given on 8/13/1999. On 9/20/1999, the subject received a 2nd dose of Twinrix adult (batch number not available), intramuscularly. In the beginning of Dec 1999, two months after vaccination, the subject developed pseudo grippal syndrome. In the beginning of March 2000, the subject experienced decreased of visual acuity of her left eye. There was progressively and painful. On 3/13/2000 MRI brain showed hypersignal of left optic nerve. Diagnosis of optic neuritis was made. On 3/15/2000 a lumbar puncture was performed. Electrophoresis of cerebrospinal fluid CSF was normal and subject was treated with bolus of corticoids at 500 mg daily. On 3/20/2000, brain scan was normal. Ultrasound Doppler of vessels of the neck was normal. On 3/23/2000, anticardiolipin antibodies were negative. After taking corticotherapy at 1mg/kg, left hemiparesis improved. On 3/31/2000 MRI showed bilateral subdural hematoma and thrombophlebitis of superior longitudinal sinus (not suspected adverse events, it was considered as lumbar post puncture syndrome or post corticoids syndrome). A Scan of control was made. On 4/10/2000, subdural hematoma regressed. On 4/31/2000, the subject recovered walking. On 6/5/2002 the subject was hospitalized due to left retro orbital pain and sensitive disorder of right hemi corpus. In June 2002, MRI brain showed hypersignal of encephalic white substance. Kaolin cephalin clotting time was prolonged due to positive lupus anticoagulant. The other basic investigations were normal. At the time of reporting, the events were resolved with sequelae. The events were dubiously related to vaccination with Twinrix. No more information will be available. This case has been closed.

VAERS ID:128438 (history)  Vaccinated:1999-09-21
Age:  Onset:1999-09-21, Days after vaccination: 0
Gender:Female  Submitted:1999-09-22, Days after onset: 1
Location:Georgia  Entered:1999-09-23, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: well child check;
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES0996083 LL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESN0941AA3 LL
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: pt devel redness, warmth, swelling & tenderness @ vax site (c/w cellulitis) w/in 6hr of inj;

VAERS ID:128459 (history)  Vaccinated:1999-09-21
Age:16.0  Onset:1999-09-22, Days after vaccination: 1
Gender:Male  Submitted:1999-09-22, Days after onset: 0
Location:Michigan  Entered:1999-09-24, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none
Other Medications:
Current Illness:
Preexisting Conditions: strep pharyngitis week ago & on ATB
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.092151IM 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0010AA4IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt erythematous rash;no fever, no chills, no SOB, no angioedema, no sore throat;

VAERS ID:128584 (history)  Vaccinated:1999-09-21
Age:21.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Male  Submitted:1999-09-23, Days after onset: 2
Location:Washington  Entered:1999-09-27, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIES6660AC0SC 
Administered by: Public     Purchased by: Private
Symptoms: Neck pain, Pain
SMQs:, Arthritis (broad)
Write-up: p/vax pt c/o significant pain in lt arm, neck & thigh;no fever;recommended urgent care visit;pt recovered w/o incident;pt awakened pain free 9/22/99;

VAERS ID:128696 (history)  Vaccinated:1999-09-21
Age:82.0  Onset:1999-09-22, Days after vaccination: 1
Gender:Female  Submitted:1999-09-22, Days after onset: 0
Location:New Mexico  Entered:1999-09-28, 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: baby asprin;avazapan; norvast cytomil paxel; tarazadore
Current Illness: none
Preexisting Conditions: depression; hypertension; dyspepsia
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER1585H  LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt exp redness & swelling along anterior portion of lt upper arm; soreness; sl warmth

VAERS ID:128698 (history)  Vaccinated:1999-09-21
Age:1.3  Onset:1999-09-22, Days after vaccination: 1
Gender:Male  Submitted:1999-09-23, Days after onset: 1
Location:New York  Entered:1999-09-28, 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:
Current Illness:
Preexisting Conditions: mom has sz disorder
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: p/vax pt generalized tonic clonic sz w/no fever;mom has sz disorder

VAERS ID:128704 (history)  Vaccinated:1999-09-21
Age:1.3  Onset:1999-09-22, Days after vaccination: 1
Gender:Male  Submitted:1999-09-22, Days after onset: 0
Location:South Dakota  Entered:1999-09-28, 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: none
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES09564103IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIES09610303SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0376J0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: p/vax pt rt leg edematous; rt thigh measures 12''''; lt thigh measures 10 3/4 at inj site

VAERS ID:128706 (history)  Vaccinated:1999-09-21
Age:1.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Male  Submitted:1999-09-22, Days after onset: 1
Location:Ohio  Entered:1999-09-28, 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: PPD, conn, #249411, lt arm
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: CBC; EKG; WNL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0711J0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Cyanosis, Dyspnoea, Hypotonia, Somnolence, Stupor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: p/vax pt was crying; gasped; went limp; turned blue; eyes wide open; when came to started crying & was sleepy; examined by paramedics-nl exam

VAERS ID:128752 (history)  Vaccinated:1999-09-21
Age:0.4  Onset:0000-00-00
Gender:Female  Submitted:1999-09-24
Location:Louisiana  Entered:1999-09-29, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt-1st dose DTAP/IPV/HIB;9/22/99;starring & startle
Other Medications:
Current Illness: diaper rash
Preexisting Conditions: none
Diagnostic Lab Data: none done just observation
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4643051IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS520313A1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P05531SCRL
Administered by: Private     Purchased by: Private
Symptoms: Hyperreflexia, Similar reaction on previous exposure to drug, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)
Write-up: p/vax pt had some staring spells; excessive startle reflex during sleep x24 hours;

VAERS ID:128765 (history)  Vaccinated:1999-09-21
Age:91.0  Onset:1999-09-24, Days after vaccination: 3
Gender:Female  Submitted:1999-09-29, Days after onset: 5
Location:New York  Entered:1999-09-30, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: no
Other Medications: none
Current Illness:
Preexisting Conditions: Alzheimers, NIDDM; NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES36415   
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.6473900   
Administered by: Private     Purchased by: Other
Symptoms: Acidosis, Condition aggravated, Hyperglycaemia, Myocardial infarction
SMQs:, Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Tumour lysis syndrome (broad)
Write-up: p/vax pt acute non-ketotic ketoacidosis; blood sugar-800 in pt w/NIDDM controlled w/diet

VAERS ID:128770 (history)  Vaccinated:1999-09-21
Age:4.0  Onset:1999-09-23, Days after vaccination: 2
Gender:Male  Submitted:1999-09-24, Days after onset: 1
Location:Maryland  Entered:1999-09-30, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NOEN
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4623554IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1648H1SC 
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES4618543PO 
Administered by: Private     Purchased by: Private
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: fever & seizure;

VAERS ID:128784 (history)  Vaccinated:1999-09-21
Age:71.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Female  Submitted:1999-09-24, Days after onset: 3
Location:New York  Entered:1999-09-30, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA
Other Medications:
Current Illness: burn on chest
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: p/vax pt devel erythema, warmth, tenderness 6x4cm of lt deltoid area p/vax;tx keflex, cold compress, APAP;

VAERS ID:128790 (history)  Vaccinated:1999-09-21
Age:55.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Female  Submitted:1999-09-24, Days after onset: 3
Location:Indiana  Entered:1999-09-30, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Norvasc/Premarin;pt recv hep b vax lot# 2296A4 on 9/22/99;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES09507403IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chills, Injection site hypersensitivity, Injection site oedema, Injection site pain, Myalgia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: chills, aches began evening of 9/21/99 & cont through 9/23/99;lt arm became red, warm & swollen from shoulder to antecubital space-area measures 12cm x 13cm;area is tender to touch;

VAERS ID:128948 (history)  Vaccinated:1999-09-21
Age:5.0  Onset:1999-09-22, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Georgia  Entered:1999-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0008BA IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 1day p/vax pt devel large 3-4" red & indurated tender area around inj site;

VAERS ID:128983 (history)  Vaccinated:1999-09-21
Age:9.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Male  Submitted:1999-09-27, Days after onset: 6
Location:Michigan  Entered:1999-10-07, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: ATB, Ringworm, Depakote
Current Illness: NONE
Preexisting Conditions: has cyst of penal region of brain;no allergies
Diagnostic Lab Data: NONE
CDC Split Type: MI99091
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0751J3 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0919J2SC 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7258BA5 RA
Administered by: Public     Purchased by: Public
Symptoms: Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt was snot feeling well;about 4hr later had T104;took to walk in center @ hosp dx rxn to vax;

VAERS ID:129138 (history)  Vaccinated:1999-09-21
Age:31.0  Onset:1999-09-29, Days after vaccination: 8
Gender:Male  Submitted:1999-09-29, Days after onset: 0
Location:Unknown  Entered:1999-10-08, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~0.00~Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0240SCRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax T98.8, P70, R16, BP 122/84;c/o swelling & soreness to rt arm;pt states is a direct result of anthrax immun;pain is exp w/direct pressure;upon rising in AM very red/tingly 3x3cm nodule;dx post anthrax vaccine nodule;

VAERS ID:129187 (history)  Vaccinated:1999-09-21
Age:11.0  Onset:1999-09-27, Days after vaccination: 6
Gender:Male  Submitted:1999-09-29, Days after onset: 2
Location:Georgia  Entered:1999-10-12, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: positive spinal tap
CDC Split Type: GA99112
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2937A20IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1970H1SC 
Administered by: Public     Purchased by: Public
Symptoms: CSF test abnormal, Headache, Infection, Meningitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 6 days p/vax pt c/o severe h/a, n/v, fever;taken from MD office by amb to hosp;dx viral meningitis;pt sent home to wait out disease process;

VAERS ID:129202 (history)  Vaccinated:1999-09-21
Age:0.7  Onset:1999-09-23, Days after vaccination: 2
Gender:Male  Submitted:1999-09-23, Days after onset: 0
Location:Ohio  Entered:1999-10-12, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OH99066
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM910A22IMRA
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1614H0IMLL
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt had some erythema & swelling as had a/w/ vax but 2 days p/vax parent changed pt diaper in AM & noticed it was red, swollen & hard, hot to touch & sensitive;

VAERS ID:129325 (history)  Vaccinated:1999-09-21
Age:56.0  Onset:1999-09-22, Days after vaccination: 1
Gender:Female  Submitted:1999-10-06, Days after onset: 14
Location:Virginia  Entered:1999-10-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: hypothyroidism
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0003BA1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: large area (12cm) of erythema, induration @ site of shot;

VAERS ID:129347 (history)  Vaccinated:1999-09-21
Age:0.2  Onset:1999-09-21, Days after vaccination: 0
Gender:Male  Submitted:1999-09-22, Days after onset: 1
Location:California  Entered:1999-10-13, Days after submission: 21
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: CA990107
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7389AA0IM 
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1232140IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N09560SC 
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: hyperflexion of arms & legs x 1 9/21/99 PM & x 1 9/22/99;also x 1 @ MD office;T101-controlled w/APAP;started on phenobarbital elixir x 3 days then shop;

VAERS ID:129486 (history)  Vaccinated:1999-09-21
Age:11.0  Onset:1999-10-08, Days after vaccination: 17
Gender:Male  Submitted:1999-10-11, Days after onset: 3
Location:Texas  Entered:1999-10-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Welbutrin
Current Illness: NA
Preexisting Conditions: NKDA;h/o depression
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2994B91 RA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Rash, Skin ulcer, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: pt guardian reported rash 17 days p/vax;pt examined & urticaria noted on trunk w/isolated lesion noted rt upper arm & rt thigh;negative temp;c/o SOB eval instructed to use DPH OTC;

VAERS ID:129619 (history)  Vaccinated:1999-09-21
Age:57.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:New Jersey  Entered:1999-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt states both elbows ached w/1st & 2nd anthrax
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0442  
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Myalgia, Similar reaction on previous exposure to drug
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: p/3rd vax rxn seemed worse, kept pt awake @ noc d/t pain;hyper extending arms seemed to alleviate some pain;

VAERS ID:129736 (history)  Vaccinated:1999-09-21
Age:5.0  Onset:1999-09-23, Days after vaccination: 2
Gender:Female  Submitted:1999-10-01, Days after onset: 8
Location:Texas  Entered:1999-10-22, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NA
CDC Split Type: TX99195
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES912A24IMLA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0802D4PO 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0709J0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site reaction
SMQs:
Write-up: large local rxn lt arm deltoid;

VAERS ID:129746 (history)  Vaccinated:1999-09-21
Age:1.4  Onset:1999-10-01, Days after vaccination: 10
Gender:Female  Submitted:1999-10-15, Days after onset: 14
Location:Colorado  Entered:1999-10-22, 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: anemia
Preexisting Conditions: NA
Diagnostic Lab Data: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESP1333AA0SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1071J0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0729J3IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: p/vax pt brought pt to office on 10/2/99 w/ c/o swelling & redness of lateral rt thigh;identified site of varivax;

VAERS ID:130357 (history)  Vaccinated:1999-09-21
Age:66.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Male  Submitted:1999-09-23, Days after onset: 2
Location:Maine  Entered:1999-11-05, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, Servent-asthma
Current Illness: NONE
Preexisting Conditions: asthma, sinus allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH499822610 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1585H0 RA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: swelling rt arm, redness, warm, arm sized doubled very sore;

VAERS ID:130865 (history)  Vaccinated:1999-09-21
Age:4.0  Onset:1999-09-27, Days after vaccination: 6
Gender:Female  Submitted:1999-09-27, Days after onset: 0
Location:Washington  Entered:1999-11-16, Days after submission: 50
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: NA
CDC Split Type: WA991598
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES6916FA3 RA
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS402253A3 LA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES0800D3PO 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0429J0 LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity
SMQs:, Hypersensitivity (narrow)
Write-up: about 6 days p/vax noted red, warm rash on both shoulders @ site of inj;does not hurt or itchy so it could have started 1-2 days prior;no fevers;no rashes elsewhere on body;does not look infected;

VAERS ID:132934 (history)  Vaccinated:1999-09-21
Age:0.4  Onset:1999-09-21, Days after vaccination: 0
Gender:Male  Submitted:1999-12-09, Days after onset: 79
Location:Indiana  Entered:1999-12-29, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: eye drops
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: IN99044
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES09984101IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.061131IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.N072621SCRL
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 9/21/99: Immediate hives on face and trunk w/i 5 mins of administration of vax. Called dr office and child was taken to his office; hives had started to fade by the time the child left the clinic.

VAERS ID:133026 (history)  Vaccinated:1999-09-21
Age:49.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Female  Submitted:1999-09-25, Days after onset: 4
Location:California  Entered:2000-01-05, Days after submission: 102
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cefezil/Tyliprn
Current Illness: NONE
Preexisting Conditions: Allergic to Tetracyline
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982300IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site hypersensitivity, Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Area red, hot, raised x 4 days post injection. 9/27/99, pt states arm fine now w/no problems.

VAERS ID:133224 (history)  Vaccinated:1999-09-21
Age:2.0  Onset:1999-09-23, Days after vaccination: 2
Gender:Female  Submitted:2000-01-03, Days after onset: 102
Location:Colorado  Entered:2000-01-12, Days after submission: 9
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: Tylenol, Motrin
Current Illness: contact dermatitis, left thigh
Preexisting Conditions: GU Reflux on L, grade II-III
Diagnostic Lab Data: Blood Culture (no growth)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7172DA3IMRL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.P01672SCLL
Administered by: Other     Purchased by: Other
Symptoms: Cellulitis
SMQs:
Write-up: Cellulitis, right thigh. Required hospitalization for IV antibiotics.

VAERS ID:133526 (history)  Vaccinated:1999-09-21
Age:1.2  Onset:1999-09-28, Days after vaccination: 7
Gender:Female  Submitted:1999-10-18, Days after onset: 20
Location:Wisconsin  Entered:2000-02-01, Days after submission: 106
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: WI99040
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM890A23IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS402253A3IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.N082622IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1985H0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 9/28/99, fever 103 for 1 day only. Rash on 10/1/99, Neck red, back, neck, butt rash, looks like sunburn, not bumpy much. 10/11/99, f/u, left message to call PHD w/info re:pt''s fever & rash outcome. 11/22/99, no contact from MD.

VAERS ID:151034 (history)  Vaccinated:1999-09-21
Age:34.0  Onset:2000-01-07, Days after vaccination: 108
Gender:Male  Submitted:2002-01-24, Days after onset: 748
Location:Pennsylvania  Entered:2000-04-21, Days after submission: 643
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, Loloft, Trazodone, Lorazepam, Dugpar, Alprazolax, Allergy, Prozac, Paxil, buspirone, Claritin D
Current Illness: UNK
Preexisting Conditions: Medical history included "life-long" depression, anxiety, unspecified speech impediment for which he received speech therapy, allergies to pollen and mold, allergic rhinitis, rustachian tube dysfunction, chronic serous otitis media, low blood pressure, prostatitis, fatigue, and chronic bilateral knee pain, chronic sinusitis, lebyrinthitis, Lyme disease, sinus bradycardia, premature
Diagnostic Lab Data: MRI-nml; LP-nml; protein profile-consistent with multiple sclerosis. 01/26/2000 MRI brain (with and without contrast): "IMPRESSON: 1. Findings compatible with left optic neuritis. 2. A single focus of deep white matter disease in the left
CDC Split Type: 2000004258
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM123B91IMLA
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal, Multiple sclerosis, Optic neuritis
SMQs:, Optic nerve disorders (narrow), Demyelination (narrow), Ocular infections (broad)
Write-up: This is a spontaneous report from an infectious disease physician. On an unspecified date, the vaccinee received the second dose of Lymerix. The vaccinee subsequently, experienced optic neuritis. Physician stated that at this time is was not clear whether the pt developed multiple sclerosis or if this could be adverse effect of the vaccine. This case is considered to be medically serious. The most recent information, received on 4/19/2000, reports the condition of the pt is unknown. Request for additional information has been forwarded to the primary care physician. Follow-up states that this report describes multiple sclerosis in a 33 male who received Lyme disease vaccine recombinant. Additional info was received via the litigation process. Medical history included "life-long" depression, anxiety, unspecified speech impediment for which he received speech therapy, allergies to pollen and mold, allergic rhinitis, rustachian tube dysfunction, chronic serous otitis media, low blood pressure, prostatitis, fatigue, and chronic bilateral knee pain. Following the reported onset of the multiple sclerosis, the vaccinee experienced bursitis of the right heel, tendonits/bursitis of the right shoulder after a fall from ten foot, acute pharyngitis/bronchitis, otitis media and externa sinusitis, urinary tranct infection caused by escherichia coli, chest pain, and cholelithiasis. These were not reported as adverse events due to vaccine administration, but were found during the course of review of the vaccinee''s medical records. Therefore, they are not listed as adverse events. He reports bilateral knee pain, left being worse. He''s had his parin for two years; however, he feels it became worse a month after he received his second LYMErix. The vaccinee returned to the physician''s office on 11/24/1999 with chief complaints of "possible sinus infection, cough." The vaccinee also wanted the physician "to recheck his knee. He''s continuing to have locking and extreme stiffness when he gets down to do any filing. he''s unable to strai

VAERS ID:156203 (history)  Vaccinated:1999-09-21
Age:1.0  Onset:1999-09-25, Days after vaccination: 4
Gender:Male  Submitted:2000-05-16, Days after onset: 234
Location:Ohio  Entered:2000-07-10, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99092259
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Infection, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Four days post vax, this pt developed greater than 100 rash with low-grade fever. He had no recent exposure to varicella. At the time of this report his condition had worsened.

VAERS ID:156382 (history)  Vaccinated:1999-09-21
Age:29.0  Onset:1999-09-28, Days after vaccination: 7
Gender:Female  Submitted:2000-05-16, Days after onset: 231
Location:New York  Entered:2000-07-13, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: 10/29/1999-diagnostic chemistry
CDC Split Type: WAES99110034
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 7 days post vax the pt presented with hives and was diagnosed with an allergic rash. The rash was described as patchy, red and itchy. Pt was treated with Benadryl. 5 weeks post vax the pt developed a major outbreak of hives. Pt had been using Claritin for one week. Physician stated that the pt has mild, recurrent crops of hives described as erythematous, slightly raised , hive lesions.

VAERS ID:157362 (history)  Vaccinated:1999-09-21
Age:0.5  Onset:0000-00-00
Gender:Male  Submitted:2000-07-11
Location:Washington  Entered:2000-07-19, 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:
Current Illness:
Preexisting Conditions: developmental delay, infantile spasms
Diagnostic Lab Data: EEG-arrythmia
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES7122RA2SCRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2634A22SCLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESN0973A2SCLL
Administered by: Private     Purchased by: 0
Symptoms: Arrhythmia, Convulsion, Infantile spasms
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Neonatal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Seizures occurred after dx''d with infantile spasms by neurologist. Parents reported activity cluster similar to infantile spasms occurring about 1 week, post vax. No treatment. The pt is on chronic anticonvulsant. Followup info states developemental delay first noted 9/21/1999 and infantile spasms diagnosed 10/28/1999.

VAERS ID:159088 (history)  Vaccinated:1999-09-21
Age:36.0  Onset:2000-01-02, Days after vaccination: 103
Gender:Male  Submitted:2000-08-16, Days after onset: 226
Location:Pennsylvania  Entered:2000-08-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Allegra
Current Illness: NONE
Preexisting Conditions: mold allergy
Diagnostic Lab Data: HLA DR4 - positive
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM123B9   
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Blindness, Laboratory test abnormal, Paraesthesia, Visual acuity reduced
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad)
Write-up: Shortly post 2nd dose, pt suffered from left knee pain. On 01/02/2000, he lost vision in left eye with on 50% returning. On 04/17, he experienced tingling in left arm and leg. On 07/27, he started to suffer from hip, knee and ankle pains in right leg. The annual report states scared optical nerve (poor vision).

VAERS ID:164309 (history)  Vaccinated:1999-09-21
Age:2.0  Onset:0000-00-00
Gender:Female  Submitted:2000-12-26
Location:Virginia  Entered:2000-12-29, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Pulmonic Stenosis, Williams Syndrome.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0939J0SC 
Administered by: Private     Purchased by: Private
Symptoms: Blister, Infection, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This child has vesicular eruptions. Diagnosed with atypical varicella.

VAERS ID:173528 (history)  Vaccinated:1999-09-21
Age:  Onset:0000-00-00
Gender:Female  Submitted:2001-06-06
Location:Nebraska  Entered:2001-07-24, Days after submission: 48
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:
Vaccination
Manufacturer
Lot
Dose
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Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0410SCRA
Administered by: Military     Purchased by: Military
Symptoms: Eczema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Numerous unexplained skin rashes (eczema) all over legs, arms and back. Will fade and reappear and itch.

VAERS ID:182059 (history)  Vaccinated:1999-09-21
Age:3.5  Onset:0000-00-00
Gender:Male  Submitted:2002-02-26
Location:California  Entered:2002-03-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Diagnosis Autism
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Other
Symptoms: Abnormal behaviour, Aggression, Autism, Pyrexia, Roseola
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Immediate fever, slowly degenerated over weeks time. Language disappeared and regressed over the next six months. many fevers and viruses. On 12-99 roseola. 01/01 hand, foot, mouth. 01/01 scarlett fever, roseola rash has never disappeared on arms, face, thighs. His behavior became aggressive.

VAERS ID:239151 (history)  Vaccinated:1999-09-21
Age:1.01  Onset:2005-02-02, Days after vaccination: 1961
Gender:Female  Submitted:2005-05-16, Days after onset: 102
Location:Unknown  Entered:2005-06-07, Days after submission: 22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0503USA00255
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection, Skin ulcer
SMQs:, Lack of efficacy/effect (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 6 year old female who on 09/21/1999 was vaccinated with a dose of varicella virus vaccine live. On 02/02/2005 the patient experienced mild chickenpox that lasted 5 days with about 20 lesions. Subsequently, the patient recovered. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested.

VAERS ID:281289 (history)  Vaccinated:1999-09-21
Age:  Onset:2006-03-23, Days after vaccination: 2375
Gender:Unknown  Submitted:2007-05-16, Days after onset: 418
Location:Unknown  Entered:2007-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0609USA00300
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Varicella
SMQs:
Write-up: Information has been received from a registered nurse concerning a patient who on 21-SEP-1999 was vaccinated with a dose of Varivax. Subsequently, on 23-MAR-2006, the patient developed breakthrough varicella. Unspecified medical attention was sought. There was no product quality complaint. No additional information is expected.

VAERS ID:313546 (history)  Vaccinated:1999-09-21
Age:1.1  Onset:2007-03-23, Days after vaccination: 2740
Gender:Male  Submitted:2008-05-16, Days after onset: 420
Location:Unknown  Entered:2008-05-23, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA03604
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:
Write-up: Information has been received from a county health registered nurse concerning an 8 year old male who on 21-SEP-1999 was vaccinated with varicella virus vaccine live (Oka/Merck). On 23-MAR-2007 the patient developed varicella, , 50 lesions. The nurse reported that an outbreak of varicella had taken place in the local school district in April 2007, and this student was identified during the county health investigation. An immunization clinic was conducted in the school where students received a second dose of varicella virus vaccine live (Oka/Merck). This is one of 28 reports received from the same source. No further information is available.

VAERS ID:128743 (history)  Vaccinated:1999-09-21
Age:  Onset:1999-09-22, Days after vaccination: 1
Gender:Female  Submitted:1999-09-27, Days after onset: 5
Location:Foreign  Entered:1999-09-29, Days after submission: 2
Life Threatening? No
Died? Yes
   Date died: 1999-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: esophageal reflux; no relevant family hx; pt born at term (3.5kg); no problem w/BCG
Diagnostic Lab Data:
CDC Split Type: 1999025154
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0 GM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER 0 GM
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Gastrointestinal disorder, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: a mild esophageal reflux was noticed by MD; next morning fever & a droopy appearance (asthenia) was noticed; at noon sudden death occurred; an autopsy is scheduled;

VAERS ID:129439 (history)  Vaccinated:1999-09-21
Age:12.0  Onset:1999-09-29, Days after vaccination: 8
Gender:Female  Submitted:1999-10-13, Days after onset: 14
Location:Foreign  Entered:1999-10-18, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: lab test-nl; neuro borreliosis-excluded
CDC Split Type: WAES99100435
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Write-up: p/vax pt exp peripheral facial paresis lt sided & was hosp;

VAERS ID:132925 (history)  Vaccinated:1999-09-21
Age:1.5  Onset:1999-09-30, Days after vaccination: 9
Gender:Female  Submitted:1999-12-21, Days after onset: 82
Location:Foreign  Entered:1999-12-29, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: plasma calcium=2.53 glucose tol test=4.8 phosphate=1.73 electrolytes=normal
CDC Split Type: WAES99121284
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Aphasia, Dyskinesia, Hypertrophy breast, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 19 mo old female, vax with MMRII on 9/21/99 and on 9/30/99 had a fever of 39 c.,which remained until 10/3/99 when it suddenly dropped 35.1 c. Suddenly she had strange tongue movements, lifting arms & shoulders. She tried to speak, but had

VAERS ID:152655 (history)  Vaccinated:1999-09-21
Age:44.0  Onset:1999-09-21, Days after vaccination: 0
Gender:Male  Submitted:2000-05-26, Days after onset: 248
Location:Foreign  Entered:2000-06-05, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: X-Ray-Cervical spine and left shoulder-no pathological results.
CDC Split Type: WAES00052185
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.6350110IMLA
Administered by: Other     Purchased by: Other
Symptoms: Pain
SMQs:
Write-up: Information has been received from a health authority concerning a 44 year old male pt who, post vax, was complaining of pain in his left arm and shoulder and also abolition of the motoric system in this area (rani musculares N. axillaris) was seen. There was no injection site inflammation. The pt was treated with ibuprofen, vitamin B-complex and physical therapy, but he is not yet recovered. The reporting physician stated that there is a causal relationship to the vaccination. X-Rays of the cervical spine and left shoulder showed no pathological results (no degenerative alterations or calcifications around the rotator cuff resp.). Further information is not expected.

VAERS ID:173351 (history)  Vaccinated:1999-09-21
Age:  Onset:0000-00-00
Gender:Male  Submitted:2001-07-12
Location:Foreign  Entered:2001-07-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES01062573
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypoaesthesia, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Information has been received from a health care professional concerning a male pt (age or date of birth unknown) who on 9/21/99 was vaccinated with a 1 ml dose of hepatitis B vaccine recombinant (yeast) (batch number unknown). Subsequently, in 1999, the pt developed burning pain in the left shoulder and arm and the sensation of numbness of the whole left hand. As of 6/19/01, it was reported that the burning pain in the left shoulder, upper and lower arm, as well as, the numbness of the whole hand, more intense on the palm persisted. The pt''s adverse experiences were considered to be "Other Important Medical Events" by the reporter due to the long time interval. No further information is available.

VAERS ID:180777 (history)  Vaccinated:1999-09-21
Age:0.2  Onset:1999-09-22, Days after vaccination: 1
Gender:Female  Submitted:2001-01-16, Days after onset: 482
Location:Foreign  Entered:2002-02-01, Days after submission: 381
Life Threatening? No
Died? Yes
   Date died: 1999-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Autopsy-pending
CDC Split Type: 19990251541
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPIHI: DT+IPV+HIB+HEPB (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMGM
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMGM
Administered by: 0     Purchased by: 0
Symptoms: Asthenia, Gastrooesophageal reflux disease, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 21-SEP-1999, at 10:00 AM, the pt received in one buttock her first Engerix-B injection for hepatitis B prophylaxis and in her other buttock poliomyelitis prophylaxis. At this occasion, a mild esophageal reflux was noticed by the physician. On 22-SEP-1999, in the morning, fever and droopy appearance (asthenia). An autopsy is scheduled. The reporter''s causality assessment is not specified.

VAERS ID:129180 (history)  Vaccinated:1999-09-22
Age:14.0  Onset:1999-09-30, Days after vaccination: 8
Gender:Female  Submitted:1999-10-04, Days after onset: 4
Location:Michigan  Entered:1999-02-12, Days after submission: 233
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxcil
Current Illness: cough & h/a
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)CONNAUGHT LABORATORIESV0010AA  LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: sharp pain in lt shoulder where vax given;

VAERS ID:129460 (history)  Vaccinated:1999-09-22
Age:39.0  Onset:1999-09-22, Days after vaccination: 0
Gender:Female  Submitted:1999-10-10, Days after onset: 18
Location:Pennsylvania  Entered:1999-10-18, 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: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Other
Symptoms: Headache, Hypertonia, Influenza, Lymphadenopathy, Myalgia, Nausea, Pain, Photosensitivity reaction, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: approx 30min p/vax flu-like sx occurred followed by a high fever-102-103, nausea, stiffness, swollen glands, very sensitive muscles/skin;couldn''t touch w/o aching, h/a, sensitive to light;

VAERS ID:129538 (history)  Vaccinated:1999-09-22
Age:41.0  Onset:1999-09-28, Days after vaccination: 6
Gender:Male  Submitted:1999-09-29, Days after onset: 1
Location:Indiana  Entered:1999-10-19, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Prilosec;Zestril;
Current Illness: NONE
Preexisting Conditions: HTN
Diagnostic Lab Data: NONE
CDC Split Type: IN99032
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM29940G0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: vomiting twice;rash @ inj site lt deltoid;itching on back & legs;went to ER;given DPH & told not to take any additional hep b vax;

VAERS ID:129549 (history)  Vaccinated:1999-09-22
Age:53.0  Onset:1999-09-23, Days after vaccination: 1
Gender:Female  Submitted:1999-10-15, Days after onset: 22
Location:Illinois  Entered:1999-10-19, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Public     Purchased by: Private
Symptoms: Dermatitis bullous, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: red bumpy dots, ovals w/yellow centers that itchy back, chest, arms, legs & buttocks since 9/23/99;pt still has rash;

VAERS ID:129585 (history)  Vaccinated:1999-09-22
Age:15.0  Onset:1999-09-23, Days after vaccination: 1
Gender:Female  Submitted:1999-10-06, Days after onset: 13
Location:South Carolina  Entered:1999-10-20, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp rash under arms w/dose 1 hep b vax;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: eczema-allergic to ASA
Diagnostic Lab Data:
CDC Split Type: SC99062
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3092A91IMRA
Administered by: Public     Purchased by: Public
Symptoms: Lymphadenopathy, Rash, Similar reaction on previous exposure to drug
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt devel rash under arms next day lasted until 2nd hep b vax given 9/22/99;on 9/23/99 rash underarms worsened & spread across chest & up neck;went to MD 9/27/99;given Stera-prep dose pack w/no improvement;

VAERS ID:129663 (history)  Vaccinated:1999-09-22
Age:18.0  Onset:1999-09-23, Days after vaccination: 1
Gender:Male  Submitted:1999-10-04, Days after onset: 11
Location:Texas  Entered:1999-10-22, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT Scan-neg;LP neg, MRI-neg, lab test neg, EEG neg;
CDC Split Type: U199900709
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIES 0 LA
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIES7126AA0 LA
Administered by: Other     Purchased by: Private
Symptoms: Convulsion, Muscle twitching
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: p/vax pt devel sz activity which lasted approx 10 seconds w/involuntary muscle contractions;no incontinence, no head injury;pt responded well & was transferred to ER for eval;pt hosp for testing which was negative;

VAERS ID:129890 (history)  Vaccinated:1999-09-22
Age:1.0  Onset:1999-10-18, Days after vaccination: 26
Gender:Male  Submitted:1999-10-25, Days after onset: 7
Location:California  Entered:1999-10-26, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: PPD by Connaught lot# 249311 given 9/22/99;fluoride drops
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.1974H0 RA
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES802A60PO 
Administered by: Private     Purchased by: Private
Symptoms: Pharyngitis, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: onset of fever followed by facial rash which then spread to trunk;URI like sx;diffuse rash erythematous sl raised maculopapular rash to think/face;

VAERS ID:130285 (history)  Vaccinated:1999-09-22
Age:0.5  Onset:1999-10-01, Days after vaccination: 9
Gender:Male  Submitted:1999-10-15, Days after onset: 14
Location:Pennsylvania  Entered:1999-11-04, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: soy allergy (dehydrated & was hosp)
Diagnostic Lab Data: x-ray & US=pus under skin; repeat US p/ aspiration showed refilling w/ pus; culture;bloodwork;
CDC Split Type: PA9969
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4577872IMRL
Administered by: 0     Purchased by: 0
Symptoms: Abscess, Injection site abscess, Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: p/vax mom & grandma noted red patch like a rash & hard lumps to legs, one on each side, like bug bite;taken to MD; dx-poss sterile abscess; aspirated, refilled w/pus;hosp & leg(s) drained; no limit of leg movement 60 day follow-up received on 01/19/01 provided states the phone number for the pt has been disconnected.

VAERS ID:131058 (history)  Vaccinated:1999-09-22
Age:58.0  Onset:1999-09-27, Days after vaccination: 5
Gender:Female  Submitted:1999-09-30, Days after onset: 3
Location:Colorado  Entered:1999-11-23, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol, Progesterone, OHEA, Pamelo, Ibuprofen, Gucifenesin, synthroid & numerous herbs (Ginko, dandeion root, milk thistle, ect)
Current Illness: hep c, hypothyroid;
Preexisting Conditions: hep C, hypothyroidism, mult chem sensitivities & post traumatic stress disorder;
Diagnostic Lab Data: CBC, thyroid, liver function <11 normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM615A41IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Agitation, Anorexia, Asthenia, Dizziness, Headache, Injection site hypersensitivity, Injection site pain, Lymphadenopathy, Myalgia, Nausea, Rhinitis, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: p/vax pt c/o having soreness @ inj site, whole arm ached, felt hyper, nauseated to the point of not being able to eat, h/a, dizziness, head congestion, fatigue & hives;welt type hives on arm/shoulder & @ inj site;saw MD;

VAERS ID:132164 (history)  Vaccinated:1999-09-22
Age:16.0  Onset:1999-09-22, Days after vaccination: 0
Gender:Female  Submitted:1999-09-30, Days after onset: 8
Location:Pennsylvania  Entered:1999-12-28, Days after submission: 89
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: PA9989
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2933A20IMRA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.N04923SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Pain, Pallor, Stupor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Pt lost color in her face,became faint & lost consciousness for 2-3 mins.; started within 30 sec. of receiving IPV. Pt was weak & semiconscious for 1 hr.; complained of pain & soreness in rt arm for 16 hrs.

VAERS ID:133298 (history)  Vaccinated:1999-09-22
Age:45.0  Onset:1999-09-23, Days after vaccination: 1
Gender:Female  Submitted:1999-09-24, Days after onset: 1
Location:Alaska  Entered:2000-01-14, Days after submission: 112
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: AK200013
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH49982090IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pain, swelling, left deltoid.

VAERS ID:151673 (history)  Vaccinated:1999-09-22
Age:28.0  Onset:1999-09-22, Days after vaccination: 0
Gender:Female  Submitted:2000-05-01, Days after onset: 222
Location:Alaska  Entered:2000-05-08, 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: Diffuse itching
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0412SC 
Administered by: Military     Purchased by: Military
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Diffuse itching over entire body with no hives.

VAERS ID:151782 (history)  Vaccinated:1999-09-22
Age:33.0  Onset:1999-10-10, Days after vaccination: 18
Gender:Male  Submitted:2000-04-13, Days after onset: 186
Location:Delaware  Entered:2000-05-09, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0413SCLA
Administered by: Military     Purchased by: Military
Symptoms: Euphoric mood, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt felt euphoric, intermittently (several hours at a time) over a 3-4 day period. Welt on his left arm, lasted over 30 days. Follow up 06/05/2000: "Patient recovered from adverse event."

VAERS ID:151875 (history)  Vaccinated:1999-09-22
Age:48.0  Onset:0000-00-00
Gender:Male  Submitted:2000-04-21
Location:North Carolina  Entered:2000-05-12, 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:
Diagnostic Lab Data:
CDC Split Type: 20000050671
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAMLY130D91IM 
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia
SMQs:, Arthritis (broad)
Write-up: Post vax, the vaccinee experienced joint pain. He initially treated himself with Advil. He then presented to his physician who treated him with anti-inflammatories.

VAERS ID:157760 (history)  Vaccinated:1999-09-22
Age:46.0  Onset:1999-09-24, Days after vaccination: 2
Gender:Female  Submitted:2000-03-23, Days after onset: 181
Location:Colorado  Entered:2000-07-21, Days after submission: 119
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: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ0920229SEP1999
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES465308 IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, 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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Two days post vax the pt developed a low grade fever and an injection site reaction characterized by redness and swelling. Pt was treated with Benadryl and cold packs.

VAERS ID:173958 (history)  Vaccinated:1999-09-22
Age:47.0  Onset:1999-09-25, Days after vaccination: 3
Gender:Male  Submitted:2001-07-26, Days after onset: 670
Location:California  Entered:2001-08-07, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Arthrinol; Cytotec
Current Illness: Psoriatic arthritis
Preexisting Conditions: Psoriatic arthritis only
Diagnostic Lab Data: EMG testing-physical changes
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4998301 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Laboratory test abnormal, Muscle atrophy, Parkinson's disease, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Not reported to doctor until last immunization; arthralgia, muscle atrophy, tremor, Parkinson''s. Slow to onset, 2 days, post injection of opposite sides arthralgia and declined progress to neuro specialist. Sees rheumotologist and neurologist.

VAERS ID:177430 (history)  Vaccinated:1999-09-22
Age:  Onset:1999-10-07, Days after vaccination: 15
Gender:Female  Submitted:2000-08-10, Days after onset: 308
Location:Connecticut  Entered:2001-11-09, Days after submission: 456
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: NONE
Diagnostic Lab Data: Bone scan, x-ray, MRI, LABS all unremarkable.
CDC Split Type: 02000006030
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0103AA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Polymyalgia rheumatica, Shoulder pain
SMQs:, Rhabdomyolysis/myopathy (broad), Vasculitis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: After receiving a vaccination, on 10/07/1999, the patient experienced persistent proximal shoulder and thigh pain similar to polymyalgia rheumatica. The patient was responsive to Prednisone greater than or equal to 10mg every day, but normal erythrocyte sedimentation rate 2 wks after the vaccination.

VAERS ID:196576 (history)  Vaccinated:1999-09-22
Age:  Onset:0000-00-00
Gender:Male  Submitted:2003-01-17
Location:New York  Entered:2003-01-22, 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: Tuberculin, Protein Purified Derivative PPD
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Blood lead (LLT: Blood lead) 09/20/1996 Blood lead level - 2.
CDC Split Type: HQ4431401OCT2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES 0  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1  
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES 3  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Drug toxicity, Nervous system disorder
SMQs:, Anticholinergic syndrome (broad), Drug abuse and dependence (broad)
Write-up: A legal complaint was received from an attorney concerning a male child who received injections of ORIMUNE, DTP/ACTHIB, MMR II, Recombivax HB, Varivax, polio virus, DTaP, and DTP/HIB vaccines as well as tine/PPD from October 1995 through September 1999. The legal complaint states that the child was poisoned by the cumulative doses of mercury in the thimerosal and suffers from the toxic neurological effects of mercury poisoning. Mercury poisoning was considered medically important. No further information was available at the date of this report.

VAERS ID:196771 (history)  Vaccinated:1999-09-22
Age:  Onset:0000-00-00
Gender:Male  Submitted:2003-01-24
Location:New York  Entered:2003-01-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0392200A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 4  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1  
OPV: POLIO VIRUS, ORAL (ORIMUNE)LEDERLE LABORATORIES 3PO 
Administered by: Other     Purchased by: Other
Symptoms: Drug toxicity, Nervous system disorder
SMQs:, Anticholinergic syndrome (broad), Drug abuse and dependence (broad)
Write-up: This report describes the occurrence of mercury poisoning in a male child of unspecified age who was vaccinated with diphtheria and tetanus toxoids and acellular pertussis vaccine (manuf unk) for prophylxis. This report was received as part of litigation proceedings, and has not been verified by a physician or other health care professional. The subject''s medical history, concurrent conditions, and concurrent medications were not reported. The subject received an injection of diphtheria and tetanus toxoids and acellular pertussis vaccine (manuf unk) on 9/22/99. He also received hep B vaccine 10/10/95, 11/17/95 and 6/10/96; combination diphtheria and tetanus toxoids and pertussis/Haemophilus influenzae type B conjugate vaccine (DTP+ActHIB 11/17/95, 1/22/96, 3/18/96 and 3/20/97; Orimune 11/17/95, 1/22/96, 3/20/97 and 9/22/99; and MMR II 12/19/96 and 9/22/99. The subject''s attorney alleged that "as a result of mercury in thimerosal-adultcreated infant that the subject received as an infant, he now suffers and in the future will continue to suffer, from the toxic neurological effects of mercury poisoning." The mercury poisoning in this report is considered medically serious (OMIC).

VAERS ID:256828 (history)  Vaccinated:1999-09-22
Age:4.0  Onset:2005-03-24, Days after vaccination: 2010
Gender:Male  Submitted:2006-05-12, Days after onset: 413
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: varicella~Varicella (unknown mfr)~~10~In Sibling
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0510USA08936
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Varicella Information has been received from a physician and a school nurse concerning an 10 year old female who on 22-SEP-1999 was vaccinated with a dose of varicella virus vaccine live (Oka/Merck). It was also noted that the patient was vaccinated with a dose of measles virus vaccine live (Ender-Edmonston) (+) mumps virus vaccine live (Jeryl-Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) on 09-AUG-1996 and 17-MAY-2000. A school nurse reported to the physician that between 24-MAR-2005 and 09-MAY-2005 the child developed a mild case of break through varicella with less than 50 lesion. Unspecified medical attention was sought. The outcome was recovered. A product quality complain was not involved. It was also noted that the patient''s brother developed chickenpox after vaccination with varicella virus vaccine live (Oka/Merck) (WASE0510USA08935). No additional information is expected.

VAERS ID:129667 (history)  Vaccinated:1999-09-22
Age:27.0  Onset:1999-09-25, Days after vaccination: 3
Gender:Male  Submitted:1999-10-04, Days after onset: 9
Location:Foreign  Entered:1999-10-22, Days after submission: 18
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: 9/24/99 recv YF vax PMC
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: coronarography=normal;echocardiography-myocarditis;electrocardiogram-could evoke an infarction;serum creatine kinase-increased;serum creatine kinase-cardiac enzymes are normalizing;
CDC Split Type: WAES99092181
Vaccination
Manufacturer
Lot
Dose
Route
Site
BCG: BCG (NO BRAND NAME)UNKNOWN MANUFACTURER    
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Chest pain, Electrocardiogram abnormal, Infection, Laboratory test abnormal, Myocarditis, Vascular occlusion
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: p/vax pt to ER w/cardiac pain & hosp;CPk was 1000, cardiac enzymes were increased;afebrile & no influenza-like sx were reported;coronarography nl;electrocardiogram could evoke an infarction;cardiac echography revealed myocarditis;

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