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Case Details (Sorted by Vaccination Date)

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VAERS ID:315552 (history)  Vaccinated:2001-10-08
Age:1.0  Onset:2007-04-15, Days after vaccination: 2015
Gender:Female  Submitted:2008-05-16, Days after onset: 397
Location:Illinois  Entered:2008-05-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: body temp 04/15/07 - Fever
CDC 'Split Type': WAES0704USA03851
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0225L SC 
Administered by: Other     Purchased by: Other
Symptoms: Body temperature increased, Varicella post vaccine
SMQs:, Neuroleptic malignant syndrome (broad)
Write-up: Information has been received from a registered nurse concerning a 6 year old female with no allergies and medical history who on 08-OCT-2001 was vaccinated SQ with 0.5 mL dose of varicella virus vaccine live (Oka/Merck) (Lot# 638252/0225L). Concomitant therapy included measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (MSD). On 15-APR-2007, the patient developed chickenpox with 30 to 40 lesions. It was described as multiple papular vesicular lesions on the trunk, extremities, and scalp. There were also several lesions on patient''s palate. The patient also experienced fever. Unspecified medical attention was sought and no lab diagnostic tests were performed. At the time of the report the patient still had chickenpox lesions. A product quality complaint was not involved. Additional information has been requested.

VAERS ID:177588 (history)  Vaccinated:2001-10-08
Age:12.0  Onset:2001-10-08, Days after vaccination: 0
Gender:Female  Submitted:2001-11-06, Days after onset: 29
Location:Foreign  Entered:2001-11-12, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Fruit allergy
Diagnostic Lab Data: Pulse 120 and then 79; BP 140/80 and then 119/66; no neurological or organic abnormalities
CDC 'Split Type': WAES01106248
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1SC 
Administered by: Other     Purchased by: Other
Symptoms: Blood pressure increased, Dizziness, Feeling cold, Gait disturbance, Heart rate increased, Malaise, Muscle spasms, Pharyngeal oedema, Syncope vasovagal, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a hlth professional concerning a 12 year old female girl who on Oct 8.2001 was vaccinated with a second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation)(lot #72370). There was no concomitant medication. Approximately 5 minutes post vaccination, the girl felt a lump in her throat and dizziness. She was not pale and was not cold sweating. She felt that the lump became bigger and informed that she was allergic to certain fruits (developed rash). Her pulse became a little slower and she was given epinephrine (Adrenaline) 0.3ml. She felt better but was hospitalized for a couple of hrs. There was no information regarding the pt''s outcome. It was noted that the pt received a first dose of measles (+) mumps (+) rubella vaccine (manufacturer unknown) (batch #14201) on mar 6, 1990 and there were no reactions reported. No further information is available. Other business partner numbers include N011295 and 011696. F/U states: The pt developed gait disturbance, shaking, freezing and malaise. Upon admission the the hospital, the gait disturbance was described as periodic contractions of extremities but convulsions were not suspected. Her pulse was 120; BP 140/80. Five hours, post vax, she was recovered. Her pulse was 79 and BP 119/66. She was examined and no neurological or organic abnormalitites were found. It was assessed that she probably experieinced a vasovagal reaction with hyperventilation. She was discharged that same day. The reporter there to be a probable relationship between the pt''s experiences and the vaccination with MMR. No further information is available.

VAERS ID:180312 (history)  Vaccinated:2001-10-08
Age:1.0  Onset:2001-10-13, Days after vaccination: 5
Gender:Male  Submitted:2002-07-29, Days after onset: 289
Location:Foreign  Entered:2002-01-23, Days after submission: 186
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: MRI; EEG-both neg
CDC 'Split Type': WAES0201USA00413
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a health professional concerning a 10 month old male pt who on 10/8/01 was vaccinated SC with a dose of Hep-B vaccine recombinant (yeast). On 10/13/01, the pt developed afebrile convulsions and was hospitalized. The checkup was negative (MRI, EEG). The pt was discharged on 10/17/01. A treatment with clobazam was prescribed for 3 days. He was considered as recovered on 10/15/01 by the pediatrician. It was also noted that the pt suffered from a 2nd relapse 2 months later, linked to a febrile laryngitis. Follow-up from another pediatrician indicated that a second hospitalization 1-2 month ago. Approximately February or March 2002, for relapse of convulsions with status epilepticus. The diagnosis of essential epilepsy was set up. The patient was treated with valproic acid and had no further convulsions since then. Upon internal review the patient''s experience of a second relapse (Grand Mal convulsion) was considered an important medical event. File to be comopleted. The case is closed. No further information is available. (OMIC)

VAERS ID:232267 (history)  Vaccinated:2001-10-08
Age:59.0  Onset:2001-10-09, Days after vaccination: 1
Gender:Male  Submitted:2002-10-10, Days after onset: 366
Location:Foreign  Entered:2005-01-14, Days after submission: 827
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam; Ranitidine
Current Illness:
Preexisting Conditions: Osteoarthritis; Gout
Diagnostic Lab Data:
CDC 'Split Type': PJP200200011
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Pancreatitis
SMQs:, Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: A report was received from a foreign authority on 1/3/02 concerning a 59 year old male patient who experienced severe abdominal pain and pancreatitis, which resulted in prolonged hospitalization one day after receiving the Fluvirin vaccine on the 10/8/01. The patient has a past history of gout and osteoarthritis. The patient was receiving Meloxicam and Ranitidine concomitantly. On 10/8/01, the patient received the Fluvirin vaccine. On 10/9/01, the patient experienced severe abdominal pain, for which he was hospitalized and diagnosed with pancreatitis. At the time of reporting, the patient was recovering. There was insufficient information to determine the reporter''s causality assessment.

VAERS ID:263166 (history)  Vaccinated:2001-10-08
Age:46.0  Onset:2006-06-18, Days after vaccination: 1714
Gender:Female  Submitted:2006-09-15, Days after onset: 89
Location:Foreign  Entered:2006-09-19, Days after submission: 4
Life Threatening? No
Died? Yes
   Date died: 2006-06-24
   Days after onset: 6
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Blood culture, blood culture ans ascitic fluid serotype 19A S. pneumonia. 06/06
CDC 'Split Type': WAES0609AUS00088
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.   UN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Bacterial infection, Drug ineffective, Pneumonia, Sepsis
SMQs:, Agranulocytosis (broad), Lack of efficacy/effect (narrow), Eosinophilic pneumonia (broad)
Write-up: Information was obtained on request by the Company via a public case details form concerning a 46 year old female who on 10/08/2001 was vaccinated with pneumococcal 23v polysaccharide vaccine for prophylactic inoculation and vaccination. On 6/18/06 the pt developed pneumococcal infection, vaccination failure and sepsis, described as invasive pneumococcal disease due to serotype 19A blood culture and ascitic fluid overwhelming sepsis. On 6/24/06 the pt died, which was reported by the agency as unrelated death. The agency considered the pneumococcal infection, vaccination failure and sepsis were certainly related to therapy with pneumococcal 23 polysaccharide vaccine. The original reporting source was not provided. Additional information is not expected.

VAERS ID:176311 (history)  Vaccinated:2001-10-09
Age:3.3  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Maryland  Entered:2001-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cellutitis
Preexisting Conditions: HGSC Sickle Cell Disease
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1068K5IMRA
Administered by: Private     Purchased by: 0
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt developed erythema and swollen area around vaccine site.

VAERS ID:176341 (history)  Vaccinated:2001-10-09
Age:40.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:2001-10-12, Days after onset: 3
Location:California  Entered:2001-10-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever;Typhoid (unknown mfr);;12;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to poison oak
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0346K0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypokinesia, Injection site erythema, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt developed a temperature of 103F, swelling and redness of arm and painful to move. Treated with aspirin, Tylenol and ibuprofen. Was test for Staph and was negative at time of vaccine.

VAERS ID:176427 (history)  Vaccinated:2001-10-09
Age:74.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-10, Days after onset: 1
Location:Colorado  Entered:2001-10-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Local Reaction;UNK. INFLUENZA VACCINE;;.00;In Patient
Other Medications: Synthroid, Estrace, Nicorette, Plavix, Avapro, Celebrex
Current Illness: NONE
Preexisting Conditions: Allergies to penicillin, sulfa, erythromycin, iodine, indocin, and aspirin. Hypertension, hypothyroidism, TIA, osteoarthritis
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0945K1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: The patient experienced diffuse redness, swelling and erythema of the right arm after vaccination.

VAERS ID:176452 (history)  Vaccinated:2001-10-09
Age:1.1  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:2001-10-10, Days after onset: 1
Location:Illinois  Entered:2001-10-18, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809003IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0575L0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The patient experienced hives by the injection site, which lasted 1 hour. The patient was treated with Benadryl.

VAERS ID:176507 (history)  Vaccinated:2001-10-09
Age:1.9  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:2001-10-11, Days after onset: 2
Location:Louisiana  Entered:2001-10-19, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xopenex, Claritin, Cefzil
Current Illness: BOM, RAD, URI
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAMA514A23IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1670K5IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T11282SCRA
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The patient''s mother reports a rash started 2 hrs after the vax. The patient was seen in the ER with an urticarial rash which was treated wtih DepoMedrol and Benadryl. On 10/10 at office visit, patient still covered with urticarial lesions. The patient was placed on Orapred, Benadryl and Calamine Lotion. On 10/11 the mother of the patient states the rash is improved.

VAERS ID:176539 (history)  Vaccinated:2001-10-09
Age:23.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-10, Days after onset: 1
Location:New Mexico  Entered:2001-10-22, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU0674AA IMRA
Administered by: Military     Purchased by: Military
Symptoms: Hypersensitivity, Paraesthesia
SMQs:, Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Influenza administered right arm; 2 inch radius around shot, red blotched and hot with touch. Arm all the way to hand tingles (next day at 1600).

VAERS ID:176553 (history)  Vaccinated:2001-10-09
Age:65.0  Onset:2001-10-10, Days after vaccination: 1
Gender:Female  Submitted:2001-10-15, Days after onset: 5
Location:Pennsylvania  Entered:2001-10-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sore throat, cough
Preexisting Conditions: CAD, HTN, Breast CA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES469132 IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Post vax, the patient complained of redness and soreness around the injection site.

VAERS ID:176556 (history)  Vaccinated:2001-10-09
Age:2.0  Onset:2001-10-10, Days after vaccination: 1
Gender:Male  Submitted:2001-10-12, Days after onset: 2
Location:California  Entered:2001-10-22, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESV0541AA3IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA599AA3IMLL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Feeling hot
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: The patient''s left leg developed a large erythema area, warm to the touch due to vaccination.

VAERS ID:176589 (history)  Vaccinated:2001-10-09
Age:0.6  Onset:2001-10-10, Days after vaccination: 1
Gender:Male  Submitted:2001-10-12, Days after onset: 2
Location:Oklahoma  Entered:2001-10-23, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Diflucan
Current Illness: Eczema
Preexisting Conditions: Eczema
Diagnostic Lab Data: CBC, UA = WNL
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM516A22IMRA
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0707K2IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R14742IMLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809002IMLA
Administered by: Private     Purchased by: Public
Symptoms: Abnormal behaviour, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad)
Write-up: Mother states rectal temp of patient at home is 103F. The patient''s temp at the dr''s office is 100.8F. The patient''s mother states the patient was "acting funny" after getting immunizations. The patient was sent to the hospital for lab work. Over the counter meds were used to reduce the fever.

VAERS ID:176598 (history)  Vaccinated:2001-10-09
Age:48.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Pennsylvania  Entered:2001-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar symptoms last year;FLUZONE 2000-2001;;47.00;In Patient
Other Medications: Niospan; ASA 1 po daily
Current Illness: NONE
Preexisting Conditions: Allergy to dust; (currently on Niospan and ASA for increased triglycerides)
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0675BA IM 
Administered by: Public     Purchased by: Other
Symptoms: Arthralgia, Back pain, Diarrhoea, Fatigue, Headache, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow)
Write-up: Employee called on 10/15/01 to report that at 23:00 that evening, post vax, he developed a headache, lower back and knee "joint" pain. The following day, pot vax, on 10/10/01, he had a low-grade fever of 100F, muscle aches, felt very fatigued and experienced diarrhea. On 10/11/01, muscle aches improved, no diarrhea but had malaise. He took 1000mg Tylenol. On 10/12/01, myalgia was gone, had no diarrhea, no fever but felt tired. On 10/13/01, he felt fine.

VAERS ID:176628 (history)  Vaccinated:2001-10-09
Age:0.1  Onset:2001-10-15, Days after vaccination: 6
Gender:Female  Submitted:2001-10-16, Days after onset: 1
Location:D.C.  Entered:2001-10-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CSF-no growth; UA/UC-neg; HCT-27%; Hgb 9
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0853L1IMLL
Administered by: Private     Purchased by: Public
Symptoms: Candidiasis, Haematocrit decreased, Pyrexia, Upper respiratory tract infection
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: History of a fever of 106.4F, 6 days after vaccine administered. History of thrush and URI.

VAERS ID:176646 (history)  Vaccinated:2001-10-09
Age:1.0  Onset:2001-10-17, Days after vaccination: 8
Gender:Male  Submitted:2001-10-18, Days after onset: 1
Location:Maryland  Entered:2001-10-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0739L0SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES481549 IM 
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: The pt experienced a fever of 104 and a seizure.

VAERS ID:176690 (history)  Vaccinated:2001-10-09
Age:4.9  Onset:2001-10-10, Days after vaccination: 1
Gender:Male  Submitted:2001-10-11, Days after onset: 1
Location:Texas  Entered:2001-10-24, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pulmicort resppules and albutoral.
Current Illness: Rash
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUO537CA3IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PASTEUR MERIEUX INST.T13912SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0899L1IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Day after immunizations, at site of injections have red, subsequently warm area. left thigh measures 5cm by 5cm. Prescribed Augmentin

VAERS ID:176780 (history)  Vaccinated:2001-10-09
Age:1.3  Onset:2001-10-10, Days after vaccination: 1
Gender:Male  Submitted:2001-10-12, Days after onset: 2
Location:California  Entered:2001-10-29, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESUA603AA IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESU0513DB IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4815503IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt developed a 12.5 x 10 cm area of redness, a 6.5 x 5 cm area of swelling and tenderness to touch on left lateral thigh. Pt was able to ambulate. Pt was treated with cool compresses for 24 hrs and then warm compresses and with Motrin. Pt was to follow up in 2-3 days.

VAERS ID:176818 (history)  Vaccinated:2001-10-09
Age:30.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-16, Days after onset: 7
Location:Minnesota  Entered:2001-10-29, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5235A41IMLA
Administered by: Public     Purchased by: Public
Symptoms: Chest pain, Influenza
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: The patient called the clinic on 10/12/2001 stating she had an onset of chest pain the same day of the vaccine. The patient stated the chest pain felt like a heart attack. The patient denied SOB, a cough or rash. The patient felt flu-like symptoms. During the phone contact with the patient on 10/12/2001, the patient did not have labored breathing and did not sound distressed. The patient was instructed to follow-up with the ER as soon as possible with the severe reported chest pain.

VAERS ID:176848 (history)  Vaccinated:2001-10-09
Age:68.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-11, Days after onset: 2
Location:Pennsylvania  Entered:2001-10-30, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin; Lozol; Vioxx; Prinivil 10mg; Prilosec 20mg
Current Illness: NONE
Preexisting Conditions: High BP; Diverticulitis; Stricture of esophagus
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0669AA IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0690K1IMRA
Administered by: Public     Purchased by: Other
Symptoms: Abasia, Dizziness, Hyperhidrosis, Injection site erythema, Injection site pain, Injection site swelling, Pyrexia, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: On 10/9/01, right arm was painful, with swelling at the injection site and developed a temperature of 102F. On 10/10/01, swelling extended to right elbow and right shoulder and was still very red and painful. She was dizzy, could not focus and needed assistance walking. She was trembling and had profuse perspiring. On 10/11/01, swelling had slightly subsided and redness had lessened. She saw an MD.

VAERS ID:176859 (history)  Vaccinated:2001-10-09
Age:59.0  Onset:2001-10-10, Days after vaccination: 1
Gender:Female  Submitted:2001-10-22, Days after onset: 12
Location:Kansas  Entered:2001-10-30, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diarrhea
Preexisting Conditions: Fragrance, Niacin, Nizeral, Cipro and ploclyco, Morphine and Thirmersol.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Other     Purchased by: Public
Symptoms: Diarrhoea, Headache, Malaise, Myalgia, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow)
Write-up: Had diarrhea, vomiting, muscle aches more severe and headache. Nauseated, ill feeling. Went to Dr. on 10/17/2001 and he gave me Cedox (antibiotic for sinus infection).

VAERS ID:176881 (history)  Vaccinated:2001-10-09
Age:4.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:2001-10-17, Days after onset: 8
Location:Oklahoma  Entered:2001-10-30, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM516A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T13912IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0592L1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Post vax the patient''s right upper arm was swollen within hours after vaccination. The swelling and redness increased extending up to the right earlobe. The patient was treated with Atarax, Orapred and Tylenol with codeine.

VAERS ID:176886 (history)  Vaccinated:2001-10-09
Age:  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:2001-10-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': TX01158
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE PRAXSIS4773893IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0736L0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0780L0 LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Ten minutes after vaccine given, greater than quarter size red area with a 2 by 3 mm wheal at injection site of varicella on left arm. Benadryl 3 ml po given. Within 10-15 minutes redness had diminished and wheal disappeared. Reviewed signs with mom.

VAERS ID:176923 (history)  Vaccinated:2001-10-09
Age:44.0  Onset:2001-10-12, Days after vaccination: 3
Gender:Male  Submitted:2001-10-16, Days after onset: 4
Location:Alaska  Entered:2001-10-31, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': AKZ00162
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0573AA7IMRA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4749361IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Hypokinesia, Injection site erythema, Injection site inflammation, Injection site pain, Injection site swelling, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient''s left deltoid, axillae and left chest wall, swollen, red and inflamed. Painful and impedes use of left arm. Symptoms developed 3 days after receiving pneumococcal vaccine in left deltoid. Seen by MD and dx''d with infection and started on antibiotics.

VAERS ID:176973 (history)  Vaccinated:2001-10-09
Age:28.0  Onset:2001-10-12, Days after vaccination: 3
Gender:Male  Submitted:2002-01-22, Days after onset: 102
Location:Unknown  Entered:2001-11-01, Days after submission: 82
Life Threatening? No
Died? Yes
   Date died: 2001-10-21
   Days after onset: 9
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Aplastic anemia; Colitis; Hematuria; Pleural Effusion; Prostatic abscess; Sepsis; Tuberculosis
Diagnostic Lab Data: chest X-ray -10/19/01 - Suspicion of infilitration in both lungs bases; Compute Axial - 09/25/01 - Increase in size of left pleural effusion; Acid-fast bacilli stain -09/04/01, Urine culture -10/11/01
CDC 'Split Type': WAES01101833
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Condition aggravated, Cystitis haemorrhagic, Haemorrhage intracranial, Injection site induration, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic cerebrovascular conditions (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a physician concerning a 28 year old Haitian male who on 10/9/01 was vaccinated with pneumococcal vaccine 23 polyvalent. On 10/11/01, the pt was hospitalized for the following other unrelated pre-existing conditions: aplastic anemia, prostatic abscess, hematuria, sepsis, colitis and a tuberculosis pleural effusions. On 10/12/01, the pt developed a severe injection site reaction described as severe swelling and induration from the right deltoid to his mid-forearm. On that same date, the pt suffered from hemorrhagic cystitis secondary to Klebsiella infection, bibasal pneumonia and developed an intracranial hemorrhage. As of 10/19/01, the pt was on a ventilator and was doing very poorly. A chest X-ray on that same date showed a suspicion of infilitration in both lung bases and a clinical correlation was suggested. The pt was being treated with piperacillin sodium (+) tazobactam (Zosyn), gentamicin and metronidazole (Flagyl). On 10/21/01, the pt died. The cause of death. The cause of death was intracranial hemorrhage. The reporting physician did not feel that the pt''s hemorrhagic cystitis and intracranial bleed were related to his pneumococcal vaccine. Additional information is not expected.

VAERS ID:177223 (history)  Vaccinated:2001-10-09
Age:38.0  Onset:2001-10-11, Days after vaccination: 2
Gender:Male  Submitted:2001-10-25, Days after onset: 14
Location:Michigan  Entered:2001-11-06, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zestril (Lisimopril)
Current Illness: Hypertension (controlled)
Preexisting Conditions: Hypertension (controlled)
Diagnostic Lab Data: SGOT increased to 71 (normal 0-37) and SGPT increased to 47 (normal 0-40).
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO591EA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: Generalized myalgias, arms, shoulders, legs and elevation of liver enzymes (SGOT and SGPT).

VAERS ID:177267 (history)  Vaccinated:2001-10-09
Age:56.0  Onset:2001-10-22, Days after vaccination: 13
Gender:Female  Submitted:2001-10-26, Days after onset: 4
Location:Massachusetts  Entered:2001-11-06, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MICHIGAN DEPT PUB HLTHU0516AA IMLA
Administered by: Private     Purchased by: 0
Symptoms: Fatigue, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Axillary node swelling, fatigue, left arm soreness; starting 3 days after vaccine lasting 1 week. Motrin and ice pack.

VAERS ID:177424 (history)  Vaccinated:2001-10-09
Age:80.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-11, Days after onset: 2
Location:Michigan  Entered:2001-11-08, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cipro 250 BID, Tenormin, Prevacid, Synthroid, Dyazide, Accupril, Premarin.
Current Illness: Urinary Tract Infection.
Preexisting Conditions: Htn, Hypothyroidism, Pernicious Ammonia.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1448K1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Red and swollen area on right arm, 3x5 inches surrounding injection site of Pneumovax, nausea and general malaise. Pt started Cipro 250 BID for VTL on 10/08/2001.

VAERS ID:177718 (history)  Vaccinated:2001-10-09
Age:2.0  Onset:2001-11-03, Days after vaccination: 25
Gender:Male  Submitted:2001-11-07, Days after onset: 4
Location:Wisconsin  Entered:2001-11-16, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Platelet 9,000 decreased to 3000 than 26,000.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0786L0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Petechiae, Thrombocytopenia, Thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad)
Write-up: Pt developed idiopathic thrombocytopenic purpura. He presented with sudden onset of petechiae.

VAERS ID:177799 (history)  Vaccinated:2001-10-09
Age:77.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:2001-11-02, Days after onset: 24
Location:New York  Entered:2001-11-16, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ambien, Nexium, ASA, Tricor, folic acid, Toprol XL, Arthripower and Mycelex.
Current Illness: Oral candidiasis
Preexisting Conditions: CAD, Hyperlipidemia and GERD
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURV0669AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0946K0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 10/11/2001 the patient was seen at the Dr''s office for tenderness and pain at the injection site with associated redness and swelling. The symptoms were noted within 2 hours after receiving the injection. The patient was treated with Levaquin for 5 days.

VAERS ID:177834 (history)  Vaccinated:2001-10-09
Age:66.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-11-06, Days after onset: 28
Location:Hawaii  Entered:2001-11-16, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lopid, Fosamax and Synthroid.
Current Illness: NONE
Preexisting Conditions: Hypertension, decreased thyroid, osteoporosis and diverticulosis.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0573AA2IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1449K0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site oedema, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: The patient experienced erythema and edema on the should and neck adjacent to the injection site.

VAERS ID:177847 (history)  Vaccinated:2001-10-09
Age:0.2  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-18, Days after onset: 9
Location:North Carolina  Entered:2001-11-16, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Infant Tylenol.
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': NC01096
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM507A20IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA608AA0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT08420IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4805670IMLL
Administered by: Private     Purchased by: Public
Symptoms: Diarrhoea, Irritability, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: The patient experienced extreme fussiness, vomiting and diarrhea a few hours after the vaccinations. The patient had a rash from head to toe the next day.

VAERS ID:178175 (history)  Vaccinated:2001-10-09
Age:60.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-11-21, Days after onset: 43
Location:Illinois  Entered:2001-11-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tenormin, Zocor, Prinivil
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0575AA IM 
Administered by: Other     Purchased by: Other
Symptoms: Headache, Nausea, Skin warm
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt felt sick to stomach, had a bad headache. Went to bed during this time and face at one point felt like it was on fire from the inside out. Felt bad next day.

VAERS ID:178479 (history)  Vaccinated:2001-10-09
Age:69.0  Onset:2001-10-12, Days after vaccination: 3
Gender:Female  Submitted:2001-11-20, Days after onset: 39
Location:South Carolina  Entered:2001-12-03, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI, Lovazepam, Elotris, Trimethoprim, Mevacor, Zantac Toprol Nitorpatch, Premarin, Urecholine, Paraton forte, Ultram, Lactulose, Celebrex and Bumex
Current Illness: NONE
Preexisting Conditions: Sulfa, morphine and Benadryl
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO600AA1  
Administered by: Private     Purchased by: 0
Symptoms: Injection site reaction
SMQs:
Write-up: Local reaction

VAERS ID:178539 (history)  Vaccinated:2001-10-09
Age:41.0  Onset:2001-10-10, Days after vaccination: 1
Gender:Female  Submitted:2001-11-25, Days after onset: 46
Location:South Carolina  Entered:2001-12-04, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OCP, Claritin D, Chlortrimeton, MVI
Current Illness: NONE
Preexisting Conditions: Healthy except hay fever.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0600AA IM 
Administered by: Private     Purchased by: Other
Symptoms: Injection site reaction
SMQs:
Write-up: Local reaction.

VAERS ID:178697 (history)  Vaccinated:2001-10-09
Age:  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-10-23, Days after onset: 14
Location:Texas  Entered:2001-12-06, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERU0599BA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Hypersensitivity, Injection site oedema
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Site of injection red and swollen, approximately 2 cm.

VAERS ID:179360 (history)  Vaccinated:2001-10-09
Age:0.2  Onset:2001-12-12, Days after vaccination: 64
Gender:Female  Submitted:2001-12-10, Days after onset: 2
Location:Oregon  Entered:2001-12-26, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CXR- clear/wnl; Blood and CSF cultures negative; 11.1 WBC
CDC 'Split Type': OR200153
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM513A20IMRL
HBPV: HIB POLYSACCHARIDE (HIBIMUNE)LEDERLE LABORATORIES4773840IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT09080SCLL
Administered by: Public     Purchased by: Public
Symptoms: Cough, Pyrexia, Rhinitis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Admitted to Med Center 10/12/2001 with temp 101 at home, runny nose, congestion, cough, vomiting, no diarrhea. Diagnosed with febrile illness.

VAERS ID:180144 (history)  Vaccinated:2001-10-09
Age:52.0  Onset:2001-10-12, Days after vaccination: 3
Gender:Female  Submitted:2001-12-14, Days after onset: 63
Location:Mississippi  Entered:2002-01-18, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': MS02001
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0737L0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: The pt came in on 12/14/01. States she broke out 4-5 days, post vax of MMR and went to ER and got no treatment. Went back to ER on 10/25/01 and was dx''d with hives and given a "shot" and prescription for Atarax 25mg.

VAERS ID:181457 (history)  Vaccinated:2001-10-09
Age:68.0  Onset:2001-10-10, Days after vaccination: 1
Gender:Male  Submitted:2001-10-19, Days after onset: 9
Location:Illinois  Entered:2002-02-19, Days after submission: 123
Life Threatening? No
Died? Yes
   Date died: 2001-10-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Heart valve replacement; CAD
Diagnostic Lab Data: C & S X 2-reported as staph aureus
CDC 'Split Type': IL01053
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0572EA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Bacterial infection, Cardiogenic shock, Chills, Pyrexia
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow)
Write-up: We were contacted by HD who received a call from a MD stating pt received flu shot on 10/09/01 and developed rigors and a fever of 103F later that night. He was seen in ER and developed cardiogenic shock and died.

VAERS ID:185608 (history)  Vaccinated:2001-10-09
Age:0.9  Onset:2001-10-10, Days after vaccination: 1
Gender:Female  Submitted:2002-05-15, Days after onset: 217
Location:New York  Entered:2002-05-29, Days after submission: 14
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': WAES01102225
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1145K0 RL
Administered by: Private     Purchased by: Public
Symptoms: Strabismus
SMQs:, Ocular motility disorders (narrow)
Write-up: Information has been received from a physician''s assistant concerning an 11 month old female who on 10/11/2001 was vaccinated with with a first dose of varicella in the right thigh. It was noticed for the first time shortly after the vaccinee was administered that the pt''s right eye seemed to turn in more. The pt was referred to opthalmology. At the time of this report, it was unknown if the pt recovered. Conflicting additional info was received from the physician''s assistant. Additional info states that the pt was vaccinated on 10/09/2001, and the onset of the pt''s strabismus was 10/10/2001. No additional info is expected.

VAERS ID:185719 (history)  Vaccinated:2001-10-09
Age:1.0  Onset:2001-10-30, Days after vaccination: 21
Gender:Female  Submitted:2002-05-15, Days after onset: 196
Location:Unknown  Entered:2002-05-30, Days after submission: 15
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': WAES01110005
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Blister, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Information has been received from a health professional concerning a 12 month old female who on 10/09/2001 was vaccinated with varicella vaccine live. On 10/30/2001, the pt developed bumps all over, a vesicular, pustular rash for "a few days." The registered nurse reported that the pt had one symmetrical dark, scaly, 1cm lesion on her back and multiple 10-15 blisters, some crusted, on her trunk, scalp, and legs. Additional info has been requested.

VAERS ID:185903 (history)  Vaccinated:2001-10-09
Age:1.5  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:2002-05-16, Days after onset: 219
Location:Unknown  Entered:2002-05-31, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0354035A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS514A20IMLL
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site infection, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Report 2001025056-1 describes an infection at the injection site in an 18 month old male who received an injection of Infanrix. This report was received from the vaccinee''s father and has not been verified by a physician or other healthcare professional. Medical history, concurrent conditions, and concurrent medications were not specified. On 10/09/2001, the pt received his first injection of Infanrix. Approximatley sixteen hours post-vaccination, the pt developed a "red nickle-sized circle" on his leg about two inches below the injection site. The next morning, 10/10/2001, the redness increased in size to about 3.5 inches and was "giving off heat." On 10/11/2001, the pt was seen by a physician, who reportedly made a diagnosis of infection at the injection site and prescribed Keflex.

VAERS ID:187205 (history)  Vaccinated:2001-10-09
Age:1.0  Onset:2001-11-14, Days after vaccination: 36
Gender:Male  Submitted:2002-06-27, Days after onset: 224
Location:Unknown  Entered:2002-07-03, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT scan, labs-normal; EEG-abnormal, indicating seizure disorder
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0733L0 LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0237L0 RL
Administered by: Private     Purchased by: Private
Symptoms: Electroencephalogram abnormal, Epilepsy, Eye movement disorder, Neurodevelopmental disorder
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: Five days after receiving his MMR, (the child) had a seizure. He did not have a fever. He had a CT + bloodwork- Normal. He had an EEG which showed "spikes". He had more seizures. He had a 48 hour EEG with video monitoring on 11/10/02 -11/11/02. At this time, he was diagnosed with epilepsy. He is currently on Phenobarbitol, which has controlled his seizures. He does, however, continue to have "episodes" where his eyes rolled back for a few seconds and he collapses. (The child) has also been diagnosed with a developmental delay. He was not walking at 15 months and was refereed to a physical therapist. He is still not walking at 20.5 months although he is talking some steps. He had no developmental delays prior to receiving the MMR shot As per follow up letter; the pt has not recovered fron vaccination. Pt has seizures daily. He was hospitalized in August and he was specifically diagnosed with complex partial seizures. Although pt began pulling up to standing at 12 months, he just started walking at 22 1/2 months. The annual follow up received on 8/5/03 states pt was averaging 40 seizures per day until 7/14/03. He is now on the ketogenic diet and seizure-free for 2 weeks. He will have to remain on this diet for at least 2 years. Pt still has developmental delays. He receives speech, OT and PT. He will have to start pre-school in October for physically challenged children. He had no delays prior to the MMR and varicella vaccines.

VAERS ID:188356 (history)  Vaccinated:2001-10-09
Age:14.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2002-07-30, Days after onset: 294
Location:Indiana  Entered:2002-08-02, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, ADVAIR
Current Illness:
Preexisting Conditions: Asthma NOS
Diagnostic Lab Data:
CDC 'Split Type': WAES01101790
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 6IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site oedema, Injection site reaction, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 14 year old white female with mild asthma who on 09 OCT 2001 (also reported as 10 OCT 2001) was vaccinated with a seventh dose of pneumococcal vaccine 23 polyvalent (lot # 479567, invalid) IM in the right arm and influenza virus vaccine in the left arm. Concomitant therapy included fluticasone propionate, salmeterol xinafoate, and albuterol. On 09 OCT 2001 (also reported as in the evening of 11 OCT 2001), the patient developed extreme tenderness and a blotchy, erythematous rash around the injection site of the pneumococcal vaccine. By the morning of 12 OCT 2001, the patient''s right arm was so sore that hte patient could not use that arm. The physician reported that the patient subsequently recovered on 19 OCT 2001. No additional information is expected.

VAERS ID:211271 (history)  Vaccinated:2001-10-09
Age:39.0  Onset:2001-10-12, Days after vaccination: 3
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2003-10-30
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': PJP200300859
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE04861KA IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Muscular weakness, Nausea, Paralysis, Speech disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: A report was received from a consumer on 10/22/03 concerning a 39 year old female vaccinee who experienced Guillain-Barre syndrome requiring hospitalization, with nausea, weakness of the arms and legs with difficulty controlling her muscles, and difficulty speaking 3 days after receiving fluvirin on 10/9/01. On 10/12/01 the vaccinee felt sick and her arms and legs became weak and she had difficulty controlling her muscles. By 10/26/01 the vaccinee was completely paralyzed and she was hospitalized. She was admitted to hospital and was diagnosed with Guillain Barre syndrome. During the 17 days in hospital the vaccinee received two and a half weeks of inpatient rehabilitation, with another 7 months outpatient rehabilitation. The vaccinee has not recovered and she still has residual effects of the Guillain Barre syndrome including difficulty speaking. No follow-up. Permission not granted to contact physician.

VAERS ID:220768 (history)  Vaccinated:2001-10-09
Age:3.0  Onset:2003-05-16, Days after vaccination: 584
Gender:Male  Submitted:2004-05-14, Days after onset: 364
Location:Indiana  Entered:2004-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: Body height: 36.8 inches; Body weight: 30lbs;
CDC 'Split Type': WAES0305USA02215
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0563L   
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Drug ineffective, Erythema, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a medical assistant concerning a 32 month old white male pt with no medical history who on 10/09/01 was vaccinated in the left upper arm with a first dose of varicella virus vaccine live (Lot # 638242/0563L) (Lot # for diluent: 640357/0832L). There was no illness at the time of vaccination. On 05/16/03 (previously reported as 05/14/03) the pt developed a "chickenpox outbreak" described as "small, red, vesicular bumps on entire body". There was no relevant diagnostic lab data completed. Subsequently the pt recovered in June 2003. No further information is expected.

VAERS ID:255747 (history)  Vaccinated:2001-10-09
Age:1.0  Onset:2005-03-20, Days after vaccination: 1258
Gender:Male  Submitted:2006-05-12, Days after onset: 417
Location:Massachusetts  Entered:2006-05-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Asthma; penicillin allergy
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0504USA03402
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0787L   
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Rash vesicular, Skin ulcer, Viral infection
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a RN concerning a 4 yr old white male, with penicillin allergy and a history of asthma, who on 09Oct01 was vaccinated (unk route) in the right thigh with a first dose of varicella virus vaccine live (lot 639432/0787L). There was no illness at the time of vaccination. There were no relevant diagnostic test or lab studies performed. On 20Mar05 the pt experienced rash and lesions and was diagnosed with chickenpox. Subsequently, the pt recovered on 30Mar05. No additional information has been requested.

VAERS ID:178463 (history)  Vaccinated:2001-10-09
Age:73.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Female  Submitted:2001-11-27, Days after onset: 49
Location:Foreign  Entered:2001-12-03, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: It was noted that allergy testing (phenol, pollen and dust) was negative.
CDC 'Split Type': WAES01112473
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0SCLA
Administered by: 0     Purchased by: 0
Symptoms: Face oedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a HCP concerning a 73 year old female who on 09-OCT-2001 was vaccinated with the first dose of pneumoccocal vaccine 23 polyvalent. On 09-OCT-2001, 2 hours after vaccination, the pt developed urticaria and swelling of the face. The pt was hospitalized and treated with IV steroids. It was noted that allergy testing (phenol, pollen and dust) was negative. Subsequently, the pt recovered after 72 hours. No further information is available. File closed.

VAERS ID:178829 (history)  Vaccinated:2001-10-09
Age:20.0  Onset:2001-10-09, Days after vaccination: 0
Gender:Male  Submitted:2001-12-05, Days after onset: 57
Location:Foreign  Entered:2001-12-11, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mild hayfever (as young child) ongoing; Asthma(no attacks since 7 years of age); Psoriasis
Diagnostic Lab Data:
CDC 'Split Type': 20010284091
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5161C61IM 
Administered by: Other     Purchased by: Other
Symptoms: Paraesthesia, Paralysis
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: On 9/11/01, the pt received the 1st dose of Engerix-B. On 10/09/2001, the pt received the 2nd dose of Engerix-B, both from the same batch number 5161C6. Following the 2nd dose, the pt developed slight paralysis, loss of power and tingling in his arm. This event is considered "Other Important Medical Event". The most recent information received on 11/28/01, reports the outcome of the event as recovered. No other details were received. Further information has been requested.

VAERS ID:176283 (history)  Vaccinated:2001-10-10
Age:0.3  Onset:2001-10-11, Days after vaccination: 1
Gender:Male  Submitted:2001-10-11, Days after onset: 0
Location:Louisiana  Entered:2001-10-15, Days after submission: 4
Life Threatening? No
Died? Yes
   Date died: 2001-10-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM513A2 IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA894AA IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.2137L SCRL
Administered by: Private     Purchased by: 0
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad)
Write-up: Received immunizations on 10/10/01 and presented on 10/11/01 to ER with asystole and was unable to revive.

VAERS ID:176350 (history)  Vaccinated:2001-10-10
Age:0.7  Onset:2001-10-11, Days after vaccination: 1
Gender:Male  Submitted:2001-10-12, Days after onset: 1
Location:New York  Entered:2001-10-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES999A22IMRA
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.0698K2IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T05952 RA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: The day following the vaccination noticed rash on the face which gradually became bigger and redder. In clinic today noticed maculopapular rash over forehead, nose neck and sparingly on trunk. Possibly viral exanthema or allergic reaction. Benadryl prescribed.

VAERS ID:176395 (history)  Vaccinated:2001-10-10
Age:40.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-11, Days after onset: 1
Location:Illinois  Entered:2001-10-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Seasonal hay fever
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0591AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chills
SMQs:
Write-up: Pt developed chills and shivering that started at 21:00 and continued all night.

VAERS ID:176396 (history)  Vaccinated:2001-10-10
Age:43.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-11, Days after onset: 1
Location:Illinois  Entered:2001-10-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0591AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Chills
SMQs:
Write-up: Pt developed chills and uncontrollable shivering. A follow up report received 10/18/2001 adds: Reporter states pt had chills lasting several hours. Did not take temperature; went to bed and recovered with rest. No sequeale to this symptom.

VAERS ID:176399 (history)  Vaccinated:2001-10-10
Age:87.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-11, Days after onset: 1
Location:Maryland  Entered:2001-10-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESEO2761HA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Acute generalized urticaria. The patient was placed on Benadryl for urticaria which progressed as any other problems. He received no other vaccines on that day, he is on no regular meds has had 3 other recorded flu shots, but has never before had an adverse event to any vaccine.

VAERS ID:176400 (history)  Vaccinated:2001-10-10
Age:6.0  Onset:2001-10-11, Days after vaccination: 1
Gender:Male  Submitted:2001-10-11, Days after onset: 0
Location:Louisiana  Entered:2001-10-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness: NONE
Preexisting Conditions: Asthma, ADHD
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESEO2751HA2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Eye disorder, Eye swelling, Headache, Ocular hyperaemia, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)
Write-up: This patient received a flu shot on 10/10/2001 and the following morning broke out in whelps on his back, ear, neck and chest. Saw the doctor 10/11/01. The doctor order Atarax and Patanol for eyes itching and redness. The child also complained of headache and eyes were swollen. Follow up 10/19/2001: "RN confirmed that child was improving when seen in the office morning of October 11; he was given the meds to decrease the time to fully recover from the urticaria and rash. No other vaccines at this visit, no vaccines in previous 4 weeks, no history of adverse events for child. " Reporter confirmed that child was improving when seen in the office morning of Oct 11: he was given the meds to decrease the time to fully recover from the irticaria and rash. No other vaccines at this visit, no vaccines in previous 4 weeks, no Hx of AE for child.

VAERS ID:176402 (history)  Vaccinated:2001-10-10
Age:4.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-11, Days after onset: 1
Location:Virginia  Entered:2001-10-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO5993A0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives at the vaccine site and even all over his body within 15 minutes. Benadryl with resolution in 10 minutes. Follow up 10/19/2001: "MA who gave vaccination confirmed that child received flu shot only. No other vaccines given in the previous 4 weeks; mother did elude to a possible egg sensitivity. Report correct; child did clear within 10 min of receiving benadryl." MA who gave vaccination confirmed that child received flu shot only. No other vaccines given in the previous 4 weeks: mother did elude to a possible egg sensitivity. Report correct: child did clear within 10 mins of receiving benadryl.

VAERS ID:176455 (history)  Vaccinated:2001-10-10
Age:0.8  Onset:2001-10-14, Days after vaccination: 4
Gender:Female  Submitted:2001-10-15, Days after onset: 1
Location:Guam  Entered:2001-10-18, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0050L1SCRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T12732IMLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4818162IMLL
Administered by: Private     Purchased by: Private
Symptoms: Rash erythematous, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt developed erythematous maculopapular rashes mostly con fluent all over the body except face 10/14/2001, 4 days after 9 month old immunizations were given.

VAERS ID:176470 (history)  Vaccinated:2001-10-10
Age:0.5  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-15, Days after onset: 5
Location:New York  Entered:2001-10-18, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS992A22IM 
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA628AA2IM 
Administered by: Private     Purchased by: Private
Symptoms: Apnoea, Feeling abnormal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalopathy/delirium (broad)
Write-up: A few hours post vax the patient showed symptoms of apnea with periods of shaking of 15-30 seconds. The patient seemed "out of it".

VAERS ID:176519 (history)  Vaccinated:2001-10-10
Age:0.2  Onset:2001-10-11, Days after vaccination: 1
Gender:Male  Submitted:2001-10-13, Days after onset: 2
Location:New Jersey  Entered:2001-10-22, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: 10/13- CBC, lytes, U/A - Nml, CT head - Neg.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM516A20IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1763K0IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T090920SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4623770IM 
Administered by: Public     Purchased by: Public
Symptoms: High-pitched crying, Injection site erythema, Irritability, Oral intake reduced, Sepsis, Urine analysis abnormal
SMQs:, Agranulocytosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad)
Write-up: Vaccines-DTaP, IPV, Comvax, (Hep/HIB), Prevnar given 10/10. Irritability began 10/11 AM, temp 99.6 - 99.8. Injection sites erythema. Decreased feeding and worsening irritability 10/12. Bouts of high pitched crying and refused to feed with decreased urine output. Hospitalized to r/o sepsis on 10/13- CBC, lytes, U/A - Nml, CT head - Neg. Baby did well and began feeding and sleeping.

VAERS ID:176602 (history)  Vaccinated:2001-10-10
Age:75.0  Onset:2001-10-12, Days after vaccination: 2
Gender:Male  Submitted:2001-10-16, Days after onset: 4
Location:Mississippi  Entered:2001-10-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Baby ASA and Altrace
Current Illness: NONE
Preexisting Conditions: NKDA-HTN Bypass surgery
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0601AA0IM 
Administered by: Public     Purchased by: Public
Symptoms: Contusion, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left arm with raised area at ? site injection below bruised in about a 12 inch area running down arm also yellowish area.

VAERS ID:176642 (history)  Vaccinated:2001-10-10
Age:0.8  Onset:2001-10-14, Days after vaccination: 4
Gender:Female  Submitted:2001-10-18, Days after onset: 4
Location:Pennsylvania  Entered:2001-10-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0328BA   
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5155B9 IMRL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA561AA  RL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.1232 SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES477453 IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: The pt developed generalized urticaria, including significant erythema and induration to the right thigh. This was second injection of all 5 vaccines. The pt felt most likely due to Prevnar, no respiratory distress. the pt was treated with Benadryl.

VAERS ID:176748 (history)  Vaccinated:2001-10-10
Age:70.0  Onset:2001-10-11, Days after vaccination: 1
Gender:Male  Submitted:2001-10-18, Days after onset: 7
Location:Florida  Entered:2001-10-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prinurl, Adexu, Combiveal, zeutar
Current Illness: NONE
Preexisting Conditions: CAD, COPD, Cellepc rlunetu
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU068LAA4IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0995L1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelly, redness and warmth right deltoid.

VAERS ID:176843 (history)  Vaccinated:2001-10-10
Age:0.3  Onset:2001-10-11, Days after vaccination: 1
Gender:Male  Submitted:2001-10-15, Days after onset: 4
Location:Illinois  Entered:2001-10-30, Days after submission: 15
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': IL01041
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM996A21IMLL
HBPV: HIB POLYSACCHARIDE (HIBIMUNE)LEDERLE LABORATORIES4733801IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T08421IMRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES479239 IMLL
Administered by: Public     Purchased by: Public
Symptoms: Irritability, Rash
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: The patient''s parent stated the patient broke out in a rash all over his body except his face. The patient was very fussy. The patient was not treated as the rash cleared up on it''s own.

VAERS ID:176937 (history)  Vaccinated:2001-10-10
Age:34.0  Onset:2001-10-11, Days after vaccination: 1
Gender:Female  Submitted:2001-10-18, Days after onset: 7
Location:Florida  Entered:2001-10-31, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, Claritin, Flonase, Cenestin
Current Illness:
Preexisting Conditions: Asthma, Hypoglycemia Osteoporosis
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE04821KA IM 
Administered by: Other     Purchased by: Other
Symptoms: Flushing, Malaise, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)
Write-up: Aching, woke up in middle of night feeling like I was going to pass out. Feeling really flush feeling. Nauseated, Ill feeling passed in about 24 hours.

VAERS ID:176952 (history)  Vaccinated:2001-10-10
Age:3.0  Onset:2001-10-23, Days after vaccination: 13
Gender:Male  Submitted:2001-10-26, Days after onset: 3
Location:Missouri  Entered:2001-10-31, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: "a cold"
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0514AA3IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0786L SCLA
Administered by: Public     Purchased by: Private
Symptoms: Maculopathy
SMQs:, Retinal disorders (narrow)
Write-up: 10/10/2001 pt presented for DTap and Varicella Vaccination. On history parents reported Toby "had a cold". Day 13 (10/23/2001) 1 maculopapular lesion on buttock, Day 16 about is maculopapular lesion. (Us cab bed (2) with fluid.

VAERS ID:176987 (history)  Vaccinated:2001-10-10
Age:1.3  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-11, Days after onset: 1
Location:California  Entered:2001-11-01, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: History of RAD
Diagnostic Lab Data: CBC; LP-neg; CT Scan-enlarged bifrontal subarachnoid spaces, otherwise neg; CXR-neg; cultures-all neg
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA628AA3IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0743L0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt was seen for a well visit at 09:30 and received MMR and HIB at about 12:30 to 13:00. He developed a fever and was given Tylenol and was put down for a nap. At about 17:00, he awoke from his nap with a generalized tonic/clonic seizure which lasted about 8-9 minutes. He was taken to ER by EMS with a fever of 104F on arrival. He was treated with Cefotan. Diagnosed was UTI

VAERS ID:177025 (history)  Vaccinated:2001-10-10
Age:31.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Female  Submitted:2001-10-25, Days after onset: 15
Location:Missouri  Entered:2001-11-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control Pills, Intel Inhaler, Zyrtec, Serovent, Singulair
Current Illness: NONE
Preexisting Conditions: Asthma and hypothyroidism
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0681AA  RA
Administered by: Other     Purchased by: Private
Symptoms: Pruritus, Rash, Tongue disorder
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: 30 minutes post vax the patient experienced itching, noticed a rash, and then felt her tongue getting thick. The patient was treated in the ER with an injection in the hip and was advised she probably had a reaction to some component of the vaccine.

VAERS ID:177095 (history)  Vaccinated:2001-10-10
Age:1.0  Onset:2001-10-19, Days after vaccination: 9
Gender:Female  Submitted:2001-10-23, Days after onset: 4
Location:Hawaii  Entered:2001-11-01, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0591L0SCRL
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash morbilliform
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: The patient developed a diffuse morbilliform rash and a fever of 100-102.6 nine days after receiving the vaccination.

VAERS ID:177244 (history)  Vaccinated:2001-10-10
Age:0.6  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-30, Days after onset: 20
Location:Indiana  Entered:2001-11-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM508A22IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.T139023SCLL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4797903IMLL
Administered by: Public     Purchased by: Public
Symptoms: Rash, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Pt developed vomiting and rash around face after a fourth IPV and fourth Prevnar were given in error. Symptoms started an hour later. Pt was taken to ER and was treated for urticaria with Benadryl and released.

VAERS ID:177639 (history)  Vaccinated:2001-10-10
Age:0.8  Onset:2001-10-10, Days after vaccination: 0
Gender:Female  Submitted:2001-11-01, Days after onset: 22
Location:Wisconsin  Entered:2001-11-12, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Children''s Tylenol
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4809731IMLL
Administered by: Private     Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vomiting after each feeding for one week. Diet gradually advanced from clear liquids to bland solids. Vomiting resolved.

VAERS ID:177651 (history)  Vaccinated:2001-10-10
Age:1.6  Onset:2001-10-18, Days after vaccination: 8
Gender:Male  Submitted:2001-10-23, Days after onset: 5
Location:Michigan  Entered:2001-11-12, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': MI2001085
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM506A23IMRL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1590K2IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0734L0SCRL
Administered by: Public     Purchased by: Public
Symptoms: Cough, Feeling hot, Rash, Rhinorrhoea
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (narrow)
Write-up: Pt developed a rash on 10/18 described as small, light pink, bumpy rash on back, stomach and face. Pt felt warm but temperature was not measured. Rash faded and was almost gone by 10/22. On 10/23/01 pt developed runny nose and cough but rash had subsided. Mother was advised to have pt evaluated by MD.

VAERS ID:178057 (history)  Vaccinated:2001-10-10
Age:29.0  Onset:2001-10-12, Days after vaccination: 2
Gender:Female  Submitted:2001-10-15, Days after onset: 3
Location:Idaho  Entered:2001-11-21, Days after submission: 37
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type': ID01056
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0382AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The patient started having pain in the left arm and armpit on 10/12/2001. The patient called on 10/15/2001 and stated that the left arm pain was gone but the left armpit was still sore. The patient denies nausea or fever.

VAERS ID:178114 (history)  Vaccinated:2001-10-10
Age:0.2  Onset:2001-10-11, Days after vaccination: 1
Gender:Male  Submitted:2001-11-09, Days after onset: 29
Location:California  Entered:2001-11-21, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Pt''s mother says she collected stools for clinic lab and was told that baby had no diarrhea/problem found in stool.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1IM 
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC. 1IM 
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES 1IM 
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)MERCK & CO. INC. 1  
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Mother says that baby was seen for 1st shots and told to sign papers to get shots including Rotavirus. The next day, after feeding, the baby began to vomit and was having diarrhea approx. 15 minutes afterwards. Repeated episodes after each feeding. Went back to clinic and was given a container to collect stools. Was later told that it was not diarrhea and formula was changed. He continued to have episodes. Called HC and seen there on 11/9/01.

VAERS ID:178119 (history)  Vaccinated:2001-10-10
Age:80.0  Onset:2001-10-11, Days after vaccination: 1
Gender:Female  Submitted:2001-11-14, Days after onset: 34
Location:Illinois  Entered:2001-11-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor; Fosamax; Tenormin; Flurinot; Zoloft
Current Illness:
Preexisting Conditions: Previously resolved pneumonia
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE02101HA  LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1071K0 RA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Injection site reaction
SMQs:
Write-up: Cellulitis of right arm.

VAERS ID:178282 (history)  Vaccinated:2001-10-10
Age:12.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Female  Submitted:2001-10-17, Days after onset: 7
Location:Wyoming  Entered:2001-11-27, Days after submission: 41
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: Hearing loss secondary to history of otitis media as a young child.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1192K0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Confusional state, Dyspnoea, Incoherent, Lethargy, Pain, Pharyngolaryngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)
Write-up: On the evening after shot (given around 17:00) pt developed fever and was happier than usual. The next day she was lethargic, confused, decreased strength, incoherent, breathing heavier, had body aches, sore throat and slept all day. Then she was ok.

VAERS ID:178320 (history)  Vaccinated:2001-10-10
Age:1.3  Onset:2001-10-17, Days after vaccination: 7
Gender:Female  Submitted:2001-11-16, Days after onset: 30
Location:Massachusetts  Entered:2001-11-28, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: Spinal Fluid-nml
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (NO BRAND NAME)UNKNOWN MANUFACTURER4772533  
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1327J0SCLA
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4797973  
Administered by: Private     Purchased by: Public
Symptoms: Dyskinesia, Muscle twitching, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow)
Write-up: Vaccine MMR given 10/10/2001. 10/17/2001 fever. 10/20/2001 rash, twitching, myozlmic jerks.

VAERS ID:178336 (history)  Vaccinated:2001-10-10
Age:66.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-11-12, Days after onset: 33
Location:California  Entered:2001-11-28, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prinivil, Glucophage, Calipizide, Zocor and Prevacid.
Current Illness: NONE
Preexisting Conditions: Type II Diabetes, Hypertension, elevated cholesterol.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0598AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad)
Write-up: The patient continues to have muscle tenderness with movement of the left upper extremity. The patient denies tenderness to touch at the injection site.

VAERS ID:178478 (history)  Vaccinated:2001-10-10
Age:  Onset:2001-10-17, Days after vaccination: 7
Gender:Female  Submitted:2001-11-21, Days after onset: 35
Location:Vermont  Entered:2001-12-03, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0600AA SC 
Administered by: Public     Purchased by: Other
Symptoms: Hypokinesia, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: The pt developed pain at the injection site, initially on 10/19/01, and the pain worsened. It went up the neck and down arms to chest and down hands to 4th and 5th digits which was prickly. Cannot move right arm. Seen MD and the flu vaccine could not be ruled out. It may be related.

VAERS ID:178569 (history)  Vaccinated:2001-10-10
Age:11.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:North Carolina  Entered:2001-12-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EKG = wnl
CDC 'Split Type': NC01102
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5223C90IMLL
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Feeling hot, Loss of consciousness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), 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 (broad)
Write-up: Approximately 10 minutes after receiving the vaccine, the patient stated that he was feeling hot and short of breath. He then lost consciousness for about 30 seconds. The patient''s upper extremities shook during this time. After the patient regained consciousness, he was oriented to person/place only. The patient''s vital signs remained stable throughout.

VAERS ID:178732 (history)  Vaccinated:2001-10-10
Age:0.2  Onset:2001-10-10, Days after vaccination: 0
Gender:Female  Submitted:2001-10-10, Days after onset: 0
Location:Wyoming  Entered:2001-12-07, Days after submission: 58
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Oxygen
Current Illness:
Preexisting Conditions: Mother of child reported that child had apnea birth 02 for IM
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS996A2 IMLL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0005L1IMRL
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES481578 IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT0842 SCRL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES480898 IMLL
Administered by: Public     Purchased by: Private
Symptoms: Agitation, Dyspnoea, Skin discolouration, Somnolence, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Two month old female baby for immunizations. Baby''s skin color is slightly pale. Baby crying, threw up, difficulty breathing. RN noted emesis on the exam table consisted of moderate amount of thick clear mucous with a small amount of light red liquid consistent with the liquid infant Tylenol. Baby very lethargic, extremities flaccid, and responding slowly to painful stimuli. Oxygen applied at 4 liters by blow-by.

VAERS ID:180115 (history)  Vaccinated:2001-10-10
Age:72.0  Onset:2001-10-11, Days after vaccination: 1
Gender:Female  Submitted:2001-11-15, Days after onset: 35
Location:Maryland  Entered:2002-01-18, Days after submission: 64
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: coronary artery disease, hypercholesterolemia, CVA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE02761HA7IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site swelling, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt arm became swollen, hard and aches. Chills and fever for several days following vaccination.

VAERS ID:180444 (history)  Vaccinated:2001-10-10
Age:11.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-12, Days after onset: 2
Location:North Carolina  Entered:2002-01-24, Days after submission: 104
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to dog hair and dust
Diagnostic Lab Data:
CDC 'Split Type': 20010243821
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 1IM 
Administered by: Other     Purchased by: Other
Symptoms: Agitation, Flushing, Headache, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad)
Write-up: On 10/10/01, the pt received his 2nd 10mcg, IM dose of Engerix-B. Ten minutes later, the pt experienced "agitation, severe headache, heat sensations, flushing" and 1 episode of "passing out". The pt received Benadryl immediately and ER observation later for a brief period. As of 10/10/01, the adverse events had resolved.

VAERS ID:180461 (history)  Vaccinated:2001-10-10
Age:0.2  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-10-15, Days after onset: 5
Location:Kansas  Entered:2002-01-24, Days after submission: 101
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK-done in hospital
Preexisting Conditions: NONE
Diagnostic Lab Data: Premature birth
CDC 'Split Type': KS200146
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM517A2 IMRL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0916L IMLL
HIBV: HIB (ACTHIB)CONNAUGHT LABORATORIESUA600AA IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT1390 SC 
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES482371 IMLL
Administered by: Private     Purchased by: Public
Symptoms: Anaemia, Apnoea, Atelectasis, Bradycardia, Convulsion, Encephalopathy, Lethargy
SMQs:, Haematopoietic erythropenia (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad)
Write-up: Pt was given vaccines in clinic according to hospital records. Approx 1/2 hour later mother was at home and noticed he became leghargic and apneic, was taken to ER by EMS, is currently in NICU on ventilater. (Mother did not have pink card and didn''t know that baby had received immunization in the hospital -- thought we were giving 2mg shot. Diagnosed with seizures, bradycardia, anemia gastroesopageal reflux, encephalopathy, respiratory failure, R upper lobe atelectasis

VAERS ID:180528 (history)  Vaccinated:2001-10-10
Age:47.0  Onset:2001-10-17, Days after vaccination: 7
Gender:Female  Submitted:2001-11-14, Days after onset: 28
Location:Arizona  Entered:2002-01-25, Days after submission: 72
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': 20010267721
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 0IM 
Administered by: Other     Purchased by: Other
Symptoms: Chills, Headache, Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Report 20010267721 describes (skin) bumps on a 47 year old female who received hep B vaccine recombinant (Engerix-B). This report was received from the vaccinee and has not been verified by a physician or other healthcare professional. Medical history, concurrent conditions, and concurrent medications were not specified. Reportedly, on 10/10/2001, the vaccinee received her first intramuscular injection of Engerix-B. Reportedly, on 10/17/2001, she developed "chicken pox-like bumps" on her forearms and scalp. Reportedly also, the vaccinee had chills and a headache which subsequently subsided. Reportedly, she then experienced new red bumps with little raised heads which were very small (1/4 inch in diameter). Some of the bumps were behind her ear. Reportedly, some of the bumps left a scab. The vaccinee stated that she has been awakened by itching. The vaccinee stated that one of her two sons experienced the same events, but his symptoms lasted for only two weeks. His bumps have healed but he has scars because he scratches. As of 11/09/2001, the vaccinee''s events were ongoing.

VAERS ID:180857 (history)  Vaccinated:2001-10-10
Age:74.0  Onset:2001-10-14, Days after vaccination: 4
Gender:Female  Submitted:2001-10-19, Days after onset: 5
Location:New York  Entered:2002-02-04, Days after submission: 108
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Toprol xl 100mg, BabyASA gD/Betapet, Diyoxin
Current Illness: NONE
Preexisting Conditions: High cholesterol, elevated BP, heart condition
Diagnostic Lab Data: Blood work-iver enzymes up, digoxin lever up
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0599BA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.146K IMLA
Administered by: Other     Purchased by: Private
Symptoms: Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Flu shot on 10/10/2001. Went to the doctor''s on the 14th for fever, vomiting, aches and pains. The doctor said that it''s the virus, no Rx, but did blood work.

VAERS ID:180967 (history)  Vaccinated:2001-10-10
Age:1.3  Onset:2001-10-30, Days after vaccination: 20
Gender:Male  Submitted:2002-02-01, Days after onset: 94
Location:Texas  Entered:2002-02-06, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EEG, MRI-normal
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0149L IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0780L IMRA
Administered by: Private     Purchased by: Other
Symptoms: Schizophrenia
SMQs:, Psychosis and psychotic disorders (narrow)
Write-up: Sz disorder (new onset petit mal sz activity).

VAERS ID:181231 (history)  Vaccinated:2001-10-10
Age:71.0  Onset:0000-00-00
Gender:Female  Submitted:2002-01-21
Location:Florida  Entered:2002-02-12, Days after submission: 22
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: Lymphoma, chronic atrial fib
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0681AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Laboratory test abnormal, Malaise, Pyrexia, Thinking abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: The vaccinee was admitted to the hospital few days after the vaccine, "very ill." Hospital diagnoses included fever, altered mental status

VAERS ID:183468 (history)  Vaccinated:2001-10-10
Age:5.0  Onset:0000-00-00
Gender:Male  Submitted:2002-04-08
Location:Illinois  Entered:2002-04-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM996A2  RL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.01J4K  LL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURT1273  RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0373L  LL
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt received vaccination at school three days later seen in ER with erythema/induration on the right thigh. Prescribed with Keflex. Follow-up on 10/15/2001. 8.5cm x 4.5cm faint erythema with induration.

VAERS ID:185715 (history)  Vaccinated:2001-10-10
Age:  Onset:0000-00-00
Gender:Male  Submitted:2002-05-15
Location:Unknown  Entered:2002-05-30, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC 'Split Type': WAES01104875
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a physician concerning a male who on approximately 10/10/2001 was vaccinated with varicella vaccine. The physician reported that the pt subsequently presented to the office with a break through case of chicken pox .The pt had about 100 pox that had a short papular phase. The physician indicated that the pt''s sister had been immunized three days before the pt and had not become ill. The physician collected isolates from the pt. Additional info has been requested.

VAERS ID:185756 (history)  Vaccinated:2001-10-10
Age:17.0  Onset:2001-11-10, Days after vaccination: 31
Gender:Male  Submitted:2002-05-15, Days after onset: 185
Location:Unknown  Entered:2002-05-30, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Upper respiratory infection
Diagnostic Lab Data:
CDC 'Split Type': WAES01114220
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0256L0  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1333K0  
Administered by: Other     Purchased by: Other
Symptoms: Depression, Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (narrow)
Write-up: Information has been received from a physician concerning a 17 year old male who on 10/10/2001 was vaccinated with the first dose of varicella. Concomitant vaccination that same day included the first dose of hep B vaccine. At the time of vaccination, the pt had an upper respiratory infection. The pt was not on any chronic medicaitons. On 11/10/2001, the pt reported to the ER with right facial paralysis. He was diagnosed with Bell''s palsy and was started on oral steroids and eye drops and was sent home. The pt was seen the next day by a primary care physician and later by a neurologist. No cause for the Bell''s Palsy was found. It was noted that the mother of the pt alerted the physician that the package insert for lists Bell''s Palsy as an adverse experience to varicella vaccine. It was reported that the pt was physically doing better but he was not back to his baseline status. The physician stated that the pt was not doing well emotionally because of the Bell''s Palsy. The pt was seen again on 11/23/201 and he seemed to be slowly improving; however, he was at a very difficult age and was depressed over his physical appearance. The pt was scheduled to follow-up with a neurologist on 12/11/2001. On 11/28/2001, the physician reported that the pt should have completed the steroids at this time and he was using the eye drops as much, "as much as a 16 year old could be expected to use them." Upon internal review, the pt''s Bell''s Palsy was considered to be an other important medical event. Additional info has been requested.

VAERS ID:188358 (history)  Vaccinated:2001-10-10
Age:  Onset:2001-10-10, Days after vaccination: 0
Gender:Unknown  Submitted:2002-07-30, Days after onset: 293
Location:Unknown  Entered:2002-08-02, Days after submission: 3
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': WAES01102573
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a health care professional concerning a pt who on approx. 10/10/01 was vaccinated with a dose of pneumococcal vaccine 23 polyvalent. Subsequently, the pt experienced hives on the trunk of their body. As of 10/18/01, it was reported that the hives now look like a football on the pt''s stomach. Unspecified medical attention was sought. The reporter indicated that the pt may have been vaccinated with pneumococcal vaccine 23 polyvalent before. Additional information has been requested.

VAERS ID:188364 (history)  Vaccinated:2001-10-10
Age:53.0  Onset:2001-10-11, Days after vaccination: 1
Gender:Female  Submitted:2002-07-30, Days after onset: 292
Location:Hawaii  Entered:2002-08-02, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Constipation; oral candidiasis (thrush)
Preexisting Conditions: Fibromyalgia; GERD; Hypertension NOS; Hypothyroidism; Menopause; Allergic rhinitis NOS; Sjogren''s Syndrome
Diagnostic Lab Data:
CDC 'Split Type': WAES01103103
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR  IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1456K IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a physician concerning a 53 year old white female with hypertension, hypothyroidism, Sjogren''s Syndrome, fibromyalgia, GERD, allergic rhinitis and menopause who on 10/10/01 at 10:30 was vaccinated IM in the left deltoid, with a dose of pneumococcal vaccine 23 polyvalent (lot 636158/1456K). Concomitant vaccination the same day included a dose of influenza virus vaccine (Fluzone) (lot U0573AA) given IM in the right deltoid. At the time of vaccination, the pt was experiencing constipation and oral thrush. On 10/11/01, at 10:15, the pt developed erythema and induration at the left deltoid injection site. The pt sought medical attention and the pt subsequently recovered. It was also reported that another pt (WAES 0112USA02132) had a similar experience following exposure to pneumococcal vaccine 23 polyvalent. No further information is available.

VAERS ID:191850 (history)  Vaccinated:2001-10-10
Age:50.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Male  Submitted:2001-12-28, Days after onset: 79
Location:Michigan  Entered:2002-10-23, Days after submission: 298
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: X-rays - negative
CDC 'Split Type': U200101219
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO713AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: From correspondence received on 12/03/01, it was reported that a 50 year old male patient received a Fluzone SV ''01-''02 vaccination administered on 10/10/01 That same day the patient developed pain at the injection site. X-rays negative - pain unresolved.

VAERS ID:191871 (history)  Vaccinated:2001-10-10
Age:40.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Female  Submitted:2001-12-18, Days after onset: 69
Location:North Dakota  Entered:2002-10-23, Days after submission: 308
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: Possible Sulfa--skin reaction
Diagnostic Lab Data:
CDC 'Split Type': U200101282
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0672AA   
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: It was reported that a 40 year old female patient received Fluzone SV 2001-2002 vaccinated on 10/10/01 at 12 PM. Reportedly within one hour of vaccination the patient developed pruritus and hives that lasted for 48 hours. Treated with Prednisone, Triamunolone cream and Atartar. The patient recovered from this experienced.

VAERS ID:196782 (history)  Vaccinated:2001-10-10
Age:33.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Female  Submitted:2003-01-21, Days after onset: 468
Location:Georga  Entered:2003-01-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; Zithromax, erythromycin, Flonase
Current Illness:
Preexisting Conditions: Pregnancy NOS (LMP=8/30/01); cleft lip and palate
Diagnostic Lab Data: Chest x-ray - pneumonia; Ophthalmoscopy normal; Ultrasound 9 week, normal; Ultrasound normal; Serum alpha-fetoprotein normal; Serum varicella zoster negative
CDC 'Split Type': WAES01114271
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0468L   
Administered by: Other     Purchased by: Other
Symptoms: Cough, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad)
Write-up: Information has been received from a physician through a pregnancy registry concerning a 33 year old caucasian female with a repaired cleft palate/lip and no previous pregnancies who on 10/1/01 tested negative for varicella antibodies. On 10/10/01, the pt was vaccinated with a dose of varicella virus vaccine live (638902/0468L). Concomitant therapy included azithromycin, erythromycin, albuterol, and fluticasone propionate. The physician reported that the pt was three weeks pregnant at the time of vaccination and did not know. The pt''s date of last menstrual period was reported by the physician to be 8/30/01. The pt''s estimated delivery date was determined to be 6/24/02 according to her 9 week ultrasound on 11/20/01. On 1/9/02, serum alpha-feto protein screening was normal. On 1/22/02, an ultrasound was normal. On an unspecified date the pt had a fever and cough. On 3/12/02, a chest x-ray reveled pneumonia, and the pt was hospitalized for pneumonia. On 6/6/02, 37 weeks from LMP, the pt delivered a normal baby girl weighing 7 lbs. 4oz. Complications during labor and delivery included inadequate pelvis and signs and symptoms of pregnancy induced hypertension. The pt did not have any varicella or herpes zoster symptoms or local reaction post vaccination with varicella vaccine live. The infant had no symptoms of congenital varicella zoster syndrome. Additional info received via medical records indicate that the infant had congenital ptosis. The pt had mild palpebral fissure asymmetry (the right was a bit smaller than the left). The physician did not see any signs of anisocoria or EOM problems to suggest a neuro-ophthalmic lesion. Funduscopic exam was normal. The physician recommended reassurance. A review of the medical records indicated no other adverse symptoms were noted. No additional info is expected.

VAERS ID:207252 (history)  Vaccinated:2001-10-10
Age:32.0  Onset:2001-10-12, Days after vaccination: 2
Gender:Female  Submitted:2003-07-30, Days after onset: 656
Location:Michigan  Entered:2003-08-05, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0211USA01781
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1070K1 RA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Info has been received from a medical assistant concerning a 32-year-old female principal who on 10/10/2001 (also reported by the MA as approx 11/11/2002) was vaccinated in the right deltoid with a second dose of pneumococcal vaccine 23 polyvalent (Lot #636159/1070K). Concomitant vaccines that day included influenza virus vaccine (also reported by MA as approx 11/11/2002). The MA reported that on 10/12/2001, the pt developed a local reaction of swelling, heat, pain and mild erythema (also reported as approx 11/11/2002). The pt visited her physician and subsequently recovered. Additional info is not expected.

VAERS ID:246368 (history)  Vaccinated:2001-10-10
Age:0.5  Onset:2002-11-23, Days after vaccination: 409
Gender:Male  Submitted:2005-10-27, Days after onset: 1068
Location:Illinois  Entered:2005-10-31, Days after submission: 4
Life Threatening? No
Died? Yes
   Date died: 2002-11-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: seizure~Pneumo, 7-valent (Prevnar)~1~0~In Patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Convulsion (seizures)
Diagnostic Lab Data: UNK
CDC 'Split Type': HQWYE198324OCT05
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURERUNK  UN
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIESUNK2IM 
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Pneumonia, Respiratory failure, Sepsis, Viral infection
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad)
Write-up: Information regarding Prevnar (pneumococcal 7 valent conjugate vaccine (diphtheria crm197 protein) injection) was received from the mother of a 19 month old white male pt who experienced pneumonia and seizure. At 6 months of age, the pt received the third dose of Prevnar on 10Oct01. The pt also received the third dose of Diphtheria and tetanus toxoids and pertussis (manf unk) on 10Oct01. The pt has a past history of experiencing a seizure following receipt of his first and second dose of Prevnar, IPV, Comvax, and DTP (manf unk) vaccines. The child also experienced many episodes of seizures following receipt of his third doses of Prevnar and an unspecified DTP vaccine. The indication for Prevnar was immunization. Product was administered on 10Oct01. Dose regimen was 1 dose 1 time per day (IM). Concomitant medications were not reported. On an unk date in 2002, the child developed pneumonia. On 23Nov02, he experienced a seizure and died. The mother stated that the cause of death was pneumonia and a fatal seizure. No additional information was available at the time of this report. See related serious cases: HQWYE203024OCT05, HQWYE227825OCT05, and HQWYE203124OCT05. Discharge Summary received which revealed dx: respiratory failure, sepsis syndrome & multi-system failure.

VAERS ID:255493 (history)  Vaccinated:2001-10-10
Age:1.0  Onset:2006-05-10, Days after vaccination: 1673
Gender:Male  Submitted:2006-05-15, Days after onset: 5
Location:Virginia  Entered:2006-05-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5205A22IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0026L0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0983L0SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Red, itchy rash on trunk identified as chicken pox by MD.

VAERS ID:176976 (history)  Vaccinated:2001-10-10
Age:1.0  Onset:2001-10-12, Days after vaccination: 2
Gender:Male  Submitted:2001-11-30, Days after onset: 49
Location:Foreign  Entered:2001-11-01, Days after submission: 29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Abdominal Echography-nml; Leukocytes-7100/mm3; neutrophils (62%); lymphocytes (25%); hemoglobin (12.4 g/dl); platelets (276,000); CRP (1 mg/dl); urine cytobacteriological exam-nml; Proteinuria (0.20 g/l).
CDC 'Split Type': WAES01102640
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 0IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anorexia, Gastroenteritis, Proteinuria, Pyrexia, Viral infection, Vomiting, White blood cell count decreased
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (broad)
Write-up: Information has been received from a health professional concerning a 13 month old male who on 10/10/01 was vaccinated with the 1st dose of MMRII. That evening, he developed vomiting and a temperature of 37.7C. The symptoms persisted until 10/12/01, at which time, the pt was hospitalized. He developed vomiting, again, on 10/14/01 and was re-hospitalized on 10/16/01. The pt was dx''d with viral gastroenteritis. Outcome was not known at the time of this report. It was also noted that the child received the 3rd dose of diphtheria toxoid (+) Haemophilus B conjugate vaccine (+) pertussis vaccine (+) poliovirus vaccine (+) tetanus toxoid, in 2/01 and that no reaction was reported. Additional information is not expected. F/U information received from a business partner on 11/15/01, indicated that the pt recovered from the experience. Additional information is not expected. The pt''s recovery status was added to the report. F/U states that the pt''s symptoms had improved on 10/13/01 and the pt was discharged. Follow-up information received on 11/15/2001 indicated that the child developed vomiting, anoxeria and a fever two days after vaccination and was hospitalized on 10/12/2001. At emergency unit admission, the patient temperature was 17.8C and cardiopulmonary and neurological examinations were normal. On 12/10/2001, biology showed leucocytes at 7100/mm*3. It was noted that the child clinically improved and was discharged on 10/11/2001, the following day. The patient vomitied digested blood, and was again hospitalized with presence of a fever of 17.5 C. The child clinically improved and was discharged with "antiacide" on 10/16/2001 after recovery. It was noted that the child probably experienced a viral gastroenteritis. No further info is available. Case closed.

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