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Found 489662 cases in entire database

Case Details (Sorted by Vaccination Date)

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VAERS ID:174480 (history)  Vaccinated:2001-08-08
Age:6.0  Onset:2001-08-08, Days after vaccination: 0
Gender:Male  Submitted:2001-08-08, Days after onset: 0
Location:Connecticut  Entered:2001-08-20, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: CT200104
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0503CA3IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T11462 SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0022L1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Dyspnoea, Hypoxia, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Pt presented back to clinic at 10:40 with questionable dyspnea, urticaria of face, wheezing, O2 sats at that time were 89%. He was given 25mg of Benadryl Elixir at 10:45, applied nasal O2 and given Epinephrine 0.2 ml of 1:1000 sol at 10:45 along with Albuterol nebulizer 0.5cc/2cc NS at 10:50. O2 sats increased to 100% at 10:55 with good aeration and lessening urticaria. Transported to ER with nasal O2 for observation and further treatment.

VAERS ID:174516 (history)  Vaccinated:2001-08-08
Age:1.2  Onset:2001-08-13, Days after vaccination: 5
Gender:Female  Submitted:2001-08-16, Days after onset: 3
Location:Connecticut  Entered:2001-08-21, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild atopic dermatitis
Preexisting Conditions: Atopic dermatitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0165L SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0496L SCRL
Administered by: Private     Purchased by: Public
Symptoms: Rash papular
SMQs:
Write-up: Five days post vax, the patient developed 6 red papules.

VAERS ID:174613 (history)  Vaccinated:2001-08-08
Age:0.2  Onset:2001-08-08, Days after vaccination: 0
Gender:Female  Submitted:2001-08-21, Days after onset: 13
Location:New Hampshire  Entered:2001-08-23, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM505A20IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA600AA0IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809060IMLL
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Crying, Hypotonia, Pallor, Pyrexia, Staring
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Seen in office on 8/16/01 and Mom reported at that time that on 8/8/01 from approximately 2 PM to 4:20 PM pt had temperature of 98.3 to 101 F. Baby was screaming then became a zombie. Flaccid, staring, pale but no cyanosis. Responded to Tylenol within 30 minutes.

VAERS ID:174665 (history)  Vaccinated:2001-08-08
Age:4.0  Onset:2001-08-08, Days after vaccination: 0
Gender:Male  Submitted:2001-08-08, Days after onset: 0
Location:Texas  Entered:2001-08-24, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: TX01112
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES984A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T059523IMRA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt given MMR #2 and after approx. 10 minutes, developed 1 hive approx. 10mm X 10mm. He was given 2 1/2cc po Benadryl at 09:50; (subsided at 10:10).

VAERS ID:174707 (history)  Vaccinated:2001-08-08
Age:4.0  Onset:2001-08-09, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Arkansas  Entered:2001-08-27
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: NONE
CDC Split Type: AR0134
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM5016A24IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T11283SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0592L1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0237L0SCRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Post vax, the patient developed a large 8 x 10cm area of redness, firmness and warmth on the lateral thigh.

VAERS ID:174712 (history)  Vaccinated:2001-08-08
Age:5.0  Onset:2001-08-09, Days after vaccination: 1
Gender:Male  Submitted:2001-08-13, Days after onset: 4
Location:Utah  Entered:2001-08-27, 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: UT012511
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM989A24 RA
Administered by: Private     Purchased by: 0
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This child had an induration, redness 18 x 13cm.

VAERS ID:174735 (history)  Vaccinated:2001-08-08
Age:1.1  Onset:2001-08-17, Days after vaccination: 9
Gender:Female  Submitted:2001-08-22, Days after onset: 5
Location:Minnesota  Entered:2001-08-28, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0254L0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0447K0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Blister, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: This infant was immunized 08/08/01. She had a rash on her face, body, extreme started 08/18/01. Blisters on her buttock on 08/17/01, and the next day head to toe pruritic rash.

VAERS ID:174748 (history)  Vaccinated:2001-08-08
Age:5.0  Onset:2001-08-09, Days after vaccination: 1
Gender:Female  Submitted:2001-08-20, Days after onset: 11
Location:Kansas  Entered:2001-08-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM981A24IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T07874SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0014L1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling and redness locally at left thigh injection site about 5cm in diameter on 8/9/01.

VAERS ID:174759 (history)  Vaccinated:2001-08-08
Age:2.0  Onset:2001-08-09, Days after vaccination: 1
Gender:Male  Submitted:2001-08-17, Days after onset: 8
Location:California  Entered:2001-08-28, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Drug reaction possibly; atopic dermatitis (mild)
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM678A20IM 
Administered by: Private     Purchased by: Public
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: Pt developed erythema multiforme (minor) and is recovering.

VAERS ID:175160 (history)  Vaccinated:2001-08-08
Age:1.0  Onset:2001-08-17, Days after vaccination: 9
Gender:Male  Submitted:2001-08-20, Days after onset: 3
Location:California  Entered:2001-09-06, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD/Parkedale/00390P/ID/LFA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA010089
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM992A2 IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1277K SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1895K SCLL
Administered by: Public     Purchased by: Public
Symptoms: Injection site induration, Injection site reaction, Skin ulcer
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt developed 2 blister lesions over the left thigh area of induration. Discharge is clear and drying.

VAERS ID:175348 (history)  Vaccinated:2001-08-08
Age:4.3  Onset:2001-08-08, Days after vaccination: 0
Gender:Male  Submitted:2001-08-20, Days after onset: 12
Location:Georgia  Entered:2001-09-14, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: GA01079
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM972A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05323SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0380L0SCRA
Administered by: Private     Purchased by: 0
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt''s left arm was swollen and hot to touch and red.

VAERS ID:177408 (history)  Vaccinated:2001-08-08
Age:13.0  Onset:2001-08-08, Days after vaccination: 0
Gender:Female  Submitted:2001-08-08, Days after onset: 0
Location:Georgia  Entered:2001-11-08, Days after submission: 92
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: motor twitching;Hep B (unknown mfr);2;10;In Patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: BP 88/50
CDC Split Type: GA01095
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5168A22IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypotension, Muscle twitching, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt collapsed with related motor twitching, approximately 5 minutes after hep B administration (3rd injcetion). Recover with fan and cold compress, complained of nausea. Soda given and advised to eat high protein sandwich (peanut butter). Recommend seeing pediatrician.

VAERS ID:181441 (history)  Vaccinated:2001-08-08
Age:  Onset:2001-08-11, Days after vaccination: 3
Gender:Male  Submitted:2001-12-05, Days after onset: 116
Location:Pennsylvania  Entered:2002-02-15, Days after submission: 72
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mom-thrynoid
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: PA0210
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Joint stiffness, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Baby born 3 days after mom''s 3rd series for rabies vaccine post exposure series. Baby stiff all over.

VAERS ID:191491 (history)  Vaccinated:2001-08-08
Age:0.2  Onset:2001-08-08, Days after vaccination: 0
Gender:Male  Submitted:2001-08-10, Days after onset: 2
Location:Unknown  Entered:2002-10-17, Days after submission: 433
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: U200100930
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURUO515DA0IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUA610AA0IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURT09090IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site reaction, Screaming, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: From telephone contact with reporting physician, it was stated that a 3 month old male infant received first dose of a Tripedia,an ActHIB and an IPOL vaccination on 08/08/01. One to two hours after injections the patient cried inconsolably. His right thigh where Tripedia was given was red and swollen On 08/09/01, the patient was very sleepy. From additional correspondence received on 10/10/01 it was reported that the patient recovered from this experience. Additional vaccine and patient information was also provided.

VAERS ID:199569 (history)  Vaccinated:2001-08-08
Age:18.0  Onset:2001-10-09, Days after vaccination: 62
Gender:Female  Submitted:2003-03-07, Days after onset: 514
Location:Idaho  Entered:2003-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES0209USA02673
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Erythema nodosum, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Info has been received from a registered nurse concerning an 18 y.o. female who was vax''d w/a 1st and 2nd dose of Hep B vax recombinant on 6/21/01 and 8/6/01, respectively. On 10/9/01 the PT presented to the MD''s office w/swelling and redness of her lower right leg and was diagnosed w/Erythema Nodosum. The PT was treated w/prednisone. Subsequently, the PT refused her 3rd dose of Hep B vax recombinant. Add''l info has been requested.

VAERS ID:249887 (history)  Vaccinated:2001-08-08
Age:4.0  Onset:2005-11-09, Days after vaccination: 1554
Gender:Male  Submitted:2005-12-20, Days after onset: 41
Location:Missouri  Entered:2005-12-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER   UN
Administered by: Public     Purchased by: Public
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: Had rash symptom consistent with varicella in outbreak situation.

VAERS ID:175179 (history)  Vaccinated:2001-08-08
Age:  Onset:2001-08-08, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Foreign  Entered:2001-09-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: HQ5478104SEP2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNC: MENINGOCOCCAL (MENINGITEC)PFIZER/WYETH  IM 
Administered by: 0     Purchased by: 0
Symptoms: Agitation, Crying, Pain, Pallor, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: It was reported that an infant female received a 2nd dose of menignoccoccal group C conjugate vaccine on 08/08/01. On the same date she also received polio, DTP, and Hib. Subsequent to immunization, she developed swelling of her legs, pallor, and was also screaming in pain. She was admitted to the hospital. The reporter noted that the reaction was not considered to be serious. No additional information was available as of the date of this report.

VAERS ID:175199 (history)  Vaccinated:2001-08-08
Age:  Onset:2001-08-08, Days after vaccination: 0
Gender:Female  Submitted:2001-09-05, Days after onset: 28
Location:Foreign  Entered:2001-09-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: U2001009800
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  SC 
Administered by: 0     Purchased by: 0
Symptoms: Crying, Oedema peripheral, Pain, Skin discolouration
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: It was reported that a baby girl (less than 1 year) was concomitantly administered a Diphtheria-Tetanus-Pertussis, a Haemophilus Influenzae type B, a Poliomyelitis and a Meningococcal C vaccine. All the vaccines were from unknown manufacturer. It was reported that the same day the infant presented with swelling of legs, discoloration, screaming pain. She was admitted to the hospital. Stop date of all reactions was reported that day after the infant was considered as recovered. The report stated that she was due to have Infanrix Hib on next occasion. Further info is not expected. The case is closed.

VAERS ID:176326 (history)  Vaccinated:2001-08-08
Age:57.0  Onset:2001-08-13, Days after vaccination: 5
Gender:Male  Submitted:2001-10-11, Days after onset: 59
Location:Foreign  Entered:2001-10-16, Days after submission: 5
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: The pt''s wife is a chronic Hep-B carrier (HBsAGpos)
Diagnostic Lab Data: Lab results on 8/13/01 included: HBsAG (+), HBeAG-neg; Anti HBe (+); Anti HBs-neg; Anti HBc-IgM-(+); AST 800 U/L, ALT 760 U/L; total bilirubin 5.4 mg/dl and direct bilirubin 5.4 mg/dl; on 9/7/01 Anti HBc-(+); HBeAG-neg; HBsAG-neg; Anti HBs-
CDC Split Type: WAES01100085
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.7280111IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Hepatitis, Hyperbilirubinaemia, Jaundice, Malaise
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Hepatitis, non-infectious (narrow), Acute pancreatitis (narrow), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow)
Write-up: A 57 year old male was vaccinated IM with a first dose of hepatitis b vaccine recombinant, respectively. On 08/13/01, the patient experienced malaise and jaundice. He was admitted to the hospital and diagnosed with acute hepatitis B. Subsequently, the patient recovered after two weeks. the patient''s experience were considered to be immediately life-threatening by the reporter. F/U states: Information has been received from a health professional concerning a 57 year old male, whose wife is a chronic Hep-B carrier, who was vaccinated IM with a 1st and 2nd dose of Hep-B vaccine recombinant (yeast) on 6/7/01 (lot 679011) and 8/8/01 (batch 728022), respectively. There was no concomitant therapy. On 8/13/01, the pt experienced malaise and jaundice. He was admitted to the hospital and dx''d with acute Hep-B. It was reported that on 5/30/01, the pt was HBsAG and AntiHBs negative. Subsequently, the pt recovered after 2 weeks. F/U received on 10/24/01 indicated that the pt was discharged on 8/21/01 and at that time, a period of another 90 days of convalescence was recommended. The pt''s experiences were considered to be immediately life-threatening by the reporter.

VAERS ID:176971 (history)  Vaccinated:2001-08-08
Age:1.3  Onset:2001-08-08, Days after vaccination: 0
Gender:Female  Submitted:2001-10-26, Days after onset: 79
Location:Foreign  Entered:2001-11-01, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES01102847
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1321K0SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anaphylactic reaction, Cough, Salivary hypersecretion, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a health authority concerning a 15 month old female who on 9/8/01 was vaccinated SC with a 1st dose of MMRII. Fifteen minutes, post vax, the pt developed a rash, coughing, wheezing, salivary secretion and urticaria around the mouth. The pt was hospitalized via an EMS. She was treated with adrenalin and hydrocortisone sodium succinate (Solu-Cortef). Subsequently, the next day, the pt recovered from her experience. The reporter''s assessment was allergic reaction, suspect anaphylactic. No further information is available. The date of vaccination has been changed from 9/8/01 to 8/8/01.

VAERS ID:174437 (history)  Vaccinated:2001-08-09
Age:0.3  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-08-13, Days after onset: 4
Location:Ohio  Entered:2001-08-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM982A21IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA610AA1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T10981 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4808951IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling and redness at left upper leg. Redness extends from knee to hip and hot to touch. Extreme fussiness from child. She cries whenever leg is touched. Mom to give Tylenol and apply cold compress. Whole thigh from knee to hip involved.

VAERS ID:174439 (history)  Vaccinated:2001-08-09
Age:0.5  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-08-10, Days after onset: 1
Location:Pennsylvania  Entered:2001-08-20, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUA513CA2IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA611PA2IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815430IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Erythematous patchy rash on back, a few on face and erythema around the site of the HIB vaccine.

VAERS ID:174468 (history)  Vaccinated:2001-08-09
Age:  Onset:0000-00-00
Gender:Male  Submitted:2001-08-13
Location:Illinois  Entered:2001-08-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05053 RA
Administered by: Private     Purchased by: 0
Symptoms: Injection site induration, Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: DTAP shot given in left arm deltoid area on 8/9/01. Pt developed local reaction with mild induration and swelling. Movements of arm were normal.

VAERS ID:174502 (history)  Vaccinated:2001-08-09
Age:0.3  Onset:2001-08-10, Days after vaccination: 1
Gender:Male  Submitted:2001-08-15, Days after onset: 5
Location:Texas  Entered:2001-08-21, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0513AA IMLL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5208A2 IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA605AA IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES481543 IMLL
Administered by: Private     Purchased by: 0
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt had a febrile seizure.

VAERS ID:174507 (history)  Vaccinated:2001-08-09
Age:0.5  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-08-10, Days after onset: 1
Location:Pennsylvania  Entered:2001-08-21, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUA513CA2IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA611AA2IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815430IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Pt had erythematous patchy rash on face, back, and a few on extremities. Also had erythema around the site of HIB vaccine.

VAERS ID:174510 (history)  Vaccinated:2001-08-09
Age:1.6  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-08-10, Days after onset: 1
Location:Tennessee  Entered:2001-08-21, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergy to milk based products; mother was diabetic while pregnant.
Diagnostic Lab Data: Hemoglobin-10.8
CDC Split Type: TN01041
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM506A23IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1822K1IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1513K0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4797950IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1337K0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Crying, Haemoglobin decreased, Respiratory disorder
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Depression (excl suicide and self injury) (broad)
Write-up: A 19 month old child received 5 vaccines on 8/9/01 in the morning. In the early afternoon, mom called me to report that the baby''s breathing was irregular every few breaths, after a hard crying session. Baby fell asleep again and continued the pattern. Mother was concerned that the child was having a reaction to vaccines that were given that morning.

VAERS ID:174531 (history)  Vaccinated:2001-08-09
Age:5.0  Onset:2001-08-09, Days after vaccination: 0
Gender:Male  Submitted:2001-08-14, Days after onset: 5
Location:New York  Entered:2001-08-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Amox.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0378AA3IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13103SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0696L1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Thirteen hours after the injection the patient experienced a fever and a seizure.

VAERS ID:174572 (history)  Vaccinated:2001-08-09
Age:9.0  Onset:2001-08-10, Days after vaccination: 1
Gender:Male  Submitted:2001-08-14, Days after onset: 4
Location:Missouri  Entered:2001-08-22, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1358K1IMRA
Administered by: Private     Purchased by: Public
Symptoms: Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt had facial swelling and generalized urticaria.

VAERS ID:174583 (history)  Vaccinated:2001-08-09
Age:59.0  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-08-09, Days after onset: 0
Location:Maryland  Entered:2001-08-22, Days after submission: 13
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.476952 IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Injection site swelling, Injection site warmth, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt received routine Pneumovax to deltoid area in AM. Returned approximately 51/2 hours later with complaints of swollen, warm, tender right upper arm. Pt also complained of nausea. Slight pain remains at site on 08/15/2001.

VAERS ID:174655 (history)  Vaccinated:2001-08-09
Age:4.0  Onset:2001-08-10, Days after vaccination: 1
Gender:Male  Submitted:2001-08-10, Days after onset: 0
Location:Nevada  Entered:2001-08-24, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM507A23IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 3SC 
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Feeling hot
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: This child''s arm was red and warm from the shoulder to the mid arm upper side only. The grandmother is instructed to use hot packs and Tylenol.

VAERS ID:174662 (history)  Vaccinated:2001-08-09
Age:48.0  Onset:2001-08-10, Days after vaccination: 1
Gender:Female  Submitted:2001-08-13, Days after onset: 3
Location:Texas  Entered:2001-08-24, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergy to PCN, Rocephin, Sulfa, Codeine and Keflex.
Diagnostic Lab Data: NONE
CDC Split Type: TX01116
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3376A4 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Rash on neck and feels like throat is swelling. Rash is spreading to arms. Treated with Solu-Medrol 125mg, IM X 1 stat and Prednisone 20mg 3 X po X 4 days and Hydroxyzine 25mg every 6 hours prn.

VAERS ID:174696 (history)  Vaccinated:2001-08-09
Age:1.0  Onset:2001-08-10, Days after vaccination: 1
Gender:Male  Submitted:2001-08-21, Days after onset: 11
Location:California  Entered:2001-08-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1827K2IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4792372IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1140K0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Infection, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt''s mother called on 8/10/01 and said pt had developed a lump at Comvax or varicella injection site. On 8/11/01, pt developed raised lump at varicella injection site with "bumps". On 8/21/01, pt came in for office visit and has what appears to be chickenpox only at varicella injection site in less than a 1" circle. He denies fever or any other symptoms.

VAERS ID:174723 (history)  Vaccinated:2001-08-09
Age:1.3  Onset:2001-08-14, Days after vaccination: 5
Gender:Male  Submitted:0000-00-00
Location:Michigan  Entered:2001-08-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Dimetapp, Motrin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1391K0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809071IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1893K0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt developed hives.

VAERS ID:174786 (history)  Vaccinated:2001-08-09
Age:1.5  Onset:2001-08-10, Days after vaccination: 1
Gender:Female  Submitted:2001-08-23, Days after onset: 13
Location:Colorado  Entered:2001-08-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815452IMLL
Administered by: Private     Purchased by: Private
Symptoms: Abasia, Injection site pain, Screaming
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad)
Write-up: Pt screaming with pain for 5 hours; unable to walk for 30 hours. No mass or erythema. Symptom free after 48 hours.

VAERS ID:174830 (history)  Vaccinated:2001-08-09
Age:1.3  Onset:2001-08-11, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:New York  Entered:2001-08-29
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 (INFANRIX)SMITHKLINE BEECHAM973A23IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt developed erythema and induration at right upper arm below DTAP vaccination point. Range of motion (+).

VAERS ID:174835 (history)  Vaccinated:2001-08-09
Age:1.7  Onset:2001-08-09, Days after vaccination: 0
Gender:Male  Submitted:2001-08-28, Days after onset: 19
Location:Texas  Entered:2001-08-30, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM982A73IMLA
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1758K0IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4783200IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0437K0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Crying, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt developed fever, prolonged crying and brief (about 2 minutes) of generalized seizure.

VAERS ID:174922 (history)  Vaccinated:2001-08-09
Age:1.3  Onset:2001-08-10, Days after vaccination: 1
Gender:Male  Submitted:2001-08-24, Days after onset: 14
Location:Iowa  Entered:2001-09-04, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM508A22IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1670K2IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: At site of Comvax, pt developed redness, induration and warmth measuring 23mm x 12mm.

VAERS ID:175127 (history)  Vaccinated:2001-08-09
Age:48.0  Onset:2001-08-09, Days after vaccination: 0
Gender:Male  Submitted:2001-08-28, Days after onset: 19
Location:Florida  Entered:2001-09-06, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.R09582 IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Red spot below injection site, warm to the touch. No itching.

VAERS ID:175130 (history)  Vaccinated:2001-08-09
Age:1.0  Onset:2001-08-16, Days after vaccination: 7
Gender:Female  Submitted:2001-08-30, Days after onset: 14
Location:Minnesota  Entered:2001-09-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM508A22IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0657L2IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0698L0SCRL
Administered by: Private     Purchased by: 0
Symptoms: Lymphadenopathy, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Development of fever within a week of the MMR, then exanthem (looking like German measles) with lymphadenopathy around 2 days later.

VAERS ID:175153 (history)  Vaccinated:2001-08-09
Age:4.0  Onset:2001-08-10, Days after vaccination: 1
Gender:Female  Submitted:2001-08-10, Days after onset: 0
Location:Texas  Entered:2001-09-06, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX01124
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0371AB5IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1407K1IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T04851 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1511K1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The pt returned to the clinic the same day of vax with wheals on her face. No other complaints. Was referred to another facility. Requested the Mom to call the clinic to report.

VAERS ID:175349 (history)  Vaccinated:2001-08-09
Age:5.2  Onset:2001-08-10, Days after vaccination: 1
Gender:Female  Submitted:2001-08-14, Days after onset: 4
Location:Georgia  Entered:2001-09-14, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA01077
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM991A33IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05321IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1274K1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0522K0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Injection site erythema, Injection site pain, Injection site swelling, Pruritus
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Mom stated that child complained of soreness in right arm on 8/10/01 AM and 8/11/01 AM. Right arm was swollen and very red from shoulder to elbow. The pt had blisters and itching. Child was taken to ER on 8/11/01 and was given hydrocortisone and advised to apply cool compresses to arm. Denied having increased temperature. Arm was much improved by Monday and child returned to school.

VAERS ID:175484 (history)  Vaccinated:2001-08-09
Age:3.0  Onset:2001-08-10, Days after vaccination: 1
Gender:Female  Submitted:2001-08-10, Days after onset: 0
Location:Idaho  Entered:2001-09-18, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ID01040
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM988A23IMRA
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS591313A3IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0508K0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site inflammation, Injection site swelling, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Arthus-like rash and swelling on right deltoid.

VAERS ID:175685 (history)  Vaccinated:2001-08-09
Age:5.0  Onset:2001-08-09, Days after vaccination: 0
Gender:Male  Submitted:2001-08-10, Days after onset: 1
Location:Kentucky  Entered:2001-09-25, Days after submission: 46
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: History of asthma.
Diagnostic Lab Data:
CDC Split Type: KY2001062
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1893K0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Choking, Cough, Dyspnoea, Pallor
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: The mother called LCHD reporting as leaving the parking lot. The child started coughing, choking, breathing. Problems and turned pale. Parents rushed the child to the local hospital. Did not come and report to the Health Dept at that time. After treatment and returned home the mother called me. Received steroids and nebulizer treatment at ER.

VAERS ID:175931 (history)  Vaccinated:2001-08-09
Age:0.2  Onset:2001-08-10, Days after vaccination: 1
Gender:Male  Submitted:2001-09-24, Days after onset: 45
Location:New York  Entered:2001-10-02, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: blood culture and CSF - neg
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM986A20IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747290IMRL
Administered by: Private     Purchased by: Private
Symptoms: Crying, Decreased appetite, Irritability, Meningitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: The pt experienced fussiness, not eating well, screaming. The pt was taken to the ER and had blood work and urine done. The pt refused spinal tap and was discharged. The pt was then seen by an "on call" pediatrician on 8/11 with a temp of 102.7 and was admitted to the medical center. A spinal tap was performed and the pt was treated with IV antibiotics. The pt had possible spinal meningitis.

VAERS ID:175945 (history)  Vaccinated:2001-08-09
Age:1.0  Onset:2001-08-19, Days after vaccination: 10
Gender:Female  Submitted:2001-08-20, Days after onset: 1
Location:Washington  Entered:2001-10-02, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WA011780
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0377L0SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747380IMRL
Administered by: Private     Purchased by: Public
Symptoms: Rash morbilliform, Rhinorrhoea
SMQs:, Hypersensitivity (narrow)
Write-up: A 1 year old female received MMR on 8/9/01 and on 8/19/01 she developed a rash on her face, head, neck and migrating down her body. No fever. She had a mild runny nose. Reassurance. Dx''d with measles rash secondary to vaccine.

VAERS ID:175946 (history)  Vaccinated:2001-08-09
Age:0.6  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-08-10, Days after onset: 1
Location:Washington  Entered:2001-10-02, Days after submission: 53
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: Normal exam with tachycardia from crying
CDC Split Type: WA011778
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM986A22IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA569A32IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809752IMRL
Administered by: Private     Purchased by: Public
Symptoms: Screaming, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hostility/aggression (broad)
Write-up: Pt had inconsolable crying X 5 hours, like she was in pain. No sign of swelling or redness at site.

VAERS ID:176090 (history)  Vaccinated:2001-08-09
Age:0.4  Onset:2001-08-23, Days after vaccination: 14
Gender:Male  Submitted:2001-08-27, Days after onset: 4
Location:California  Entered:2001-10-05, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESV0317AB1IMRA
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1823K1IMLA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.R06681IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 2.5 cm in duration central dimpling LT thigh.

VAERS ID:176324 (history)  Vaccinated:2001-08-09
Age:4.0  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-08, Days after onset: 60
Location:Louisiana  Entered:2001-10-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Runny nose
Preexisting Conditions: NONE
Diagnostic Lab Data: 08/20/01, Diagnostic Lab Test: Thrombopenia. Myelography - Nml. 08/21/01 Platelet count - 1000 /mm^3. 08/28/01, Platelet count - 128000 /mm^3.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T09080SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0160L1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral, Pain, Pharyngolaryngeal pain, Platelet disorder, Purpura, Pyrexia, Thrombocytopenia
SMQs:, Cardiac failure (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 8/9/01, pt complained of throat hurting. Temperature was 103F on Thursday, Friday and Saturday. Rx''d with Tylenol and on Sunday had more rash and fever. Treated with Tylenol and Benadryl. Feet had been hurting X 2 days. Rash on abdomen and developed edema of feet. Went to ER. States rash, by this time, looked like blood blisters. Rash to waist and hands. IV antibiotics and steroids given. In 24 hours, no edema. Pt was discharged on 8/11/01 and to follow-up with MD. Doctor dx''d "purpura". On 10/4/01, pt''s mother called to inquire as to time of DTAP #5 for school. Mentioned a "problem" after IPV + MMR as noted above. This was 1st knowledge of any adverse reaction we had.

VAERS ID:176619 (history)  Vaccinated:2001-08-09
Age:5.0  Onset:2001-08-23, Days after vaccination: 14
Gender:Female  Submitted:2001-10-05, Days after onset: 43
Location:Tennessee  Entered:2001-10-23, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seizure medication
Current Illness:
Preexisting Conditions: Epilepsy
Diagnostic Lab Data:
CDC Split Type: TN01051
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM988A20IMLA
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5194A21IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R143320SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1513R0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Two weeks post vax, pt experienced fever as high as 103F for three days. Each evening of these 3 days, the pt had 1-2 seizures. Pt''s mother describes these seizures as similar in character to previous epileptic seizures the child has experienced.

VAERS ID:176772 (history)  Vaccinated:2001-08-09
Age:17.0  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-19, Days after onset: 71
Location:Pennsylvania  Entered:2001-10-26, 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: Zyrtec, Flonase, BCP''s, Allergy injections
Current Illness: NONE
Preexisting Conditions: Enviornmental allergies
Diagnostic Lab Data: Temp 98.8 Pulse 94 Respiration 20, Blood pressure 104/75. Pulse ox 100% on room air. Pt had a rapid strep test which was negative. There were many laboratory tests performed on this young lady so I suggest you look at the report. It had 25
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)CONNAUGHT LABORATORIESUB035AA0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Conjunctival haemorrhage, Erythema, Fatigue, Nasal congestion, Pain, Pharyngolaryngeal pain, Pyrexia, Rash maculo-papular, Serum sickness, Swelling face, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: After being vaccinated today this pt developed a sore throat, nasal congestion, and left sided facial swelling. The pt denies any throat swelling or difficulty swallowing. No shortness of breath. No chest pain or chest tightness. the pt is now here for evaluation concerned that she is having an allergic reaction to her vaccination. She returned to the ER on 8/11 with complaints of continued nasal congestion, development of fever and achiness. She called again and said and said that both eyes were bloody looking and swollen and she was vomiting again. She was instructed to come to the office where she also stated that she felt like her joints were stiff in her knees, and a little in other joints. She appears to be somewhat fatigued. She also has subconjunctival hemorrhages suspected from the coughing and vomiting. She has significant rhinorrhea. Her oropharynx shows diffuse erythema of the posterior pharynx. She had developed a fine maculopapular rash throughout that was also petechial on her bilateral lower extremities. It was decided that she had developed a serum sickness like rxn on put on prednisone.

VAERS ID:176842 (history)  Vaccinated:2001-08-09
Age:0.7  Onset:2001-08-12, Days after vaccination: 3
Gender:Female  Submitted:2001-10-03, Days after onset: 52
Location:South Carolina  Entered:2001-10-30, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pehnobarb, Topanex
Current Illness:
Preexisting Conditions: descreased muscle tone at birth, developemental delay, seizures.
Diagnostic Lab Data: EEG
CDC Split Type: SC0149
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0014AB0 LL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0867J2IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T081620IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4805670IMRL
Administered by: Public     Purchased by: Public
Symptoms: Hypokinesia, Hypotonia, Infantile spasms
SMQs:, Peripheral neuropathy (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: The patient''s mother states 3 days after receiving the 1st set of baby shots, the patient was diagnosed with "infantile spasms" and was seen by a Pediatric Neurologist. At birth the patient was diagnosed with decreased muscle tone and was receiving therapy. The patient''s mother states that before the shots the patient was moving her arms, smiling and "talking", but now, the patient just looks at her and does not move hre arms or legs.

VAERS ID:179522 (history)  Vaccinated:2001-08-09
Age:1.3  Onset:2001-12-10, Days after vaccination: 123
Gender:Male  Submitted:2001-12-20, Days after onset: 10
Location:New Jersey  Entered:2001-12-27, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER0696L   
Administered by: Private     Purchased by: Private
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: The child presented with vesicular rash on face and extremities on 12/11/01. Mom stated that the rash had appeared the day before and was not itching. The pt was not in any distress and was afebrile. He had no respiratory signs or symptoms upon exam.

VAERS ID:179778 (history)  Vaccinated:2001-08-09
Age:1.3  Onset:2001-08-16, Days after vaccination: 7
Gender:Female  Submitted:2001-08-13, Days after onset: 3
Location:Oklahoma  Entered:2002-01-09, Days after submission: 149
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Motrin Suspension and OTC Decongestant
Current Illness: Mild URI and nasal congestion
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OK0152
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM995A23IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0287K3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0015L0SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1242K0SCRL
Administered by: Other     Purchased by: Other
Symptoms: Feeling hot, Injection site oedema, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt has edema almost an erysipelas over the injection site, tender and hot, improved with warm packs and antibiotics.

VAERS ID:180447 (history)  Vaccinated:2001-08-09
Age:22.0  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2001-11-07, Days after onset: 90
Location:Virginia  Entered:2002-01-24, Days after submission: 78
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: 20010245201
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3338A20IMLA
Administered by: Private     Purchased by: Other
Symptoms: Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Report 20010245201 describes muscle tenderness of the lower back in a 22 year old female who received an injection of hep B vaccine recombinant (Engerix-B). Medical history, concurrent conditions, and concurrent medications were not specified. On 08/09/2001, the pt received her first injection of Engerix-B in her left arm. Two hours post-immunization, the pt experienced muscle tenderness in the lower back that persisted for one week. She also experienced pain in her left elbow. The events resolved.

VAERS ID:182436 (history)  Vaccinated:2001-08-09
Age:1.3  Onset:2001-08-14, Days after vaccination: 5
Gender:Female  Submitted:2002-03-08, Days after onset: 206
Location:Indiana  Entered:2002-03-14, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Atrial-septal defect dx''d at the age of 1 year old.
Diagnostic Lab Data: CXR-clear
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809001IM 
Administered by: Public     Purchased by: Public
Symptoms: Cold sweat, Dehydration, Listless, Pallor, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Temperature of 105F, listless, dehydrated, pale and "clammy", 5 days after each of 2 PCV7 doses. Treated with Motrin and antibiotics.

VAERS ID:182855 (history)  Vaccinated:2001-08-09
Age:25.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Florida  Entered:2002-03-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0737L  LA
Administered by: Other     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:182917 (history)  Vaccinated:2001-08-09
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2002-03-19
Location:Unknown  Entered:2002-03-28, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ1352615MAR2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES  IM 
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: An investigator reported that an unidentified child received Prevnar and Hep B vaccines on 08/09/2001, as part of the GMA/Local study. Post immunization, the child developed a fever that was rated grade 3. A fever of grade 3 measures greater than or equal to 103 deg. F. but less than or equal to 105 deg. F. According to the protocol, grade 3 adverse reactions require a clinic visit within 48 hrs of the event. This case was considered serious since fever (grade 3) was considered medically important for this event. The investigator assessed the relationship between fever and Prevnar as "possibly related."

VAERS ID:186082 (history)  Vaccinated:2001-08-09
Age:47.0  Onset:2001-08-09, Days after vaccination: 0
Gender:Female  Submitted:2002-05-28, Days after onset: 292
Location:New York  Entered:2002-06-05, 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: UNK
Current Illness: NONE
Preexisting Conditions: Medical History: Anaphylaxis, concurrent concitions: allergy to insect sting, Penicillin allergy, specific allergy (drug)
Diagnostic Lab Data: Cardiac Monitoring - 08/09/01 - RRR w/o murmur, gallop or run.; Clinical Serology test - 3/01/02-results have not been returned; Vital signs- 08/09/01 -Improved over 30 minutes.
CDC Split Type: WAES0112USA01321
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0031L0IM 
Administered by: Private     Purchased by: Private
Symptoms: Dysphonia, Hypersensitivity, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Initial and follow up reports have been received from a licensed practical nurse concerning a 47 year old adult female homemaker who on 08/09/01 was vaccinated IM in the left deltoid with the first dose of Hepatitis A virus vaccine inactivated. On 08/09/01 at 14;23, immediately post-vaccination, the patient developed hoarseness and her throat tightened. There were no other symptoms. Subsequently, 20 minutes later, the patient started to "feel better" and her voice returned. She denied SOB, lip or tongue swelling, or any fever or chills. Her vital signs improved over 30 minutes and she was noted to have been a little hoarse, but had no stridor and her lungs were completely clear. It was reported that due to the mild allergic reaction, the patient could not be administered dose two. Her heart had a regular rate and rhythm and was without murmur when she galloped or ran It was noted that serology testing was performed in 03/02, but that results have not been returned. The patient recovered from the experience. Unspecified medical attention was sought. The reporter considered the mild allergic reaction to be another important medical event. No further information is available.

VAERS ID:187563 (history)  Vaccinated:2001-08-09
Age:1.3  Onset:2001-08-15, Days after vaccination: 6
Gender:Male  Submitted:2002-05-30, Days after onset: 288
Location:Pennsylvania  Entered:2002-07-15, Days after submission: 46
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Ear infections
Diagnostic Lab Data: UNK
CDC Split Type: WAES01081687
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0696L0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a company representative concerning her 15 month old son with a history "significant for ear infections" who on 8/9/01 was vaccinated with the 1st dose of MMRII (lot 637834/0696L), administered in the left thigh. On 8/15/01, the pt developed a rash on his abdomen and legs. It was also reported that he "seemed to be tired and much quieter at school today". In addition, it was reported that the pt''s vaccinations "are all current". Follow-up information, from the physician, was received on 9/7/01. It was noted that "the only side effect to my knowledge was a rash". Subsequently, the pt recovered. No further information is expected.

VAERS ID:187627 (history)  Vaccinated:2001-08-09
Age:38.0  Onset:2001-08-16, Days after vaccination: 7
Gender:Male  Submitted:2002-07-01, Days after onset: 319
Location:California  Entered:2002-07-16, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Numerous canker sores in mouth;Hep A (Havrix);0;38;In Patient
Other Medications: Prevacid
Current Illness: NONE
Preexisting Conditions: Acid reflux
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5186C61  
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM703A61  
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURR044721  
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESUA331AD1  
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Asthenia, Hypoaesthesia, Tendonitis, Visual disturbance
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (broad)
Write-up: 2/7/01 hep A+B #1, yellow fever, typhoid-numerous canker sores in mouth. 8/9/01 hep A+B #2-numbness in extremities, joint pain, fleatgas in vision al, weakness, tendon pain. The 60 day follow-up states same effects as repeated originally.

VAERS ID:188340 (history)  Vaccinated:2001-08-09
Age:13.0  Onset:2001-08-10, Days after vaccination: 1
Gender:Male  Submitted:2002-07-30, Days after onset: 354
Location:California  Entered:2002-08-02, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD Tine Test
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Body Temp. -08/10/01 -103 F to almost 104 F
CDC Split Type: WAES01081204
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1068K   
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site inflammation, Injection site oedema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a physician concerning a 13 year old Caucasian male patient with no known medical history or allergies who on 08/08/01 at 15:30 was vaccinated in the upper left arm with a dose of pneumococcal vaccine 23 polyvalent (lot number 637262/1068K). Concomitant therapy on 09/09/01 included tuberculin purified protein derivative (PPD Tine Test). There was no illness at the time of vaccination. Subsequently, on 08/10/01, the patient experienced an injection site reaction that was red, painful, warm to the touch, about 3.5 in X 6.5 in in size and a fever of 103 degree F to almost 104 deg. F that continued through 08/12/01. The patient sought unspecified medical attention and the doctor recommend treatment with diphenhydramine HCL (Benadryl) cream, ice and children ibuprofen (Motrin). FOLLOW UP information from the physician indicated that on 08/11/01, the patient presented to the office and he was a"sick trooper today and he definitely looks it and acts it". This is a reaction to the vaccine he received which happens to be pneumococcal vaccine 23 polyvalent". He was pale faced and very unhappy. Everything hurts him, especially his right arm where the vaccine was given. His chest was normal, lungs clear, HR 80 NSR and his abdomen was normal. He had a rather large erythematous, painful, warm to the hot swelling and induration measuring 4.5 inches in length and 3.5 inches wide red-hot induration. His neuro exam was intact. The physician reported that this was " the first severe reaction to pneumococcal vaccine 23 polyvalent in many cases of having had the shot". The physician planned to keep in touch with the family. FOLLOW UP information from the physician indicated that the patient had totally recovered. It was reported that the patient''s school required him to receive pneumococcal vaccine 23 polyvalent. No further information is available.

VAERS ID:191490 (history)  Vaccinated:2001-08-09
Age:0.2  Onset:0000-00-00
Gender:Male  Submitted:2001-08-15
Location:Texas  Entered:2002-10-17, Days after submission: 428
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: U200100928
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURUO515DA   
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA606AA   
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT08412   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: From telephone contact with reporter on 08/10/01, it was stated that a 2 month old male infant received a Tripedia lot # UO515DA, an ActHIB lot # UA606AA and IPOL lot #T08412 vaccination on 08/09/01. The patient experienced a local reaction of redness and swelling at the symptomaticly by physician, the reaction resolved.

VAERS ID:191492 (history)  Vaccinated:2001-08-09
Age:0.2  Onset:0000-00-00
Gender:Male  Submitted:2001-08-15
Location:Texas  Entered:2002-10-17, Days after submission: 428
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: U2001-00931
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURUO515DA   
HIBV: HIB (ACTHIB)AVENTIS PASTEURUA606AA   
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT08412   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site reaction
SMQs:
Write-up: From telephone contact with reporter on 08/10/01, it was stated that a 2 month old male infant received a Tripedia lot UO515AA, IPOL lot # T08412 and an ActHIB lot UA606AA vaccination on 08/09/01 . Patient experienced a local reaction of redness and swelling at the Tripedia injection site. Treated symptomaticaly by physician, the reaction resolved.

VAERS ID:232409 (history)  Vaccinated:2001-08-09
Age:1.0  Onset:2005-01-07, Days after vaccination: 1247
Gender:Female  Submitted:2005-01-11, Days after onset: 4
Location:West Virginia  Entered:2005-01-14, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815453 LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0640L05464L  RL
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Less 20 lesions itching No Fever

VAERS ID:267162 (history)  Vaccinated:2001-08-09
Age:1.0  Onset:2006-11-15, Days after vaccination: 1924
Gender:Female  Submitted:2006-11-17, Days after onset: 2
Location:Virginia  Entered:2006-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4817983IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0928K0SCLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Breakthrough chickenpox.

VAERS ID:176260 (history)  Vaccinated:2001-08-09
Age:2.0  Onset:2001-08-11, Days after vaccination: 2
Gender:Male  Submitted:2001-10-03, Days after onset: 53
Location:Foreign  Entered:2001-10-12, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20010232301
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1IMLL
Administered by: 0     Purchased by: 0
Symptoms: Diarrhoea, Injection site pain, Pyrexia, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: On 8/9/01, the pt received the 2nd Engerix-B pediatric (Hep-B vaccine). One day, post vax, on 8/10/01, the pt experienced injection site reaction. A profound abscess at the injection site was suspected. Two days, post vax, on 8/11/01, the pt developed fever, diarrhea and pain in the leg lasting until 8/13/01. As an exam on 8/13/01, showed no injection site reaction, a viral infection was dx''d. The pt was hospitalized at an unspecified date. Information received on 10/01/01, reported that the outcome of the events was unknown. The reporter did not assess the relationship to treatment with Engerix-B pediatric. No further information will be available.

VAERS ID:176327 (history)  Vaccinated:2001-08-09
Age:1.0  Onset:2001-08-17, Days after vaccination: 8
Gender:Female  Submitted:2001-10-11, Days after onset: 55
Location:Foreign  Entered:2001-10-16, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Lab test-thrombopenia; Myelography-nml; Platelet count on 8/21/01 was 1000 /mm3 and on 8/28/01 was 128,000 /mm3.
CDC Split Type: WAES01100632
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SC 
Administered by: 0     Purchased by: 0
Symptoms: Haematoma, Petechiae, Purpura, Pyrexia, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad)
Write-up: Information has been received from a health authority concerning a 12 month old female who on 8/9/01 was vaccinated with the 1st dose of MMRII, SC. On 8/17/01, the pt developed purpura on her lower limbs and thorax associated with diffuse petechiae, hematoma and fever which led to her hospitalization on 8/20/01. Treated with corticosteroids for 7 days (prednisolone at 4mg/kg/day). Subsequently, the pt recovered without any sequelae. The case is considered as complete. No further information is available.

VAERS ID:193061 (history)  Vaccinated:2001-08-09
Age:8.0  Onset:2002-08-01, Days after vaccination: 357
Gender:Male  Submitted:2002-11-11, Days after onset: 102
Location:Foreign  Entered:2002-11-13, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: Temperature 40-41C
CDC Split Type: D0039720A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Other     Purchased by: Other
Symptoms: Blister, Diarrhoea, Lymphadenopathy, Pancreatitis, Pyrexia, Rash, Splenomegaly, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: A physician reported the occurrence of pancreatitis in an 8 year old male who was vaccinated with Hepatitis B vaccine for prophylaxis. A pharmacist, who is also the mother of the subject, first reported this case. On 8/9/01 the subject received a dose of Hepatitis B vaccine (Engerix-B). On 8/25/01, the subject developed pancreatitis, swollen lymph nodes, swollen spleen, swollen kidney, fever (about 40-41 C), diarrhea (for about 3 wks), vomiting (for 3 days) and exsiccation. Treatment with antibiotics included first cefadroxil for about three days and was followed by asithromycin. Infectious mononucleosis was suspected. Antibiotic treatment was discontinued after leukocytosis occurring on 9/3/01. Additionally, the subject developed a blistering skin rash at hands and feet, which was infected with Streptococoacea and Staphylococcacea. The subject was hospitalized on 09/4/2001. Admission examination showed dry lips and tongue, white furred tongue, severe sweling of cervical lymph nodes, reddened acoustic ducts, white film on tonsils, abdomen soft, pressure pain in liver region, spleen palpable, no meningism. On the fourth day in teh hospital the subject experienced severe epigastric pain. Pancreatitis was diagnosed. The subject received completely parenteral feeding for five days. From 9/8/01 until 9/10/01 the subject additionally developed eoagulopathy. Treatment included fresh frozen plasma. Despite negative serology for HBV IgM, infectious mononucleosis was still suspected. Alternatively, CMV infection was suspected by differential diagnosis, but no serology has been performed. The subject was released on 9/20/01. On 9/24/01 the subject was rehospitalized for blistering skin rash at hands and feet, which was infected with Streptococcea and Staphylococcacea, and perleche. Treatment included flucloxacilline sodium, benzyl penicillins, potassium permanganate and povidone-iodine. The subject was released again on 9/29/01 in good health. Tonsillitis, enteritis, fever, pancreatitis and coagulopathy due to suspected mon

VAERS ID:487285 (history)  Vaccinated:2001-08-09
Age:11.0  Onset:2013-01-17, Days after vaccination: 4179
Gender:Male  Submitted:2013-03-20, Days after onset: 61
Location:Foreign  Entered:2013-03-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1303PRT009210
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.HM04990 SCUN
Administered by: Other     Purchased by: Other
Symptoms: Mumps, Pyrexia, Salivary gland enlargement, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Case of vaccination failure received from the Health Authorities in a foreign country on 11-Mar-2013 under the reference number C201303-11 via the local site Sanofi Pasteur MSD Foreign. The primary reporter was a physician. Case medically confirmed. A 22-year-old male patient received a dose of MMR II (batch number reported as HM04990) subcutaneously on 09-Aug-2001. He had previously received a dose of MMR (manufacturer unknown, batch number not reported) subcutaneously on 27-Sep-1991. On 17-Jan-2013 he experienced mumps with fever and swelling of the salivary glands which lasted 14 days. The reporter stated that this case may be due to a probable vaccination failure. The patient was administered corrective treatment with unspecified anti-inflammatory therapy and he recovered on 31-Jan-2013. The patient had no relevant clinical or pharmacological history and no known previous adverse event to other drugs. To be noted that the batch number HM04990 reported by the Health Authorities for the suspected dose of MMR II vaccine did not match any batch numbers registered by the company for MMR II vaccine and MMRVaxPro vaccine in a foreign country.

VAERS ID:174346 (history)  Vaccinated:2001-08-10
Age:23.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Female  Submitted:2001-08-10, Days after onset: 0
Location:California  Entered:2001-08-14, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Deconamine SR, Nasacort, Celexa, Micronor, Prilosec, Fioricet prn
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0411L3IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: After 45 minutes of administering Hep-B vaccine, pt experienced redness and itching at right arm, with generalized itching followed after 5 more minutes.

VAERS ID:174384 (history)  Vaccinated:2001-08-10
Age:1.0  Onset:0000-00-00
Gender:Female  Submitted:2001-08-13
Location:California  Entered:2001-08-15, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EEG-pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0600L0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0469L0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Breath holding, Convulsion, Dyskinesia, Eye movement disorder
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt had apparent breath holding spell followed by seizure activity X 1 minute with rolling back of eyes and jerking of upper and lower extremities.

VAERS ID:174406 (history)  Vaccinated:2001-08-10
Age:5.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Male  Submitted:2001-08-10, Days after onset: 0
Location:Montana  Entered:2001-08-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 12.5mg/5mg tsp; no resp effort; pulse ox 99%, T 99, pulse 92, resp 24.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU0515CA2IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURT04840IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0600L1SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0088L0SCRL
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Pt received vaccines this morning, approx 1000 this am, home about 1045, pt went outside to play, at 1105 dad noticed pt looked red, 1115 dad saw some bumps on skin, called immun. clinic, instructed to call peds, instructed to come in upon arrival pt flushed? face to waist with large hives on trunk. Face, scattered hives on legs given Benadry 12.5mg/5mg tsp; no resp effort; pulse ox 99%, T 99, pulse 92, resp 24. Monitored x 2 hrs-released home.

VAERS ID:174470 (history)  Vaccinated:2001-08-10
Age:41.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Female  Submitted:2001-08-13, Days after onset: 3
Location:Nevada  Entered:2001-08-20, 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: Claritin; PPD/LFA/0 previous doses which was given on 8/10/01.
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0523L0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Asthenia, Dizziness, Dysphonia, Dyspnoea, Headache, Pallor
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Friday evening pt complained of dizziness followed by hoarseness, headache and weakness. Noticed pale skin coloration. She also complained of SOB, beginning on Sunday evening. Client went to see PMD. No Rx''s given.

VAERS ID:174471 (history)  Vaccinated:2001-08-10
Age:4.0  Onset:2001-08-11, Days after vaccination: 1
Gender:Female  Submitted:2001-08-13, Days after onset: 2
Location:California  Entered:2001-08-20, 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: On 8/8/01 was given PPD/Parkedale/01080P/LFA/1 previously
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM507A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T10983 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1518K1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt returned for U/A dip. Left arm redness and swollen. Pt was seen through urgent care at site of DTAP vaccine. Pt had a reaction.

VAERS ID:174512 (history)  Vaccinated:2001-08-10
Age:1.5  Onset:2001-08-11, Days after vaccination: 1
Gender:Male  Submitted:2001-08-15, Days after onset: 4
Location:Arizona  Entered:2001-08-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815450IMRL
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 24 hours, post vax, pt broke out into hives.

VAERS ID:174547 (history)  Vaccinated:2001-08-10
Age:0.1  Onset:2001-08-14, Days after vaccination: 4
Gender:Male  Submitted:2001-08-14, Days after onset: 0
Location:Connecticut  Entered:2001-08-22, Days after submission: 8
Life Threatening? No
Died? Yes
   Date died: 2001-08-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Captopril, ASA, Zantac
Current Illness:
Preexisting Conditions: Hypoplastic left heart
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM177A21IMRL
Administered by: Private     Purchased by: Public
Symptoms: Apnoea, Bacterial infection, Heart disease congenital, Pallor
SMQs:, Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Baby became pale, was not breathing. EMS responded and baby was intubated and transported to ER. Resuscitation was attempted but was not successful. Autopsy report states baby was a twin with left hypoplastic heart syndrome, surgically corrected one week ago and complicated by lung streptococcal infection. Death certificate states cause of death as left hypoplastic heart syndrome.

VAERS ID:174676 (history)  Vaccinated:2001-08-10
Age:14.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Female  Submitted:2001-09-10, Days after onset: 31
Location:California  Entered:2001-08-24, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood sugar-98
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1031K0IMLA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM697A20IMLA
Administered by: Public     Purchased by: Public
Symptoms: Eye movement disorder, Hyperhidrosis, Loss of consciousness, Muscle rigidity, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Post vax, the pt lost consciousness and had rigidity of both upper and lower extremities, rolling up of eyeballs for a few minutes, pallor and sweating.

VAERS ID:174746 (history)  Vaccinated:2001-08-10
Age:23.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Female  Submitted:2001-08-20, Days after onset: 10
Location:Minnesota  Entered:2001-08-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zithromax, Cefixtone.
Current Illness: Gonorrhea
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5235A41IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 3 days after 2nd Hepatitis B injection, this patient developed itching rash, to the lower abdomen only. Had same amount of itching after injection. Injection site without rash.

VAERS ID:174790 (history)  Vaccinated:2001-08-10
Age:2.0  Onset:2001-08-17, Days after vaccination: 7
Gender:Male  Submitted:2001-08-20, Days after onset: 3
Location:California  Entered:2001-08-29, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815460IMLL
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The patient experienced urticaria 7 days post vaccination.

VAERS ID:174863 (history)  Vaccinated:2001-08-10
Age:0.2  Onset:2001-08-10, Days after vaccination: 0
Gender:Female  Submitted:2001-08-10, Days after onset: 0
Location:Arizona  Entered:2001-08-31, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: One previous apnea spell
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM981A20IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1526K IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T050520SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747340IMRL
Administered by: Private     Purchased by: Public
Symptoms: Apnoea, Petechiae, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Hypersensitivity (narrow)
Write-up: Petechial rash throughout body, mother saw wheals that quickly resolved. One episode of apnea (she was having these before).

VAERS ID:174905 (history)  Vaccinated:2001-08-10
Age:5.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Male  Submitted:2001-08-10, Days after onset: 0
Location:Massachusetts  Entered:2001-08-31, 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: Epi-pen
Current Illness: NONE
Preexisting Conditions: Allergies to penicillin, azithromycin and various dyes
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1325J1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Anaphylactic reaction, Swelling, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt developed anaphylaxis, swelling and hives. He improved with subcutaneous epinephrine.

VAERS ID:175245 (history)  Vaccinated:2001-08-10
Age:8.0  Onset:2001-08-11, Days after vaccination: 1
Gender:Male  Submitted:2001-08-27, Days after onset: 16
Location:Alaska  Entered:2001-09-11, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever;UNCLASSIFIED/UNSPECIFIED VACCINE;;.00;In Patient
Other Medications:
Current Illness: 4 days prior had respiratory inf
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: AK200157
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5212B90IMRA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM655A90IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt received shots on 8/10/01 and had red marks on shoulders Friday night but had been playing football. By 20:00, Saturday night, (away from home), had itching, circular rash on stomach and it was worse by 02:00, Sunday, over shoulders, arms and back with welts. Pt was given Benadryl and is continuing on Benadryl, Cortizone cream and Aveeno baths. Hives resolved after 4 days. Doctor wrote medical comments for future Hepatitis shots.

VAERS ID:175684 (history)  Vaccinated:2001-08-10
Age:4.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Male  Submitted:2001-08-13, Days after onset: 3
Location:Kentucky  Entered:2001-09-25, Days after submission: 43
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: KY2001063
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM501A24IMLL
MEN: MENINGOCOCCAL (MENOMUNE-A/C)CONNAUGHT LTD.AT10983SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.M0253L1SCRL
Administered by: Public     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash to the left upper thigh, approximately 3 x 3 1/2 in size. Immunization given on 08/01/2001 and the patients mom states rash noted on 08/10/01. No other adverse reactions reported.

VAERS ID:175777 (history)  Vaccinated:2001-08-10
Age:18.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Female  Submitted:2001-09-05, Days after onset: 26
Location:Pennsylvania  Entered:2001-09-27, 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:
Current Illness:
Preexisting Conditions: History of migraine headaches since the age of 13.
Diagnostic Lab Data: NONE
CDC Split Type: PA0155
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEUR017AB0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: On 8/10/01 at 19:00, pt vomited until 8/11/01 in the AM and then she had an onset of a headache, nausea, fever and fatigue. Symptoms continued on an intermittent basis. On 8/23/01, pt seen by PMD and put on Inderal and Vioxx for 1 month. Pt is to see PMD on 9/7/01 for evaluation. On 9/5/01, mother reports that headaches continue. Other symptoms have resolved.

VAERS ID:175865 (history)  Vaccinated:2001-08-10
Age:4.0  Onset:2001-08-11, Days after vaccination: 1
Gender:Male  Submitted:2001-08-18, Days after onset: 7
Location:West Virginia  Entered:2001-10-01, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: GE Reflux; Bronchitis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM505A24IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T12733 RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0736L1SCLL
Administered by: Private     Purchased by: 0
Symptoms: Injection site erythema, Injection site mass, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt''s right leg was swollen, red, warm to touch and with a knot.

VAERS ID:176500 (history)  Vaccinated:2001-08-10
Age:5.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Male  Submitted:2001-08-13, Days after onset: 3
Location:Kansas  Entered:2001-10-19, Days after submission: 67
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: KS200134
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0514EA5IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T08424IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0023L2SCRA
Administered by: Public     Purchased by: Public
Symptoms: Eye swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 45 minutes post vax, the patient complained of itching and swollen eyes. The patient''s mother reported being able to see his glands. Motrin and Benadryl were given.

VAERS ID:176794 (history)  Vaccinated:2001-08-10
Age:  Onset:2001-08-14, Days after vaccination: 4
Gender:Male  Submitted:2001-09-24, Days after onset: 41
Location:Texas  Entered:2001-10-29, Days after submission: 35
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: TX01143
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0258K0SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.023420SC 
Administered by: Public     Purchased by: 0
Symptoms: Blister, Pruritus
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Eruption of about 100 blisters on 08/14/2001, about 150 more blisters on 09/12/2001, about 25 blisters on 09/21/2001 and severe itching with no fever.

VAERS ID:176892 (history)  Vaccinated:2001-08-10
Age:42.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Male  Submitted:2001-09-28, Days after onset: 49
Location:Illinois  Entered:2001-10-30, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EKG normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.T016321 RA
Administered by: Private     Purchased by: 0
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Chest pain following Imovax thought he was having a heart attack even though pain was right side of chest. Cardiac work up was negative.

VAERS ID:177777 (history)  Vaccinated:2001-08-10
Age:1.5  Onset:2001-08-15, Days after vaccination: 5
Gender:Female  Submitted:2001-11-08, Days after onset: 85
Location:California  Entered:2001-11-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM596A23IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA606AA3IMRL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: The patient developed a fever 5 days after the vaccines were given.

VAERS ID:178064 (history)  Vaccinated:2001-08-10
Age:15.0  Onset:2001-08-11, Days after vaccination: 1
Gender:Male  Submitted:2001-10-15, Days after onset: 65
Location:Texas  Entered:2001-11-21, Days after submission: 37
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: WBC = 1.4
CDC Split Type: TX01169
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.5223C91IM 
Administered by: Public     Purchased by: Unknown
Symptoms: Abasia, Anorexia, Arthritis, Fatigue, Fluid retention, Leukopenia, Pyrexia
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow)
Write-up: The patient was admitted to the hospital on 09/11/2001. The patient was running a fever, 104-105F, could not walk, and could not eat. The patient complained of being tired and weak on 08/11/2001. On 08/27/2001 the patient was taken to minor care. The patient was taken to the ER on 08/29/2001 with arthritis and fluid around his heart. Annual follow up received on 2/07/2005 states: "Doctors have told us that they do not know if pt is recovered or if the problems will reoccur - Pt is exempt from vaccine immunizations of Hep B in the future - doctors told us that and the vaccine was the cause of all his illnesses."

VAERS ID:179386 (history)  Vaccinated:2001-08-10
Age:22.0  Onset:2001-08-20, Days after vaccination: 10
Gender:Male  Submitted:2001-12-12, Days after onset: 114
Location:Maryland  Entered:2001-12-26, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD/Aventis-Pasteur/C0832AA/ID
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40082570  
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Lymphangitis
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The pt developed localized tenderness and redness over the site of vaccinia vaccination with lymphangitis to axilla; treated with 5 days of Augmentin, 875mg BID.

VAERS ID:179686 (history)  Vaccinated:2001-08-10
Age:1.0  Onset:2001-08-11, Days after vaccination: 1
Gender:Male  Submitted:2001-12-14, Days after onset: 125
Location:North Carolina  Entered:2002-01-03, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cefzil
Current Illness: OM
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM507A23IMLL
HBPV: HIB POLYSACCHARIDE (HIBIMUNE)LEDERLE LABORATORIES477255  RL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT085422SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809733IMLL
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Injection site mass
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Left upper leg redness, hardness to palpation, mild to moderate. Brought to ER. Received Benadryl, Motrin and warm compress.

VAERS ID:185056 (history)  Vaccinated:2001-08-10
Age:1.1  Onset:2001-08-26, Days after vaccination: 16
Gender:Female  Submitted:2002-05-15, Days after onset: 262
Location:Washington  Entered:2002-05-22, 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:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES01061178
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0378L0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0495L0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Nasopharyngitis, Skin ulcer
SMQs:
Write-up: Information has been received from a physician concerning a 13 month old female with no past medical history or known allergies who on 08/10/2001 was vaccinated with the first dose of varicella vaccine SC in the left arm. Concomitant therapy that day included the first dose of MMR vaccine SC in the right arm. There were no other concomitant medication. It was noted that there were no adverse events following prior vaccinations. On 08/26/2001, 16 days after vaccination, the child developed 3-5 vesicles. It was noted that the child was afebrile. In approximately September 2001, the child developed a mild cold/URI symptoms. Follow-up info reported the the child had recovered from her experience without sequelae. It was noted that other pts from the same doctor''s office reported similar symptoms. No further info is expected.

VAERS ID:185391 (history)  Vaccinated:2001-08-10
Age:29.0  Onset:2001-08-25, Days after vaccination: 15
Gender:Male  Submitted:2002-05-15, Days after onset: 263
Location:Unknown  Entered:2002-05-24, 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: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES01083013
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: Information has been received from a male consumer with no past medical history and no allergies who on 08/10/2001 was vaccinated with a dose of varicella vaccine. There was no concomitant medication. On 0/25/2001, the pt began "breaking out with chicken pox all over." It was confirmed by the pt''s physician on 08/27/2001 that the pt had chicken pox. The physician told the pt to take Tylenol and Advil. The pt was also prescribed Valtrex. It was noted that the pt was afraid to take Valtrex while he had the chicken pox. Additional info has been requested.

VAERS ID:185882 (history)  Vaccinated:2001-08-10
Age:5.0  Onset:2001-08-10, Days after vaccination: 0
Gender:Male  Submitted:2002-05-16, Days after onset: 279
Location:California  Entered:2002-05-31, Days after submission: 15
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: Gluten allergy; celiac sprue dx''d in 1998
Diagnostic Lab Data: UNK
CDC Split Type: 20010198011
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS 1IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEUR  IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site mass, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On 8/10/01, the vaccinee received a left deltoid dose of Infanrix and an IM 0.5ml dose of IPOL; the vaccinee had received an unspecified number of previous doses of Infanrix. Subsequently, the vaccinee developed a 5-6cm lump in diameter at the injection site which was more diffuse than a palpable mass. It did not extend to the joints. It was "slightly enlarged". The lump was hot to touch. The injection site was painful and the the pain was confined to the injection site. The vaccinee had no fever. There was diffuse erythema not confined to the injection site. The swelling resolved in 5 days after being treated with ice and observed. No drugs were used to treat the adverse event. The vaccinee was treated by a physician. The reporter stated that the adverse events were moderate in severity and were related to Infanrix. The adverse events resolved on 8/16/01. As of 8/28/01, the adverse events had resolved.

VAERS ID:187578 (history)  Vaccinated:2001-08-10
Age:  Onset:2001-09-10, Days after vaccination: 31
Gender:Unknown  Submitted:2002-05-30, Days after onset: 262
Location:Unknown  Entered:2002-07-15, Days after submission: 46
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01091188
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Rash morbilliform
SMQs:, Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a pt (demographics unspecified) who on 8/10/01 was vaccinated with a dose of MMRII. On 9/10/01, it was reported that "now" the pt has a "measles-like rash". The pt sought unspecified medical attention. Additional information has been requested.

VAERS ID:188787 (history)  Vaccinated:2001-08-10
Age:1.3  Onset:2001-09-08, Days after vaccination: 29
Gender:Female  Submitted:2002-08-05, Days after onset: 331
Location:Indiana  Entered:2002-08-13, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Failure to thrive
Diagnostic Lab Data: Stool cultures negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPH: DTAP + HIB (TRIHIBIT)AVENTIS PASTEURU0340AA0IMRL
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Persistent diarrhea for 2 months with weight loss starting 3-4 weeks after immunization with no cause found.

VAERS ID:216949 (history)  Vaccinated:2001-08-10
Age:  Onset:0000-00-00
Gender:Male  Submitted:2004-02-05
Location:Unknown  Entered:2004-02-26, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0430135A
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS145A92  
Administered by: Other     Purchased by: Other
Symptoms: Fatigue, Headache, Hypoaesthesia, Joint swelling, Myalgia, Night sweats
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad)
Write-up: This report described the occurrence of myalgias in a male patient who received Lyme disease vaccine recombinant for prophylaxis. This report was received as part of litigation proceedings, and has not been verified by a physician or other health care professional. The patient''s attorney reported that the patient received injections of Lymerix on 12/9/99, 2/28/00 and 5/10/01 according to the client and medical records. However, an immunization record supplied by the attorney indicated that the dates of immunization were 12/9/99, 2/17/00, and 8/10/01. This represents a schedule of 0, 2, and 20 months rather than the recommended schedule of 0, 1, and 12 months. On 9/3/03, the patient''s attorney alleged that the patient suffered myalgia, aching hands, feet and legs, fatigue, joint swelling, night sweats, numbness and headaches. The onset of his symptoms is not clear at this time. Treatment and outcomes of the alleged events were not reported.

VAERS ID:223740 (history)  Vaccinated:2001-08-10
Age:0.2  Onset:2001-08-12, Days after vaccination: 2
Gender:Male  Submitted:2004-07-07, Days after onset: 1060
Location:Texas  Entered:2004-07-07
Life Threatening? No
Died? Yes
   Date died: 2001-08-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: born at 28 weeks gestation
Diagnostic Lab Data: Autopsy indicated SIDS
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (NO BRAND NAME)UNKNOWN MANUFACTURER508A2 IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0448L1IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1676K IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURT0561 IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH481543 IMLL
Administered by: Military     Purchased by: Military
Symptoms: Sudden infant death syndrome, Unevaluable event
SMQs:, Neonatal disorders (narrow)
Write-up: My son died on Sunday evening after getting shots on friday afternoon. He was in perfect health prior to his shots and death. Nurse follow up on 07/26/04 states: "Complete."

VAERS ID:224612 (history)  Vaccinated:2001-08-10
Age:4.0  Onset:2004-07-25, Days after vaccination: 1080
Gender:Male  Submitted:2004-07-27, Days after onset: 2
Location:Missouri  Entered:2004-08-02, 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: NONE
Current Illness: Tick bites
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT05622SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0737L0SCRL
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Pyrexia, Rash papular, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Pap/Vesic lesions 2 mm lesion right ankle, abd, fever on back. Itchy scalp.

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