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Case Details (Sorted by Vaccination Date)

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VAERS ID:166825 (history)  Vaccinated:2001-02-23
Age:1.7  Onset:2001-02-24, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Connecticut  Entered:2001-03-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO320AB3IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R147322SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725550IM 
Administered by: Private     Purchased by: Private
Symptoms: Cough, Febrile convulsion, Pyrexia, Rhinitis, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: This child received Prevnar on 02/23/01. On 02/24/01, he had a temp of 104.3,and "body shaking". he was sent to the ER with a febrile seizure. On 02/26/01, the patient was seen by PCP fever down, giving Tylenol/Motrin alternating. No other sickness, positive coryza, slight cough, TM''s nml, throat nml, A/P URI, febrile seizure. Hold future Prevnar.

VAERS ID:166902 (history)  Vaccinated:2001-02-23
Age:4.0  Onset:2001-02-25, Days after vaccination: 2
Gender:Male  Submitted:2001-02-26, Days after onset: 1
Location:Georgia  Entered:2001-03-12, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Heart Murmur
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM972A23IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R14373SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1444D1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt''s mother reports increased swelling, redness, fever 2 days post vaccine.

VAERS ID:166927 (history)  Vaccinated:2001-02-23
Age:57.0  Onset:2001-02-23, Days after vaccination: 0
Gender:Female  Submitted:2001-02-28, Days after onset: 5
Location:Pennsylvania  Entered:2001-03-12, 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: Cat bite
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0367AA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Office visit on 2/26/01, right deltoid red and warm to touch and painful. Seen by doctor and placed on Keflex 500mg X 10 days. Dx''d with allergic reaction secondary to TD vaccine.

VAERS ID:166950 (history)  Vaccinated:2001-02-23
Age:32.0  Onset:2001-02-23, Days after vaccination: 0
Gender:Female  Submitted:2001-02-27, Days after onset: 4
Location:Montana  Entered:2001-03-12, 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: Prozac
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3375A41IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt developed hives and itching post vaccine.

VAERS ID:227860 (history)  Vaccinated:2001-02-23
Age:1.3  Onset:2004-10-06, Days after vaccination: 1321
Gender:Male  Submitted:2004-10-11, Days after onset: 5
Location:Virginia  Entered:2004-10-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0826K0  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0922K0  
Administered by: Private     Purchased by: Public
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Got chickenpox had vaccine (sibling has c pox)

VAERS ID:167104 (history)  Vaccinated:2001-02-23
Age:1.0  Onset:2001-02-25, Days after vaccination: 2
Gender:Male  Submitted:2001-03-13, Days after onset: 16
Location:Foreign  Entered:2001-03-16, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Augmentin, Clamoxyl
Current Illness:
Preexisting Conditions: otitis media
Diagnostic Lab Data:
CDC Split Type: 20010056714
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM  IM 
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Diffuse vasculitis, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Vasculitis (narrow), Hypersensitivity (narrow)
Write-up: This report describes the occurrence of an urticarial vasculitis in a 6 month old boy receiving Hepatitis B vaccine. On 02/23/01, a dose of Hepatitis B, Hepatitis A, DTPA-IPV and Haemophilus Influenzae vaccine were given. On 02/25/01, this boy was hospitalized with a diagnosis of diffuse urticarial cutaneous vasculitis. He was treated with Corticosteroids. On 03/01/01, he was discharged. As of 03/13/01, at the time of the last report he had completely recovered. The reporting physician did not assess a causal relationship. However, the treating pediatrician considered the event to be related to the concomitant Augmentin and unrelated to DTPa-IPV, Hepatitis A, Hepatitis B and HIB vaccine. Additional info has been requested.

VAERS ID:168553 (history)  Vaccinated:2001-02-23
Age:75.0  Onset:2001-02-23, Days after vaccination: 0
Gender:Male  Submitted:2001-04-03, Days after onset: 38
Location:Foreign  Entered:2001-04-11, Days after submission: 8
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Leukopenia; Metastatic lung neoplasm; non insulin-dependent diabetes mellitus; Renal carcinoma
Diagnostic Lab Data: WBC-4.65nl on 12/6/00-showed leukocytopenia; WBC-3.61nl on 3/13/01-showed leukocytopenia
CDC Split Type: waes01032270
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  SC 
Administered by: 0     Purchased by: 0
Symptoms: Asthenia, Chills, Cough, Leukopenia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad)
Write-up: Information has been received from a healthcare professional concerning a 75 year old male who on 2/23/01 was vaccinated SC in the upper arm with a 1st dose of pneumococcal vaccine 23 polyvalent. The same day, the pt experienced rigors and fever and complained of extreme weakness and coughing. The fever and rigors lasted for a few days. It was reported that the pt''s weakness and coughing have remarkably improved but were still present as of 3/19/01. The pt''s adverse experiences were considered to be life threatening by the reporter. No further information is available.

VAERS ID:168554 (history)  Vaccinated:2001-02-23
Age:69.0  Onset:2001-02-24, Days after vaccination: 1
Gender:Female  Submitted:2001-12-28, Days after onset: 307
Location:Foreign  Entered:2001-04-11, Days after submission: 261
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Hypertension, non-Hodgkin''s lymphoma
Diagnostic Lab Data: Labs included serum: massive leucocytosis and elevation of C-reactive protein: CSF-no inflammatory alterations: CCT-nml.
CDC Split Type: WAES01032830
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1518J0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Encephalopathy, Erysipelas, Immune system disorder, Laboratory test abnormal, Leukocytosis, Psychotic disorder
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hostility/aggression (broad), Chronic kidney disease (broad)
Write-up: Information has been received from a health authority concerning a 70 year old female who on 2/23/01 was vaccinated, IM in the left deltoid, with a 1st dose of pneumococcal vaccine 23 polyvalent. On 2/24/01, the pt developed psychotic symptoms and was hospitalized. It was noted that bacterial encephalitis, cerebral ischemia, hemorrhage and intoxication were ruled out. Immuno-associated encephalopathy with transitional psychosis was suspected. The symptoms lasted until 2/28/01. It was also reported that the pt had erysipelas from 2/24/01 until 3/2/01. The site of the erysipelas was not reported. It was noted that no information about therapeutic measures was available and that the pt recovered. No further information is available.

VAERS ID:169532 (history)  Vaccinated:2001-02-23
Age:0.5  Onset:2001-02-24, Days after vaccination: 1
Gender:Male  Submitted:2001-05-18, Days after onset: 82
Location:Foreign  Entered:2001-05-08, 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: Augmentin (2/17/01-2/25/01) 9 days
Current Illness: Fever; otitis media
Preexisting Conditions:
Diagnostic Lab Data: UA-nml; Stool tests-nml
CDC Split Type: WAES01042088
Vaccination
Manufacturer
Lot
Dose
Route
Site
6VAX-F: DTAP+IPV+HEPB+HIB (HEXAVAX)AVENTIS PASTEUR6296880090J2IMRL
HEPA: HEP A (VAQTA)MERCK & CO. INC.0090J0IMLL
Administered by: Other     Purchased by: Other
Symptoms: Ecchymosis, Joint swelling, Oedema peripheral, Pyrexia, Rash, Serum sickness, Swelling, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: On 2/23/01, the pt was vaccinated IM in the left thigh, with a 1st dose of Hep-A virus vaccine inactivated. Concomitant vaccine therapy on 2/23/01, included a 3rd dose of IM in the right thigh of diphtheria toxoid + haemophilus b conjugate vaccine + hepatitis a vaccine recombinant (yeast) + pertussis vaccine (acellular 2 component act) + poliovirus vaccine inactivated + tetanus toxoid. On the evening of 2/24/01, the pt developed a generalized rash. On 2/25/01, he developed a general swelling and was hospitalized. The following symptoms were noted at the hospital: severe edema of the limbs, swollen joints (no redness or reduction of mobility), general urticaria, no breathing problems and fever (38.2C). Lung and heart auscultation was normal; abdomen was negative for hepatosplenomegaly; urine sedimentation was normal; there was no hematuria or blood in the stools. Serum sickness related to amoxicillin was dx''d and treatment with amoxicillin trihydrate (+) clavulanate potassium (Augmentin) was discontinued. The pt was treated with methylprednisolone (Medrol) 20 mg daily, starting on 2/25/01 until 3/1/01 and "guaifensen" syrup from 2/25/01 until 3/1/01. The swelling disappeared on 2/28/01 and the pt was discharged from the hospital. The rash abated progressively until 3/9/01. The urticarial lesions were followed by the appearance of ecchymosis due to diapedesis of red blood cells. It was noted that the pt recovered. Initially, the relationship between the events and the study therapies was unknown; however, conflicting information indicated that the relationship of the study was probably not related. Clarification was later received stating that the reporting investigator felt that the pt''s experience was probably not related to the study therapies, but related to the amoxicillin trihydrate (+) clavulanate potassium (Augmentin). No further information is available. It was noted that the pt recovered.

VAERS ID:166762 (history)  Vaccinated:2001-02-24
Age:1.1  Onset:2001-02-26, Days after vaccination: 2
Gender:Female  Submitted:2001-02-26, Days after onset: 0
Location:Illinois  Entered:2001-03-08, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.T012022 RA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4767241 LA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This patient had redness (onset at 2:40) at the site of Prevnar injection, resolving spontaneously during 48 hours after vaccinations.

VAERS ID:168692 (history)  Vaccinated:2001-02-24
Age:11.0  Onset:2001-02-24, Days after vaccination: 0
Gender:Female  Submitted:2001-02-24, Days after onset: 0
Location:Texas  Entered:2001-04-13, Days after submission: 47
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD, Connaught, Lot # C0046AA, left arm.
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX01023
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5203AG1IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0820K1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Lethargy, Loss of consciousness, Muscle rigidity
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: This child was sitting in the lobby on the bench after about 5 minutes of receiving the Hep B, MMR, and PPD; when without provocation the child hyperextended back to neck. Dropping on the bench. Seconds later she was less rigid, she was asked to sit but she was still lethargic. 911 was called, the mother ran to find the father who is an RN assistant. The child totally recovered in 5 minutes. No illnesses were reported, the mother and father said she is a healthy child.

VAERS ID:170647 (history)  Vaccinated:2001-02-24
Age:0.3  Onset:2001-02-26, Days after vaccination: 2
Gender:Female  Submitted:2001-05-30, Days after onset: 92
Location:Ohio  Entered:2001-06-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glycerin suppository
Current Illness: Allergic Colitis
Preexisting Conditions: Allergic Colitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM978A21IMRL
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS582953A1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T02661IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: On 2/26/01 Mom reported immunization site was red and baby had a fever. Was seen on 2/28/01, and dime size red area on skin under IPV site with area of induration 1x2cm beneath. No tenderness, baby happy. Temp not taken.

VAERS ID:172829 (history)  Vaccinated:2001-02-24
Age:48.0  Onset:0000-00-00
Gender:Female  Submitted:2001-05-02
Location:Texas  Entered:2001-07-03, Days after submission: 62
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: MRI
CDC Split Type: TX01074
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7360BA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Hypoaesthesia, Neck pain
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Pt developed feelings of numbness in legs, backache and neck pain 3-4 wks post vax. It was explained to her that these symptoms were not side effects of this TD booster, and if there was a reaction, it would have occurred within 24 to 48 hours.

VAERS ID:271984 (history)  Vaccinated:2001-02-24
Age:1.1  Onset:2007-02-08, Days after vaccination: 2175
Gender:Male  Submitted:2007-02-08, Days after onset: 0
Location:Texas  Entered:2007-02-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Break out all over body

VAERS ID:167029 (history)  Vaccinated:2001-02-25
Age:40.0  Onset:2001-02-25, Days after vaccination: 0
Gender:Male  Submitted:2001-02-25, Days after onset: 0
Location:Iowa  Entered:2001-03-13, Days after submission: 16
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Laceration to right hand
Preexisting Conditions: Allergy: codeine, status/post aortic valve replacement 10 years ago.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)CONNAUGHT LABORATORIESUO301AA12IMRA
Administered by: Public     Purchased by: 0
Symptoms: Bradycardia, Hyperhidrosis, Hypotension, Pallor, Shock, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: This patient was in hypotensive shock: hypotension 124/96 - 70/40, Pulse 82/46, diaphoresis, pallor, bradycardia. Treatment with IV fluids. A question of 2 degree vasovagal syncope.

VAERS ID:167183 (history)  Vaccinated:2001-02-25
Age:0.7  Onset:2001-02-27, Days after vaccination: 2
Gender:Female  Submitted:2001-03-07, Days after onset: 8
Location:Georgia  Entered:2001-03-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM973A21IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1291K1IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01871IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES474734 IMLL
Administered by: Public     Purchased by: Public
Symptoms: Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: Mom called to report that she took pt to ER the day after receiving injections because of persisting fever and irritability. No swelling, no redness at sites. Today child is still irritable but not febrile. Advised to give Motrin and bring child to clinic if still irritable.

VAERS ID:180510 (history)  Vaccinated:2001-02-25
Age:2.0  Onset:2002-01-08, Days after vaccination: 317
Gender:Female  Submitted:2002-01-10, Days after onset: 2
Location:West Virginia  Entered:2002-01-24, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: 0     Purchased by: 0
Symptoms: Herpes zoster, Infection
SMQs:
Write-up: Shingles on left arm.

VAERS ID:182949 (history)  Vaccinated:2001-02-25
Age:2.1  Onset:2002-02-23, Days after vaccination: 363
Gender:Male  Submitted:2002-03-27, Days after onset: 32
Location:Ohio  Entered:2002-03-29, 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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Blood culture-(+) Strep pneumonia; CXR-RML and RLL pneumonia with empyema
CDC Split Type: HQ1068328FEB2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES4773983IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0977K0SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725470IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1153K SC 
Administered by: Other     Purchased by: Other
Symptoms: Pleural effusion, Pneumonia
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: A physician reported that a male child "completed the Prevnar series almost a year ago." Subsequently, at 25 months of age, he developed an unspecified pneumococcal infection. No further info was available at the date of this report. Pneumococcal infection is considered medically important. Additional info received on 03/11/2002, from physician. The pt was diagnosed with right upper/ right middle lobe pneumonia and has recovered. The blood isolate will be serotyped and the physician will be sending follow-up information. Follow-up info received on 03/18/2002, from physician. Notification received that the "local hospital lab could not get the S. Pneumoniae to grow," so there will be no isolate to serotype. Info relevant to VAERS form was requested by midical monitor to physician. Follow up info received on 03/21/2002 from physician. A 25 month old male received a 2nd dose of Prevnar vaccine on 04/25/2001. On 02/23/2002, the child developed a febrile illness with pneumonia. A blood culture was positive for strep pneumoniae. A chest x-ray revealed RML and RLL pneumonia with empyema. On 03/05/2002, a surgical incision and drainage was performed. The outcome was "resolving pneumonia." The lot numbers of the Prevnar vaccines that were administered was also provided with follow up.

VAERS ID:252456 (history)  Vaccinated:2001-02-25
Age:0.0  Onset:0000-00-00
Gender:Unknown  Submitted:2006-03-03
Location:Unknown  Entered:2006-03-09, 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:
Diagnostic Lab Data:
CDC Split Type: WAES0602USA05909
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.   UN
Administered by: Other     Purchased by: Other
Symptoms: Antisocial behaviour, Aphasia, Immune system disorder, Mental retardation severity unspecified, Nervous system disorder, Neurodevelopmental disorder
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: Information has been received regarding a case in litigation concerning a child who, as an infant, was vaccinated with a dose of hepatitis B virus vaccine rHBsAg yeast manufacturer unknown. the alleged result of receiving the mercury contained in the thimerosal containing vaccinations is that he suffers, and will continue to suffer, neurological and immunological damage with symptoms including, but no limited to, developmental delay, loss of language, and failure to meet social and motor milestones. Upon internal review, neurological and immunological damage, developmental delay, loss of language, and failure to meet social and motor milestones were determined to be other important medical events (OMIC). No further information is available.

VAERS ID:166764 (history)  Vaccinated:2001-02-26
Age:0.3  Onset:2001-02-28, Days after vaccination: 2
Gender:Male  Submitted:2001-03-01, Days after onset: 1
Location:Virginia  Entered:2001-03-08, 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: Bronchiolitis
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES01040903
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0356BA1IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1528K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05951IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733321 RL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This infants right leg with 1 1/2 - 2 cm redness, 3 x 3 cm induration.

VAERS ID:166767 (history)  Vaccinated:2001-02-26
Age:29.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Male  Submitted:2001-02-27, Days after onset: 1
Location:Delaware  Entered:2001-03-08, 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: A year ago pulled upper back muscle at the base of the neck.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV048B0SCRA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Hypoaesthesia, Pruritus, Rash, Rash pustular
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: After this patient''s shot #1, at approximately 8 PM (same day), the patient reports a rash (red band, with white raised bumps) may be 10-12. This rash was on the right wrist, underneath the thumb area. The rash was itchy, and is still itchy today, but redness is not as bad and the white bumps have gone down. At approximately the same time (8 PM last night) right leg was numb from top of the right gluteal area all the way to the foot, the majority of numbness has lessened, however, the right knee and foot (ankle-inner area) are still numb, the knee is the worst. The patient also reports numbness in the right deltoid area and right elbow. (Feel as if the right side was in "icy hot".)

VAERS ID:166820 (history)  Vaccinated:2001-02-26
Age:2.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-02-27, Days after onset: 1
Location:Pennsylvania  Entered:2001-03-08, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Mild URI
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725540IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pain in jaw, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Osteonecrosis (broad)
Write-up: This child had a fever of 103F, complaining of severe jaw pain, no redness, or swelling.

VAERS ID:166821 (history)  Vaccinated:2001-02-26
Age:0.8  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-03-01, Days after onset: 3
Location:Wisconsin  Entered:2001-03-08, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4733511IM 
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: During the 1st 24 hours, this child had a fever of 100.8; she responded to Motrin. Then it seemed ok until the 2nd night, she had a spiked fever of 102.5. The 3rd day , the fever again 101 to 102.5. she was seeing the MD on the 3rd day. Now recovering.

VAERS ID:166828 (history)  Vaccinated:2001-02-26
Age:4.5  Onset:2001-02-26, Days after vaccination: 0
Gender:Male  Submitted:2001-02-27, Days after onset: 1
Location:Washington  Entered:2001-03-08, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Febrile seizure 10/3/98. Hydrocele 2/8/99.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747270 LA
Administered by: Private     Purchased by: Public
Symptoms: Agitation, Cough, Dyspnoea, Laryngitis, Muscle spasms, Pharyngolaryngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad)
Write-up: The patient was normal when he went to bed at 9:30 PM. Awoke about 11:00 screaming, legs cramping, yelling it hurts, throat sore (could swallow liquid), could bend chin to chest. The fever and chills resolved by arrival to the ER, he was coherent, given instructions for croup all though not quiet, typical barking cough. seems fine in AM.

VAERS ID:166847 (history)  Vaccinated:2001-02-26
Age:38.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-03-01, Days after onset: 3
Location:North Carolina  Entered:2001-03-08, 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: PPD, Intradermal, Unk.
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0177K SC 
Administered by: 0     Purchased by: 0
Symptoms: Confusional state, Dyspnoea, Injection site vesicles, Injection site warmth, Skin disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)
Write-up: This patient reports shortness of breath lasting 3 minutes with confusion (2 episodes) after returning home. MMR site red, warm to touch. Has blister and skin tear approximately 10 mm (left upper arm).

VAERS ID:166867 (history)  Vaccinated:2001-02-26
Age:46.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-02-26, Days after onset: 0
Location:Arizona  Entered:2001-03-09, 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: Paxil, vioxx, surmontil, darvocet, prargil, TB skin test
Current Illness:
Preexisting Conditions: Fibromyalgia, herniated back disc
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEA: MEASLES (ATTENUVAX)MERCK & CO. INC.1042K0SCLA
Administered by: Public     Purchased by: Other
Symptoms: Lymphadenopathy
SMQs:
Write-up: L elbow regional lymphadenopathy

VAERS ID:166935 (history)  Vaccinated:2001-02-26
Age:0.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Male  Submitted:2001-02-26, Days after onset: 0
Location:Oklahoma  Entered:2001-03-12, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5155B90IMLL
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The pt experienced a red rash on face and trunk. Denies any respiratory distress. The mother was questioned about hive like appearance and she was unsure. Advised to call MD. Treated with Benadryl.

VAERS ID:166973 (history)  Vaccinated:2001-02-26
Age:4.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Male  Submitted:2001-02-28, Days after onset: 1
Location:California  Entered:2001-03-12, 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: PPD,Connaught, lot 00390P,L arm
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESW357CA4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T02663SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1712J1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site inflammation
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: redness injection site, hot to touch, inflammation.

VAERS ID:167037 (history)  Vaccinated:2001-02-26
Age:1.5  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-03-02, Days after onset: 4
Location:Massachusetts  Entered:2001-03-13, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0278CA3IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R050722 LL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733460IMRL
Administered by: Private     Purchased by: Other
Symptoms: Gait disturbance, Injection site pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Pain in right leg, shaky leg, limping, fever to 102F. Symptoms are subsiding by 3/1/01. Last temperature was on 2/27/01.

VAERS ID:167053 (history)  Vaccinated:2001-02-26
Age:18.0  Onset:2001-03-01, Days after vaccination: 3
Gender:Female  Submitted:2001-03-05, Days after onset: 4
Location:Pennsylvania  Entered:2001-03-13, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM2953A40IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0999K1SCLA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES4688683IMRA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: This patient had redness and swelling of her right arm.

VAERS ID:167055 (history)  Vaccinated:2001-02-26
Age:11.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-03-06, Days after onset: 8
Location:Arizona  Entered:2001-03-13, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1057K2IMRA
Administered by: Other     Purchased by: Public
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow)
Write-up: This child presented to school nurses office 02/27/01 at 8:30 AM with a few scattered papules on both forearms and more diffuse maculo-papular rash upper and lower legs bilaterally. Afebrile. The family physician advised Benadryl for 6 days. Rash resolved on the 7th day.

VAERS ID:167136 (history)  Vaccinated:2001-02-26
Age:  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-03-07, Days after onset: 9
Location:Arizona  Entered:2001-03-14, 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: UTI (12/29/00)
Preexisting Conditions: Bronchiolitis; GERD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM978A20IMLA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1526K0IMRA
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1526K0IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.105330SCLA
Administered by: Private     Purchased by: Private
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)
Write-up: Screaming reaction, post vax with pertussis, which lasted approx. 6-8 hours.

VAERS ID:167157 (history)  Vaccinated:2001-02-26
Age:17.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-02-28, Days after onset: 2
Location:California  Entered:2001-03-15, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5173A20IMLA
Administered by: Public     Purchased by: Other
Symptoms: Application site oedema, Hypersensitivity, Injection site pain, Myalgia, Pharyngolaryngeal pain, Pyrexia, Viral infection
SMQs:, Rhabdomyolysis/myopathy (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Pt states onset of fever, myalgias and sore arm about 3 hours, post vax, while at work. On 2/27/01, in with complaint of sore throat, fever of 102.5F, myalgias and sore arm. No erythema. Edema at injection site. Improved on 2/28/01. Viral syndrome versus vaccine reaction.

VAERS ID:167158 (history)  Vaccinated:2001-02-26
Age:1.3  Onset:2001-03-05, Days after vaccination: 7
Gender:Male  Submitted:2001-03-08, Days after onset: 3
Location:New York  Entered:2001-03-15, 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: Diazepam, Ferrous sulfate; Mylicon, MVI plus fluoride; acetaminophen for fever; albuterol by nebulizer; Baclofen; Zantac
Current Illness: NONE
Preexisting Conditions: Profound psychomotor retardation, seizure disorder, status post perinatal asphyxia, who has had global developmental delay as well as spasticity and hearing loss. He has had speech therapy. Diet consists of tube feeds consisting of Pediasure with H2o flush per the G-tube. Pt is small for age. Previously dx''d with cerebral palsy, asthma, bronchopulmonary dysplasia.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1519K0IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1144K0IMRL
Administered by: Other     Purchased by: Private
Symptoms: Blood pressure increased, Pyrexia, Rash morbilliform
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Hypersensitivity (narrow)
Write-up: Rash dx''d by MD as vaccine induced measles on 3/7/01. Elevated temperature on 3/6/01 and 3/7/01 between 99F (R) and 100F (R). Pt is recovering. BP-98/62.

VAERS ID:167235 (history)  Vaccinated:2001-02-26
Age:2.3  Onset:2001-03-07, Days after vaccination: 9
Gender:Female  Submitted:2001-03-12, Days after onset: 5
Location:Colorado  Entered:2001-03-19, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4754403IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA526AA3IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01872 RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0258K0SCRL
Administered by: Private     Purchased by: Private
Symptoms: Infection, Pyrexia, Rash, Rash morbilliform, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Measles, rash, fever, rhinitis,Koplik''s spots.

VAERS ID:167239 (history)  Vaccinated:2001-02-26
Age:13.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-02-26, Days after onset: 0
Location:California  Entered:2001-03-19, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM679A20IMRA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD690 LA
Administered by: Other     Purchased by: Other
Symptoms: Headache, Hyperhidrosis, Injury, Loss of consciousness
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), Accidents and injuries (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt felt like she was going to pass out post 2 vaccines. Mom brought pt back to exam room and pt passed out, fell off exam table and hit pubic area. Pt was diaphoretic, clammy and c/o of headache, vital signs taken, pt stabilized.

VAERS ID:167258 (history)  Vaccinated:2001-02-26
Age:96.0  Onset:2001-02-28, Days after vaccination: 2
Gender:Female  Submitted:2001-03-15, Days after onset: 15
Location:Utah  Entered:2001-03-19, 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: B12/IM/RD
Current Illness: Hypertension, confusion
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4705930IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt developed redness at injection site, spreading from site down to elbow.

VAERS ID:167408 (history)  Vaccinated:2001-02-26
Age:35.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-02-28, Days after onset: 2
Location:Texas  Entered:2001-03-20, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7360BA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Asthenia, Difficulty in walking, Dizziness, Dyspnoea, Ear pain, Hyperhidrosis, Injection site erythema, Injection site oedema, Injection site pain, Lymphadenopathy, Muscle spasms, Pharyngolaryngeal pain, Photophobia, Pyrexia, Respiratory rate increased, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: Approximately 45 minutes post vax, the pt complained of left arm hurting at the injection site. That evening the arm still hurt but was now red, and swollen and hot to the touch. The pt experienced a high fever with sweats and shakes. He states his head felt like it was going to "explode". Like a migraine headache. Her chest felt like a weight was on it. She could not breathe easily, was breathing fast and deep. The pt experienced muscle spasms. They felt like convolutions in her body. She could not control them. She had light sensitivity and was sensitive to loud noises. She was weak, had trouble walking, sore throat, ear ache, loss of appetite, dizziness and tired. The lymph gland under th left arm pit was very painful and swollen. The left side of mer neck and down her shoulder blade was sore and achy.

VAERS ID:167722 (history)  Vaccinated:2001-02-26
Age:2.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:2001-02-28, Days after onset: 1
Location:North Carolina  Entered:2001-03-23, Days after submission: 23
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: NC01031
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725461 LL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This child had a large erythema reaction to Prevnar. Erythema measures 9 cm x 5.5 cm.

VAERS ID:167737 (history)  Vaccinated:2001-02-26
Age:16.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Male  Submitted:2001-03-05, Days after onset: 6
Location:Arkansas  Entered:2001-03-23, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: AR0116
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1657K0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Decreased appetite, Pharyngolaryngeal pain, Pyrexia, Somnolence, Throat tightness, Tinnitus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Hypersensitivity (broad)
Write-up: Subjective fever, ears ringing, sore throat and neck "feels" swollen. Also have a decreased appetite and increased sleep.

VAERS ID:167808 (history)  Vaccinated:2001-02-26
Age:11.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:2001-03-02, Days after onset: 3
Location:Oregon  Entered:2001-03-26, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;Rash;DTP (unknown mfr);;6;In Patient;;Vaccine not specified;;3;In Sibling
Other Medications: Prilosec prn
Current Illness: Mild stomach ache
Preexisting Conditions: "Nervous stomach"
Diagnostic Lab Data: UNK
CDC Split Type: OR200108
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5159A21IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Influenza like illness, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Had second Hep-B shot on 2/20/01. On 2/27/01, 2/28/01 and 3/01/01, had stomachache and vomiting. Also, had stomachache and vomiting after the 1st Hep-B on 1/24/01 with gradual improvement in stomach pain over 30 days. Referred to MD on 3/2/01 and he believes it is not related to the Hep-B series. Other children in the family, later, had the same flu-like symptoms who were not vaccinated.

VAERS ID:167853 (history)  Vaccinated:2001-02-26
Age:0.2  Onset:2001-02-28, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:California  Entered:2001-03-27
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
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM973A20IMRL
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3142A20IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T02660IMLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH4725560IMRL
Administered by: Military     Purchased by: Military
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The pt experienced a rash on legs with an onset date of 2/28/01.

VAERS ID:167862 (history)  Vaccinated:2001-02-26
Age:55.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:2001-02-28, Days after onset: 1
Location:Ohio  Entered:2001-03-27, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prempro
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESUO365AA IM 
Administered by: Public     Purchased by: Public
Symptoms: Back pain, Chest pain, Neck pain
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)
Write-up: On 2/27/01, 23:59 midnight (38 hours, post vax) client stated that she experienced soreness in the left chest area through to her back. States it hurts to turn head to the left. Pain relieved by aspirin. Referred to doctor.

VAERS ID:167894 (history)  Vaccinated:2001-02-26
Age:1.3  Onset:2001-03-09, Days after vaccination: 11
Gender:Female  Submitted:2001-03-20, Days after onset: 11
Location:Wisconsin  Entered:2001-03-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: hx of viral exanthem
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM950A23IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1797K IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1016K0SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733322IMRL
Administered by: Private     Purchased by: Private
Symptoms: Irritability, Rash morbilliform
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: The pt developed a morbilliform rash, and fussy for a couple of days.

VAERS ID:167933 (history)  Vaccinated:2001-02-26
Age:4.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:2001-03-19, Days after onset: 20
Location:California  Entered:2001-03-28, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergy to penicillin
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM981A24IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05053SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1167K1SCRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Pruritus, Rash vesicular, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Large swelling occupying most of the left thigh which developed 1-2 days, post vax. Skin erythematous with a few vesicular eruptions. Swelling lasted 5-6 days but redness and oozing vesicles lasted 7-8 days and subsided. Indurated, dark pigmentated 10cm X 10cm patchy area. Itching lasted 2 weeks.

VAERS ID:167961 (history)  Vaccinated:2001-02-26
Age:3.0  Onset:2001-03-16, Days after vaccination: 18
Gender:Male  Submitted:2001-03-16, Days after onset: 0
Location:North Carolina  Entered:2001-03-29, 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: Flovent, Nasonex, Zyrtec
Current Illness: Asthma
Preexisting Conditions: Asthma, allergic rhinitis
Diagnostic Lab Data:
CDC Split Type: NC01035
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4749360IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1148K0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Mother reports post vaccine child had red bumps on body.

VAERS ID:168023 (history)  Vaccinated:2001-02-26
Age:1.4  Onset:2001-02-28, Days after vaccination: 2
Gender:Male  Submitted:2001-03-12, Days after onset: 12
Location:Michigan  Entered:2001-04-02, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Foriole
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUA563AB (B)3 LL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA563AB (A)3 LL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T026623 RL
TTOX: TETANUS TOXOID (NO BRAND NAME)LEDERLE LABORATORIES4725483 RL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site induration, Injection site pain, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: The right leg has elevated erythema, induration, heat, pain, and some surrounding urticaria.

VAERS ID:168274 (history)  Vaccinated:2001-02-26
Age:0.3  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Rhode Island  Entered:2001-04-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild URI
Preexisting Conditions: Food allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES472550 IMLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Induration at injection site

VAERS ID:168322 (history)  Vaccinated:2001-02-26
Age:25.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:2001-03-19, Days after onset: 20
Location:Oregon  Entered:2001-04-04, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: antibiotics for URI (bronchitis)
Current Illness: URI Bronchitis (last stages)
Preexisting Conditions: Asthma, sensitivity to latex gloves
Diagnostic Lab Data:
CDC Split Type: OR200113
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3384A60IMRA
Administered by: Public     Purchased by: Public
Symptoms: Accident, Erythema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Hypersensitivity (narrow)
Write-up: Pt experienced rash on chest and face/scalp on 2/27/01 and complained of itchiness and redness, especially on face and scalp. States this lasted about 2 weeks after onset of symptoms on 2/27/01. States she had another bout of facial rash on 3/17/01. (Pt also exposed to chemicals at work site on the same date of 2/26/01).

VAERS ID:168844 (history)  Vaccinated:2001-02-26
Age:1.1  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:California  Entered:2001-04-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725561 LA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site oedema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: No data provided. A follow up report received 4/20/2001 adds: On evening of the Prevnar immunization (no other immunizations were given that date) mom noted redness, warmth and swelling at the injection site. The following day, the site was still warm and the redness and swelling was more extensive, approx 3 inches across the left arm. Mom also noted that the fingers and toes of both hands and feet were swollen and itchy. Mom called pediatrician and was advised to give Benadryl. Symptoms subsided quickly and are fully resolved.

VAERS ID:169892 (history)  Vaccinated:2001-02-26
Age:0.3  Onset:2001-04-02, Days after vaccination: 35
Gender:Female  Submitted:2001-05-07, Days after onset: 35
Location:Indiana  Entered:2001-05-16, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Physiologic GE Reflux
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0357CA0IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1521K0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T04840IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725520IMLL
Administered by: Private     Purchased by: Private
Symptoms: Petechiae, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad)
Write-up: Vaccine given 02/26/01; presented on 4/2/01 with petechial rash and platelet count 2,000. Dx''d with ITP by Labs and Bone marrow aspiration.

VAERS ID:170394 (history)  Vaccinated:2001-02-26
Age:0.6  Onset:2001-03-08, Days after vaccination: 10
Gender:Male  Submitted:2001-05-22, Days after onset: 74
Location:Kentucky  Entered:2001-05-31, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: father has hx of petit mal seizures as baby
Diagnostic Lab Data: EEG; Blood work; Cat Scan; X-rays
CDC Split Type: KY2001037
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0356AA2IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0002L2IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R14332SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733422IMLL
Administered by: Public     Purchased by: Unknown
Symptoms: Dyskinesia, Eye movement disorder, Grand mal convulsion, Opisthotonus, Postictal state
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Dystonia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: On 3/8/01 at 20:00, had grand mal seizure when lying in grandmother''s lap, 30 minutes after a bath. Head went back, eyes rolled back, clonic movements all extremities and cyanotic. Grandmother gave CPR. All of episode lasting 3-5 minutes. He was lethargic afterwards. No fever. Saw in ER. On 3/11/01, 30 minutes after a bath, had a grand mal seizure. No CPR. Seen in ER and hospitalized 3 days. On 3/12/01, had a seizure lasting 1-2 minutes. Dx''d with epilepsy. Put on Phenobarbital.

VAERS ID:170939 (history)  Vaccinated:2001-02-26
Age:1.0  Onset:2001-03-09, Days after vaccination: 11
Gender:Male  Submitted:2001-05-30, Days after onset: 81
Location:Unknown  Entered:2001-06-01, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data:
CDC Split Type: WAES01031017
Vaccination
Manufacturer
Lot
Dose
Route
Site
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.  IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0400K SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0446K0SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Infection, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Rash, fever - Information has been received from a health professional concerning a 14 month old male, with no known drug allergies. who on 26 Feb 2001 was vaccinated with measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live second generation lot 635125/0400k. Concomitant vaccines included one dose of varicella virus vaccine live MSD lot 635980/0446k and hib conj-hepatitis b vaccine MSD lot 636992/1174k. On 09 Mar 2001 the patient developed a red rash, without blisters or lesions, on her abdomen and neck and low grade fever.

VAERS ID:171370 (history)  Vaccinated:2001-02-26
Age:0.1  Onset:2001-03-04, Days after vaccination: 6
Gender:Female  Submitted:2001-06-04, Days after onset: 91
Location:New Hampshire  Entered:2001-06-14, Days after submission: 10
Life Threatening? No
Died? Yes
   Date died: 2001-03-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: NH0117
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS518A20IMLL
Administered by: Private     Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)
Write-up: The baby died from SIDS.

VAERS ID:172140 (history)  Vaccinated:2001-02-26
Age:2.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:2001-06-14, Days after onset: 106
Location:California  Entered:2001-06-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 1IM 
Administered by: Private     Purchased by: Private
Symptoms: Dysphemia, Eye disorder, Tic, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: Morning after began severe stuttering with facial tics, twitching eyes, shaking and was completely gone on the 4th day, as suddenly as it began. Dx''d over phone and given steps for stopping stuttering.

VAERS ID:172703 (history)  Vaccinated:2001-02-26
Age:3.0  Onset:2001-02-28, Days after vaccination: 2
Gender:Male  Submitted:2001-04-16, Days after onset: 46
Location:Tennessee  Entered:2001-07-02, Days after submission: 77
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: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC Split Type: HQ8170508MAR2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733310IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Injection site reaction. A physician reported that a 3 yr old male received 1st dose of Prevnar 2/26/01 he developed a rash 5cm by 6cm in area at the injection site. The rash was red in the middle surrounded by a raised red ring. The physician stated the rash resembled ring worm. the child was treated with diphenydramine. He recovered 3/5/01.

VAERS ID:172778 (history)  Vaccinated:2001-02-26
Age:0.2  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-04-10, Days after onset: 42
Location:Texas  Entered:2001-07-03, Days after submission: 84
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO371AB0IM 
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA562AB, UA387A0IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05610IM 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733490IM 
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Decreased appetite, Hypokinesia, Screaming
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt developed extreme crying for 48 hrs. She had 3 minutes of tonic clonic seizures 26 hrs after shots. She had decreased activity and eating for 4 days.

VAERS ID:175867 (history)  Vaccinated:2001-02-26
Age:1.0  Onset:2001-06-17, Days after vaccination: 111
Gender:Female  Submitted:2001-08-16, Days after onset: 60
Location:Ohio  Entered:2001-10-01, Days after submission: 46
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: 07/00/01 - Blood Culture - Positive for streptococcus pneumoniae within 24 hours. Repeat culture on day 5 was negative. White Blood Cell Count - increased mildly elevated with no shift. Erythrocyte Sedimentation Rate - increased. Ultrasound
CDC Split Type: HQ3830330JUL2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733332IM 
Administered by: Private     Purchased by: Private
Symptoms: Bacterial infection, Bone disorder, Pyrexia, Red blood cell sedimentation rate increased, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: A 12 month old female completed the series of Prevnar injections in February 2001. The patient was not receiving concomitant therapy and she had no preexisting illnesses at the time of vaccination. In July 2001 (at the age of 17 months), the patient was hospitalized for Streptococcal pneumoniae osteomyelitis. An unspecified culture was positive for streptococcus pneumoniae. Follow-up information received on 08/03/01 indicated that the child was previously well and considered up to date on her Prevnar vaccinations having received her 3rd dose in 02/01. She presented in June 2001, with a 2 day history of fever between 102 and 103 deg. F. and favoring her left leg. She was seen in the ER on day 2 of illness where examination revealed a blood culture positive for Streptococcus pneumoniae, "mildly" elevated white blood cell count with no shift, and increased erythrocyte sedimentation rate. Ultrasound of hip on day 2 and bone scan on day 3 were negative; however, an MRI on day 4 was positive. A repeat blood culture on day 5 was negative. She was initially treated with IV nafcillin, then switched over to ceftriaxone for 1 week. She then began oral amoxicillin with plans to continue treatment for three weeks. As of 08/03/01, plans were to repeat the bone scan at the end of antibiotic treatment for further evaluation. The S. pneumoniae isolate was not serotyped; however, arrangements were being made to have this done. Follow-up information was received from the original reporter on 08/15/01, which provided the lot numbers and dates of Prevnar doses administered. Also, the patient''s birthday was provided; the patient was 15 months of age (several days shy of 16 months) when the events occurred (06/17/01). The following patient had no preexisting illnesses at the time of the vaccination and had no history of adverse events following previous vaccination. The reporter also noted that the patient received Varivax (MSD) and Engerix B (SKB) vaccines within 4 weeks of receiving Prevnar, but dates were not provided. The patient

VAERS ID:179200 (history)  Vaccinated:2001-02-26
Age:4.0  Onset:2001-12-11, Days after vaccination: 288
Gender:Male  Submitted:2001-12-11, Days after onset: 0
Location:West Virginia  Entered:2001-12-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1246K0 LA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Four to five lesions, itching.

VAERS ID:180376 (history)  Vaccinated:2001-02-26
Age:  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2001-03-09, Days after onset: 11
Location:Virginia  Entered:2002-01-24, Days after submission: 321
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: 2001006233
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5166A20IMLA
Administered by: Other     Purchased by: Other
Symptoms: Hypoaesthesia, Peripheral coldness
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: On 26 February 2001, the vaccinee received her first left deltoid "adult" dose of Engerix-B. Post-vaccination, on 26 February 2001, the vaccinee experienced numbness and cold sensation in her left arm. As of 6 March 2001, the outcome of the events was resolved.

VAERS ID:185841 (history)  Vaccinated:2001-02-26
Age:1.6  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:2002-05-16, Days after onset: 443
Location:Puerto Rico  Entered:2002-05-31, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: The vaccinee has no recorded illness or allergies
Diagnostic Lab Data: UNK
CDC Split Type: A0344404A2001005976
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM983A21  
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEUR 0IMLL
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEUR 0IMLL
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This report describes injection site redness and swelling in a 19-month ol female who received DTaP. In 04/00, the vaccinee received her first dose of Infanrix; No adverse events were reported. On 02/26/01, the vaccinee received her second dose of Infanrix. She also received IPv IM, ACTHIB IM. Post-vaccination, on 02/26/01, the vaccinee experienced redness and swelling at the site of the injection. The pt was taken to the local hospital following the incident, where an unspecified intravenous antibiotic was administered. The vaccinee recovered on 02/27/01 w/out complications. The vaccine provider considered these events to be posssibly related to the administration of IPOL and ACTHIb. As of 03/06/01, the outcome of the events were recovered. The Infanrix dosing schedule was interrupted.

VAERS ID:186340 (history)  Vaccinated:2001-02-26
Age:43.0  Onset:2001-02-26, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Kentucky  Entered:2002-06-12
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: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEURU0365AA  LL
Administered by: Private     Purchased by: Unknown
Symptoms: Back pain, Headache, Hyperhidrosis, Muscular weakness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Fever, muscle weakness, headache, sweating, back pain around the shoulders.

VAERS ID:187520 (history)  Vaccinated:2001-02-26
Age:1.0  Onset:2001-03-27, Days after vaccination: 29
Gender:Male  Submitted:2002-05-30, Days after onset: 428
Location:Texas  Entered:2002-07-15, Days after submission: 46
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES01050113
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0012L0SCRL
Administered by: Private     Purchased by: Private
Symptoms: Cough, Decreased appetite, Oedema, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning a 13 month old white male with no known allergies and no pertinent medical history who on 02/26/2001 was vaccinated SC in the right lateral thigh with a first dose of MMR II. There was no illness at the time of vaccination. On 03/27/2001, the pt experienced fever, cough, poor appetite, swollen tonsils and a slight rash. It was noted that the pt presented to the office with a several day history of the fever, cough and decreased appetite. No treatment was given. Subsequently, the pt recovered. No further info is available.

VAERS ID:188401 (history)  Vaccinated:2001-02-26
Age:63.0  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:2002-08-01, Days after onset: 519
Location:Washington  Entered:2002-08-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Glucopaz,Amaryl,Insulin Humulin,Procardia,Cozaar,Triam,Ducolax,Pravachol,Doxapin,MetrocarbamolAspirin, Nitro patch
Current Illness: 2/26/01 Office visit for tx of viral influenza, Rx for Erythromycin 2/27/01
Preexisting Conditions: Type II diabetes, hypertension
Diagnostic Lab Data: EKG on 3/22 in ER. Unknown results.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0365880IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest pain, Cough, Furuncle, Heart rate increased, Muscular weakness, Nausea, Pyrexia, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Write-up: Td receiv''d for clean nail stepped on Jan ''01. W/in 24 hrs, temp 101,cough,emesis;Erythromycin started. Next 3wks experienced pain in chest, rapid pulse, pronounced muscle weakness. Mar 14th boil on(R)hip. Mar 22nd to ER for tremors, nausea. Currently(L)side weak,drops items occasionally.

VAERS ID:190792 (history)  Vaccinated:2001-02-26
Age:13.0  Onset:2001-02-28, Days after vaccination: 2
Gender:Female  Submitted:2001-11-17, Days after onset: 262
Location:Minnesota  Entered:2002-09-30, Days after submission: 316
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: No previous history of migraine
Diagnostic Lab Data:
CDC Split Type: U200100497
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURR11700IM 
Administered by: Private     Purchased by: Unknown
Symptoms: Migraine, Visual disturbance
SMQs:, Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: It was reported that a 13 year old female patient received a Typhim VI vaccination on 02/26/01.Reportedly 48 hours after vaccination, the patient developed a migraine headache and lose of vision in one eye for 20 minutes. These symptoms repeated again in 24 hours. Further information is requested.

VAERS ID:204491 (history)  Vaccinated:2001-02-26
Age:1.0  Onset:2001-03-14, Days after vaccination: 16
Gender:Female  Submitted:2003-05-30, Days after onset: 806
Location:Unknown  Entered:2003-06-04, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;Measles + Mumps + Rubella (MMR II);;1;In Sibling
Other Medications:
Current Illness:
Preexisting Conditions: Hyperbilirubinaemia
Diagnostic Lab Data:
CDC Split Type: WAES0303USA02028
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0015L   
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Otitis media
SMQs:
Write-up: Information has been received from a nurse concerning a 12 month old female patient with a history of hyperbilirubinemia at birth and no concomitant medication who on Feb 26, 2001 was vaccinated with a dose of MMR II (lot # 635922/0015L). Concomitant therapy on Feb 26, 2001 included a dose of varicella virus vaccine live (lot #1342K not valid for this product). It was reported that the patient was well at the time of vaccination. The patient visited the office on March 2001 for right otitis media. It was also reported that the child was back in the office on March 2001 for a visit and the right otitis media was still present. It was reported that the patient was not hospitalized. Additional information has been requested. The reporter indicated that the patient''s sibling also had an experience (WAES0302USA00161).

VAERS ID:211705 (history)  Vaccinated:2001-02-26
Age:18.0  Onset:2003-10-20, Days after vaccination: 966
Gender:Female  Submitted:2003-10-29, Days after onset: 9
Location:Massachusetts  Entered:2003-11-05, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 200302795
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUA298AA0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Meningitis
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow)
Write-up: It was reported that a 20 year old female pt received Menomune , lot UA298AA, administered SC in the rigth arm at 9:30am on 2/26/01. The pt developed meningococcemia secondary to Group C N. meningitis, on 10/20/03. The pt was hospitalized and still remains in the ICU. She has not recovered from these events. No other info was reported. From additional information obtained on 11/3/03 from a telephone contact with the reporting physician, it was reported that the physician spoke with the patient''s father who reported that the patient was still in the intensive care unit and was intubated and in renal failure. Additionally, the patient may lose her fingertips due to the vasopressive therapy she is undergoing. From additional information received on 11/6/03 from the responsible physician, it was reported that the patient also received a Mantoux tuberculin skin test (lot number and manufacturer not reported) on 2/26/01 at the same doctor''s visit. No other information was provided at this time.

VAERS ID:220732 (history)  Vaccinated:2001-02-26
Age:4.2  Onset:2004-05-13, Days after vaccination: 1172
Gender:Female  Submitted:2004-05-13, Days after onset: 0
Location:Georgia  Entered:2004-05-19, 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: ROM
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0954J3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1274K0SCRA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725553IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1148K0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Child broke out with chicken pox.

VAERS ID:224567 (history)  Vaccinated:2001-02-26
Age:1.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:New York  Entered:2004-07-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER1231K SC 
Administered by: Other     Purchased by: Other
Symptoms: Bacterial infection, Vaccine positive rechallenge
SMQs:
Write-up: Varicella infection/Clinical.

VAERS ID:358618 (history)  Vaccinated:2001-02-26
Age:1.0  Onset:2009-09-16, Days after vaccination: 3124
Gender:Male  Submitted:2009-09-18, Days after onset: 2
Location:North Carolina  Entered:2009-09-28, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: Clinical observation.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.09391L0SCUN
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Rash papular, Rash pustular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Small red papule pustules on groin area, back, abdomen & bottom.

VAERS ID:168405 (history)  Vaccinated:2001-02-26
Age:  Onset:2001-03-01, Days after vaccination: 3
Gender:Male  Submitted:2001-03-29, Days after onset: 28
Location:Foreign  Entered:2001-04-09, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Paracetamol, Nystatin
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: HQ8664521MAR2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURERA937A2A5121IM 
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS217AD7A1IM 
MNC: MENINGOCOCCAL (MENINGITEC)PFIZER/WYETH436201IM 
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER 1PO 
Administered by: 0     Purchased by: 0
Symptoms: Hypersensitivity, Oedema genital, Rash maculo-papular, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: It was reported that a male pt received Meningitec, DPT, haemophilus influenza type B and oral poliovirus vaccines on 2/26/01. On 3/1/01, the pt developed a "diffuse" maculo-papular erythematous rash with swelling of the face and perineum. The reporter indicated that this was a questionable allergic reaction. He was hospitalized.

VAERS ID:168414 (history)  Vaccinated:2001-02-26
Age:0.7  Onset:2001-02-27, Days after vaccination: 1
Gender:Female  Submitted:2001-03-26, Days after onset: 27
Location:Foreign  Entered:2001-04-09, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: LP-did not confirm the dx of Guillain-Barre Syndrome
CDC Split Type: WAES01031711
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPIPV: DTP + IPV (NO BRAND NAME)SANOFI PASTEURR07742IM 
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1408J1IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Neurological symptom
SMQs:
Write-up: Information has been received from a healthcare professional concerning an 8 month old female pt who on 2/26/01 was vaccinated and subsequently, approx. 1 or 2 days, post vax, the pt started to develop unclear neurological symptoms beginning in her feet, which at first looked like the beginning of Guillain-Barre Syndrome. The pt was hospitalized and an investigation was performed. It was reported that the pt was still suffering, as of 3/12/01, from unclear neurological symptoms, which mainly are the "tendency to over extension of her feet when being in upright position and trying to stand and combined with a difficult passive bending". It was reported that the file was to be closed. No further information is available. This is a consolidation of 2 reports concerning the same pt. It had been determined that WAES01031259 is a duplicate of WAES01031711. Therefore, WAES01031259 is being deleted from our files and the reports consolidated into WAES01031711. WAES01031259 was previously submitted to the FDA on 3/19/01.

VAERS ID:169041 (history)  Vaccinated:2001-02-26
Age:  Onset:2001-02-28, Days after vaccination: 2
Gender:Male  Submitted:2001-04-18, Days after onset: 48
Location:Foreign  Entered:2001-04-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U2001006360
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: 0     Purchased by: 0
Symptoms: Bacterial infection, Candidiasis, Rash, Skin disorder
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: On 2/28/01, the baby was unwell with a florid rash. He was admitted to the hospital. The hospital diagnosed impetigo and thrush. They felt it was unrelated to vaccination. The symptoms lasted until 3/5/01. At the time of this report, the child had recovered. No further information is expected. Case is closed.

VAERS ID:169147 (history)  Vaccinated:2001-02-26
Age:1.0  Onset:2001-02-28, Days after vaccination: 2
Gender:Male  Submitted:2001-04-23, Days after onset: 53
Location:Foreign  Entered:2001-04-27, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES01041513
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.  IM 
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: 0     Purchased by: 0
Symptoms: Bacterial infection, Candidiasis, Malaise, Rash, Skin disorder
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: On 2/28/01 the pt was unwell with a florid rash. He was admitted to the hospital. The hospital diagnosed him with impetigo and thrush. On 3/5/01 the pt recovered. It was felt that the pt''s symptoms were not related to the vaccines. No further information is expected. The case is closed.

VAERS ID:169363 (history)  Vaccinated:2001-02-26
Age:0.5  Onset:2001-02-27, Days after vaccination: 1
Gender:Male  Submitted:2001-04-27, Days after onset: 58
Location:Foreign  Entered:2001-05-03, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Brentan (miconazole)
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: U2001006630
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPIPV: DTP + IPV (NO BRAND NAME)BERNA BIOTECH, LTD0040 IM 
HIBV: HIB (ACTHIB)AVENTIS PASTEURT01021 IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site reaction, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: A foreign report from Aventis Pasteur Sa regarding events in Denmark. Case reported by Health Authorities through AP MSD Denmark. "It was reported that a 6 month old male was administered concomitantly an Haemophilus influenzae type B and a Diphtheria - Tetanus - Acellular Pertussis - inactivated Poliomyelitis (Ditekipol) vaccines. The day after he was hospitalized due to rash (site not reported). He recovered (duration of the symptoms not reported). Further data has been requested. F/U on 9/27/01: batch number of the vaccine (P2): T01021 (Act-Hib) and 0040 (Di-Te-Ki-Pol). The infant developed universal urticaria on face, spreading to trunk and lower extremities but primarily localized (injection site not reported) with redness and swelling 3cm in diameter. The infant was under Brentan (miconazole) but neither the indication nor the therapy dates were reported. To be noticed that mother of infant has hay fever. No further info is available. Case closed.

VAERS ID:166765 (history)  Vaccinated:2001-02-27
Age:0.3  Onset:2001-02-28, Days after vaccination: 1
Gender:Female  Submitted:2001-03-01, Days after onset: 1
Location:Virginia  Entered:2001-03-08, 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: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO371AA1IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1524K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05951IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733321IMRL
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Injection site induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: This infant''s right thigh had 2 distinct areas of 1 cm induration and redness.

VAERS ID:166823 (history)  Vaccinated:2001-02-27
Age:0.8  Onset:2001-02-27, Days after vaccination: 0
Gender:Male  Submitted:2001-02-28, Days after onset: 1
Location:Tennessee  Entered:2001-03-08, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747291IMLL
Administered by: Public     Purchased by: Public
Symptoms: Agitation, Blister, Choking, Dyspnoea, Hypersensitivity, Pharyngitis, Pyrexia, Rash, Rash maculo-papular
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Agranulocytosis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: The infant was taken to the PMD on 02/28/01 with a rash and a fever within 24 hours after his Prevnar injection. The patient is crying, irritable, chokes easily, dime sized, red maculo-papular rash to the abdomen, buttocks, and shoulder since the night before, also blisters on the buttocks. Difficulty breathing this AM while eating. PMD feels it is a reaction to the vaccine does not recommend to repeat vaccine, also diagnosed pharyngitis.

VAERS ID:166831 (history)  Vaccinated:2001-02-27
Age:0.2  Onset:2001-02-27, Days after vaccination: 0
Gender:Male  Submitted:2001-03-05, Days after onset: 6
Location:Texas  Entered:2001-03-08, 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: Sacralfate, Prilosec.
Current Illness: NONE
Preexisting Conditions: Peptic Ulcer Disease.
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO341BA0IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA557AA0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T018720SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4725470IMLL
Administered by: Private     Purchased by: Private
Symptoms: Insomnia, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: This infant had fussiness within 24 hours after his shot lasting for more than 6 days, decreased sucking, and difficulty falling asleep.

VAERS ID:166865 (history)  Vaccinated:2001-02-27
Age:4.5  Onset:2001-02-27, Days after vaccination: 0
Gender:Male  Submitted:2001-02-27, Days after onset: 0
Location:Massachusetts  Entered:2001-03-09, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of asthma, allergy to prelone and alupent
Diagnostic Lab Data: O2 sats - 99-100%, Temp of 96.3, Heart rate- 80
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0313BA4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T012123SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0404L1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Hypersensitivity, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: The mother came to the office with the pt at 2:15 pm stating "allergic reaction to shots" from earlier in AM. The pt received the vaccines around 11:30 - 11:45 on 2/27/01. The pt was presented with right entire face was raised and red. Treated with epinephrine and Benadryl.

VAERS ID:166984 (history)  Vaccinated:2001-02-27
Age:1.7  Onset:2001-03-02, Days after vaccination: 3
Gender:Female  Submitted:2001-03-02, Days after onset: 0
Location:Massachusetts  Entered:2001-03-12, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0299BA3IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T01212SCLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733460IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Vaccine received on 2/27/01 and had 2.5 cm red area with induration. Temperature was 104F on 3/2/01 and then 100F (R), that day. Treated with Tylenol and cold compresses to the area. No more DTAP.

VAERS ID:167152 (history)  Vaccinated:2001-02-27
Age:64.0  Onset:2001-02-27, Days after vaccination: 0
Gender:Female  Submitted:2001-03-06, Days after onset: 7
Location:Alabama  Entered:2001-03-14, 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: Premarin; K+; ASA; Cartiaxt; HTCZ; Vit C & E.
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.040815 SCRA
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES471637 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt states that area at TD site (LA) was swollen, red, deep pain and "swelling at night". All symptoms starting "next day". Took Tylenol approx. 8 hours, post vax. Started compresses (heat) "next day".

VAERS ID:167196 (history)  Vaccinated:2001-02-27
Age:1.0  Onset:2001-03-01, Days after vaccination: 2
Gender:Female  Submitted:2001-03-10, Days after onset: 9
Location:Washington  Entered:2001-03-16, 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: FU: cultures were returned on 3/12/01 showed that child was infected with rotovirus. No treatment given as infection had almost run its course.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1091J2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1710J0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747240IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1154K0SCLL
Administered by: Other     Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Diarrhea, vomiting X 1 day, fever (100-102F) X 5 days.

VAERS ID:167201 (history)  Vaccinated:2001-02-27
Age:3.5  Onset:2001-03-01, Days after vaccination: 2
Gender:Female  Submitted:2001-03-05, Days after onset: 4
Location:Illinois  Entered:2001-03-16, 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: 2/27/01 on Cefzil and Pan Mist for cold and OM
Current Illness: Cold and OM
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733320IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Reddened area, 2 days post vax, given in right deltoid. Area seen on 3/2/01 the size of 9cm X 10cm was reddened and warm to touch. Denies pain. Complains of being "itchy". Started Benadryl and Augmentin.

VAERS ID:167843 (history)  Vaccinated:2001-02-27
Age:2.3  Onset:2001-03-01, Days after vaccination: 2
Gender:Male  Submitted:2001-03-19, Days after onset: 18
Location:Vermont  Entered:2001-03-27, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733320IMLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Fever, complaining of leg pain X 2 days, large red and tender area 7.5cm X 11cm. Dx''d with local reaction at Prevnar site.

VAERS ID:167844 (history)  Vaccinated:2001-02-27
Age:1.5  Onset:2001-03-01, Days after vaccination: 2
Gender:Female  Submitted:2001-03-19, Days after onset: 18
Location:Vermont  Entered:2001-03-27, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bilateral serous otitis media
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3329A22IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733320IMLL
Administered by: Private     Purchased by: Public
Symptoms: Gastroenteritis, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Noninfectious diarrhoea (broad)
Write-up: Complained of pain to left thigh and red. Triage done, seen by MD on 3/4-3/6 for ? viral GE.

VAERS ID:168191 (history)  Vaccinated:2001-02-27
Age:70.0  Onset:2001-02-27, Days after vaccination: 0
Gender:Female  Submitted:2001-03-29, Days after onset: 30
Location:Oregon  Entered:2001-04-03, 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: Estinyl, Ogen cream,benadryl
Current Illness:
Preexisting Conditions: Allergies: pollens, house dust, Clindamycin, some foods
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0945K IMLA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Erythema, Pain, Pruritus, Rash macular, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Swelling and pain started within 1/2 hr after shot given - extreme by night fall. Advised to use ice and aspirin. Red blotches appeared on entire upper arm following day. Chills the first night. Pain replaced by itching after 2 days. All symptoms gone after a week.

VAERS ID:168656 (history)  Vaccinated:2001-02-27
Age:3.0  Onset:2001-02-27, Days after vaccination: 0
Gender:Female  Submitted:2001-02-27, Days after onset: 0
Location:Texas  Entered:2001-04-13, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: TX01026
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS618A91IMLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4747260IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Child received Hep-A #2 and Pneumococcal conjugate. Had no reaction to Hep-A #1. Injection site clear; no redness or swelling noted. Small rash on face (cheeks) and on arms. Rash was mild; no hives noted; child playing. No itching noted. Treated with Benadryl po.

VAERS ID:168701 (history)  Vaccinated:2001-02-27
Age:45.0  Onset:2001-02-28, Days after vaccination: 1
Gender:Female  Submitted:2001-03-01, Days after onset: 1
Location:Texas  Entered:2001-04-13, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin, Tenormin
Current Illness: sinus infection
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: TX01038
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIES7345AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site abscess, Injection site erythema, Injection site mass, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Following vax, the pt developed a pustule at the site of the injection. The next day a knot developed about 2 cm below the injection site and it was red and warm to the touch. The pt experienced tenderness around the knot and under the left arm. The pt denies a fever. The pt took Tylenol and was using warm packs at site on arm.

VAERS ID:168791 (history)  Vaccinated:2001-02-27
Age:39.0  Onset:2001-03-03, Days after vaccination: 4
Gender:Female  Submitted:2001-03-09, Days after onset: 6
Location:Washington  Entered:2001-04-17, Days after submission: 38
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: WA011743
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1181K SCLA
Administered by: Public     Purchased by: 0
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pain, Pruritus, Pyrexia, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: 5-6 days, post vax, left arm was swollen and red, hot, burning and itchy and discolored. Had a low-grade fever, then aches and pains all over. Then arm was even more sore, swollen and hurt under her arm so she saw a doctor on 3/8/01. Treated with Keflex 500mg. Fever broke on night of 3/8/01.

VAERS ID:170138 (history)  Vaccinated:2001-02-27
Age:0.3  Onset:2001-02-28, Days after vaccination: 1
Gender:Male  Submitted:2001-05-15, Days after onset: 75
Location:Pennsylvania  Entered:2001-05-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0356BA1IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1039K1IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05611SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4720471IMRL
Administered by: Private     Purchased by: Private
Symptoms: Ear disorder, Eye discharge, Infection, Lacrimation increased, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lacrimal disorders (narrow)
Write-up: Ear infection; tearing eyes with green discharge; fevers and vomiting.

VAERS ID:172004 (history)  Vaccinated:2001-02-27
Age:0.2  Onset:2001-03-01, Days after vaccination: 2
Gender:Female  Submitted:2001-06-13, Days after onset: 103
Location:Michigan  Entered:2001-06-19, 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: No well baby
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO371AB0IMRL
HIBV: HIB (HIBTITER)PFIZER/WYETH4747150IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T050520SCLL
PNC: PNEUMO (PREVNAR)PFIZER/WYETH4725540IMLL
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis contact, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Patient was seen in office for hives on face (chin, cheeks only). Dr thought possible contact dermatitis. Pt has been in since 4/27/01 for her 4 months series and received Pneumococcal #2 without problems.

VAERS ID:172006 (history)  Vaccinated:2001-02-27
Age:1.0  Onset:2001-06-08, Days after vaccination: 101
Gender:Male  Submitted:2001-06-12, Days after onset: 4
Location:Ohio  Entered:2001-06-19, 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: blood culture + for strep pneumoniae. urine -neg, CxR nl, CBC - nl, UA- nl
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES471221 IMLL
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Infection, Irritability, Pharyngitis, Pneumonia, Pyrexia, Rhinitis
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow)
Write-up: 6/8/01 cold symptoms. Fever 105.1F irritability. diarrhea. blood culture positive for Strep pneumoniae (pain sensitive) Pt had received 3 doses of Prevnar. Received ceftniaxone times 1 then po Augmentin.

VAERS ID:172670 (history)  Vaccinated:2001-02-27
Age:1.5  Onset:2001-03-04, Days after vaccination: 5
Gender:Female  Submitted:2001-04-16, Days after onset: 42
Location:New York  Entered:2001-07-02, Days after submission: 77
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: Ear infection NOS
Diagnostic Lab Data: UNK
CDC Split Type: HQ8237409MAR2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: A mother reported that her 18 month old daughter received Prevnar, poliomyelitis and DTP vaccines on 2/27/01. On 3/4/01, she developed a fever of 103F and severe diarrhea. On 3/5/01, she developed vomiting. She was treated with ibuprofen. As of 3/6/01, her symptoms persisted.

VAERS ID:172704 (history)  Vaccinated:2001-02-27
Age:0.7  Onset:2001-02-27, Days after vaccination: 0
Gender:Male  Submitted:2001-05-15, Days after onset: 76
Location:Florida  Entered:2001-07-02, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: HQ8176108MAR2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES    
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.    
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 1IM 
Administered by: 0     Purchased by: 0
Symptoms: Oedema, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Urticaria. A physician reported that pt received Prevnar, Tripedia, and IPV vaccines and subsequently developed urticaria swelling. The onset of the adverse event was 1 hr post immunization. He recovered.

VAERS ID:179264 (history)  Vaccinated:2001-02-27
Age:1.0  Onset:2001-12-06, Days after vaccination: 282
Gender:Male  Submitted:2001-12-06, Days after onset: 0
Location:Pennsylvania  Entered:2001-12-19, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1141K0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Present vesicles and papules on buttocks, inner thighs. Lesions lower legs some on pharynx.

VAERS ID:183230 (history)  Vaccinated:2001-02-27
Age:4.0  Onset:2002-02-04, Days after vaccination: 342
Gender:Male  Submitted:2002-04-01, Days after onset: 56
Location:New Hampshire  Entered:2002-04-08, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1333K0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Infection
SMQs:
Write-up: Varicella rash/illness with recovery in approx. 8 days. No further symptoms as of 2/14/02.

VAERS ID:183257 (history)  Vaccinated:2001-02-27
Age:1.6  Onset:2001-03-01, Days after vaccination: 2
Gender:Male  Submitted:2001-03-12, Days after onset: 11
Location:California  Entered:2002-04-09, Days after submission: 392
Life Threatening? No
Died? Yes
   Date died: 2001-03-01
   Days after onset: 0
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: Probable primary site of this child''s infection is an upper respiratory tract infection.
CDC Split Type: CA010144
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1237H3IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4733510IMRL
Administered by: Public     Purchased by: Public
Symptoms: Bacterial infection, Brain oedema, Coma, Cyanosis, Gastrointestinal disorder, Haematoma, Injury, Nervous system disorder, Petechiae, Pyrexia, Renal disorder, Sepsis, Tracheitis, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Administered 0.5cc of Prevnar, RT, IM and 0.5cc of Hib, LT, IM per doctor''s orders. Per F/U 4/15/02: Group A Streptococcal Sepsis, tracheitis and bronchitis (chronic); cerebral edema with herniation of brain, temperal lobe; thymic petechiae; S/P attempted resuscitation; Blunt force injury of abdomen-laceration of the gastro-splenic ligament, avulsive, recent; retroperitoneal and perinephric hematoma, left (10ml), recent; hemoperitoneum (35ml); blunt force injury of right leg with contusion of thigh, small, organizing; child''s abdominal injury is inconsistent with resuscitative efforts. The child was reportedly found unresponsive in his crib by his mother on 3/1/01 AM. She and the child''s grandmother are reported to have initiated CPR and called for EMS. EMS found the decedent "unresponsive and cyanotic" at the scene and transported him to the ER. The child''s body temperature (R) was measured at 107.9F at the ER.

VAERS ID:198346 (history)  Vaccinated:2001-02-27
Age:1.5  Onset:2001-03-11, Days after vaccination: 12
Gender:Male  Submitted:2003-02-20, Days after onset: 711
Location:Massachusetts  Entered:2003-02-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; INTAL; Benadryl
Current Illness: NONE
Preexisting Conditions: Asthma; Autistic disorder; Disability NOS; Food allergy; Wart
Diagnostic Lab Data: Body height measurement: 39 inches; Body weight measurement: 40 pound;
CDC Split Type: WAES0302USA01300
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.635452/0788K1SC 
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Autism, Clumsiness, Difficulty in walking, Hypotonia, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a pediatrician concerning a 19 month old male with asthma, food allergies and warts on his abdomen who on 12/4/00, at 15 months, was vaccinated with a first dose of varicella virus vaccine live (lot # 635454/1144K). On 2/27/01, at 18 months old, he was vaccinated with the second dose of varicella virus vaccine live. Concomitant therapy included alum, potassium (+) diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid (TRIPEDIA) (lot # U029915A), poliovirus vaccine (IPOL) (lot # R0692), cromolyn sodium (INTAL), diphenhydramine HCl (BENADYRL), and albuterol nebulizer (manufacturer unknown). On 3/11/01, at 19 months old, the patient had an acute muscle weakness with flaccid muscle tone. Upon waking from his nap, he was found by his mother to be unable to sit or stand up. It was reported that the child was extremely floppy, although he was still able to suckle. Roughly 6 hours after the onset of the incident, the patient crawled out of his mothers lap and walked across the floor and appeared fine. It was noted that over the next couple of months the patient appeared increasingly clumsy and weak. Follow up information received from a nurse indicated that the child has severe handicaps and has several problems. It was also noted that the child was autistic. The patient''s severe handicaps, several problems, and autism were considered to be incidental findings. The reporter felt that the patient''s experience was possibly disabling. Additional information has been requested. Reported on 03/26/2003: "Follow up information received from a physician indicated that on 03/11/2001, the office received a phone call from the parents of the child stating that the child was not able to sit up, was "dizzy" when he sat up, and cried when he went up to sit. The child was seen in the office and was diagnosed with right otitis media and tonsillitis. On 03/21/2001, the mother reported that the patient was "much better." It was noted that the patient recovered. Follow up information received fr

VAERS ID:215756 (history)  Vaccinated:2001-02-27
Age:0.2  Onset:2001-02-27, Days after vaccination: 0
Gender:Female  Submitted:2004-01-26, Days after onset: 1063
Location:Illinois  Entered:2004-01-30, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0401USA01373
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1548K0  
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEUR    
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia, Rash, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a consumer concerning her 9 week old daughter who on 2/27/01, 5/1/01, and 1/9/02 was vaccinated with a first, second, and third dose of HIB conjugate vaccine (lot numbers 638138/1548K [also reported as 1548KO], 639437/0929L, and 639437/0929L respectively). Concomitant vaccination on 2/27/01 included a dose of diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid, a dose of poliovirus vaccine inactivated and an RV shot. The patient''s vaccination history was noted to include a first, second, and third dose of hepatitis B virus vaccine on 8/14/01 (lot # 640323/0753L), 11/19/01 (lot # 640323/0753L), and 1/9/02 (lot # 641449/1230L) respectively, a dose of MMR on 4/1/02 (lot # 638706/0745L [also reported as 0745LO], and a dose of varicella virus vaccine live on 1/9/02 (lot # 638244/0466L). After vaccination on 2/27/01, the patient experienced a severe urinary infection. The patient was sent to the hospital and remained there for two days. The mother also reported that each time the patient had a shot (any shot), she experienced a rash around the diaper area and a fever. While in the hospital the patient was given antibiotics to treat the urinary infection. The mother was told to just wait through the fevers. The patient recovered from the urinary infection but will be given a series of tests to determine what vaccine or ingredient of the vaccine she is allergic to. It was noted that therapy with HIB conjugate vaccine was discontinued. A product quality complaint was not involved. Additional information has been requested. Follow up on 03/22/04 states: "Additional information was received from a physician which indicated that the Hib conj vaccine (OMPC) was not administered in his office. No further information is expected."

VAERS ID:237946 (history)  Vaccinated:2001-02-27
Age:1.0  Onset:2004-05-03, Days after vaccination: 1161
Gender:Female  Submitted:2005-05-16, Days after onset: 378
Location:California  Entered:2005-05-24, 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: UNK
CDC Split Type: WAES0405USA00417
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Private     Purchased by: Public
Symptoms: Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 4 year old female with no allergies or medical history who at 12 months of age 4 was vaccinated SC with a 0.5ml dose of varicella virus vaccine live. There was no concomitant medication. There was no illness at the time of vaccination. On 5/3/04, the patient came to the physician with a breakout of 20 lesions. No treatment was required. It was noted that therapy was discontinued. A product quality complaint was not involved. Follow up information received from the physician who indicated that the patient had a break through varicella with about 70 lesions. Subsequently, the patient recovered. No further information is expected.

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