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Case Details (Sorted by Vaccination Date)

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VAERS ID: 124762 (history)  
Age: 0.2  
Gender: Male  
Location: Ohio  
Vaccinated:1999-06-10
Onset:1999-06-10
   Days after vaccination:0
Submitted: 1999-06-14
   Days after onset:4
Entered: 1999-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457790 / 0 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2808A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402203A / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P00402 / 0 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Crying, Cyanosis, Hyperventilation, Hypotension, Pallor, Somnolence, Stupor
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: baby was treated w/phototherapy p/birth for hyperbilirubinemia;
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: p/vax pt had very poor pallor;dusky appearance;eyes fixed/starring;very minimal weak cry;respirations inc, tachycardia;mom & pt kept in office for over 30min for cont observation;pallor returned;hypotensive episode;slept extended period;


VAERS ID: 124774 (history)  
Age: 1.1  
Gender: Male  
Location: Texas  
Vaccinated:1999-06-10
Onset:1999-06-10
   Days after vaccination:0
Submitted: 1999-06-11
   Days after onset:1
Entered: 1999-06-15
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 1001460 / 3 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1616H / - LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1751H / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0313J / 0 RA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Agitation, Crying, Cyanosis, Oedema, Rash, Vasodilatation, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: cleft palate--s/p 2 surgeries w/o complications; NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 5min post vax swelling, entire body turned dark red, pulling @ ears/face; bumps appeared;screaming; 1 1/2hr later lips, finger tips turned blue, vomited;


VAERS ID: 124956 (history)  
Age: 0.2  
Gender: Male  
Location: Arizona  
Vaccinated:1999-06-10
Onset:1999-06-10
   Days after vaccination:0
Submitted: 1999-06-11
   Days after onset:1
Entered: 1999-06-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 1001460 / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0973AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0956 / 0 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Hypotonia, Hypoventilation, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: premature triplet born @ 34 weeks
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt was limp w/shallow breathing & not responsive for 2-3minutes;possible ALT;parents stimulated until woke up;


VAERS ID: 124992 (history)  
Age: 11.0  
Gender: Male  
Location: Georgia  
Vaccinated:1999-06-10
Onset:1999-06-10
   Days after vaccination:0
Submitted: 1999-06-10
   Days after onset:0
Entered: 1999-06-18
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1750H / - RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Hypotension, Muscle twitching, Nausea, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: ADHD, A/R, enunisis
Preexisting Conditions:
Diagnostic Lab Data: EEG ordered
CDC Split Type:

Write-up: p/vax pt fell to floor w/jerking motion which appeared to be a sz c/o nausea & feeling hot, cold compress applied;BP 90/60;placed on chair;exam per MD bottom lip swollen;EEG ordered to r/o sz disorder;


VAERS ID: 124993 (history)  
Age: 51.0  
Gender: Male  
Location: Washington  
Vaccinated:1999-06-10
Onset:1999-06-11
   Days after vaccination:1
Submitted: 1999-06-15
   Days after onset:4
Entered: 1999-06-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2888A4 / 4 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zocor x 1yr
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt reported macular papular rash started 24hr p/vax;urticaria as well;took DPH w/same relief;rash greatly dec by 6/15/99;rash on trunk & upper extremities;


VAERS ID: 125016 (history)  
Age: 27.0  
Gender: Female  
Location: Georgia  
Vaccinated:1999-06-10
Onset:1999-06-10
   Days after vaccination:0
Submitted: 1999-06-10
   Days after onset:0
Entered: 1999-06-21
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2908A6 / 0 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 564B6 / 0 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Bradycardia, Convulsion, Cyanosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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:

Write-up: immed p/vax pt exp syncopal episode;pt had sz like disturbance;color very muddy;MD called pt regained consciousness immed;VS BP 82/60, 106/62, P40-60;


VAERS ID: 125076 (history)  
Age: 54.0  
Gender: Male  
Location: New York  
Vaccinated:1999-06-10
Onset:1999-06-13
   Days after vaccination:3
Submitted: 1999-06-16
   Days after onset:3
Entered: 1999-06-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Arteriosclerosis, Cardiovascular disorder, Condition aggravated, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Died? Yes
   Date died: 1999-06-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: hypertension
Diagnostic Lab Data: An autopsy was performed & the COD was determined to be cardiovascular disease & HTN;
CDC Split Type: 19990139611

Write-up: pt who was reported in excellent health & did not have HTN, high cholesterol, or cardiovascular disease recv vax & was found dead;COD=cardiovascular disease & HTN


VAERS ID: 125134 (history)  
Age: 0.5  
Gender: Female  
Location: Oklahoma  
Vaccinated:1999-06-10
Onset:1999-06-11
   Days after vaccination:1
Submitted: 1999-06-15
   Days after onset:4
Entered: 1999-06-23
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0998410 / 0 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0575H / 0 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798M / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: mom reports dime size hard knot on rt legs appeared p/vax;still present following tuesday;


VAERS ID: 125154 (history)  
Age: 3.0  
Gender: Male  
Location: Florida  
Vaccinated:1999-06-10
Onset:1999-06-11
   Days after vaccination:1
Submitted: 1999-06-18
   Days after onset:7
Entered: 1999-06-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 902A2 / 2 RA / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1668H / 2 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792B / 2 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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: FL99018

Write-up: rt arm red, hot, swollen to 7 1/4" from where shot was given to elbow;lt arm 6";saw to MD p/talking w/on-call nurse 6/11/99;took DPH & Motrin;child had ant bites;


VAERS ID: 125230 (history)  
Age: 0.6  
Gender: Male  
Location: Ohio  
Vaccinated:1999-06-10
Onset:1999-06-15
   Days after vaccination:5
Submitted: 1999-06-21
   Days after onset:6
Entered: 1999-06-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 939790 / 3 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2808A2 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 412353M / 3 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: diarrhea 4 days prior to shots
Preexisting Conditions: lactose intolerance
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: p/vax pt devel red bumpy @ both sites on thighs, rash spread over thighs eval in office papular erythema & skin colored rash over both thighs from knee to upper thigh;


VAERS ID: 125249 (history)  
Age: 9.0  
Gender: Male  
Location: Unknown  
Vaccinated:1999-06-10
Onset:1999-06-17
   Days after vaccination:7
Submitted: 1999-06-17
   Days after onset:0
Entered: 1999-06-29
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 0 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt seen w/diffuse redness & large hive & itchiness @ site of shot;


VAERS ID: 125281 (history)  
Age: 18.0  
Gender: Female  
Location: Illinois  
Vaccinated:1999-06-10
Onset:1999-06-10
   Days after vaccination:0
Submitted: 1999-06-16
   Days after onset:6
Entered: 1999-06-30
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1141H / 2 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Hypersensitivity, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: BCP
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: IL99035

Write-up: p/vax broke out in hives w/a sl fever (about 100) the evening of 6/10/99;called the MD & said was having an allergic rxn to vax;took DPH & hives went away p/3 days;


VAERS ID: 125380 (history)  
Age: 0.0  
Gender: Female  
Location: Virginia  
Vaccinated:1999-06-10
Onset:1999-06-12
   Days after vaccination:2
Submitted: 1999-06-28
   Days after onset:16
Entered: 1999-07-07
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 0108J / 0 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cerebral ischaemia, Cerebral thrombosis, Laboratory test abnormal, Meningitis, Thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI sinus thrombosis
CDC Split Type:

Write-up: Aseptic Meningitis & Thrombosis of the Superior Sagittal Sinus in Brain 2 days p/vax; Annual follow-up dated 9/22/00 provided no additional data.


VAERS ID: 125443 (history)  
Age: 43.0  
Gender: Male  
Location: Oregon  
Vaccinated:1999-06-10
Onset:1999-06-11
   Days after vaccination:1
Submitted: 1999-06-22
   Days after onset:11
Entered: 1999-07-08
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1595H / 0 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Condition aggravated, Headache, Migraine, Visual disturbance, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pt exp hives w/Td @ age 38yr poss allerg rash;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: migraine h/a;amitrex, PCN, Percocet;PPD 1999 red area poss allergic 9?);
Diagnostic Lab Data:
CDC Split Type:

Write-up: migraines since 1st dose of vax p/18 hr w/migraine since, n/v, vision disturbances;h/a reported daily;


VAERS ID: 125669 (history)  
Age: 31.0  
Gender: Female  
Location: Maryland  
Vaccinated:1999-06-10
Onset:1999-06-11
   Days after vaccination:1
Submitted: 1999-06-11
   Days after onset:0
Entered: 1999-07-14
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568B6 / - LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4998088 / 0 LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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: amoxicillin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: p/vax pt exp red, hot & swollen at inject site


VAERS ID: 126429 (history)  
Age: 0.3  
Gender: Female  
Location: California  
Vaccinated:1999-06-10
Onset:1999-06-18
   Days after vaccination:8
Submitted: 1999-07-29
   Days after onset:41
Entered: 1999-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988066 / 0 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: atopic dermatitis, URI
Preexisting Conditions: NONE
Diagnostic Lab Data: barium enema 6/18/99
CDC Split Type:

Write-up: adm to hosp on 6/18/99 dx w/intuss;


VAERS ID: 126730 (history)  
Age: 19.0  
Gender: Female  
Location: New York  
Vaccinated:1999-06-10
Onset:1999-06-14
   Days after vaccination:4
Submitted: 1999-06-16
   Days after onset:2
Entered: 1999-07-30
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 0 - / -

Administered by: Private       Purchased by: Other
Symptoms: Face oedema, Headache, Myalgia, Urticaria, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Bone surgery
Diagnostic Lab Data:
CDC Split Type: 1999014021

Write-up: p/vax pt devel hives & swelling of lips;sx temporarily relieved w/antihistamines;next day pt devel low grade aches & pain which got worse;pt had muscle aches, h/a & by 6/14/99 pt presented to MD office vomiting;


VAERS ID: 126742 (history)  
Age: 48.0  
Gender: Female  
Location: Connecticut  
Vaccinated:1999-06-10
Onset:1999-06-11
   Days after vaccination:1
Submitted: 1999-06-21
   Days after onset:10
Entered: 1999-07-30
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 0 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Arthritis, Herpes zoster, Osteoarthritis, Rash
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 1999014383

Write-up: p/vax pt exp bullseye rash, joint swelling, arthritic pain, herpes zoster outbreak;tx w/percocet for post herpetic neuralgia;lymerix was discontinued;pt recovered;


VAERS ID: 127630 (history)  
Age: 0.11  
Gender: Male  
Location: Virginia  
Vaccinated:1999-06-10
Onset:1999-06-11
   Days after vaccination:1
Submitted: 1999-08-23
   Days after onset:73
Entered: 1999-08-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00795 / - - / IM
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988079 / 0 - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abnormal faeces, Gastrointestinal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Biliary system related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: bloody stools w/mucous daily for 6wk;no tx;no effect on appetite;no illness detected;no fever;no apparent pain. This patient had some blood stools - trace of blood for approximately 3 weeks afte receiving Rotateq. He has thrived since and is quite healthy, without any known adverse effects. No further studies were done.


VAERS ID: 128065 (history)  
Age: 15.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-06-10
Onset:1999-07-22
   Days after vaccination:42
Submitted: 1999-08-06
   Days after onset:15
Entered: 1999-09-07
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1399H / 0 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Ascites, Coordination abnormal, Coronary artery thrombosis, Ear pain, Encephalitis, Generalised oedema, Headache, Hypertonia, Hypokinesia, Infection, Meningitis, Myalgia, Myocarditis, Neck pain, Neuropathy, Otitis externa, Otitis media, Sepsis, Splenomegaly, Thinking abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? Yes
   Date died: 1999-08-01
   Days after onset: 10
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MMR & Td in ''98 w/o problem; none
Current Illness: none
Preexisting Conditions: Lorabid & PCN allergies; severe ear infections, usually otitis externa, H/A for many years, controlled w/ ibuprofen; no sz hx
Diagnostic Lab Data: CSF-no growth p/72hr;blood culture-no growth p/48hr; CT-nl; MRI-lt mastoiditis; CSF gram stain smear-mod. segmented WBC-no organisms
CDC Split Type: PA9956

Write-up: pt seen by FMD c/o lt ear pain; dx: otitis externa;7/26 c/o lt ear pain;h/a;off balance;dx OM;tx:Bactrim DS; 7/28-severe h/a,neck pain;difficulty walking;change in mental status,+ Kernig''s sign;hosp;IV Claforan, Vanco, Acyclovir; expired 8/


VAERS ID: 129001 (history)  
Age: 0.2  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-06-10
Onset:1999-06-14
   Days after vaccination:4
Submitted: 1999-06-16
   Days after onset:2
Entered: 1999-10-06
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0989570 / 0 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 410303A / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N07263 / 0 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / - - / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC count, blood cultures, urine cultures, CXR & LP-results were not provided;
CDC Split Type: 899169001L

Write-up: p/vax pt devel fussiness & a fever of 103.2 R;pt hosp for 1 day;CBC count, urine & blood cultures, CXR & LP performed-results were not provided;pt recovered; A 15-day follow up report received 10/28/2002 adds: It was reported, "A nurse reported that a 2-month-old male received Hib-Titer, Rota Shield, DTaP (Aventis Pasteur S) and IPV (Aventis Pasteur SA) vaccines on 06/10/1999. Four days later, he developed fussiness andn a fever of 103.2 deg. F rectally. He was hospitalized for 1 day. A complete blood count, urine and blood cultures, chest x-ray and lumbar puncture were performed; however, the results were not provided. The infant recovered". From additional info received on 10/21/1999, it was reported that the vaccine was purchased with public funds rather than private funds as previously reported. Follow-up #1 (08/22/2002): During internal review of all files, it was deemed necessary to amend the report by upgrading this case to a 15-Day Alert Report, due to this being serious unlabeled.


VAERS ID: 150218 (history)  
Age: 2.75  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-06-10
Onset:1999-06-10
   Days after vaccination:0
Submitted: 2000-01-06
   Days after onset:210
Entered: 2000-03-17
   Days after submission:71
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 3253A / 1 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: rash~DTaP (Tripedia)~ 1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WI9946

Write-up: Within 24 hours, post vax, pt developed speckly rash on trunk and fever of 102.


VAERS ID: 152647 (history)  
Age: 0.75  
Gender: Male  
Location: New York  
Vaccinated:1999-06-10
Onset:1999-09-01
   Days after vaccination:83
Submitted: 2000-02-04
   Days after onset:156
Entered: 2000-06-03
   Days after submission:119
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / IM
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 3 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Decreased appetite
SMQs:

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: malaise
Diagnostic Lab Data:
CDC Split Type: HQ7126201DEC1999

Write-up: In September 1999, the pt developed a decreased appetite.


VAERS ID: 154332 (history)  
Age: 44.0  
Gender: Male  
Location: West Virginia  
Vaccinated:1999-06-10
Onset:0000-00-00
Submitted: 1999-09-29
Entered: 2000-06-15
   Days after submission:260
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Allergy to PCN.
Diagnostic Lab Data:
CDC Split Type: 19990185961

Write-up: The pt received his first and second doses of vax on 05/06 and 06/10/99, respectively. Following second dose of vax, he experienced a hive-like reaction. No treatment was given. The vax was discontinued. Per physician: the risk of type 1 hypersensitivity was stronger that the risk of Lyme disease. The most recent information, received on 07/15 reports the condition of the pt is resolved.


VAERS ID: 154374 (history)  
Age: 69.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1999-06-10
Onset:1999-06-16
   Days after vaccination:6
Submitted: 1999-09-29
   Days after onset:105
Entered: 2000-06-15
   Days after submission:260
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Cranial nerve disorder, Facial palsy, Headache
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Headaches
Diagnostic Lab Data: MRI of brain-multiple white matter lesions on 5/26/99, Serum Lyme Antibody-slightly positive on 6/99, Spinal Fluid Lyme Serum-nonreactive in 6/99, Western Blot Serum IGG Lyme Ti-nonreactive in 6/99.
CDC Split Type: 19990194281

Write-up: On 4/26/99, the pt received her 1st Lymerix and her ongoing headaches persisted. A neurologist evaluated these headaches and he felt they were tension type with exacerbations of migraines. The radiologist felt the differential dx of such lesions included:deep white matter ischemic disease, MS, Lyme disease, and migraine headaches. She was treated with nortriptyline and Naprosyn. On 6/10/99, the pt received her 2nd dose of Lymerix and 6 days later, 6/16/99, she began to have left-sided facial weakness. Further evaluation revealed left-sided palsy. The physician stated this would be consistent with minimally elevated Lyme antibody from the recent vaccine. She was examined by an ophthalmologist, and he found the pt had palsies of the left IV, VI and VII cranial nerves. The most recent information received on 7/29/99 reports the symptoms are ongoing. The reporting physician stated it highly unlikely that Lyme disease is the cause of the pt''s cranial neurapathies. She is seronegative, and her spinal fluid analysis are normal. "It has been postulated that she may have the cranial neuropathy secondary to the Lyme vaccine. It does seem temporally related." The etiology of the pt''s cranial nerve palsies is uncertain. "The fact that the headaches began prior to her ever receiving the vaccine makes me think it is unlikely secondary to the vaccine and that she has some other underlying illness. MS would still be a possibility." However, the neurologist and ophthalmalogist feel that it is unlikely. Additional information has been requested.


VAERS ID: 154404 (history)  
Age: 64.0  
Gender: Male  
Location: New York  
Vaccinated:1999-06-10
Onset:1999-06-11
   Days after vaccination:1
Submitted: 1999-09-29
   Days after onset:110
Entered: 2000-06-15
   Days after submission:260
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Hypokinesia, Joint stiffness
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 19990198801

Write-up: This is a spontaneous report from a doctor of pharmacy referring to a 64 year old male pt who on 1/10/99, received the 2nd dose of Lymerix. Within 24 hours, post vax, he experienced bilateral shoulder stiffness and could not raise his arms. The most recent information, received on 7/5/99, reports the condition of the pt as ongoing.


VAERS ID: 154865 (history)  
Age: 41.0  
Gender: Female  
Location: Arizona  
Vaccinated:1999-06-10
Onset:1999-06-20
   Days after vaccination:10
Submitted: 2000-05-30
   Days after onset:345
Entered: 2000-06-21
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Lymphadenopathy, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99061725

Write-up: Ten day post vax, pt experienced posterior auricular adenopathy and a rash. No further information is available.


VAERS ID: 155317 (history)  
Age: 0.2  
Gender: Female  
Location: Texas  
Vaccinated:1999-06-10
Onset:1999-06-15
   Days after vaccination:5
Submitted: 1999-09-23
   Days after onset:100
Entered: 2000-06-22
   Days after submission:273
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH - / - - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / - - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. - / - - / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / - - / PO

Administered by: Private       Purchased by: Other
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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: UNK
CDC Split Type: U1999005480

Write-up: On 6/15/99, the infant developed a low-grade fever and vomiting. That evening, her temperature was 102.4. On 6/18/99, the infant developed loose stools. The infant was seen by a physician and unspecified blood tests were performed. The physician reportedly dx a virus. Tylenol was prescribed.


VAERS ID: 155397 (history)  
Age: 0.75  
Gender: Female  
Location: Michigan  
Vaccinated:1999-06-10
Onset:0000-00-00
Submitted: 1999-12-23
Entered: 2000-06-23
   Days after submission:182
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457794 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 412353A / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N1062 / 1 LA / -

Administered by: Private       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: U1999010950

Write-up: "A nurse reported that a 9 month old female inadvertently received 2 doses of Acel-Imune on 6/10/99. The infant also received Hib-Titter and IPV vaccines. This report was received on the date of immunizations; no adverse experience had occurred at that time."


VAERS ID: 125077 (history)  
Age: 37.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1999-06-11
Onset:1999-06-11
   Days after vaccination:0
Submitted: 1999-06-21
   Days after onset:10
Entered: 1999-06-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Anaemia, Anorexia, Arthralgia, Chills, Collagen disorder, Condition aggravated, Dizziness, Face oedema, Headache, Hypokalaemia, Insomnia, Laboratory test abnormal, Myalgia, Neuralgia, Paraesthesia, Photophobia, Syncope, Thinking abnormal, Tremor, Weight increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haematopoietic erythropenia (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: avid runner (100 miles), migraine h/a, vagal rxn during pregnancy;
Diagnostic Lab Data: 6/99 MRI,ANA,Sed rate nl;rheumatoid factor positive;LP no WBC & some residual RBC''s;K,HGB,HCT,CO2,BUN,CRCL results unknown
CDC Split Type: 19990140051

Write-up: chills, deep muscle pain in injected arm (almost neuropathic);arm shook uncontrollably;diff concentrating;felt like vagal exp like blacked out & dizzy;stress like h/a w/photophobia;myalgia ,arthralgia, numbness;not eating/sleeping well


VAERS ID: 125087 (history)  
Age: 2.0  
Gender: Male  
Location: Arkansas  
Vaccinated:1999-06-11
Onset:1999-06-12
   Days after vaccination:1
Submitted: 1999-06-17
   Days after onset:5
Entered: 1999-06-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Public       Purchased by: Public
Symptoms: Injection site hypersensitivity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives covering pt body;also around inj site, entire back covered also around hair line, neck, arms, legs;


VAERS ID: 125100 (history)  
Age: 35.0  
Gender: Male  
Location: Ohio  
Vaccinated:1999-06-11
Onset:1999-06-12
   Days after vaccination:1
Submitted: 1999-06-18
   Days after onset:6
Entered: 1999-06-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 1 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Cough, Diarrhoea, Dysphonia, Hyperhidrosis, Laryngitis, Myalgia, Nausea, Pyrexia, Sinusitis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: allergic rhinitis
Diagnostic Lab Data: nasal cytology;4+ polys/sinus series abnormal
CDC Split Type:

Write-up: fever, chills, sweats, myalgia, arthralgia, nausea, diarrhea w/in 24hr of vax;laryngitis w/dysphonia,nonproductive cough began 6/15/99;ER visit 6/16;allergy clinic 6/18/99 found to have lt maxillary sinusitis w/laryngitis;tx amoxil;


VAERS ID: 125113 (history)  
Age: 1.3  
Gender: Male  
Location: New York  
Vaccinated:1999-06-11
Onset:1999-06-14
   Days after vaccination:3
Submitted: 1999-06-15
   Days after onset:1
Entered: 1999-06-23
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6916DA / - LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1948H / - RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0703AA / - LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1976H / - RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 458426 / - - / PO

Administered by: Other       Purchased by: Public
Symptoms: Febrile convulsion, Infection, Otitis media, Pharyngitis
SMQs:, Agranulocytosis (broad), Convulsions (narrow), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: spinal tap normal (results pending);to have neurological consult today
CDC Split Type:

Write-up: approx 3 days p/ vax pt devel fever & convulsion & seen in ER, discharged;later in day devel fever & convulsion & admitted to hosp. Annual follow-up dated 2/21/01 states the pt had otitis media at the time of the febrile seizure. The pt has another febrile seizure on 9/8/99 secondary to strep throat.


VAERS ID: 125347 (history)  
Age: 1.0  
Gender: Male  
Location: Georgia  
Vaccinated:1999-06-11
Onset:0000-00-00
Submitted: 1999-06-25
Entered: 1999-07-06
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0293J / 0 LA / -

Administered by: Private       Purchased by: Public
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: LOM
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: mild eruption of varicella lesions on trunk, rt ear & forehead;tx w/DPH & observe PRN;


VAERS ID: 125493 (history)  
Age: 1.4  
Gender: Female  
Location: North Carolina  
Vaccinated:1999-06-11
Onset:1999-06-11
   Days after vaccination:0
Submitted: 1999-06-11
   Days after onset:0
Entered: 1999-07-12
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0113J / 0 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: NC99040

Write-up: p/vax pt eyes are swelling & skin is very red on arms & legs;no breathing problem;pt taken to ER;given epi & ready for discharge;


VAERS ID: 125503 (history)  
Age: 1.3  
Gender: Male  
Location: Georgia  
Vaccinated:1999-06-11
Onset:1999-06-12
   Days after vaccination:1
Submitted: 1999-06-14
   Days after onset:2
Entered: 1999-07-12
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 455179 / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1617H / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0795K / 2 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Ecchymosis, Injection site hypersensitivity, Injection site oedema
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: p/vax pt devel redness @ age 6mo w/DTAP dose 3;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: GA99073

Write-up: on 6/12/99 pt states child leg swollen w/blisters around inj site;leg viewed approx 3PM on saturday 2 blisters noted w/redness & swelling;cont to swell on Sunday w/an added blister;now bruising;


VAERS ID: 126033 (history)  
Age: 40.0  
Gender: Female  
Location: Washington  
Vaccinated:1999-06-11
Onset:1999-06-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 1999-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 LA / -

Administered by: Military       Purchased by: Military
Symptoms: Angioneurotic oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 days p/vax pt broke out w/severe hives covering entire body x 6 days;tx- over the counter antihistamine;


VAERS ID: 126248 (history)  
Age: 0.4  
Gender: Male  
Location: Texas  
Vaccinated:1999-06-11
Onset:1999-06-20
   Days after vaccination:9
Submitted: 1999-07-19
   Days after onset:29
Entered: 1999-07-22
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7390AA / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0945AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0257 / 1 LL / IM
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988144 / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Agitation
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: contrast study w/air & barium, confirmed intussusception
CDC Split Type: SA9906

Write-up: pt exp severe abd pain-crying fetal position;resolved spontaneously;several other episodes during evening & noc;taken to hosp ER;adm for simple reduction & incidental appendectomy; dx: intussusception


VAERS ID: 126736 (history)  
Age: 35.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1999-06-11
Onset:1999-06-11
   Days after vaccination:0
Submitted: 1999-06-18
   Days after onset:7
Entered: 1999-07-30
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public       Purchased by: Other
Symptoms: Convulsion, Dizziness, Influenza, Laryngospasm, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allergic to Bees, allergic to PCN, environmental allergies, food allergies
Diagnostic Lab Data:
CDC Split Type: 1999014179

Write-up: p/vax pt started having convuls (shaking real bad), throat started to swell up, felt like fainting & had fever & flu like sx;pt was brought back to clinic & sx resolved in 1hr;no tx given;


VAERS ID: 127448 (history)  
Age: 0.2  
Gender: Female  
Location: California  
Vaccinated:1999-06-11
Onset:1999-07-10
   Days after vaccination:29
Submitted: 1999-07-20
   Days after onset:10
Entered: 1999-08-23
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7390AA / 0 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0104J / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 0 - / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 48022 / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Gastrointestinal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: hematochezia
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt dx w/intussusception during visit to ER for hematochezia on 7/10; hosp; reduction & appendectomy performed;


VAERS ID: 128304 (history)  
Age: 1.3  
Gender: Male  
Location: Illinois  
Vaccinated:1999-06-11
Onset:1999-06-20
   Days after vaccination:9
Submitted: 1999-09-10
   Days after onset:82
Entered: 1999-09-16
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462313 / 3 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 441003A / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0120J / 0 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Electroencephalogram abnormal, Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: EEG-abn; lab evidence neg for seizure etiology
CDC Split Type:

Write-up: p/vax pt c/febrile illness and febrile seizure


VAERS ID: 130814 (history)  
Age: 19.0  
Gender: Male  
Location: Unknown  
Vaccinated:1999-06-11
Onset:1999-06-12
   Days after vaccination:1
Submitted: 1999-10-22
   Days after onset:132
Entered: 1999-11-15
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 0 - / -

Administered by: Military       Purchased by: Military
Symptoms: Asthenia, Hypertonia, Migraine, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: NA
Current Illness: fatigue & h/a
Preexisting Conditions: NA
Diagnostic Lab Data: CAT Scan scheduled & neurologist;
CDC Split Type:

Write-up: p/vax pt fatigued to where can never get enough sleep, high blood pressure & migraine h/a that med will not alleviate;


VAERS ID: 132503 (history)  
Age: 51.0  
Gender: Female  
Location: Arizona  
Vaccinated:1999-06-11
Onset:1999-06-11
   Days after vaccination:0
Submitted: 1999-09-15
   Days after onset:96
Entered: 1999-12-20
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH - / 4 RA / SC

Administered by: Military       Purchased by: Military
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Rash, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: has generally dry skin w/hyperlinearity
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain,swelling & redness at inject site. Rash on legs from groin areato calves; also on upper arms. Took benadryl, lasted 3 wks. Malaise, full body erythematous papules, itching, dry skin. Took benadryl and tylenol.


VAERS ID: 132876 (history)  
Age: 0.2  
Gender: Male  
Location: New York  
Vaccinated:1999-06-11
Onset:1999-11-10
   Days after vaccination:152
Submitted: 1999-12-20
   Days after onset:40
Entered: 1999-12-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Eczema, Intussusception, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal obstruction (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: baby eczema
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slight fever(100 rectally)2 days following 2nd administration of Rotavirus vax.4 months later, intusseption occured(11/10/99). Tx''d with 4 barium enemas. Admitted to hosp. 8 hrs. for observation. Pt. was fully recovered when discharged.


VAERS ID: 132928 (history)  
Age: 1.0  
Gender: Male  
Location: Texas  
Vaccinated:1999-06-11
Onset:1999-06-13
   Days after vaccination:2
Submitted: 1999-12-21
   Days after onset:191
Entered: 1999-12-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N06511 / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0128J / 0 RL / SC

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Coordination abnormal, Oedema, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: RAD
Preexisting Conditions: RAD
Diagnostic Lab Data: MRI=Normal, Alpha Fetal protein level=Normal
CDC Split Type: WAES99102043

Write-up: Pt had vax on 6/11/99. On 6/13/99, had swollen wrists & became fussy. On 6/19/99, had ataxia. On 6/20/99, developed pin-point rash on face, arms & legs persisting still on 6/25/99, but now with a fever. Dr. considered pt''s experiences to be 60 day follow-up provided a corrected Manufacturer number.


VAERS ID: 151893 (history)  
Age:   
Gender: Male  
Location: Florida  
Vaccinated:1999-06-11
Onset:1999-06-11
   Days after vaccination:0
Submitted: 2000-04-21
   Days after onset:315
Entered: 2000-05-12
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Joint stiffness, Joint swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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: The pt had no history of Lyme disease or arthritis.
Diagnostic Lab Data:
CDC Split Type: 20000056631

Write-up: On 5/20/99, the pt received his 1st Lymerix injection and experienced tight, stiff and swollen fingers. On 6/11/99, he received his 2nd Lymerix injection and the symptoms worsened. The pt was treated with prednisone, Vioxx and Celebrex. The treatment has reduced the symptoms, somewhat, but they still are present. Additional information has been reequested.


VAERS ID: 152156 (history)  
Age:   
Gender: Female  
Location: New York  
Vaccinated:1999-06-11
Onset:1999-06-21
   Days after vaccination:10
Submitted: 2000-03-07
   Days after onset:260
Entered: 2000-05-19
   Days after submission:72
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Injection site pain, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99061437

Write-up: On approximately 1/21/99, the pt experienced tenderness at the injection site, malaise, and joint pain.


VAERS ID: 154356 (history)  
Age:   
Gender: Unknown  
Location: Unknown  
Vaccinated:1999-06-11
Onset:1999-07-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2000-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM LY123B9 / 0 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Back pain, Feeling hot, Headache, Heart rate irregular, Neck pain, Rash
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: 19990183761

Write-up: On 6/11/99, the pt received the first dose of Lymerix for prevention of Lyme disease. 18 days later, on 6/29/99, she felt hot (facial), had a severe headache, sore neck and back, and dime-sized red spots on legs. 3 days later on 7/2/99, she was found to have an irregular heart beat at a clinic. She was treated with Tylenol and aspirin. The headache resolved, and the red spots have mostly resolved. The most recent information, received on 7/22/99, reports the condition of the pt is ongoing.


VAERS ID: 154411 (history)  
Age: 49.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1999-06-11
Onset:1999-06-11
   Days after vaccination:0
Submitted: 1999-09-29
   Days after onset:110
Entered: 2000-06-15
   Days after submission:260
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Influenza like illness
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: 19990180951

Write-up: This is a spontaneous report from a nurse referring to a 49 year old female pt who on 4/9/99, received her 1st treatment with Lymerix, with no untoward affects. On 6/11/99, she received the 2nd dose and 6 to 12 hours later, she experienced flu-like symptoms and chills. No treatment was given. The most recent information received on 8/9/99, reports the symptoms resolved after 2 weeks.


VAERS ID: 154460 (history)  
Age: 50.0  
Gender: Male  
Location: New York  
Vaccinated:1999-06-11
Onset:0000-00-00
Submitted: 1999-09-13
Entered: 2000-06-15
   Days after submission:276
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Asthenia, Balance disorder, Chest pain, Disturbance in attention, Dizziness, Hyperhidrosis, Hypertension, Musculoskeletal stiffness, Myalgia, Myositis, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flonase, Allegra
Current Illness:
Preexisting Conditions: allergy to PCN, nasal congestion
Diagnostic Lab Data:
CDC Split Type: 1999024166

Write-up: Following dose 2, the pt experienced joint pain. He was seen by a physician and treated with prednisone. The most recent information received on 9/9/99, reports the condition of the pt is improving. The follow up received on 8/7/00 states anterior chest wall syndrome with chest pressure, near syncope and vertigo. The vaccinee is allergic to morphine. Concurrent clinical conditions included nasal congestion. Concurrent medications included Flonase and Allegra. The vaccinee received his first injection of LYMErix on 5/14/99. Subsequently he had mild symptoms of joint pain. The second injection of LYMErix was given on 6/11/99. Following the second injection, in Mid-July 1999, he experienced more severe joint pain, muscle stiffnesss and soreness particularly in the shoulders, biceps and tricepts region, back, calves and thighs. He subsequently developed weakness. He was an avid runner who used to run up to three miles daily and did 100 sit ups per day. He has had these symptoms on and off recently. On 8/3/99, he was started on Medrol DosePak and noted a response after 48 hrs with resolution of his symptoms. He went off the prednisone and his symptoms returned. His physician recommended a referral to a rheumatologist, and the vaccinee was seen on 8/20/99. The vaccinee denied any specific joint swelling, rash, fever, upper respiratory tract infection, dry eyes or mouth, Raynaud''s phenomenon, pleuropericarditis, gastrointestinal or genitourinary manifestations, kidney stones, or neurological abnormalities. Physical exam: the muscles were of normal size and strength. The peripheral joints had a full range of painless motion without synovial effusions, tenderness, particularly atrophy. There was no periarticular soft tissue tenderness. Impression: probable Lyme vaccine reaction. Rule out connnective tissue process. The rheumatologist stated that the lack of increased sedimentation rate and the weakness did not correlate with polymyalgia rheumatica. Plan: to obtain a CPK and probably EMG studies to rule out a myopathic process and continue to taper prednisone. 9/16/99 rheumatologist visit: The vacinee had a recent flare with stiffness through the shoulders and less to through the hips after decreasing the prednisone. There was a question of slightly decreased strength through the shoulder abductors. They were tender to palpation. Minimal weakness was detected through the hip flexors. Assessment: Probable Lyme vaccine reaction. Rule out myositis vs. polymyalgia rheumatica. He appeared to have a form of myositis but whether he actually had polymyalgia rheumatica or a mixed connective tissue disease remained to be seen, in one physician''s opinion. Plan: "The symptoms apparently occurred after an upper respiratory infection. We are obtaining a CPK and, if elevated, will proceed with EMG studies." (Results not provided). Prednisone was restarted at 5mg. Vaccinee was subsequently hospitalized on 10/11/99 for treatment and evaluation following the development of pain in his chest with dizziness and near syncope. His dizziness had started on 10/6/99 accompanied by unsteadiness and difficulty in concentrating. The symptoms recurred on 10/7/99 and again on 10/9/99 when he was near syncopal. THe dizziness was occasionally associated with nausea and sweating. Blood pressure on admission was 102/97 mmHg. Brain CT scan was performed that was normal. Echocardiogram was performed which revealed ejection fraction of 70% with normal left ventricular chamber dimensions and good systolic function. Discharge diagnoses on 10/13/99 were: near syncopal episode; chest pressure with vertigo consistent with anterior chest wall syndrome; hypertension; history of arthralgia and myalgia. He was placed on Norvasc 5mg po daily and was discharged with a blood pressure of 134/90 mmHg. Other discharge medications included prednisone 5mg daily and meclizine HCL. It was reported on 8/7/00 that the vaccinee was "doing well" and "at this time his symptoms seem to have disapp


VAERS ID: 154613 (history)  
Age:   
Gender: Female  
Location: Unknown  
Vaccinated:1999-06-11
Onset:1999-06-12
   Days after vaccination:1
Submitted: 1999-11-22
   Days after onset:163
Entered: 2000-06-19
   Days after submission:209
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / SC
RUB: RUBELLA (MERUVAX II) / MERCK & CO. INC. - / - - / SC

Administered by: Other       Purchased by: Other
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Postpartum
Diagnostic Lab Data:
CDC Split Type: WAES99060742

Write-up: 1 day post vax pt experienced itching and raised welts. Pt was treated with diphenhydramine (Benadryl). Pt continued to break out at the time of the report.


VAERS ID: 155119 (history)  
Age: 1.25  
Gender: Female  
Location: Florida  
Vaccinated:1999-06-11
Onset:1999-06-20
   Days after vaccination:9
Submitted: 2000-06-24
   Days after onset:370
Entered: 2000-06-21
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1785H / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0288J / 0 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Otitis media, Pyrexia, Rash papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD/Connaught/ID/LA on 6/11/99
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES99061435

Write-up: On 6/20/99, the pt experienced an erythematous papular rash, fever of 102.6F and a ear infection. The pt was taken to the ER, where she was treated with Suprax for the ear infection. Follow-up was received from a LPN. The pt recovered from her symptoms. No further information is available.


VAERS ID: 155124 (history)  
Age: 42.0  
Gender: Male  
Location: Ohio  
Vaccinated:1999-06-11
Onset:1999-06-23
   Days after vaccination:12
Submitted: 2000-05-24
   Days after onset:336
Entered: 2000-06-21
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 624632/1002H / - - / -

Administered by: Public       Purchased by: Public
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: WAES99061734

Write-up: Measles: skin erythema. Information has been received from a health care professional concerning a 42 year old caucasian male patient who on 11-Jun-1999 was vaccinated in the left arm with measles virus vaccine live (+) mumps virus live (+) rubella virus vaccine live (second generation). On 23-Jun-1999 the patient experienced a red rash on his stomach, legs, neck, and ears. The patient sought medical attention and was diagnosed with measles. Subsequently the patient recovered for the episodes. No further information is available.


VAERS ID: 155291 (history)  
Age: 1.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-06-11
Onset:1999-06-11
   Days after vaccination:0
Submitted: 2000-05-24
   Days after onset:348
Entered: 2000-06-22
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / SC

Administered by: Other       Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99100687

Write-up: On 6/11/99, the pt experienced an allergic reaction consisting of hives on the forehead. The pt sought unspecified medical treatment. The physician stated it was due to something he ate.


VAERS ID: 155554 (history)  
Age:   
Gender: Unknown  
Location: Unknown  
Vaccinated:1999-06-11
Onset:1999-06-12
   Days after vaccination:1
Submitted: 1999-06-23
   Days after onset:11
Entered: 2000-06-28
   Days after submission:371
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 7345AA / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Malaise, Pain, Pallor, Pharyngitis, Pyrexia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: U199900396

Write-up: It was reported that a pt received TD vaccine (1st dose in series) on 6/11/99. Reportedly on 6/12/99, the pt became pale and developed a fever, malaise and achy legs. From additional received on 6/22/99, it was reported MD stated ADR not vaccine related, stated pt had a throat infection. From follow-up #1 correspondence received on 4-May2003, the correct reporter infroamtion was provided. This case is closed.


VAERS ID: 157266 (history)  
Age: 26.0  
Gender: Male  
Location: New Jersey  
Vaccinated:1999-06-11
Onset:1999-06-29
   Days after vaccination:18
Submitted: 2000-05-16
   Days after onset:322
Entered: 2000-07-19
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0116J / 0 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES99070121

Write-up: Subsequent to receiving varicella virus vaccine live the pt developed a disseminated vesicular rash on trunk, chest, back and hands. Redness and vesicles at the injection site were also noted.


VAERS ID: 157296 (history)  
Age: 0.25  
Gender: Female  
Location: Minnesota  
Vaccinated:1999-06-11
Onset:1999-06-18
   Days after vaccination:7
Submitted: 2000-05-16
   Days after onset:333
Entered: 2000-07-19
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / 0 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 0 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048H / 0 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES99070256

Write-up: Subsequent to receiving vax pt developed a low fever, lasting several days. Pt was treated with Tylenol and in 2-3 days returned to normal activity.


VAERS ID: 165972 (history)  
Age: 39.0  
Gender: Male  
Location: California  
Vaccinated:1999-06-11
Onset:1999-06-17
   Days after vaccination:6
Submitted: 2001-02-15
   Days after onset:609
Entered: 2001-02-20
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. - / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest pain, Fatigue, Neuropathy peripheral, Pain, Tremor
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: spinal taps, EEG, EMG, EKG, MRI - results not provided
CDC Split Type: U2001004130

Write-up: It was reported that a 39 year old male pt received IPOL and HEP-B (2nd dose) on 6/11/99 for travel. The pt started with "severe pain and burning in all four limbs and trunk, tremors, fatigue" on 6/17/99. Dx''d as small fiber neuropathy. Pt was treated with Prednisone. The pt had received other travel vaccines on 5/5/99. Pt was evaluated at hospital. New being followed at another hospital. Reportedly, modified work schedule. Pt under care of a Neurologist. Further information is requested.


VAERS ID: 167033 (history)  
Age: 40.0  
Gender: Male  
Location: California  
Vaccinated:1999-06-11
Onset:1999-06-17
   Days after vaccination:6
Submitted: 2001-03-08
   Days after onset:630
Entered: 2001-03-13
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Chromaturia, Diarrhoea, Fatigue, Hypoaesthesia, Nausea, Neuropathy, Pain, Rash, Skin burning sensation, Skin test positive, Vomiting, Weight decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Acyclovir, multivitamin, Ambien, Lidoderm, Lariam
Current Illness:
Preexisting Conditions: Seasonal allergies; Herpes NOS.
Diagnostic Lab Data: CBC; BUN; ESR; ANA; ANCA; DSDNA; SPEP; Liver function tests; HglAC; Hepatitis serologies; HTLVI and HTLVII; IFEC; UPEP; UA; Sjogren''s antibody; 24 hour urine heavy metal screen; B12 level: Spinal fluid analysis; EMG/nerve conduction studies, fat pad biopsy, "QST" and skin biopsy for small fiber neuropathy. All test results were normal except for the skin biopsy which was reported as "abnormal".
CDC Split Type: 2001003784

Write-up: Report 2001003784-1 described possible progressive small fiber neuropathy in a 40 year old male who received Hep B vaccine recombinant (Engerix-B) for prophylaxis of Hep B. This report was received from the vaccinee and has been verified by a physician. On 05/05/99, and 06/11/99, the vaccinee received his first and second dose of Engerix-B, respectively. Six days after receiving the 2nd dose of Engerix-B, on 06/17/99, the vaccinee experienced pain, burning, and numbness on all limbs, trunk, and face. The neurologist considered these events to be severe in intensity. The neurologist made a diagnosis of possible progressive small fiber Neuropathy in 01/00, and treated the patient with gabapentin (Neurontin), and hydrocodone bitartrate/ paracetamol (Lortab). He was also taking paracetamol / oxycodone hydrochloride (Percocet). On 03/06/01, the neurologist reported that these adverse events were disabling / incapacitating and possibly related to Engerix-B. However, the neurologist also stated "unclear if related". As a result of the information received on 03/06/01, this report has been reclassified as serious, unexpected. As of 03/01, the outcome of the adverse events was resolved. The follow up received on 5/31/01 states pt medical history also included numerous motorcycle accidents and broken bones from 1975-1980. Other concomitant medications included Claritin, Acyclovir, multivitamin, Lariam, and Ambien. The pt reported occasional marihuana use. His family hisotyr was remarkable for Parkinson''s disease. The vaccinee experienced numbness in his left great toe. The numbness proceeded to involve both legs from the knees down. He then developed tremors on twitches in his arms and legs, which he considered to be muscle spasms. Following that he experienced burning of both arms and legs, chest and back. He developed an intermittent rash over his joints, "which was burning and painful. Additionally, he experienced "severe" fatigue and weight loss. He was treated with a one-week course of prednisone without improvement. 8/14/00: Neurology referral letter: electrolyte analysis, creatinine, creatinine phosphokinase, all were normal or negative. While taking B6 supplements, his b6 level was elevated at 90. After discontinuation of supplements, the B6 level was normal at 39.5. Cerebrospinal fluid analysis performed in December 1999 revealed one white blood cell, 402 red blood cells, glucose 66, protein 52, negative VDRL, negative CRAG, and a normal IgG index. CSF obtained on 4/21/00 showed 3 WBC, 0 RBC, protein 44, glucose 64, non-reaction VDRL, IgG index 0.8, and negative oligoclonal bands. Sjogren''s evaluation by an ophthalmologist was negative. Qualitative sensory testing was negative. Review of system was remarkable for five out of six since symptoms for dry eyes and mouth. The pt was "mildly unsteady with tendem gait. On sensory examination, proprioception, touch and vibration have normal thresholds in the hands and feet. Pin and temperture are decreased to the knees bilaterally, while touch, vibration, and proprioception ahve normal thresholds in the hands and feet. Rhomberg sign is negative. The neurologist''s impression was "clinically he appears to have a progressive small fiber neuropathy, however documentation of the neuropathy with testing and its etiology remain clusive." 8/22/00-skin biopsy report: epidermal nerve fiber density is within a normal range at all three sites (proximal thigh, distal thigh, distalleg); therefore, there is no definite evidence of a neuropathic process affecting small caliber nerve fibers. The nerve fiber swellings noted at the distal leg site are, however, suggestive of early nerve fiber degeneration and depending on the pt''s clinical progression. A repeat biopsy in 3 to 6 months'' time may be useful. 1/9/01-pain center evaluation. At this time, the pt reported some yellowing of his skin, "which may or may not be related to excessive carotene intake," and also abdominal pains with nausea, vomiting, a


VAERS ID: 180450 (history)  
Age:   
Gender: Male  
Location: California  
Vaccinated:1999-06-11
Onset:0000-00-00
Submitted: 2001-11-08
Entered: 2002-01-24
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / - - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20010256601

Write-up: On 6/11/99, the pt received an injection of Engerix-B; it was not known if he had received prior injections of Engerix-B. "Soon after the injection", the pt became immunosuppressed. The event persisted as of 10/16/01.


VAERS ID: 182003 (history)  
Age: 40.0  
Gender: Male  
Location: California  
Vaccinated:1999-06-11
Onset:1999-06-17
   Days after vaccination:6
Submitted: 2002-02-27
   Days after onset:986
Entered: 2002-03-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR - / - - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Fatigue, Neuropathy peripheral, Pain, Tremor
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Spinal Tap, EEG, EMG, EKG and a MRI-no results were provided for all procedures.
CDC Split Type: WAES0202USA02323

Write-up: Information has been received from a health professional concerning a 40 year old male who on 5/5/99 was vaccinated with unspecified vaccines for travel. On 6/11/99, the pt was vaccinated with a 2nd dose of Hep-B. The pt was vaccinated concomitantly with IPOL. On 6/17/99, the pt developed severe pain and burning in all 4 limbs and trunk, tremors and fatigue. The pt was dx''d with small fiber neuropathy. The pt was treated with prednisone. At the time of this report, the pt was being followed and was reportedly on a modified work schedule. Small fiber neuropathy, severe pain and burning, tremors and fatigue were considered to be disabling. No further information is available. A follow up report received 1/17/2003 adds: This pt had no previous history of neuropathic pain. On 06/11/1999 the pt received his 2nd injection of Engerix-B and an injection of inactivated poliomyelitis virus vaccine (IPOL, Aventis Pasteur). It was originally reported that "soon after the injection", the pt became immunosuppressed. However, on follow-up, the event was reported as chronic neuropathic pain which began on 06/17/1999. The reporter indicated the pt had "many lab tests" (not specified), computed tomography, magnetic resonance imaging, X-rays (not specified), nerve conduction studies, electromyography, electrocardiogram and lumbar puncture (dates and results not provided). The pt was treated with oral narcotic pain medication and oral steroids. The most recent info received, on 03/22/2002, indicated the chronic neuropathic pain was "severe", ongoing and possibly related to both Engerix-B and IPOL. The outcome of the immunosuppression was not provided. The Engerix-B immunization was discontinued.


VAERS ID: 216209 (history)  
Age: 2.08  
Gender: Female  
Location: Arizona  
Vaccinated:1999-06-11
Onset:2004-01-28
   Days after vaccination:1692
Submitted: 2004-01-30
   Days after onset:2
Entered: 2004-02-09
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 0289J / - - / -

Administered by: Private       Purchased by: Public
Symptoms: Blister, Rash pustular
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pustulant rash on body fluid filled blisters.


VAERS ID: 229788 (history)  
Age: 1.94  
Gender: Female  
Location: Indiana  
Vaccinated:1999-06-11
Onset:2004-11-21
   Days after vaccination:1990
Submitted: 2004-11-22
   Days after onset:1
Entered: 2004-11-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Ear pain, Pharyngolaryngeal pain, Rash, Viral infection
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Pt come in for sick visit, c/o sore throat, ear pain and rash. Dx with chicken pox by MD, No tx prescribed.


VAERS ID: 130542 (history)  
Age: 27.0  
Gender: Male  
Location: Foreign  
Vaccinated:1999-06-11
Onset:1999-06-14
   Days after vaccination:3
Submitted: 1999-10-27
   Days after onset:135
Entered: 1999-11-01
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest pain, Infection, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: WAES99101663

Write-up: p/vax pt devel pericarditis viral & chest pain & was hosp;7/5/99 adverse exp resolved;pt is recovering;


VAERS ID: 130750 (history)  
Age: 27.0  
Gender: Male  
Location: Foreign  
Vaccinated:1999-06-11
Onset:0000-00-00
Submitted: 1999-11-09
Entered: 1999-11-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Orchitis
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: WAES99110188

Write-up: p/vax pt uncle devel orchitis;hosp x 5 days;tx w/ciproxine followed by resolution of sx;


VAERS ID: 158246 (history)  
Age: 1.0  
Gender: Female  
Location: Foreign  
Vaccinated:1999-06-11
Onset:2000-06-25
   Days after vaccination:380
Submitted: 2000-07-25
   Days after onset:30
Entered: 2000-08-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. MM33300 / 0 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Neutropenia, Thrombocytopenia
SMQs:, Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES00071556

Write-up: Information has been received from a health care authority concerning a 1 year old female who on 11/6/99 was vaccinated with 1 dose of MMR batch #MM33300, which reportedly does not correspond with manufacturer''s lot #''s. On 6/25/00, the pt experienced neutropenia and thrombocytopenia and was hospitalized. At the time of reporting, the pt''s outcome was unknown. No further information is available. Follow-up provided a change of the vaccine date. Corrected.


VAERS ID: 313772 (history)  
Age: 43.0  
Gender: Male  
Location: Foreign  
Vaccinated:1999-06-11
Onset:2007-06-06
   Days after vaccination:2917
Submitted: 2008-05-28
   Days after onset:357
Entered: 2008-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS ENG2330B6 / 4 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER D007 / - UN / UN
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER D007 / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Amyotrophy, Asthenia, General physical health deterioration, Myofascitis, Weight decreased
SMQs:, Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: ANXIODEPRESSIVE SYNDROME, FIBROMYALGIA
Preexisting Conditions: Concurrent vaccinations included an injection of DTP on 26 March 1993 (batch reference V0080), on 07 May 1993 (batch reference V0080), on 07 June 1993 (batch reference V0080), on 06 June 1994 (batch reference X0050) and on 11 June 1999 (batch reference D007).
Diagnostic Lab Data: UNK
CDC Split Type: B0522339A

Write-up: This case was reported by the regulatory authority (AFSSaPS, LL20070136 and LL0700334) via an other manufacturer and described the occurrence of macrophagic myofascitis in a 42-year-old male subject who was vaccinated with ENGERIX B (GlaxoSmithKline) and with GENHEVAC B (Aventis Pasteur MSD). The subject belongs to the REVAHB association under reference 2205. Concurrent medical conditions included anxiodepressive syndrome and fibromyalgia for which the first symptoms occurred in June 1997. Concurrent vaccinations included an injection of DTP on 26 March 1993 (batch reference V0080), on 07 May 1993 (batch reference V0080), on 07 June 1993 (batch reference V0080), on 06 June 1994 (batch reference X0050) and on 11 June 1999 (batch reference D007). Co-suspected vaccine included GENHEVAC B. On 26 February 1993, 26 March 1993, 07 May 1993 and 06 June 1994, the subject received respectively the first injection of GENHEVAC B (batch reference V0152-3), the second injection of GENHEVAC B (batch reference WC0252), the third injection of GENHEVAC B (batch reference WC0343) and the fourth injection of GENHEVAC B (batch reference X00492). In June 1997, the patient reported the first symptoms of anxiodepressive state and fibromyalgia. On 11 June 1999, the subject received 5th dose of ENGERIX B (batch reference ENG2330B6). On 06 June 2007, the subject was diagnosed with macrophagic myofascitis. Regulatory authority noted that first symptoms occurred in 2005 (NOS). In 2005, he was treated with LAROXYL and RIVOTRIL. In 2007, he was treated with LYRICA. In October 2007, he was treated with physical therapy and analgesic. At this date, he presented with asthenia, general state alteration, weight loss and amyotrophy. At an unspecified date, the subject was hospitalised. At the time of reporting, the outcome of the events was unspecified. The AFSSaPS reported that the events were dubiously related to GENHEVAC B, according to the country''s intrinsic imputability. The AFSSaPS did not mention ENGERIX B as a suspect drug and did not provide country''s intrinsic imputability for ENGERIX B.


VAERS ID: 125268 (history)  
Age: 11.0  
Gender: Male  
Location: Tennessee  
Vaccinated:1999-06-12
Onset:1999-06-16
   Days after vaccination:4
Submitted: 1999-06-21
   Days after onset:5
Entered: 1999-06-30
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3068A2 / 0 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0985990 / 0 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Ecchymosis, Injection site hypersensitivity, Injection site oedema, Injection site pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: p/vax pt c/o lt arm pain & elevated temp x 2 days;T100.7 lt arm red swollen on exterior aspect below needle mark tender to touch, bluish discoloration around the needle mark;tx APAP;warm compress;


VAERS ID: 125272 (history)  
Age: 0.3  
Gender: Female  
Location: Pennsylvania  
Vaccinated:1999-06-12
Onset:1999-06-12
   Days after vaccination:0
Submitted: 1999-06-15
   Days after onset:3
Entered: 1999-06-30
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457787 / - LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402253A / - RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0492 / - RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Hypotonia, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: PA9938

Write-up: p/vax pt vomited & became very pale 7 limp approx 6hr p/vax pt perked up p/an hr T104 R;pt irritable & whining;T1030194;MD not called;


VAERS ID: 125453 (history)  
Age: 35.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-06-12
Onset:1999-06-14
   Days after vaccination:2
Submitted: 1999-06-30
   Days after onset:16
Entered: 1999-07-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: cellulitis secondary insect bite
Preexisting Conditions: allergy-iodine-anaphylaxis;
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: erythema & induration increased to 9x11cm @ site of DT vax;


VAERS ID: 125466 (history)  
Age: 26.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:1999-06-12
Onset:1999-06-22
   Days after vaccination:10
Submitted: 1999-06-30
   Days after onset:8
Entered: 1999-07-09
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM 120A9 / 0 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Amnesia, Asthenia, Cerebral ischaemia, Confusional state, Infection, Laboratory test abnormal, Leukopenia, Overdose, Speech disorder, Thinking abnormal, Vasculitis
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Drug abuse and dependence (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vasculitis (narrow), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 3 beers & muscle relaxer night a/ AE
Current Illness:
Preexisting Conditions: NKA, no ETOH or substance abuse; med hx & meds "noncontributory" per MD
Diagnostic Lab Data: MRI-abnormal signal in thalamus; CT scan, nl; toxicology nl, 22june99. EEG nl; WBC=3.5, granulocytes=48.4%, anion gap-high; Carotid US-internal stenosis <15% (no plaque bilat, nl velocities)
CDC Split Type: 19990149411

Write-up: 10 days p/vax pt devel acute confusional state, concentration poor, speech intelligible. did not recognize family, recent info 6/25/99 rpt neurological status as stable, pt could recognize family but appeared tired w/ poor concentration.


VAERS ID: 125628 (history)  
Age: 39.0  
Gender: Male  
Location: Washington  
Vaccinated:1999-06-12
Onset:1999-06-13
   Days after vaccination:1
Submitted: 1999-06-16
   Days after onset:3
Entered: 1999-07-13
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Abdominal pain, Influenza, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: nausea & flu like stomachache;felt like throwing up for hours 18-48 p/vax


VAERS ID: 125636 (history)  
Age: 26.0  
Gender: Female  
Location: Illinois  
Vaccinated:1999-06-12
Onset:1999-06-13
   Days after vaccination:1
Submitted: 1999-07-01
   Days after onset:18
Entered: 1999-07-13
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2711A4 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Rash maculo-papular, Vasodilatation
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: mental retardation 9sl) d/t anoxia @ birth
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: generalized red, raised rash, non itching-over trunk, extremities & face;given DPH;


VAERS ID: 126275 (history)  
Age: 46.0  
Gender: Female  
Location: Washington  
Vaccinated:1999-06-12
Onset:1999-06-12
   Days after vaccination:0
Submitted: 1999-07-22
   Days after onset:40
Entered: 1999-07-26
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown       Purchased by: Military
Symptoms: Arthralgia, Dizziness, Headache, Influenza, Injection site hypersensitivity, Injection site oedema, Malaise, Myalgia, Nausea, Pain, Pyrexia, Somnolence, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: penicillin, sodium pentothal, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt exp severe facial burning; next 2 wks: HA, dizziness, faintness, nausea, lethargy, flu-like sx: low grade fever, 99F occasional chills, gen muscle discomfort & achiness; joint achiness, red & swelling @ inj site


VAERS ID: 126935 (history)  
Age: 51.0  
Gender: Male  
Location: Washington  
Vaccinated:1999-06-12
Onset:1999-06-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1999-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 1 - / A

Administered by: Military       Purchased by: Military
Symptoms: Hyperhidrosis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: asprin
Current Illness: none
Preexisting Conditions: allergic to citrus
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt exp night sweats /low grade fever followed by vomiting; overnight in duration, resolved by am


VAERS ID: 132607 (history)  
Age: 59.0  
Gender: Male  
Location: Delaware  
Vaccinated:1999-06-12
Onset:1999-08-20
   Days after vaccination:69
Submitted: 1999-12-13
   Days after onset:115
Entered: 1999-12-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 0 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Arthropathy
SMQs:, Arthritis (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asprin daily
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC,Sed rate,CPK,UA,CXR,ANA,RF
CDC Split Type:

Write-up: After 3rd Anthrax injection in Aug. 99, pt.''s left middle finger began aching, then deformity of joints began in middle and little fingers of left hand.Left ankle aches sporadically. As of follow up information received on 06/16/2000 member has retired from the USAF reserves. He will be followed by the veterans administration.


VAERS ID: 152176 (history)  
Age: 28.0  
Gender: Female  
Location: New York  
Vaccinated:1999-06-12
Onset:1999-06-15
   Days after vaccination:3
Submitted: 2000-03-07
   Days after onset:266
Entered: 2000-05-19
   Days after submission:72
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: pregnancy
Diagnostic Lab Data:
CDC Split Type: WAES99072019

Write-up: Information has been received concerning a 28 year old female who on 6/12/99 was vaccinated with the first dose of Hep B. On approximately 6/15/99, the pt experienced a rash and fever. On 6/25/99, the pt discovered she was pregnant. No further information was available.


VAERS ID: 323745 (history)  
Age: 35.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:1999-06-12
Onset:1999-06-12
   Days after vaccination:0
Submitted: 2008-08-25
   Days after onset:3362
Entered: 2008-08-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER FAV041 / - UN / SC
TYP: TYPHOID LIVE ORAL TY21A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Chronic fatigue syndrome, Cognitive disorder, Migraine, Myalgia, Poor quality sleep
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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:

Write-up: Chronic fatigue syndrome: Myalgias, arthralgias, migraine HA, cognitive dysfunction, unrestful sleep after AVA. Began in 1999 after AVA #1. Had 6 AVA vaccinations since 1999. No immediate worsening of sxs after each shot but pt reports sxs worsened as years progressed. Deployment out of country also involved with significant worsening of sxs in 2003. Symptoms: Joint Pain, multiple joints, Muscle pain, Fatigue, Malaise $g60 Days, Memory Loss, short term, Headache, Migraine, Restless sleep.


VAERS ID: 125389 (history)  
Age: 35.0  
Gender: Male  
Location: Washington  
Vaccinated:1999-06-13
Onset:1999-06-14
   Days after vaccination:1
Submitted: 1999-06-29
   Days after onset:15
Entered: 1999-07-07
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 0 RA / -
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 01499219 / - - / PO

Administered by: Military       Purchased by: Unknown
Symptoms: Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: p/vax w/in 24hr devel pruritic maculopapular localized rash in rt deltoid, lt deltoid, lateral trunk posterior thigh patches R$gL;no accompanying SOB, throat swelling, fever, pain;rash persistent but resolving on 6/20/99;


VAERS ID: 131653 (history)  
Age: 31.0  
Gender: Male  
Location: South Carolina  
Vaccinated:1999-06-13
Onset:1999-06-14
   Days after vaccination:1
Submitted: 1999-10-27
   Days after onset:135
Entered: 1999-12-02
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV043 / 3 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Dermatitis exfoliative, Injection site hypersensitivity, Injection site oedema, Lymphadenopathy, Pain
SMQs:, Severe cutaneous adverse reactions (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: p/vax pt exp swelling in lt arm from shoulder to elbow;arm was red from swelling;glands in both arm pits groin & neck began swelling;gland in lt armpit extremely painful;arm began to scale;


VAERS ID: 124995 (history)  
Age: 49.0  
Gender: Female  
Location: New York  
Vaccinated:1999-06-14
Onset:1999-06-14
   Days after vaccination:0
Submitted: 1999-06-14
   Days after onset:0
Entered: 1999-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM 116A2 / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt states 1hr p/vax chills/fever disorientation, nausea, felt like someone hit pt on head w/baseball bat;h/a;


VAERS ID: 125173 (history)  
Age: 13.0  
Gender: Male  
Location: Arkansas  
Vaccinated:1999-06-14
Onset:1999-06-14
   Days after vaccination:0
Submitted: 1999-06-14
   Days after onset:0
Entered: 1999-06-25
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2933A2 / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1786H / 1 LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0998960 / 4 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Anxiety, Convulsion, Dyspnoea, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Haloperidol
Current Illness: NONE
Preexisting Conditions: Tourette''s Synd
Diagnostic Lab Data:
CDC Split Type: AR9922

Write-up: w/in 2-3min of vax pt passed out w/urinary incontinence;pt came to p/60 sec pale/sweaty then exp a sz like jerking w/trouble breathing;vital signs WNL;vagal response from anxiety caused rxn;


VAERS ID: 125179 (history)  
Age: 28.0  
Gender: Female  
Location: Nebraska  
Vaccinated:1999-06-14
Onset:1999-06-15
   Days after vaccination:1
Submitted: 1999-06-18
   Days after onset:3
Entered: 1999-06-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0997390 / - - / IM

Administered by: Public       Purchased by: Private
Symptoms: Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 3:00AM morning p/vax had T, h/a all over body aches, nausea, Tx2 days, 3rd day fever broke;sx resolved;


VAERS ID: 125181 (history)  
Age: 11.0  
Gender: Male  
Location: California  
Vaccinated:1999-06-14
Onset:1999-06-14
   Days after vaccination:0
Submitted: 1999-06-16
   Days after onset:2
Entered: 1999-06-25
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 2934A2 / 0 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0989580 / 0 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Myasthenic syndrome
SMQs:, Malignancy related conditions (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: CA-990065

Write-up: general body weakness few hours p/vax was given;MOC did not bring minor to PMD as instructed;states only called PMD & was advised to stay home;


VAERS ID: 125244 (history)  
Age:   
Gender: Female  
Location: California  
Vaccinated:1999-06-14
Onset:1999-06-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1999-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4978265 / - RA / SC
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0263J / - RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4988017 / - RA / ID
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7326A / 0 LA / SC

Administered by: Other       Purchased by: Other
Symptoms: Injection site hypersensitivity, Skin striae, Vasodilatation
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: nONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/vax pt devel 2in red area around typhoid vax given in rt forearm, warm to touch;has red streak starting towards bend of arm;able to move;advised to see MD


VAERS ID: 125275 (history)  
Age: 0.5  
Gender: Unknown  
Location: Indiana  
Vaccinated:1999-06-14
Onset:1999-06-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1999-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 888A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 45Q53A / 2 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: v, fussy;


VAERS ID: 125279 (history)  
Age: 67.0  
Gender: Female  
Location: New Jersey  
Vaccinated:1999-06-14
Onset:1999-06-14
   Days after vaccination:0
Submitted: 1999-06-24
   Days after onset:10
Entered: 1999-06-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM 116A2 / 0 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Influenza, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever x 3d;achy;flu-like sx;


VAERS ID: 125292 (history)  
Age: 1.4  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-06-14
Onset:1999-06-18
   Days after vaccination:4
Submitted: 1999-06-28
   Days after onset:10
Entered: 1999-07-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 459094 / 2 - / PO

Administered by: Other       Purchased by: Other
Symptoms: Erythema multiforme, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Hydrocortisone cream
Current Illness: unk
Preexisting Conditions: eczema to face
Diagnostic Lab Data: blood cult nl;CBC nl-differential;mono test negative;sed rate nl;ASO nl;
CDC Split Type: WI99020

Write-up: mom reported pt had rash on legs, arms & face-erythema multiforme no other adverse rxn;


VAERS ID: 125303 (history)  
Age: 44.0  
Gender: Female  
Location: Michigan  
Vaccinated:1999-06-14
Onset:1999-06-14
   Days after vaccination:0
Submitted: 1999-06-15
   Days after onset:1
Entered: 1999-07-01
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1896H / 0 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Coordination abnormal, Dizziness, Hyperhidrosis, Hypertonia, Pyrexia, Somnolence, Tachycardia
SMQs:, Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: sulfa, keflex;inc BP rx norvasc
Diagnostic Lab Data: 6/15/99 140/84
CDC Split Type: MI99064

Write-up: p/vax pt had fast heartbeat then dizziness, sweating & fever broke out;temp not taken rt leg stiff;c/o sleepiness;stills feels woozy & off balance;


VAERS ID: 125401 (history)  
Age: 4.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:1999-06-14
Onset:1999-06-21
   Days after vaccination:7
Submitted: 1999-06-25
   Days after onset:4
Entered: 1999-07-07
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0115J / 0 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: redness, swelling @ site of inj lt arm;


VAERS ID: 125450 (history)  
Age: 31.0  
Gender: Female  
Location: Mississippi  
Vaccinated:1999-06-14
Onset:1999-06-15
   Days after vaccination:1
Submitted: 1999-06-28
   Days after onset:13
Entered: 1999-07-08
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0967100 / - - / -

Administered by: Public       Purchased by: Public
Symptoms: Myalgia, Myasthenic syndrome, Osteoarthritis
SMQs:, Rhabdomyolysis/myopathy (broad), Malignancy related conditions (narrow), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: about 23hr p/vax neck, back, arms & leg muscles were very weak & sore;PAP taken but gave no relief;muscle pain & weakness cont wrists, feet & ankles swelling when ASA wears off;


VAERS ID: 126080 (history)  
Age: 0.3  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-06-14
Onset:1999-06-18
   Days after vaccination:4
Submitted: 1999-07-15
   Days after onset:27
Entered: 1999-07-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 0 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 402203A / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0957 / 0 LA / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988144 / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Malaise, Personality disorder, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: ?eczema
Diagnostic Lab Data: barium enema
CDC Split Type:

Write-up: 4days p/vax pt awoke not acting right/lethargic; began persistent vomiting; adm to hosp & dx w/intussusception


VAERS ID: 126786 (history)  
Age: 1.1  
Gender: Female  
Location: Nevada  
Vaccinated:1999-06-14
Onset:1999-06-14
   Days after vaccination:0
Submitted: 1999-07-22
   Days after onset:38
Entered: 1999-08-02
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0915AA / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0779H / 0 LL / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Face oedema, Hypersensitivity, Photosensitivity reaction, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: NV99011

Write-up: p/recv vax pt exp allergic blotching on forehead, swollen eyes, photo sensitive vision


VAERS ID: 127514 (history)  
Age: 0.4  
Gender: Female  
Location: California  
Vaccinated:1999-06-14
Onset:1999-06-19
   Days after vaccination:5
Submitted: 1999-07-20
   Days after onset:31
Entered: 1999-08-09
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A902A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 412353A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0128 / 1 RL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988094 / - - / PO

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Gastroenteritis, Ileus, Intestinal obstruction, Laboratory test abnormal, Melaena, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: abd x-ray=ileus vs obstruction;abd ultrasound & contrast enema=intuss;path report incidental appendectomy;hemorrhage, focal, mild involving serosa, muscularis & mesoappendix;periappendicitis,chronic;
CDC Split Type: 899202127A

Write-up: p/vax pt became irritable & had sticky black stool & began vomiting;dx viral GE;taken to ER 6/20/99;abd x-ray revealed an ileus pattern versus obstruction;pt transferred to another facility where intuss confirmed by abd ultrasound;recovered


VAERS ID: 127656 (history)  
Age: 35.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:1999-06-14
Onset:1999-06-16
   Days after vaccination:2
Submitted: 1999-08-19
   Days after onset:64
Entered: 1999-08-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 0 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Ear pain, Headache, Myalgia, Pyrexia, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: p/vax 6/14/99 from 6/16 - 6/25 reported sudden onset & persistence of generalized myalgias, fever/chills, bilat earache & diffuse h/a;no visual, nasal or resp sx;c/o resolved x/ for feeling lethargic;no rash;


VAERS ID: 129008 (history)  
Age: 0.2  
Gender: Unknown  
Location: Florida  
Vaccinated:1999-06-14
Onset:1999-06-18
   Days after vaccination:4
Submitted: 1999-08-12
   Days after onset:55
Entered: 1999-10-06
   Days after submission:55
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462313 / 0 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0957 / 0 - / IM
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 0 - / PO

Administered by: Private       Purchased by: Other
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type: 899225001A

Write-up: p/vax pt devel a fever of 99.6 & was seen by MD;pt hosp w/dx of fever of unk origin;max temp while in hosp was 100.9;pt recovered & was discharged on 6/20/99;


VAERS ID: 133155 (history)  
Age: 25.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:1999-06-14
Onset:1999-06-26
   Days after vaccination:12
Submitted: 2000-01-01
   Days after onset:189
Entered: 2000-01-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 1 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Hives on exposed skin only, lasted 1 day. Hydrocortozone cream applied topically.


VAERS ID: 133239 (history)  
Age: 70.0  
Gender: Female  
Location: Minnesota  
Vaccinated:1999-06-14
Onset:1999-06-20
   Days after vaccination:6
Submitted: 1999-12-13
   Days after onset:176
Entered: 2000-01-12
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 7341AA / - - / IM

Administered by: Private       Purchased by: Private
Symptoms: Arthropathy, Bone disorder, Dyspnoea, Myalgia, Oedema, Osteoarthritis, Pain, Pyrexia, Tendon rupture, Tenosynovitis, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec, Lopressor, synthroid, timoptic eye drops
Current Illness: Scraped right leg
Preexisting Conditions: Hypertension, hypothyroidism, breast cancer, glaucoma, tremor
Diagnostic Lab Data: MRI, EMG, Physical Therapy, X-ray-bone spur.
CDC Split Type:

Write-up: Pt developed very large red swollen area, chills, temp, breathing problems. 2 weeks later developed terrible pain in the upper left arm muscle and not as severe pain the right upper muscle radiating into shoulder. Dx: torn supraspinatus tendon, degenerative joint disorder, joint effusion, subchondral cysts, mild dysfunction of the median nerve at the carpal ligament, such that occurs in carpal tunnel syndrome.


VAERS ID: 150098 (history)  
Age: 37.0  
Gender: Male  
Location: Florida  
Vaccinated:1999-06-14
Onset:1999-06-30
   Days after vaccination:16
Submitted: 2000-03-06
   Days after onset:250
Entered: 2000-03-15
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV041 / 4 - / SC

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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:

Write-up: Pt developed arthralgias and myalgias 1-2 weeks after injection. Symptoms persisted for 4 months. By the time he was seen at the clinic, he was asymptomatic.


VAERS ID: 154363 (history)  
Age: 47.0  
Gender: Male  
Location: Kansas  
Vaccinated:1999-06-14
Onset:1999-07-11
   Days after vaccination:27
Submitted: 1999-08-20
   Days after onset:40
Entered: 2000-06-15
   Days after submission:300
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Face oedema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: 19990191551

Write-up: 27 days post 2nd and two months post 1st dose of vaccine, the pt experienced itching and rash of the hands (a glove-like effect to wrist) and swelling of lips. He was treated with Allegra and Hydrocortisone. The most recent information received on 8/20/99 reports the condition of the pt is ongoing.


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