MedAlerts Home
  Read the MedAlerts Blog Subscribe to the MedAlerts Blog 

Found 471248 cases in entire database

Case Details (Sorted by Vaccination Date)

This is page 1766 out of 4713

Result pages: prev   1667 1668 1669 1670 1671 1672 1673 1674 1675 1676 1677 1678 1679 1680 1681 1682 1683 1684 1685 1686 1687 1688 1689 1690 1691 1692 1693 1694 1695 1696 1697 1698 1699 1700 1701 1702 1703 1704 1705 1706 1707 1708 1709 1710 1711 1712 1713 1714 1715 1716 1717 1718 1719 1720 1721 1722 1723 1724 1725 1726 1727 1728 1729 1730 1731 1732 1733 1734 1735 1736 1737 1738 1739 1740 1741 1742 1743 1744 1745 1746 1747 1748 1749 1750 1751 1752 1753 1754 1755 1756 1757 1758 1759 1760 1761 1762 1763 1764 1765 1766 1767 1768 1769 1770 1771 1772 1773 1774 1775 1776 1777 1778 1779 1780 1781 1782 1783 1784 1785 1786 1787 1788 1789 1790 1791 1792 1793 1794 1795 1796 1797 1798 1799 1800 1801 1802 1803 1804 1805 1806 1807 1808 1809 1810 1811 1812 1813 1814 1815 1816 1817 1818 1819 1820 1821 1822 1823 1824 1825 1826 1827 1828 1829 1830 1831 1832 1833 1834 1835 1836 1837 1838 1839 1840 1841 1842 1843 1844 1845 1846 1847 1848 1849 1850 1851 1852 1853 1854 1855 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865   next


VAERS ID:176936 (history)  Vaccinated:2001-10-26
Age:36.0  Onset:2001-10-27, Days after vaccination: 1
Gender:Female  Submitted:2001-10-29, Days after onset: 2
Location:New Jersey  Entered:2001-10-31, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES1504821KA2IMLA
Administered by: Other     Purchased by: 0
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 5 cm X 3 cm warm erythematous area at vaccination sites. Therapy with reflex 500 mg twice daily.

VAERS ID:177171 (history)  Vaccinated:2001-10-26
Age:0.2  Onset:2001-10-26, Days after vaccination: 0
Gender:Female  Submitted:2001-10-31, Days after onset: 5
Location:Connecticut  Entered:2001-11-05, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM998A20IMLL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4792650IMRL
Administered by: Private     Purchased by: Public
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: Pt developed excessive screaming for 48 hours following vax.

VAERS ID:177205 (history)  Vaccinated:2001-10-26
Age:86.0  Onset:2001-10-26, Days after vaccination: 0
Gender:Female  Submitted:2001-10-30, Days after onset: 4
Location:Massachusetts  Entered:2001-11-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Osteoporosis; "inner ear problem," dementia
Diagnostic Lab Data: Stomach X-rays
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0571AD IMRA
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain upper, Anorexia, Asthenia, Dehydration, Nausea, Pain, Pyrexia, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)
Write-up: Vomiting, fever, achy, loss of appetite, stomach pain. Given IV''s. The discharge summary states weakness, dehydration, vertigo and nausea.

VAERS ID:177224 (history)  Vaccinated:2001-10-26
Age:45.0  Onset:2001-10-29, Days after vaccination: 3
Gender:Male  Submitted:2001-10-31, Days after onset: 2
Location:Missouri  Entered:2001-11-06, 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: Avendol, Trezedone and Desipreanine.
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0574AA IMLA
Administered by: Other     Purchased by: 0
Symptoms: Headache
SMQs:
Write-up: 11/01/2001 Telephone call, continued to have dull headache, back to work.

VAERS ID:177600 (history)  Vaccinated:2001-10-26
Age:43.0  Onset:2001-10-27, Days after vaccination: 1
Gender:Female  Submitted:2001-10-29, Days after onset: 2
Location:Maine  Entered:2001-11-12, 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: Cortef; Florinef
Current Illness:
Preexisting Conditions: Addison''s disease
Diagnostic Lab Data: Labs-WNL
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE09871LA IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1071K IM 
Administered by: Private     Purchased by: Private
Symptoms: Adrenal insufficiency, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Febrile illness with adrenal insufficiency in pt with Addison''s disease.

VAERS ID:177610 (history)  Vaccinated:2001-10-26
Age:40.0  Onset:2001-10-26, Days after vaccination: 0
Gender:Female  Submitted:2001-10-26, Days after onset: 0
Location:Tennessee  Entered:2001-11-12, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0681AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Arrhythmia, Hyperhidrosis, Nausea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad)
Write-up: Within 10 minutes post vax, the patient experienced heart arrhythmia, her airway was tight, she was nauseous and sweating. Patient was treated with Epipen and taken to ER. Doctors determined her reaction was due to lactose intolerance.

VAERS ID:178075 (history)  Vaccinated:2001-10-26
Age:10.0  Onset:2001-10-26, Days after vaccination: 0
Gender:Male  Submitted:2001-11-15, Days after onset: 20
Location:Virginia  Entered:2001-11-21, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Strep culture of throat - negative. BP 90/70, Pulse 100, Temp 98F all wnl.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5225A91IMLA
Administered by: Other     Purchased by: Public
Symptoms: Anxiety, Flushing, Heart rate increased, Pharyngeal oedema, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: 30 to 45 minutes after the vaccine was administered, the patient developed facial flushing, increased heart rate and complained of his throat swelling and a sense of anxiety. The patient was examined by the Family MD and was diagnosed with a reddened rash on his cheeks. The patient was treated with Decadron and Allegra.

VAERS ID:178231 (history)  Vaccinated:2001-10-26
Age:10.0  Onset:2001-10-27, Days after vaccination: 1
Gender:Male  Submitted:2001-11-15, Days after onset: 19
Location:Texas  Entered:2001-11-27, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Strep throat
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0676AA3IMLA
Administered by: Other     Purchased by: Other
Symptoms: Angioneurotic oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow)
Write-up: 1 day after rec''d flu vaccine (and 5 d after starting Pen VK for strep pharyngitis) he developed urticaria and angioedema (face & feet), lasting 7 days (hives) (angioedema x 3 d). (I have referred for testing for Pen allergy)

VAERS ID:178524 (history)  Vaccinated:2001-10-26
Age:44.0  Onset:2001-10-28, Days after vaccination: 2
Gender:Male  Submitted:2001-12-18, Days after onset: 51
Location:Pennsylvania  Entered:2001-12-04, 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: Serevent, Flovent
Current Illness: Recent viral gastroenteritis
Preexisting Conditions: Asthma; Previous opthalmic history with regards to his spectacles. He has a marked optical difference between his two eyes with his right eye being more hyperopic than his left.
Diagnostic Lab Data: MRI brain, Orbit cervical spine, Lyme titer, Myasthenia panel - results not provided.
CDC 'Split Type': U2001011820
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0679DA SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Diplopia, Encephalitis, Headache, Malaise, Neck pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Ocular motility disorders (broad), Arthritis (broad)
Write-up: It was reported by the pt that he, a 44 year old male, received a Fluzone ''01-''02 vaccination on 10/26/01. The pt developed double vision on 10/28/01; the double vision is still persisting. Pt also experienced tingling in hands and feet, and a general feeling of malaise. He complained of pain in his neck and continued pressure behind his eyes and has a splitting headache. The pt has seen a neurologist, internal medical doctor and an Ophthamologist. He was dx''d by the Ophthamologist as having post viral encephalitis triggered by the flu vaccination. The pt did state that no spinal tap was performed as of yet. From follow up correspondence received on 12/14/01 additional pt, vaccine, responsible physician, vaccine administrator and laboratory data was provided. From follow up correspondence received on 12/14/01 additional patient, vaccine, responsible physician, vaccine administrator and laboratory data was provided. From follow up correspondence received on 2/11/02 the following information was provided from teh physicians notes dated 1/14/02. The patient returns reporting overall he feels much better. He feels his ptosis is completely resolved. He feels wach eye is moving much better at this time but he questions whether his eyes are crossing inwards more. The patient has previous opthalmic history with regards to his spectacles. When examining his refraction he has a marked optical diffrence between his two eyes with his right eye being much more hyperopic than his left. He is experiencing minimal if any diplopia at this time. The patient is showing a marked improvement in his overall gaze paresis. At present he has relatively full duction in both eyes. His ptosis has also improved. However, he is demonstrating an increase in his objective strabismus angle with partial sensory suppression of his right eye. The fact that this tribasic angle is overall increased at this point is not necessarily concerning. In particular, he had very limited duction in all fields of gaze before which might potentially hide his true

VAERS ID:178671 (history)  Vaccinated:2001-10-26
Age:1.0  Onset:2001-10-27, Days after vaccination: 1
Gender:Male  Submitted:2001-10-29, Days after onset: 2
Location:Arkansas  Entered:2001-12-05, Days after submission: 37
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: The child''s mom had childhood seizures.
Diagnostic Lab Data:
CDC 'Split Type': AR0146
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT08411IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0152L0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0786L0SCRA
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: Immunizations were given on 10/26/01 at 14:00. On 10/27/01 at 14:30, the child experienced a seizure while in the grocery store with his grandmother. The child had a temperature of 102F that Tylenol was Tylenol was being given for. The child was seen by ER and released home.

VAERS ID:179217 (history)  Vaccinated:2001-10-26
Age:0.2  Onset:2001-11-02, Days after vaccination: 7
Gender:Female  Submitted:2001-11-09, Days after onset: 7
Location:Alabama  Entered:2001-12-19, Days after submission: 40
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: EEG; CXR-nml; Blood culture-neg
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0515CA0IM 
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA624AA0IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT12730SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841410IM 
Administered by: Private     Purchased by: Private
Symptoms: Apnoea, Hypokinesia, Pallor
SMQs:, Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: The pt was found apneic and pale at daycare. She required mouth-to-mouth resuscitation. In ER, she was noted to have decreased activity and color.

VAERS ID:179443 (history)  Vaccinated:2001-10-26
Age:79.0  Onset:2001-10-29, Days after vaccination: 3
Gender:Male  Submitted:2001-12-17, Days after onset: 49
Location:Michigan  Entered:2001-12-27, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI negative for any cause for swollen optic nerve.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO602BA IM 
Administered by: Public     Purchased by: Public
Symptoms: Oedema, Vision blurred
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Pt was seen by eye doctor 3 days after receiving flu shot with complaint of blurry vision. Eye doctor diagnosed pt with a swollen optic nerve. Pt treated with steroids.

VAERS ID:180552 (history)  Vaccinated:2001-10-26
Age:0.3  Onset:2001-10-27, Days after vaccination: 1
Gender:Female  Submitted:2002-01-16, Days after onset: 81
Location:Ohio  Entered:2002-01-25, 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: NONe
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAMA517A20IMLL
HIBV: HIB (ACTHIB)AVENTIS PASTEURMA573AB0IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT14460IMRL
Administered by: Private     Purchased by: Private
Symptoms: Histrionic personality disorder, Hyperacusis, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hearing impairment (narrow)
Write-up: Parents feel patient had a change in personality after her first set of immunizations. She seemed to develop hyperacoutis and became very fussy, spending a lot of time crying. Hyperacoutis improved about 2 weeks ago.

VAERS ID:182781 (history)  Vaccinated:2001-10-26
Age:46.0  Onset:2001-10-29, Days after vaccination: 3
Gender:Female  Submitted:2002-03-21, Days after onset: 143
Location:Illinois  Entered:2002-03-25, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR0593AA IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness, soreness at injection site; no fever, shaking, chills, and no evidence of cellulitis.

VAERS ID:187916 (history)  Vaccinated:2001-10-26
Age:1.1  Onset:2001-11-01, Days after vaccination: 6
Gender:Male  Submitted:2002-05-30, Days after onset: 209
Location:Unknown  Entered:2002-07-23, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01110202
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse and a health care professional concerning a 13 month of old white male who on 10/26/01 was vaccinated with a dose of MMRII. Concomitant vaccination the same day included Varivax. On 11.01.01, the patient was seen for a rash diagnosed as rash secondary to MMRII, also described as hives reaction. The RN reported that the patient has no systemic symptoms. No therapy was prescribed. Subsequently on 11/06/01, the patient recovered from the hives. No further information is expected.

VAERS ID:190377 (history)  Vaccinated:2001-10-26
Age:43.0  Onset:2001-10-26, Days after vaccination: 0
Gender:Female  Submitted:2001-10-29, Days after onset: 3
Location:Washington  Entered:2002-09-19, Days after submission: 324
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WA011787
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5257A40IMLA
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Hypoaesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: 5:30 began vomiting, total of symptoms: dizzy, lightheadedness. Left arm numb. At 9PM, afraid to go to sleep, but did. In AM, a little lightheaded and arm just sore.

VAERS ID:190378 (history)  Vaccinated:2001-10-26
Age:8.0  Onset:2001-10-26, Days after vaccination: 0
Gender:Male  Submitted:2001-10-26, Days after onset: 0
Location:Washington  Entered:2002-09-19, Days after submission: 328
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: Asthma
Diagnostic Lab Data: BP - 110/80; Pulse - 112 BPM; BP - 110/70; Pulse - 100 BPM; BP - 106/70; Pulse 96 BPM
CDC 'Split Type': WA011788
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.VHA706A20IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0377L1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Blood pressure increased, Heart rate increased, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Hypersensitivity (narrow)
Write-up: 15:30: MMR/Hep A administered within 5 minutes, dad returned to office with patient opon noting hives around mouth/lips and left cheek. RN call doctor. 15:45: 2 tsp. Benadryl administered PO. Patient swallowing easily, speaking clearly, no swelling of lips or neck or tongue. No difficulty breathing. no hives at injection site. BP and pulse monitored. Cold pack applied to face. 16:30: Patient released by doctor with instructions to take 10mg Claritin after dinner and instructed dad to call office if hoarseness or lip swelling occurs and call 911 if difficulty breathing occurs. Hives had decreased significantly by time of release.

VAERS ID:197440 (history)  Vaccinated:2001-10-26
Age:1.0  Onset:2001-10-26, Days after vaccination: 0
Gender:Female  Submitted:2003-01-13, Days after onset: 444
Location:Massachusetts  Entered:2003-02-07, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEA: MEASLES (ATTENUVAX)MERCK & CO. INC.1042K0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Asthenia, Balance disorder, Crying, Decreased appetite, Pain, Pyrexia, Sleep disorder, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)
Write-up: Overview of the five days after pt''s measle injection: Pt slept approximately 18-22 hours a day. She nursed and threw-up most times after nursing. Pt did not eat or drink water except for a few drops here and there. Pt had a high fever for five days. Pt was in pain, unsteady, cried easily, and weak. 10/26/02 11am pt received the measles vaccine. 10pm pt threw up entire belly after nursing. 10/27/02 fever all day. 6am woke up with high fever 102D. 8:30-9:30am slept-9:45am nursed and threw-up. 10-11am slept. 3pm-6pm slept. 7-10pm woke up screaming. 10:30pm nursed and did not throw up. 11pm-9:30am slept with occasional wake ups. 10/28/02 fever all ay. 9:30am woke up pt cried and slept all day with occasional wake ups to nurse and throw up. I spoke with MD who said that a dose of Tylenol which would give her "false" thoughts of feeling better in order to drink and eat without throwing up. After the Tylenol wore off pt was worse than before with more crying and listlessness. 4-5pm nursed pt to a full belly which she threw up at 6pm. 6:30-put pt to bed. 10/29/02 6am nursed and little water. 6:30-11am slept. 11am nursed. 11:15 slept. Noon up read books. 1pm nursed. 1:10 nap. 3pm nursed. 4pm not eating fever is down. 6pm nursed and slept. 8:30 threw up green. 10/30/02 seems better but very weak from vaccine. 10/31/02 pt is in pain, unsteady, cries easily, weak and sleeps a lot.

VAERS ID:280142 (history)  Vaccinated:2001-10-26
Age:1.0  Onset:2004-01-01, Days after vaccination: 797
Gender:Female  Submitted:2007-05-16, Days after onset: 1230
Location:Indiana  Entered:2007-05-24, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Body temp, 03/31/06, 100.2 F
CDC 'Split Type': WAES0604USA01041
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0898L0SCLA
PNC: PNEUMO (PREVNAR)PFIZER/WYETH4815483IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0795L0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Body temperature increased, Cellulitis, Eye discharge, Henoch-Schonlein purpura, Herpes zoster, Joint range of motion decreased, Ocular hyperaemia, Oedema peripheral, Pain, Rash vesicular, Tenderness
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Vasculitis (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Information has been received from a physician concerning a 5 year old female with no known medical history who on 26-OCT-2001 was vaccinated SC in the right arm with a first dose of Varivax (lot # 6440312/0795L). Concomitant vaccination included a first dose of MMR II (Lot # 639518/0898L) given SC in the left arm and a fourth dose of PREVNAR (lot # 481548) given IM in the right thigh. There was no illness at the time of vaccination. On 31-MAR-2006 the patient presented to the office with severe shingles involving her right arm - shoulder to fingertips, which started in the morning on 30-MAR-2006. Follow-up information from the physician indicated that on 29-MAR-2006 the patient developed a red vesicular rash on her right arm. On 31-MAR-2006 the patient was seen by the physician with a painful rash all over. Temperature was 100.2, no fever was noted at home. The rash was painful and she was not using her arm. No itching was noted. The patient was diagnosed with severe shingles from her shoulder to her palm. Thick clusters with bright red bases were noted. Some swelling was noted in the palm of her hand. She was treated with acyclovir 2 tsp qid X 5 days, acyclovir ointment qid and acetaminophen (+) hyrcocodone bitartrate (LORTAB) suspension 1 tsp every 4-6 hours for 3 days. It was reported that the patient did not have any history of chickenpox and there was no known recent exposure to chickenpox or herpes zoster. On 03-APR-2006 she was seen for a recheck and it was reported that she was better. Decreased redness was noted at the base of the lesions. Swelling of her right hand was still noted and she was not using her arm. The physician''s assessment was resolving shingles. On 07-APR-2006 the patient''s mother was called for an update and she reported that the arm, shingles were scabbed up and look better. Her hands were still swollen. The spots on her hand and palm hurt and were raised. The patient was seen because her hand was still swollen, red and painful. Physical examination showed dry/scabbed shingles lesion

VAERS ID:347986 (history)  Vaccinated:2001-10-26
Age:1.0  Onset:2008-03-13, Days after vaccination: 2330
Gender:Female  Submitted:2009-05-15, Days after onset: 428
Location:Pennsylvania  Entered:2009-05-21, 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: None
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data: diagnostic laboratory, 03/24/08, on 24-MAR-2008 Confirmed: Herpes zoster
CDC 'Split Type': WAES0804USA00398
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Laboratory test abnormal, Rash erythematous, Rash pustular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a medical assistant concerning a her 7 year old daughter with history of asthma and no drug reactions/allergies, who on 26-OCT-2001 was vaccinated with a dose of VARIVAX (Merck). There was no concomitant medication. On 20-MAR-2008 the patient experienced about 20-30 itchy, red pustule dermatomes on her head and a couple of pustule spots under her left ear. Unspecified medical attention was sought by an unspecified dermatologist who did a culture and confirmed the patient had shingles. No further information was available. The outcome was reported as recovering. There was no product quality complaint. Additional information has been requested. Follow-up has been received from a medical assistant concerning her 7 year old daughter female with a history of asthma and no drug reactions/allergies, who on 01-FEB-2002 was vaccinated with MMR II. It was previously reported that the patient was vaccinated with a dose of VARIVAX on 26-OCT-2001. On 13-MAR-2008 the patient had sudden onset of herpes zoster on the left side of her head. The patient treated with ACYCLOVIR 200mg/5cc and the patient "cleared up within one week". On 24-MAR-2008 the laboratory test confirmed Herpes Zoster. On 20-MAR-2008 the patient recovered from herpes zoster. No further information is available.

VAERS ID:440613 (history)  Vaccinated:2001-10-26
Age:63.0  Onset:2001-10-29, Days after vaccination: 3
Gender:Male  Submitted:2011-10-30, Days after onset: 3652
Location:California  Entered:2011-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CT Scan, MRI, Cardiod ultra sound, field effect test,
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0945K0IJLA
Administered by: Unknown     Purchased by: Private
Symptoms: Computerised tomogram, Nuclear magnetic resonance imaging, Ultrasound Doppler, Visual field tests, Visual impairment
SMQs:, Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: While reading newspaper vision began to blank in and out. Did nothing thinking it would go away.

VAERS ID:179348 (history)  Vaccinated:2001-10-26
Age:26.0  Onset:2001-11-10, Days after vaccination: 15
Gender:Female  Submitted:0000-00-00
Location:Foreign  Entered:2001-12-26
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI showed demyelination
CDC 'Split Type': WAES01123429
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Demyelination
SMQs:, Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Demyelination (narrow)
Write-up: Information has been received from a physician concerning a 26 year old female traveler who on approximately 26-OCT-2001 was vaccinated with MMR. Other suspect therapy included administration of Hepatitis A vaccine and typhoid vaccine both of which were administered at the same time as MMR II. Soon after vaccination on 26-OCT-2001, the pt developed lower limb neurological symptoms and subsequent investigations by a neurologist includin a MRI, showed demyelination. The neurologist stated that "the findings were indistinguishable from multiple sclerosis but could also be attributable to acute disseminated encephalomyelitis secondary to her vaccination, a significant immunological stimulus", The pt''s physician felt that she should have not received the MMR vaccine and that this was the likely cause of her problem. Demyelination was considered to be disabling. Additional information has been requested. Follow up on 08/14/2003: "On 08/01/2003 we received follow up from the original reporting physician describing the adverse event as "postvaccination spinal cord demyelination or peripheral neuropathy (diagnosis made by neurologist)". The physician stated that the patient preferred to attend her local doctor and specialist neurologist for further managment. He was unable to obtain a report of her progress despite several attempts contacting the patient herself and her neurologist. Additional information is not expected." A 15-day follow up report received 8/15/2003 adds no new info.

VAERS ID:179840 (history)  Vaccinated:2001-10-26
Age:26.0  Onset:0000-00-00
Gender:Female  Submitted:2002-01-07
Location:Foreign  Entered:2002-01-10, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': U2002000030
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.  IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIES  IM 
Administered by: Other     Purchased by: Other
Symptoms: Encephalitis, Neurological symptom
SMQs:, Noninfectious encephalitis (narrow)
Write-up: Information has been received from a physician concerning a 26 year old female traveler from the UK who on approximately 26-OCT-2001 was vaccinated with MMR II. Other suspect therapy included administration of hepatitis A vaccine and Typhim Vi, both of which were administered at the same time as MMR II. Soon after vaccination on 26-OCT-2001, onset date not reported, the pt developed lower limb neurological symptoms and subsequent investigations by a neurologist, including a MRI, showed demyelination. The neurologist stated that the "findings were indistinguishable from multiple sclerosis but could also be attributed to acute disseminated ecephalomyelitis secondary to her vaccination, a significant immunological stimulus". The pt''s physician in the UK felt she should not have received the MMR II vaccine and that this was the likely cause of her problem. Demyelination was considered to be disabling.

VAERS ID:186792 (history)  Vaccinated:2001-10-26
Age:1.6  Onset:2001-11-05, Days after vaccination: 10
Gender:Male  Submitted:2002-06-18, Days after onset: 224
Location:Foreign  Entered:2002-06-20, 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:
Preexisting Conditions: Febrile convulsion; Wolf-Hirschhorn syndrome
Diagnostic Lab Data: Bacterial infection, Morbillivirus, cerebrospinal fluid analysis, serum immunoglobulin G test, serum immunoglobulin M test-all negative results
CDC 'Split Type': WAES0206USA00531
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0452K SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Febrile convulsion, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad)
Write-up: Information has been received from a health authority concerning an 18 month old male with Wolf-Hirschhorn syndrome and a history of febrile convulsions who on 10/26/2001 was vaccinated SC with a first dose of MMR II. There was no concomitant medication. Ten days later on 11/05/2001, the pt developed fever convulsions and was hospitalized. Upon admission the convulsions stopped following treatment but he also stopped breathing and was put on artificial respiration for one day. Blood samples showed no signs of bacterial infection, Morbillivirus, IgG and IgM were negative and spinal fluid was normal. One week later while the pt was still in the hospital, he experienced a subfebrile episode of convulsions. He was discharged afebrile and well but with deteriorated motoric status. No further info is available. The case was closed.

VAERS ID:232337 (history)  Vaccinated:2001-10-26
Age:21.0  Onset:2001-10-29, Days after vaccination: 3
Gender:Female  Submitted:2002-10-10, Days after onset: 345
Location:Foreign  Entered:2005-01-14, Days after submission: 827
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': PJP200100426
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)
Write-up: A report was received on 11/23/01 regarding a 21 year old female patient who experienced anaphylactic reaction on 10/29/01 after receiving influenza vaccine on 10/26/01. The patient was treated with Piriton IV and hydrocortisone. The event resolved after treatment and the reporter considered the reaction to be medically significant (OMIC). There was insufficient information to determine the reporter''s causality assessment.

VAERS ID:249397 (history)  Vaccinated:2001-10-26
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:2005-12-15
Location:Foreign  Entered:2005-12-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': B0402751A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS519209 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Alopecia areata
SMQs:
Write-up: This case was reported and described the occurrence of auto immune pelade in a 1 year old male subject who was vaccinated with hepatitis B vaccine (Engerix B Pediatric) for prophylaxis. Past vaccination included on Dec 27 2000 ad Jan 24 2001, a diphtheria, tetanus, pertussis, poliomyelitis and haemophilus influenzae type b conjugate vaccine (Pentacog, batch T0651 and T0961) and hepatitis B vaccine (Engerix B 10 mcg, batch 3118A9). The subject had no concurrent medical condition and nor relevant medical history. On Oct 26 2001, the subject received the 3rd dose of Engerix B (10 mcg, batch 519209), intramuscular. Within several months after vaccination with Engerix B pediatric, the subjects family noticed beginning of pelade. The event persisted and worsened. An auto immune pelade was diagnosed at an unspecified date. At an unspecified date, the subject was hospitalised. At the time of reporting, the event was unresolved. The event was dubiously related to vaccination with Engerix B vaccine. This case has been closed because no further information will be available.

VAERS ID:355109 (history)  Vaccinated:2001-10-26
Age:59.0  Onset:0000-00-00
Gender:Female  Submitted:2009-08-25
Location:Foreign  Entered:2009-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MA20092212
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Gamma-glutamyltransferase increased
SMQs:, Liver related investigations, signs and symptoms (narrow)
Write-up: On 13 AUG 2009, we received from the foreign Medicines and Healthcare products Regulatory Agency the following information: A 59-year-old female patient (date of birth unknown) was vaccinated with an FLUVIRIN (batch no. and manufacturer unknown) on 26 OCT 2001. Laboratory test on 31 OCT 2001 showed raised gamma glutamyltransferase (1030) and alanine aminotransferase (387). The outcome was unknown. In 2002 patient had a similar reaction a few weeks after receipt of a further vaccination with influenza virus vaccine (see case Ma2009-2210). Patient has a known history of asthma. Company assessment: Seriousness criterion: medically significant. Causality: Insufficient data due to unknown timing. A differential diagnostic work up was not provided. Also, listed side effects of concomitant medication RAMIPRIL include increase in liver enzymes and liver failure. Expectedness assessment according to foreign agency product label: Hepatitis is unexpected after vaccination with BEGRIVAC, FLUAD, AGRIPPAL and FLUVIRIN. No change in benefit-risk-ratio. No measures are necessary. Agency ref. no.: ADR 20467961. Agency no.: E2009-05931. Addendum: On 19 AUG 2009 we were informed by the foreign agency that no further information is available. No change in assessment. (Request was sent on 17 AUG 2009, no follow-up information received.)

VAERS ID:177222 (history)  Vaccinated:2001-10-27
Age:31.0  Onset:2001-10-27, Days after vaccination: 0
Gender:Female  Submitted:2001-10-30, Days after onset: 3
Location:California  Entered:2001-11-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0592AA IM 
Administered by: Private     Purchased by: Private
Symptoms: Paraesthesia, Vasodilation procedure
SMQs:, Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad)
Write-up: Pt felt warm feet and numbness of lips and body. Treated with Benadryl only.

VAERS ID:177275 (history)  Vaccinated:2001-10-27
Age:12.0  Onset:2001-10-27, Days after vaccination: 0
Gender:Female  Submitted:2001-10-31, Days after onset: 4
Location:Illinois  Entered:2001-11-06, 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: UNK
Preexisting Conditions: sinus problems, and allergy to milk
Diagnostic Lab Data: Bloodwork and urinalysis were done but no results given.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5202A22IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Mother contacted clinic stated brought child to Dr with complaint of high fever for 2 days after having shot. Temperature was 103 and consistent. Dr had blood work and urinalysis and stated was either viral or related to vaccine. Spoke with mother on 10/31/01 and she stated child''s temperature was finally back to normal this AM.

VAERS ID:177907 (history)  Vaccinated:2001-10-27
Age:57.0  Onset:2001-10-27, Days after vaccination: 0
Gender:Female  Submitted:2001-11-13, Days after onset: 17
Location:Unknown  Entered:2001-11-19, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, asthma
Diagnostic Lab Data: 11/8/01 CBC: wnl except for WBC of 17.5, Hgb 12.7, Hct 39.9, MCH 26.3, platelets 473, neutrophils 13.3; chest x-ray: no acute disease 11/10/01 Repeat CBC: virtually same result; ESR 85, UA blood trace, leukocyte neg; RBC 3-4, WBC 1-3, bacte
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1605K SC 
Administered by: Other     Purchased by: Other
Symptoms: Blood urine, Infection, Leukocytosis, Pruritus, Pyrexia, Rash, Red blood cell sedimentation rate increased, Thrombocythaemia, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Pt had no history of varicella and varicella titer was negative. Fifteen days post vax pt started running a fever. 10/29/01 pt noted the appearance of red spots that over 10 days erupted and evolved like varicella only with a longer time period than expected. On 10/31/01 pt was given Atarax for itching and rash. Pt continued with a low grade fever of 100.3-100.5 daily. On 11/7/01, a nurse made a home visit which was followed by blood tests and a chest x-ray on 11/8/01, and pt was started on Acyclovir. On 11/10/01, pt had more blood tests and a urinalysis. She was started on Cipro for a possible UTI. On 11/13/01, pt''s fever increased to 102F, and she was admitted to the hospital for evaluation.

VAERS ID:178106 (history)  Vaccinated:2001-10-27
Age:69.0  Onset:2001-10-27, Days after vaccination: 0
Gender:Female  Submitted:2001-11-09, Days after onset: 13
Location:Texas  Entered:2001-11-21, 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: Zinc; Premarin; Protonix
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0694AA0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1456K0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chills, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 2 1/2 hours, post vax, I had chills lasting for several hours. The arm, from injection site to elbow, was hot, edematous and red. The MD saw area on Monday. Rx''d Biaxin 500mg BID X 10 days. The arm was very painful for 1 full week.

VAERS ID:179167 (history)  Vaccinated:2001-10-27
Age:25.0  Onset:2001-10-28, Days after vaccination: 1
Gender:Male  Submitted:2001-11-29, Days after onset: 32
Location:Michigan  Entered:2001-12-18, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humulin 70/30; Nexium 40mg; Zoloft 25mg
Current Illness: Diabetes Mellitus
Preexisting Conditions: Diabetes Mellitus, GERD, Depression
Diagnostic Lab Data: CPK; CBC; CMP-all wnl
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0701AA0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0923L0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypokinesia, Muscular weakness, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: The pt complained of left arm being limp, unable to use without increased pain. He had swelling in his left hand. He came to the clinic and was seen on 11/28/01. Ordered Benadryl 3tsp q 4-6 hours. Return to clinic if unresolved. Pt didn''t return for visit or return phone calls to him.

VAERS ID:179744 (history)  Vaccinated:2001-10-27
Age:50.0  Onset:2001-11-19, Days after vaccination: 23
Gender:Male  Submitted:2002-01-06, Days after onset: 48
Location:New York  Entered:2002-01-08, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: sinus condition
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES  IM 
Administered by: Other     Purchased by: Private
Symptoms: Neuropathy peripheral, Pain, Paralysis, Pyrexia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: The pt developed severe fever, chills 3 weeks after vaccines followed by neuritis and peripheral neuropathy in left arm and paralysis of left thumb and index finger. Annual follow up states patient''s strength in thumb and index finger at about 50%. Continued pain in forearm and muscle loss near wrist.

VAERS ID:180486 (history)  Vaccinated:2001-10-27
Age:51.0  Onset:2001-10-31, Days after vaccination: 4
Gender:Female  Submitted:2002-01-14, Days after onset: 75
Location:Michigan  Entered:2002-01-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0685AA IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1449K IM 
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site mass, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swollen and painful at the injection site. Also, felt a knot. Client received flu and pneumovax in the same site. On 11/5/01, still had pin-size knot but no redness. On 1/17/02, resolved.

VAERS ID:183440 (history)  Vaccinated:2001-10-27
Age:70.0  Onset:2001-10-27, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2002-04-15
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: piacoledine (soya extract); oxaceprol; Ecazide
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Echography and radiography-neg results
CDC 'Split Type': PJP200200237
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES  IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site oedema, Injection site pain, Sleep disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: In 10/01, the pt received Fluvirin, after which, the pt experienced a painful, burning sensation and edema in the injected arm, finding it difficult to sleep on that side. The pt then received physiotherapy and an injection of betamethasone. At the time of reporting, it was not known whether or not the pt had recovered. The reporter has assessed the relationship of Flurvirin to the event as possible.

VAERS ID:232339 (history)  Vaccinated:2001-10-27
Age:64.0  Onset:0000-00-00
Gender:Male  Submitted:2002-10-10
Location:Foreign  Entered:2005-01-14, Days after submission: 827
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin (Acetylsalicylic acid) 75mg
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': PJP200100428
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: A report was received from the regulatory authority on 23Nov01 regarding a 64 year old male who experienced an increase in International normalized ration (INR), which was considered serious (reason not stated), after receiving influenza vaccine on 27Oct01. The pt''s concomitant medications included warfarin and aspirin. The pt had been stable for many months, but 5 days after receiving the flu vaccination his INR increased to 4.1. The outcome of the event was reported to be unk. There was insufficient information to determine the reporter''s causality assessment.

VAERS ID:177846 (history)  Vaccinated:2001-10-28
Age:1.3  Onset:2001-10-29, Days after vaccination: 1
Gender:Male  Submitted:2001-10-30, Days after onset: 1
Location:Nebraska  Entered:2001-11-16, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM507A23IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1134L2IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4891353IMLL
Administered by: Private     Purchased by: Private
Symptoms: Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: The patient experienced a fever of 103F and irritability 24 hours post vax. The symptoms were resolved within 72 hours.

VAERS ID:178845 (history)  Vaccinated:2001-10-28
Age:57.0  Onset:2001-11-01, Days after vaccination: 4
Gender:Female  Submitted:2001-11-30, Days after onset: 29
Location:Unknown  Entered:2001-12-11, 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: Claritin, Prilosec, inhalers, hormones
Current Illness: cold 1 wk prior
Preexisting Conditions: sulfa, animal dander, pollen, dust mites
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0591EA3IMLA
Administered by: Public     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 11/1/01 pt reported having a light red rash all over her body. Dry rash.

VAERS ID:179657 (history)  Vaccinated:2001-10-28
Age:60.0  Onset:2001-11-03, Days after vaccination: 6
Gender:Female  Submitted:2001-12-26, Days after onset: 53
Location:California  Entered:2002-01-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness but had been bitten by a squirrel
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURERU0463AA   
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Five day post vaccination, the patient began to experience swelling of all of her joints. She also loss strength. She states that the pain was "excruciating".

VAERS ID:189023 (history)  Vaccinated:2001-10-28
Age:45.0  Onset:2002-01-23, Days after vaccination: 87
Gender:Female  Submitted:2002-08-15, Days after onset: 203
Location:Florida  Entered:2002-08-19, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: EKG; CXR; CAT Scan; ECG; Cardiac Catheterization; Blood Work and cultures; VQ Scans; HIDA Scan; Stomach scope; Respiratory tests
CDC 'Split Type': U200200218
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR    
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Chest pain, Dyspnoea, Fatigue, Influenza like illness, Lymphadenopathy, Myalgia, Pain in jaw, Pharyngolaryngeal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Arthritis (broad)
Write-up: It was reported that a 45 year old female pt received a Fluzone vaccination administered on 10/28/2001 two possible lot numbers were provided U0445AA or U07008AA. The pt reported experiencing flu-like symptoms in January 2002. Physician saw her; numerous tests done-possible diagnosis of chronic fatigue syndromes. Symptoms are unresolved. From follow-up report returned by the pt on 08/02/02, it was reported that she received a dose of Fluzone on 10/28/01 at a walk-in clinic. On 01/23/02, she experienced shortness of breath, fever, sore throat, swollen glands, chest pain, muscle aches, joint pain, jaw pain, and extreme fatigue. Pt also requested a copy of the report to be sent to her physician. Upon receipt of this info this report was upgraded from non-serious to 15 day. A 15-day follow up report received 09/30/2003 adds: From additional info received on 09/15/2003 from an office administrator, the reporting physician''s new address and fax number were provided. No additional relevant info was obtained. Adverse event coding was updated, and the provisional diagnosis (not confirmed) - Chronic Fatigue Syndrome - was coded. Follow up on 11/05/2003: "Case closure, on 10/27/2003. A sixth attempt for follow up information was made on 09/15/2003, at which time the responsible physician was contacted via fax. No response has been received. No further information is anticipated, therefore, this case is closed."

VAERS ID:190607 (history)  Vaccinated:2001-10-28
Age:75.0  Onset:2001-10-30, Days after vaccination: 2
Gender:Female  Submitted:2002-09-18, Days after onset: 322
Location:Nevada  Entered:2002-09-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: X-ray 9/18/02
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Unknown
Symptoms: Asthenia, Cough, Pain, Sneezing
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: Body aches; could not do ADL''s. Coughing, sneezing, no energy, in bed for 4 months, up for two hours then rest of day in bed. Puneal weight-not active.

VAERS ID:193000 (history)  Vaccinated:2001-10-28
Age:1.0  Onset:2001-11-07, Days after vaccination: 10
Gender:Male  Submitted:2002-11-08, Days after onset: 366
Location:North Carolina  Entered:2002-11-08
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: CBC showed below normal WBC
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0235M0IDLL
Administered by: Public     Purchased by: Unknown
Symptoms: Decreased appetite, Irritability, Lethargy, Pyrexia, Rash, White blood cell count decreased
SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: high fever of up to 104.6 ten days after MMR injection, rash, lethargic, irritable, poor appetite and restlessness during sleep

VAERS ID:229850 (history)  Vaccinated:2001-10-28
Age:69.0  Onset:2004-10-28, Days after vaccination: 1096
Gender:Female  Submitted:2004-11-01, Days after onset: 4
Location:Wisconsin  Entered:2004-11-30, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Previous welt with previous flu vaccine site.
Diagnostic Lab Data:
CDC 'Split Type': WI0417
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR41504AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Pruritus, Rash macular, Similar reaction on previous exposure to drug
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Describes reaction of welt (redness and warmth) at previous vaccination site (~2000). then received half dosage. This year, no vaccine. Vaccine administered 10/28/04 at left arm: denies any mark / irritation on left arm. Complained of itching and redness chest and neck about 4 hours later and blotchy red areas (itchy) on both legs 10/19: legs red. today 11/01/04 notified health department.

VAERS ID:178209 (history)  Vaccinated:2001-10-28
Age:1.5  Onset:2001-10-31, Days after vaccination: 3
Gender:Unknown  Submitted:2001-11-21, Days after onset: 21
Location:Foreign  Entered:2001-11-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Surgery to resolve cerebral angioma
CDC 'Split Type': WAES01111502
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Haemangioma, Intracranial aneurysm
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a health professional concerning an 18 month old pt who at the end of 10/2001 was vaccinated with the 1st dose of MMRII. Three days after vaccination, the pt developed convulsions and was hospitalized. It was reported that the pt presented with a cerebral aneurysm. It was noted that the pt was afebrile. Follow up information indicated that the child suffered from a cerebral angioma that was resolved by surgical operation. At the time of the report, the patient was in good health. The reporter felt that convulsions and the cerebral angioma were not related to therapy with MMR (second generation). No further information is available. Case closed.

VAERS ID:177208 (history)  Vaccinated:2001-10-29
Age:70.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Male  Submitted:2001-11-01, Days after onset: 3
Location:South Carolina  Entered:2001-11-06, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Glucose increased 232, UBC increased 160. EKG and chest X-ray normal, cardiac panel, protime, PTT and CBC normal.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0461L1IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Loss of consciousness, Pain, Pyrexia
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: At 1pm the left arm was sore. By 7pm it was red and hard shoulder to elbow. Low grade temperature per wife. He drank ice water and passed out. Ambulance summoned. ER visit.

VAERS ID:177221 (history)  Vaccinated:2001-10-29
Age:31.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-11-01, Days after onset: 3
Location:Louisiana  Entered:2001-11-06, 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: Wellbutrin and Tenormin
Current Illness: NONE
Preexisting Conditions: PMS and HTN
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO5755AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Aggression, Agitation, Amnesia
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow)
Write-up: Eight hours after Fluzone, was having a disagreement with husband, out of the ordinary, throwing things, banging hands on table, driving away without shoes, some events she did not remember doing.

VAERS ID:177231 (history)  Vaccinated:2001-10-29
Age:44.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2001-10-31, Days after onset: 1
Location:Georga  Entered:2001-11-06, 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: Sulfa
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESEO5221KA IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site induration, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt c/o hard knot at injection site with slight soreness. No c/o redness or fever.

VAERS ID:177332 (history)  Vaccinated:2001-10-29
Age:  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-10-30, Days after onset: 1
Location:Nebraska  Entered:2001-11-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS506A21 LL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1134L1 RL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.T14461 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841351 LL
Administered by: Private     Purchased by: Private
Symptoms: Irritability, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Fever (temp 101), listless and irritability

VAERS ID:177334 (history)  Vaccinated:2001-10-29
Age:0.5  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-10-30, Days after onset: 1
Location:Arkansas  Entered:2001-11-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM514A21 LL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0929L1 RL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.T08411 LL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4818161 RL
Administered by: Private     Purchased by: Public
Symptoms: Injection site swelling, Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Fever to 102, swelling of right thigh and irritability.

VAERS ID:177359 (history)  Vaccinated:2001-10-29
Age:4.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Male  Submitted:2001-10-31, Days after onset: 1
Location:Pennsylvania  Entered:2001-11-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Ringworm
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM508A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13913SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0595L1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Localized redness, swelling , itching at left deltoid. No fever.

VAERS ID:177370 (history)  Vaccinated:2001-10-29
Age:67.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-10-31, Days after onset: 2
Location:Wisconsin  Entered:2001-11-07, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4710401IMLA
Administered by: Public     Purchased by: Public
Symptoms: Discomfort, Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pt''s left arm became swollen from deltoid to entire length of arm. She complained of discomfort and hives.

VAERS ID:177577 (history)  Vaccinated:2001-10-29
Age:65.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-11-07, Days after onset: 9
Location:Unknown  Entered:2001-11-12, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Darvocet-N; Buspar; Nexium; Pravachol
Current Illness:
Preexisting Conditions: Colonic polyp; doxycycline allergy/drug allergy; gastritis; hyperlipidemia; iodine allergy; pain; penicillin allergy; F/U states: fibromyalgia; chronic pain syndrome; Cipro allergy
Diagnostic Lab Data:
CDC 'Split Type': WAES01106325
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0994L2IM 
Administered by: Other     Purchased by: Other
Symptoms: Back pain, Chills, Injection site pain, Neck pain, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Information has been received from an RN concerning a 65 year old female who was vaccinated at another physicians practice with the 1st dose of pneumococcal vaccine 23 polyvalent at the age of 52 and her 2nd dose at the age of 60. On 10/29/01, she was vaccinated with a 3rd dose of pneumococcal vaccine 23 polyvalent (lot 640744/0994L). On 10/29/01, about 4 hours, post vax, the pt came back to the office with pain in her arm, neck, back and under her breast. She had chills but no fever. She was also vomiting. The injection site was tender to touch. Subsequently, the pt was hospitalized. IV fluids and diphenhydramine hydrochloride (Benadryl) were started. She was also started on therapy with promethazine hydrochloride (Phenergan) for the vomiting. Additional information has been requested. F/U states: The pt was treated with Benadryl, IM, in the physician''s office and was kept in the office for observation. The pt still complained of pain so she went to the hospital and was admitted to the telemetry unit where she was treated with IV fluids, diphenhydramine HCI q6 hours and meperidine hydrochloride (Demerol) for pain. She was also started on therapy with Phenergan for the vomiting. The pt was discharged from the hospital on 10/30/01. The discharge dx was intractable pain. The pt was seen in the physician''s office on 11/12/01 and was currently receiving physical therapy for her pain. No further information is expected. The pt had no adverse reaction after receiving the 1st and 2nd doses.

VAERS ID:177605 (history)  Vaccinated:2001-10-29
Age:70.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Male  Submitted:2001-10-31, Days after onset: 2
Location:South Carolina  Entered:2001-11-12, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': SC0155
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0591DA IMRA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES474936 IMLA
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: The patient''s spouse reports the patient had a local reaction to the left arm with redness and swelling at the injection site.

VAERS ID:177607 (history)  Vaccinated:2001-10-29
Age:79.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-11-02, Days after onset: 4
Location:Michigan  Entered:2001-11-12, 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: Lipitor, HCTZ, Toprol, Persantine, ASA, Celebrex, Xalatan, Occupres, Calcium and Vitamin D, Multivitamin, Glucosamine
Current Illness: NONE
Preexisting Conditions: Environmental allergies, HTN, TIA, ASHD, Arthritis, Glaucoma, Cataracts, Hyperlipidemia
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0575AA IMLA
Administered by: Private     Purchased by: 0
Symptoms: Syncope, Vertigo, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Approximately seven hours post vaccine the patient had a sudden onset of vertigo, near syncope and several episodes of vomiting. 911 was called by the family. The patient''s vital signs were checked, but the patient declined treatment or transport to the hospital.

VAERS ID:177613 (history)  Vaccinated:2001-10-29
Age:59.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Male  Submitted:2001-10-31, Days after onset: 1
Location:Wisconsin  Entered:2001-11-12, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Coumadin, Prevacid, Vitamin E
Current Illness:
Preexisting Conditions: Aortic Valve Replacement
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU0678EA1IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0945K SCLA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis
SMQs:
Write-up: The patient developed cellulitis one day post vax.

VAERS ID:177736 (history)  Vaccinated:2001-10-29
Age:36.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Male  Submitted:2001-11-02, Days after onset: 4
Location:Pennsylvania  Entered:2001-11-15, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO677AA0IMLA
Administered by: 0     Purchased by: 0
Symptoms: Erythema, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Left arm four inches below injection site became red, warm, and sore to touch. No fever and no swelling. The reaction started approximately 8 hours post injection and peaked 24 hours after shot. Within 96 hours arm is back to normal.

VAERS ID:177737 (history)  Vaccinated:2001-10-29
Age:33.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2001-11-02, Days after onset: 3
Location:Pennsylvania  Entered:2001-11-15, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO677AA0IMLA
Administered by: 0     Purchased by: 0
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Employee received vaccine around 10 AM. Did not notice anything wrong until following AM when looked at upper arm red 4 inches below injection site and warm. No swelling. Observed area next 4 days and each day reaction decreased until normal on Friday 11/02/2001.

VAERS ID:177755 (history)  Vaccinated:2001-10-29
Age:69.0  Onset:0000-00-00
Gender:Female  Submitted:2001-11-07
Location:D.C.  Entered:2001-11-15, 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: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR  IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythema noted at injection site. Rx Claritin 10 x 3-9 days with relief.

VAERS ID:177758 (history)  Vaccinated:2001-10-29
Age:24.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-10-29, Days after onset: 0
Location:California  Entered:2001-11-15, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: 0
Symptoms: Flushing, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Post vax, the patient experienced facial flushing and palpitations.

VAERS ID:177768 (history)  Vaccinated:2001-10-29
Age:71.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2001-11-07, Days after onset: 8
Location:New Hampshire  Entered:2001-11-15, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide, Serevent inhaler, Albuterol inhaler.
Current Illness: NONE
Preexisting Conditions: NKDA, hypertension, asthma and hypercholesterolemia.
Diagnostic Lab Data: SGOT = 45, SGPT = 61, Alk Phos = 114, HCT = 37.5, HGB = 13.7, RBC = 4.27, WBC = 9.9, Platelets = 214, Sed rate = 68.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4710400IMRA
Administered by: Private     Purchased by: Private
Symptoms: Alanine aminotransferase increased, Blood alkaline phosphatase increased, Chills, Erythema, Hypochromic anaemia, Nausea, Pruritus, Red blood cell sedimentation rate increased, Swelling, Swelling face
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: The patient states that the day following the vaccination, she experienced some slight nausea and chills. Within 2 days her face became red, swollen and itchy. The patient''s ear lobes and complete bilateral ears became red and swollen after 1 week. The patient was treated with Prednisone.

VAERS ID:177772 (history)  Vaccinated:2001-10-29
Age:1.5  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-11-07, Days after onset: 9
Location:Massachusetts  Entered:2001-11-15, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU0515AA3IMLL
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Vaccine positive rechallenge, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: The patient experienced a fever shortly after the vaccines were administered. The patient began vomiting during the night through 11/01/2001, with the worst day being 10/31/2001. The patient''s fever continued through 11/02/2001. The patient has a history of fever reaction with prior DTaP''s. The mother states this reaction was the most severe.

VAERS ID:177793 (history)  Vaccinated:2001-10-29
Age:4.0  Onset:2001-10-31, Days after vaccination: 2
Gender:Male  Submitted:2001-11-02, Days after onset: 2
Location:Texas  Entered:2001-11-15, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0537AB4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT13913IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0790L1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 24 hours after the vaccines were administered, the patient developed swelling, redness and warmth.

VAERS ID:177815 (history)  Vaccinated:2001-10-29
Age:45.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-10-31, Days after onset: 2
Location:Massachusetts  Entered:2001-11-16, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil and Tylenol.
Current Illness:
Preexisting Conditions: Positive for Hepatitis C - treated in 2000.
Diagnostic Lab Data: Chest x-ray, CBC, Sed rate
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0668AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Erythema, Injection site swelling, Injection site warmth, Lymphadenopathy, Pain, Pyrexia, Rales, Rhinitis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: The patient experienced swelling at the injection site, redness and hot to touch. The patient had a fever, swollen glands, body aches and chills. The patient was diagnosed with left nasal turbinitis, erythema, left submandibular adenitis, right submandibular adenitis, lung sounds (rales at bases); a nonproductive cough. Still treating.

VAERS ID:177859 (history)  Vaccinated:2001-10-29
Age:1.6  Onset:2001-10-29, Days after vaccination: 0
Gender:Male  Submitted:2001-11-05, Days after onset: 7
Location:Kansas  Entered:2001-11-16, 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:
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM513A23IMLL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0484L2IMRL
Administered by: Military     Purchased by: Military
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Mild hives, started evening 29-OCT. Have continued for one week. OTL Benadryl PRN.

VAERS ID:177872 (history)  Vaccinated:2001-10-29
Age:12.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-10-30, Days after onset: 1
Location:Arizona  Entered:2001-11-16, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': AZ0124
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0360L0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Headache, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: At 16:00, pt complained of nausea, headache and "feeling sick" and pain on stomach and fever. At 19:00, she started vomiting and continues with pain. The next day at 09:00, she was home from school. She still has symptoms but not as severe.

VAERS ID:177875 (history)  Vaccinated:2001-10-29
Age:65.0  Onset:2001-11-07, Days after vaccination: 9
Gender:Female  Submitted:2001-11-09, Days after onset: 2
Location:Texas  Entered:2001-11-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1086K0  
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash from Pelvis to knees.

VAERS ID:177880 (history)  Vaccinated:2001-10-29
Age:17.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-10-31, Days after onset: 2
Location:California  Entered:2001-11-16, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 50mg po
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': CA010123
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM697A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Within 2 hours, post vax, pt developed swelling of the face and hives appeared on her body. The pt was attending school. The school nurse notified her mother and told her to give the child Benadryl. The child was given 50mg of Benadryl and the swelling and rash had subsided when seen. No swelling or hives were observed. This pt''s male sibling had the same vaccine that day also but had no reaction. Mother is allergic to eggs and strawberries.

VAERS ID:177899 (history)  Vaccinated:2001-10-29
Age:42.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-12-14, Days after onset: 46
Location:Unknown  Entered:2001-11-19, 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: Albuterol, Premarin, Ortho-Cyclen, Advair, Prevacid, Synthroid, Claritin, Singulair, Micardis, Vioxx,
Current Illness: arthralgia, sulfa allergy, respiratory condition, hypertension, asthma,
Preexisting Conditions: Breast disorder, obesity, pneumonia, abcess drainage, hemoptysis, hysterectomy, intestinal diverticulitis, tonsillectomy, salpingo-oophorectomy, partial colectomy, hypercholesterolemia, endometriosis, joint stiffness, arthralgia, sulfa allergy, rhinitis, hypothyroidism, asthma, hiatal hernia, hypertension, gastroesophageal reflux disease
Diagnostic Lab Data: CXR-neg; WBC-20,000; magnetic resonance-revealed an area centered mostly over the distal deltoid by cellulitis of the skin; upper extremity x-ray-demonstrated no fractures, dislocations or evidence of osteomylitis; hemoglobin 13.8; segmente
CDC 'Split Type': WAES01110025
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0944K IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Cellulitis, Diarrhoea, Headache, Injection site reaction, Leukopenia, Paraesthesia, Pyrexia, Rash, Vomiting, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: Information has been received from a RN concerning a 42 year old female with pulmonary disease, asthma, arthralgia, hypertension, and sulfa allergy and a history of pneumonia, obesity and benign left breast disease who on 10/29/01 was vaccinated. The RN stated that within 24 hours of receiving the vaccine the pt experienced a temperature of 101 to 102.6 F, along with localized injection site reaction of the left deltoid. On 10/31/01 the pt presented to the Dr''s office with worsening arthralgia, an elevated WBC of 20,000, vomiting, diarrhea, headache, parathesia and a rash on the left arm and face. A chest x-ray was negative. Subsequently, on 10/31/01, the pt was hospitalized. This is in follow-up to report(s) previously submitted on 11/9/01. Information has been received from a registered nurse concenring a 42 year old obese (231 lbs.) white female with asthma, hypertension, sulfa allergy, hiatal hernia, gastroesophageal reflux disease, hypothyroidism, rhinitis, arthralgia, breast disorder (left breast disease benigh) and lab test abnormality (abnormal mamogram) and a history of pneumonia, total abdominal hysterectomy and bilateral salpingo-cophorectomy for endometriosis, tonsillectomy, partial colectomy, abdominal abscess drainage, joint stiffness, hemoptysis, hypercholesterolemia and intestinal diverticulitis who on 10/29/01 was vaccinated in the left deltoid with pneumococcal vaccine 23 polyvalent (lot 636849/0944K). Concomitant therapy included montelukast sodium, rofecoxib, Claritin, Synthroid, Micardis, Prevacid, estrogene, Premarin, Advair, Ortho-cyclen and Flonase. On 10/30/01, the pt''s arm started to hurt, swell and get red. By 4-4:30pm the pt developed a fever. She became nauseated by 8pm, vomited and had diarrhea at approximately 2am. All night she had a fever of 101 to 102.6 F. She had no chest pain, cough or increased shortness of breath. On 10/31/01, the pt presented to the physician''s office with worsening of arthralgia, an elevated white blood cell count, vomiting, diarrhea, headache, paresthesi

VAERS ID:177947 (history)  Vaccinated:2001-10-29
Age:35.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-10-31, Days after onset: 2
Location:Arizona  Entered:2001-11-19, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3359A42  
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Hypersensitivity, Urticaria, Vasodilation procedure
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Reaction after her CT. #3 Hep B vaccine given 10/29/01. Check out hot flashes, hives, dizziness and red bruised. CT area at injection site. Symptoms occurred that same evening.

VAERS ID:177972 (history)  Vaccinated:2001-10-29
Age:16.0  Onset:2001-11-07, Days after vaccination: 9
Gender:Female  Submitted:2001-11-16, Days after onset: 9
Location:California  Entered:2001-11-20, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aventis PPD (Mantoux) subcutaneous right forearm
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: CPK 677
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0686L0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Blood creatine phosphokinase increased, Unevaluable event
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad)
Write-up: Pt developed polymyositis with weakness which began 11/7/01. Follow up letter from reporter dated 11/16/2001 states that "After further investigating the PCP discover that this pt was not experiencing adverse event onset due to Hep A. VAERS was notified immediately."

VAERS ID:177978 (history)  Vaccinated:2001-10-29
Age:1.5  Onset:2001-11-11, Days after vaccination: 13
Gender:Male  Submitted:2001-11-13, Days after onset: 2
Location:Pennsylvania  Entered:2001-11-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURUO536DA3IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA601AA3IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4823733IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1253K0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site erythema, Injection site swelling, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Eighteen month old boy given Varivax on 10/29/2001. Presented 11/13/2001 with redness/puffiness at site of Varivax and left inguinal node. Skin with blanching erythema, not indurated, not tender; left inguinal node about 1.5cm in diameter, mobile; given Augmentin as unable to rule out early cellulitis/edemitis.

VAERS ID:178296 (history)  Vaccinated:2001-10-29
Age:4.8  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2001-10-30, Days after onset: 0
Location:California  Entered:2001-11-27, Days after submission: 28
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': CA010124
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM666A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Mother called at approximately 4 PM and stated that child started vomiting this morning. Child had vomited 4 times and mother states that chile appears pale and c/o of anorexia, nausea and abdominal pain.

VAERS ID:178477 (history)  Vaccinated:2001-10-29
Age:55.0  Onset:2001-10-31, Days after vaccination: 2
Gender:Female  Submitted:2001-11-20, Days after onset: 20
Location:Unknown  Entered:2001-12-03, Days after submission: 13
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: Allergy to Penicillin
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0671FA IM 
Administered by: Other     Purchased by: Other
Symptoms: Hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Flu immunization given on 10/29/01. The following day, pt discovered a rash and 1 day later, this rash covered her entire body. Allergic reaction to Flu vaccine.

VAERS ID:178563 (history)  Vaccinated:2001-10-29
Age:1.3  Onset:2001-10-30, Days after vaccination: 1
Gender:Male  Submitted:2001-11-01, Days after onset: 2
Location:Indiana  Entered:2001-12-04, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU05130B0IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA603AA0IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4818123IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1882K0SCLL
Administered by: Public     Purchased by: 0
Symptoms: Diarrhoea, Injection site hypersensitivity, Injection site induration, Injection site oedema, Injection site warmth
SMQs:, Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: The mother reports the entire right thigh was hard, hot, very red and swollen. The patient also has some diarrhea.

VAERS ID:178575 (history)  Vaccinated:2001-10-29
Age:18.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Male  Submitted:2001-10-30, Days after onset: 0
Location:Tennessee  Entered:2001-12-04, Days after submission: 35
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:
Diagnostic Lab Data:
CDC 'Split Type': TN01060
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1026K0IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0742L0SC 
Administered by: Public     Purchased by: Public
Symptoms: Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: One day post vax, pt awoke with severe headache and fever. Reporter was unsure of degree of temperature but states it went up and down. Tylenol and Advil were given. Pt referred to clinic.

VAERS ID:178707 (history)  Vaccinated:2001-10-29
Age:77.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2001-11-30, Days after onset: 31
Location:Maine  Entered:2001-12-06, 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: Relafen, Buspan and Renerde
Current Illness: NONE
Preexisting Conditions: Arthralgias anxiety, depressed
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1071K  LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Oedema, Vasodilation procedure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Pt''s arm red and swollen from shoulder to elbow. Warm to touch. Prednisone tapes given.

VAERS ID:178785 (history)  Vaccinated:2001-10-29
Age:69.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2001-11-15, Days after onset: 16
Location:South Carolina  Entered:2001-12-10, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Arthritis, scoliosis, pulled chest muscle
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO673BA0 RA
Administered by: Public     Purchased by: 0
Symptoms: Injection site hypersensitivity, Myalgia, Vasodilation procedure
SMQs:, Rhabdomyolysis/myopathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Second arm felt sore Sunday. Six days later pt states felt tightness around muscle. Pt describes light red circle around muscle 10 day later. Pt also states pain extended down arm and into back and neck. Pt states will see private MD on 11/17/2001 for evaluation. Red circle nickel size around injection site today. Pt took 5 days of Amoxicillin.

VAERS ID:178906 (history)  Vaccinated:2001-10-29
Age:36.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2001-12-05, Days after onset: 37
Location:Oregon  Entered:2001-12-12, 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: Synthyroid, Pepcid,Valium, Soma, Indocin, Imitrex
Current Illness: UNK
Preexisting Conditions: GERDs, Migraine & tension headache, Hx of backpain, etiology unknown, Hx of arthralgia
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO571AD5IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Back pain, Dysgeusia, Dyspnoea, Injection site reaction, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Pt phoned emp hlth the last wk of 11/28/01 to report hx of possible adverse reaction post receiving vaccine 10/27/01 - states 20 min post injection had local reaction @ site within 2 hrs had back pain, spine at tailbone pain. Also notes funny taste in mouth. 11/9/01 had SOB & nausea. Tx in ER 11/14/01 for N&V. Admitted to hospital with tachycardia x 2 days 11/17/01, discharged home - has not worked since 11/12/01.

VAERS ID:179393 (history)  Vaccinated:2001-10-29
Age:50.0  Onset:2001-11-04, Days after vaccination: 6
Gender:Female  Submitted:2001-11-28, Days after onset: 24
Location:Georga  Entered:2001-12-26, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Faint, nausea and diaphoresis about 4 hours, post vax;UNK. TYPHOID;1;22.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: CBC-revealed WBC-3.9K with 41% neutrophils, 41% lymphocytes, 5.4% eosinophils, 0.3% basophils and 9.6% monocytes.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH4008284  LA
Administered by: Other     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site induration, Lymphoedema
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: A 50 year old female vaccinated at 14:15 on 10/29/01, using reconstituted that morning with preservative-free diluent (vaccine lot 4008284, diluent lot 040601). On 11/15/01 recheck revealed primary response with crusting scab and 3cm surrounding induration. Redness noted in areas in contact with tape and pt was switched to paper tape for dressing changes. On 11/6/01 recheck revealed 3" (about 7.5cm) redness and induration surrounding vaccine site. Fullness of axilla on the same side as vaccine site was noted without palpable node. The pt was empirically begun on Augmentin, 250mg TID and redness and induration noted to be "mostly gone" by the nurse who rechecked pt on 11/9/01. Clinical dx: ''possible secondary infection of vaccine site, vs late reaction to vaccine components''.

VAERS ID:179507 (history)  Vaccinated:2001-10-29
Age:73.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2001-12-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: BPH
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE67330KA IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site hypersensitivity, Oedema, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: On 10/29/2001 pt received pneumococcal and flu vaccines. Developed swelling, redness, pain and fever at pneumococcal injection site. Flu vaccine was given in opposite arm without problem. Medical record flagged for no future doses of pneumococcal vaccine. Report filed with FDA.

VAERS ID:179945 (history)  Vaccinated:2001-10-29
Age:47.0  Onset:2001-10-31, Days after vaccination: 2
Gender:Female  Submitted:2001-12-14, Days after onset: 44
Location:New Jersey  Entered:2002-01-14, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0600AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The pt developed a rash, 2 days post vax. It was erythematous, maculopapular and pruritic. It resolved with diphenhydramine.

VAERS ID:181373 (history)  Vaccinated:2001-10-29
Age:41.0  Onset:0000-00-00
Gender:Female  Submitted:2002-02-08
Location:Michigan  Entered:2002-02-13, 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: MVI
Current Illness: Viral Upper Respiratory Infection
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0574AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0995L0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Pyrexia, Tenderness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Complained of redness, 3x3 "raised area around injection site". Swelling into axilla and tenderness. Temperature of 100.6.

VAERS ID:181576 (history)  Vaccinated:2001-10-29
Age:39.0  Onset:2001-12-20, Days after vaccination: 52
Gender:Male  Submitted:2002-01-14, Days after onset: 25
Location:Georga  Entered:2002-02-20, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40082841 LA
Administered by: Other     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: Pt feels like there is a knot at the vaccination site when he moves his arm back and up. Healed vaccine scar present. No palpable induration felt. No redness or swelling noted. Muscle mass appears symmetrical with R deltoid. Did not notice this until after receiving the influenza vaccination. Not sore to touch. Relates history of shoulder injury 7-8 yrs ago. Pt wonders if symptoms are from this.

VAERS ID:182530 (history)  Vaccinated:2001-10-29
Age:  Onset:2001-10-29, Days after vaccination: 0
Gender:Male  Submitted:2002-03-08, Days after onset: 130
Location:Indiana  Entered:2002-03-18, Days after submission: 10
Life Threatening? No
Died? Yes
   Date died: 2001-11-01
   Days after onset: 3
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: Multiple
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Apnoea, Bacterial infection, Cardio-respiratory arrest, Encephalopathy, Grand mal convulsion, Hyperbilirubinaemia, Inappropriate antidiuretic hormone secretion, Irritability, Jaundice, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad)
Write-up: The pt was very fussy that night and stopped breathing. He was on life support for 3 days before we let him go. Diagnosis in Hopital was : Acute anoxic encephalopathy, status epilepticus, acute respiratory failure, syndrome of inappropriate ADH secretion. Per F/U states DOB as 10/27/01 not 10/29/01. Per F/U Cardio-respiratory arrest, bacterial infection, jaundiced, electrolytes abn, fine tremors, tongue fasciculations, hypertonic UE and LE. Pt seizuring when 1st examined. Tacycardia, neonatal hyperbilirubinemia.

VAERS ID:185592 (history)  Vaccinated:2001-10-29
Age:82.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Female  Submitted:2002-05-28, Days after onset: 210
Location:Pennsylvania  Entered:2002-05-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: no
Preexisting Conditions: environmental and PCN allergies
Diagnostic Lab Data: no
CDC 'Split Type': PA0201
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE065751LA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 11 a.m. flu vaccination 7:00 pm 3/4" wide & 4" long macule on medial aspect of arm, pruritic & warm to the touch

VAERS ID:187469 (history)  Vaccinated:2001-10-29
Age:1.1  Onset:2001-10-30, Days after vaccination: 1
Gender:Male  Submitted:2002-05-30, Days after onset: 211
Location:Texas  Entered:2002-07-12, Days after submission: 43
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: Otitis media NOS, upper respiratory infection NOS; Glaucoma congenital
Diagnostic Lab Data:
CDC 'Split Type': WAES01112249
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT07572 RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1388K0 LL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4841342 LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0537K0 RL
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a health care professional at a physician''s office concerning a 13 month old Hispanic male with congenital glaucoma who on 10/29/2001 at 3:30pm was vaccinated in the left thigh with a first dose of MMR II. Concomitant vaccinations included a first dose in the right thigh of varicella virus vaccine live, a third dose in the right thigh of IPOL, and a third dose in the left thigh of Prevnar. Illnesses at the time of vaccination included an upper respiratory infection and a right otitis media. On 10/30/2001 at 9am, the child presented with a 9cm red raised area to the left leg. It was also reported that the area had slight induration, and was warm to touch. It was also reported that the child experienced tenderness at the site. The child was treated with Benadryl, Keflex, and Motrin and on 11/02/2001 was noted to have recovered from all of the events. No further info is expected. The records of testing prior to release of these lots have been checked by GMP Compliance and found to be satisfactory. The lots comply with the standards of the Center for Biologics Evaluation and Research and were released. The physician also reported that a 4 year old female developed injection site erythema, induration, warmth, swelling, and tenderness and cellulitis (WAES01110332) and that a 12 month old female developed a skin lesion, and injection site sweling and tenderness (WAES01112258).

VAERS ID:188376 (history)  Vaccinated:2001-10-29
Age:60.0  Onset:0000-00-00
Gender:Female  Submitted:2002-07-30
Location:Unknown  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: Norvasc, Premarin, methotrexate, Toprol XL Tablets, minocycline
Current Illness:
Preexisting Conditions: Sulfa allergy
Diagnostic Lab Data:
CDC 'Split Type': WAES01110040
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a female with sulfa allergy who on 10/29/01 was vaccinated with pneumococcal vaccine 23 polyvalent in her right arm. Concomitant therapy included Norvasc, methotrexate, Toprol XL Tablets and Premarin. Subsequently, the pt experienced large raised red area in her right arm pit that itches and pain at the injection site. Unspecified medical attention was sought. In follow-up, the physician reported that the pt did have redness and heat at the site of the pneumococcal vaccination and it resolved spontaneously, 4 days later. The physician felt that it was "not clear to him that this was any sort of significant reaction". Additional information is not expected.

VAERS ID:188922 (history)  Vaccinated:2001-10-29
Age:42.0  Onset:2002-03-01, Days after vaccination: 123
Gender:Female  Submitted:2002-07-30, Days after onset: 150
Location:Unknown  Entered:2002-08-14, Days after submission: 15
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: Asthma NOS
Diagnostic Lab Data: Lab test - titer results were very low (3/02)
CDC 'Split Type': WAES0203USA01415
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Laboratory test abnormal
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a registered nurse concerning a 42 year old female pt with asthma who on 10/29/01 was vaccinated with a dose of pneumococcal vaccine 23 polyvalent. In March 2002, the pt''s titer results were very low. Unspecified medical attention was sought. Additional info has been requested.

VAERS ID:189503 (history)  Vaccinated:2001-10-29
Age:60.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Male  Submitted:2001-11-29, Days after onset: 30
Location:Texas  Entered:2002-08-28, Days after submission: 271
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: UNK
CDC 'Split Type': HQ8002205NOV2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES 1IMRA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: An MA reported that a 60 year old male received an injection of Pnu-Imune 23 vaccine on 10/29/01. He subsequently developed an injection site reaction characterized by heat and redness. He was seen in the ER on 10/30/01; dx''d with cellulitis and treated with 1gm of Rocephin daily. Additional information received from the vaccine provider on 11/20/01, stated that a dx of allergic reaction to pneumococcal vaccine was made and subsequent treatment included antihistamine drugs which cleared the pt''s erythema.

VAERS ID:191805 (history)  Vaccinated:2001-10-29
Age:5.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Male  Submitted:2001-12-26, Days after onset: 57
Location:New York  Entered:2002-10-23, Days after submission: 300
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': U200101108
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0594AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: From telephone call received on 11/02/01, it was reported that a 6 year old male patient received a Fluzone SV ''01 -''02 vaccination administered on 10/29/2001. Twenty-four hours after vaccination, the patient developed a local reaction 3'' in diameter at the injection site that was red and hot to the touch. Reportedly the reaction resolved and the patient recovered.

VAERS ID:191825 (history)  Vaccinated:2001-10-29
Age:65.0  Onset:2001-11-01, Days after vaccination: 3
Gender:Male  Submitted:2001-12-27, Days after onset: 56
Location:Wisconsin  Entered:2002-10-23, Days after submission: 299
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': U200101157
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO574AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypertonia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad)
Write-up: From correspondence received on 11/14/01, it was reported that a 65 year old male patient received a Fluzone SV ''01 -''01 vaccination on 10/29/01. Approximately 3 days post vaccination, the patient experienced severe myalgia in neck, shoulder and pelvic region ,mainly in proximal muscles of the body. Had difficult getting up in morning due to stiffness. After he got up and moved around an hour or two later would be more functional but some discomfort was still present. Symptoms persisting until the present with little improvement in the neck muscles at this time.

VAERS ID:194397 (history)  Vaccinated:2001-10-29
Age:0.4  Onset:2001-10-31, Days after vaccination: 2
Gender:Male  Submitted:2002-11-26, Days after onset: 391
Location:Idaho  Entered:2002-12-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Gestational diabetes mellitus; Premature birth;
Diagnostic Lab Data: Biopsy: Panniculitis w/septal lymphohistiocytic infiltrate w/admixed eosinophils; Biopsy: soft tissue and skin right thigh=granulomas w/acute and chronic inflammation; Blood: normal; Blood culture: no growth at 24 hours; Lymphocyte count: "
CDC 'Split Type': WAES0206USA02807
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEUR 0  
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC. 0  
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Hypersensitivity, Infection, Laboratory test abnormal, Skin nodule
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a health professional concerning an approximately 21 week old male patient who on 10/29/01 was vaccinated with the first 0.5 ml dose of Haemophilus b conjugate vaccine (+) hepatitis B vaccine (yeast). Concomitant therapy on 10/29/01 included a dose of diphtheria toxoids/pertussis vaccine/tetanus toxoid (manufacturer not reported) HIB conjugate vaccine (manufacturer unknown) and poliovirus vaccine (manufacturer not reported). On 01/07/02, the patient was vaccinated with the first 0.5 ml dose of Hepatitis B vaccine recombinant (yeast) (manufacturer unknown). Concomitant therapy on 01/07/02 included the second dose of 0.5 ml dose of HIB conjugate vaccine (manufacturer unknown), the second 0.5 ml dose of diphtheria toxoid/pertussis vaccine/ tetanus toxoids (manufacturer not reported) and the first 0.5 ml dose of poliovirus vaccine (manufacturer unknown). It was reported that the the patient had his shots at 2 months and 4 months and about 2 days later, developed nodules on both of his legs. The reporter''s office thought that the patient might have an infection,and they gave him an "INO" procedure. The physician at the office sent the patient to a dermatologist to see if he had an allergic reaction to the vaccine. The dermatologist then sent the patient to a university, where they thought the patient was allergic''s to the alumnium in the vaccines. It was reported that the patient sought medical attention (physician''s office). No other information was provided. Additonal information has been requested.

VAERS ID:178427 (history)  Vaccinated:2001-10-29
Age:2.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Male  Submitted:2001-11-21, Days after onset: 23
Location:Foreign  Entered:2001-11-30, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 20020274041
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM    
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER    
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: 0     Purchased by: 0
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: This report describes the occurrence of erythema exudativum multiforme in an 18 months old male receiving Infanrix-Polio-Hib. The 1st 3 vaccination with Infanrix-Polio-Hib were given on 8/8/00, 9/28/00 and 10/31/00. All former vaccinations were well tolerated. On 10/29/01, the pt received the 4th Infanrix-Polio-Hib. On the same day, the pt experienced erythema exudativum multiforme, which lasted until 11/6/01. Information received on 11/20/01, reports the outcome of the event as resolved. The reporter did not specify the causality.

VAERS ID:181767 (history)  Vaccinated:2001-10-29
Age:5.0  Onset:2001-11-08, Days after vaccination: 10
Gender:Male  Submitted:2002-02-26, Days after onset: 110
Location:Foreign  Entered:2002-02-27, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Concussion; trauma
Diagnostic Lab Data: EEG-nml; Neurological exam-nml
CDC 'Split Type': WAES0202USA01466
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0804K1IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Injury
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a health professional concerning a 5 year old male who on 10/29/01 was vaccinated IM in the "m." deltoid with a 2nd dose of Hep-A (batch HM72630). Ten days later, on 11/8/01, he presented with questionable convulsions. After a severe quarrel with his grandfather, he "made a face". The boy was conscious, did not fall down, had no myoclonia or other signs of convulsions. The day before the onset, on 11/7/01, he had "knocked together" with another child. On 11/15/01, he was referred to a neurologist. Neurological exams and EEG showed normal results. In 1/01, he had a brain concussion. Hep-A virus vaccine on 4/27/01 was well tolerated. Questionable convulsions was considered an "Other Important Medical Event". Additional information is not expected.

VAERS ID:184906 (history)  Vaccinated:2001-10-29
Age:44.0  Onset:2001-11-14, Days after vaccination: 16
Gender:Male  Submitted:2002-05-14, Days after onset: 180
Location:Foreign  Entered:2002-05-21, 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:
Current Illness:
Preexisting Conditions: Atrial fibrillation
Diagnostic Lab Data: Blood pressure-slightly elevated; electrocardiogram-hypertrophy of the septum and posterior wall, good left ventricle, enlarged left atrium; diagnostic radiology-osteochondosis C4-C5 and C5-C6; electromyography-infraspinatus seems normal wi
CDC 'Split Type': WAES0205USA00607
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES   LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Arthralgia, Asthenia, Hypoaesthesia, Hyporeflexia, Oedema peripheral, Swelling, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Information has been received from a health authority (02/1154) concerning a 44 year old male patient with atrial fib. for many years who on 29 OCT 2001 was vaccinated in the left arm with a dose of pneumococcal vaccine 23 polyvalent (Lot # not reported). Concomitant therapy included a dose in the right arm influenza virus vaccine. On 14 NOV 2001, the patient developed tenderness and swellilng in his left upper arm and shoulder and was hospitalized from 14 NOV 2001 to 01 DEC 2001. An echocardiography showed hypertrophy of the septum and posterior wall; good ventricle; enlarged left atrium. Again it was noted that the patient has suffered from atrial fib for many years. It was noted that the patient had a slightly elevated BP. Lab test/results were normal which are indicated below. Other findings include urine traces of ketones otherwise normal; osteochondrosis C4-C5 and C5-C6; EMG: infraspinatus seems normal with spontaneous activity in serratus anterior. On 12 MAR 2002, it was informed that the patient had sequelae which was seen as pain from the upper arm spreading to the lower arm and the first three fingers with numbness of the thumb. It somewhat reduces strength of the arms which was observed, but no certain pareses. it was noted that reflexes of the left arm were weak, but no atrophy. At the time of the report, the patient''s symptoms were still ongoing. No further information is available. A 15-day follow up report received 09/17/2003 adds: Follow up info on 08/27/2003 indicated that no further info was available. The case is closed.

VAERS ID:187684 (history)  Vaccinated:2001-10-29
Age:57.0  Onset:2001-10-29, Days after vaccination: 0
Gender:Male  Submitted:2002-07-09, Days after onset: 252
Location:Foreign  Entered:2002-07-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; beclomethasone dipropionate
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0206USA02553
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Myalgia, Oedema, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Information has been received from a health authority concerning a 57 year old male with asthma who on 10/29/01 was vaccinated with a dose of pneumococcal vaccine 23 polyvalent (batch reported to be unk), IM. Concomitant therapy included beclomethasone and salbutamol. On 10/29/01, the day of vaccination, the pt presented with swelling of the shoulder, fever and myalgia and was hospitalized. The pt required IV saline and paracetamol for 24 hrs. The pt was considered to be recovering after treatment (no stop date reported) and was prescribed non-steriodal medication and antibiotics (Co-amoxiclav for five days) at discharge. No further info is available.

VAERS ID:208856 (history)  Vaccinated:2001-10-29
Age:44.0  Onset:2001-11-14, Days after vaccination: 16
Gender:Male  Submitted:2003-09-02, Days after onset: 656
Location:Foreign  Entered:2003-09-05, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Has suffered from atrial fibrillation for many years.
Diagnostic Lab Data: Creatine, sodium, urea, potassium within normal values. Liver: APOS, ASAT, ALAT, GT and CK within normal values. Free T4, TSH, B12 and folate within normal values. Digitoxin reflects 21. SR, leucocytes, erythrocytes, thromboytes and eosino
CDC 'Split Type': F200201234
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   RA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.   LA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Blood pressure increased, Hypertrophy, Hypoaesthesia, Injection site oedema, Injection site pain, Joint range of motion decreased, Laboratory test abnormal, Musculoskeletal stiffness, Neck pain, Pain, Paresis, Radiculitis brachial, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad)
Write-up: Case reported by health authority. A 44 year old man was vaccinated against pneumococcal pneumonia in his left upper arm and influenzae in his right upper arm. He developed tenderness and swelling in his left upper arm and shoulder and was hospitalized from 14 Nov to 01 Dec 01. See lab data. Ecco cardiography showed hypertrophy of seprum and posterior wall. Good left ventricle. Enlarged left atrium. He has suffered from atrial fibrillation for many years. Slightly elevated blood pressure. On 12 Mar 02 it was informed that he has sequelae seen as pain from the upper arm spreading to the lower arm and the 3 first fingers with numbness of the thumb. Somewhat reduces strength of arms is observed but no certain parese. Reflexes of left arm are weak. No atrophy. At the time of reporting, symptoms were still ongoing. Follow up 27 Aug 2003. No further information is available. Case is closed. Medical Assessment: The patient developed pain and motor disorders involving the arm on the side of the pnuemococcal vaccination. However, the available clinical data (no amyotrophy) and the results of the electromyogram (normal) seem not to support the diagnosis of brachial neuritis (Parsonage Turner Syndrome). In te majority of the patients ,brachial neuritis have been reported after an infection (time to onset 1 to 3 weeks) and some cases have been reported after a traumatism or a shoulder overwork. In the current case it''s not known whether investigations for an infectious cause (especially for CMZ, EBV, or VZV) or a traumatism were carried out. At the same time, the investigations carried out revealed cervical arthrosis that could be at the origin of the "brachial neuritis picture" presented by the patient. The name of teh specific influenzae vaccine administered is unknown. FU5NOV2004. It was reported that patient had severe pain in the left shoulder and had problems sleeping at nights. Electroneurography and electromyography was done on 24NOV201 and showed neurogenic findings in deltoids muscle. The conclusion ws : unclear

VAERS ID:232455 (history)  Vaccinated:2001-10-29
Age:46.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2002-10-10, Days after onset: 344
Location:Foreign  Entered:2005-01-19, Days after submission: 832
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diclofenac; Sevredol; Co-Proxamol; MST Continus; Domperidone
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': PJP200200039
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site erythema, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: A report wsa received on 12/11/01 concerning a 46 year old female patient who experienced erythema after receiving an influenza vaccine on 10/29/01. The patient has a medical history of malignant breast neoplasm. The reporter described the patient as having breast cancer of the left breast. No surgical intervention was required. On 10/29/01 the patient received an influenza vaccine. On 10/30/01 the patient developed a 10cm area of erythema and cellulitis around the injection site. The patient had not recovered at the time of reporting the event. There was insufficient information to determine the reporter''s causality.

VAERS ID:232483 (history)  Vaccinated:2001-10-29
Age:64.0  Onset:2001-12-10, Days after vaccination: 42
Gender:Female  Submitted:2002-10-10, Days after onset: 303
Location:Foreign  Entered:2005-01-19, Days after submission: 832
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HRT
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': PJP200200120
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  SC 
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)UNKNOWN MANUFACTURER    
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURT6253 SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: A report was received on 1/28/02 concerning a 64 year old female patient who experienced a maculopapular rash after receiving an influenza vaccine on 10/29/01. The patient also received yellow fever and typhoid vaccines. She has no known allergies and is taking oral Hormone Replacement Therapy. On 12/10/01, the patient experienced a maculopapular generalized rash which had not recovered at time of reporting. There was insufficient information to determine the reporter''s causality assessment.

VAERS ID:232495 (history)  Vaccinated:2001-10-29
Age:65.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2002-10-10, Days after onset: 344
Location:Foreign  Entered:2005-01-19, Days after submission: 832
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': PJP200200213
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES760196 SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Fatigue, Nasal congestion, Pharyngolaryngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: A report was received on 2/25/02 concerning a 65 year old female patient who experienced a sore throat, pyrexia, shivering, sinus congestion and exhaustion 1 day after receiving Fluvirin on 10/29/01. At the time of the report, the patient had not recovered, though the reporter did not consider the reaction to be serious. It was unknown whether or not the patient was receiving any concomitant medication at the time of vaccination. There was insufficient information to determine the reporter''s causality assessment.

Result pages: prev   1667 1668 1669 1670 1671 1672 1673 1674 1675 1676 1677 1678 1679 1680 1681 1682 1683 1684 1685 1686 1687 1688 1689 1690 1691 1692 1693 1694 1695 1696 1697 1698 1699 1700 1701 1702 1703 1704 1705 1706 1707 1708 1709 1710 1711 1712 1713 1714 1715 1716 1717 1718 1719 1720 1721 1722 1723 1724 1725 1726 1727 1728 1729 1730 1731 1732 1733 1734 1735 1736 1737 1738 1739 1740 1741 1742 1743 1744 1745 1746 1747 1748 1749 1750 1751 1752 1753 1754 1755 1756 1757 1758 1759 1760 1761 1762 1763 1764 1765 1766 1767 1768 1769 1770 1771 1772 1773 1774 1775 1776 1777 1778 1779 1780 1781 1782 1783 1784 1785 1786 1787 1788 1789 1790 1791 1792 1793 1794 1795 1796 1797 1798 1799 1800 1801 1802 1803 1804 1805 1806 1807 1808 1809 1810 1811 1812 1813 1814 1815 1816 1817 1818 1819 1820 1821 1822 1823 1824 1825 1826 1827 1828 1829 1830 1831 1832 1833 1834 1835 1836 1837 1838 1839 1840 1841 1842 1843 1844 1845 1846 1847 1848 1849 1850 1851 1852 1853 1854 1855 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865   next

New Search

Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=1766&PERPAGE=100&ESORT=V
AX-DATE


Copyright © 2014 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166