|
VAERS ID: |
266788 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
Oregon |
Vaccinated: | 2006-11-13 |
Onset: | 2006-11-13 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 1 |
Entered: |
2006-11-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0688F / 1 |
LA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Dizziness,
Fatigue,
Panic reaction SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Advair Current Illness: odd cough & migranes per patient history Preexisting Conditions: Allergies: Diagnostic Lab Data: n/a CDC Split Type:
Write-up: Patient c/o: dizziness, lightheaded, feels as if she is going to have a panic attack, very fatigued. |
|
VAERS ID: |
266889 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 2006-10-25 |
Onset: | 2006-10-26 |
Days after vaccination: | 1 |
Submitted: |
2006-11-16 |
Days after onset: | 21 |
Entered: |
2006-11-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U2256AA / UNK |
UN / IM |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0955F / 1 |
UN / IM |
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U1948AA / 1 |
UN / IM |
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC52B012AA / 1 |
UN / IM |
Administered by: Private Purchased by: Private Symptoms: Dehydration,
Hypersensitivity,
Muscle spasms,
Pyrexia SMQs:, Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Nasocort, Zyrtec, Allergy injections. Current Illness: Preexisting Conditions: Allergic Rhinitis. PMH: environmental allergens. Eczema. Roavirus at age 2 months. Allergies: Diagnostic Lab Data: Labs: Glucose 118, CO2 21, C-reactive protein 1.8. CDC Split Type:
Write-up: Pt received injections 10/25/06. Flu and HPV in one thigh. Tdap and Menactra in other thigh unk which thigh each given. Pt then went to allergist and received allergy injection in each arm. Admitted 10/26/06 for fever 103, dehydration and muscle cramping, sent home 10/27/06. DC DX: allergic reaction. 2 day history of fever. On same day as immunizations she received routine allergy shots. Immunizations received in thighs and allergy injections in arms. Complained of arms puffed and welted evening prior to admission, became painful. Also blotchiness on legs. Complained of pain in legs. Headache since immunizations, myalgias and arthralgias especially to shoulder area. Neck pain, prickly sensaton in feet. Previous immunization reacion 3 weeks ago with pain and symptomatic problems. PMH: environmental allergens. Eczema. Roavirus at age 2 months. PE: Extremities, there is injection site visible. No rash, erythema or exudate noted around the injection sites. No other rashes. |
|
VAERS ID: |
267030 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 2006-11-15 |
Onset: | 2006-11-15 |
Days after vaccination: | 0 |
Submitted: |
2006-11-16 |
Days after onset: | 1 |
Entered: |
2006-11-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0954F / 1 |
RA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Disorientation,
Dyskinesia,
Eye movement disorder,
Pallor,
Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Adderall XL 30mg q day Depo Provera 150mg q 3 months Current Illness: none Preexisting Conditions: NKA none Allergies: Diagnostic Lab Data: none CDC Split Type:
Write-up: Within a minute of giving injection in rt deltoid, pt experienced pallor, syncope, rolling back of the eyes followed by jerky movements of upper & lower extremities. After 5 seconds, she became responsive, but disoriented to place. Pt stated that she had not eaten much all day. |
|
VAERS ID: |
267409 (history) |
Form: |
Version 1.0 |
Age: |
25.0 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 2006-09-18 |
Onset: | 2006-09-18 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 57 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0637F / 1 |
UN / - |
Administered by: Other Purchased by: Other Symptoms: Medication error SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: UNK Current Illness: Preexisting Conditions: Obesity Allergies: Diagnostic Lab Data: NONE CDC Split Type: WAES0609USA07330
Write-up: Initial and follow up information has been received from a nurse practitioner concerning a 25 year old female customer service representative. On 9/18/06, the pt was vaccinated in the right deltoid with the first dose of 0.5ml of HPV vaccine (lot 653937/0637F). There were no other illnesses noted at the time of vaccination. The nurse practitioner reported that the pt was severely obese and when she received the HPV vaccine, the medication dribbled down her arm. It was report that upon removal of the needle, blood tinged fluid flowed from the injection site. The nurse practitioner was unable to estimate the amount but assumed the pt received less than the full dose. The plan was to re inject the pt with a full dose. At the time of this report, the outcome of the events were unk. Additional information has been requested. |
|
VAERS ID: |
267410 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 2006-07-19 |
Onset: | 2006-07-19 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 118 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0697F / 1 |
UN / IM |
Administered by: Other Purchased by: Other Symptoms: Fatigue,
Malaise,
Mood swings SMQs:, Dementia (broad), Depression (excl suicide and self injury) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Hormonal contraceptives Current Illness: Preexisting Conditions: Papilloma viral infection, Penicillin allergy, Asthma. Allergies: Diagnostic Lab Data: Serum Epstein Barr neg CDC Split Type: WAES0610USA01137
Write-up: Information has been received from a nurse concerning a 21 year old female with asthma, unspecified drug reaction to Penicillin and Amoxicillin and might have been exposed to papilloma viral infection. On 7/19/06, the pt was vaccinated IM with the first dose of HPV vaccine (lot 653650/0697F). Concomitant therapy included unspecified hormonal contraceptives. Subsequently, the pt experienced fatigue, was sick and had mood swings for two months. It was reported that the pt felt rotten after receiving HPV vaccine. (date unk). The pt sought unspecified medical attention. The pt underwent a test for mononucleosis that came back neg (date unk). It was reported that the pt felt better two weeks before the second dose of HPV was due to be administered (date unk). It was reported that the pt does not want to receive the second and third dose of HPV vaccine. At the time of this report, the pt had recovered from the events (date unk). Additional information has been requested. |
|
VAERS ID: |
267411 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2006-10-02 |
Onset: | 2006-10-02 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 43 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / UN |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0688F / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Loss of consciousness SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type: WAES0610USA01138
Write-up: Information has been received from a physician concerning a 17 year old female pt with on past medical history who on 10/2/06 was vaccainted with a dose of HPV vaccine, lot 653735/0688F. Concomitant therapy included an unspecified flu shot. It was reported that after receiving HPV vaccine, the pt passed out. Medical attention was sought. the pt recovered the same day. No further information is available. |
|
VAERS ID: |
267412 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2006-09-26 |
Onset: | 2006-09-26 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 49 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0688F / UNK |
UN / - |
Administered by: Other Purchased by: Other Symptoms: Loss of consciousness SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type: WAES0610USA01157
Write-up: Information has been received from physician concerning a 17 year old female with no other pertinent medical history reported and no known allergies or adverse drug reactions reported. On 9/26/06 the pt was vaccainted with HPV vaccine (lot 653735/0688F). There were no concomitant medications reported. Subsequently, the pt passed out after receiving the vaccine. The pt sought unspecified medical attention. On 9/26/06, the pt had recovered from the event. Additional information has been requested. |
|
VAERS ID: |
267413 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Unknown |
Location: |
Unknown |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
2006-11-14 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Injection site pain SMQs:, Extravasation events (injections, infusions and implants) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: UNK Current Illness: Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES0610USA01483
Write-up: Information has been received from a registered nurse concerning an adult pt who was vaccinated with a dose of HPV vaccine. The pt complained of pain while being injected using the pre filled syringe. The nurse reported that another pt did not complain of pain when a normal syringe was used. The nurse suggested the pre filled needles may be dull causing pain during injection. The pts outcome was not reported. A product quality complaint was involved. No further information is available. |
|
VAERS ID: |
267414 (history) |
Form: |
Version 1.0 |
Age: |
15.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 2006-09-14 |
Onset: | 2006-09-14 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 61 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0800F / 1 |
UN / - |
Administered by: Private Purchased by: Private Symptoms: Lymphadenopathy,
Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: UNK Current Illness: Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES0610USA01561
Write-up: Information has been received from a healthcare professional concerning a 15 year old female student who on 9/14/06 at 3:00 pm was vaccinated in the right hip with her first dose of HPV vaccine, lot 654540/0800F. On 9/18/06 the pt developed low grade fever and swollen glands. Her outcome was unk. The reporter indicated the pt would be evaluated at her next vaccination. Additional information has been requested. |
|
VAERS ID: |
267415 (history) |
Form: |
Version 1.0 |
Age: |
27.0 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 2006-10-02 |
Onset: | 2006-10-02 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 43 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0640F / 2 |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Erythema,
Pruritus SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Hormonal Contraceptives Current Illness: Preexisting Conditions: Pap Smear abnormal, Loop electrosurgical excision procedure, seasonal allergy, penicillin allergy. Allergies: Diagnostic Lab Data: NONE CDC Split Type: WAES0610USA02296
Write-up: Information has been received from a registered nurse and a medical assistant concerning a 27 year old female with seasonal allergies, a possible penicillin allergy and had a history of an abnormal Papanicolaou smear and loop electrosurgical excision procedure. On 8/2/06, the pt was vaccinated IM in the arm with the first 0.5ml pre filled syringe dose of HPV Vaccine (lot 653650/0640F). Concomitant therapy included unspecified hormonal contraceptive (reported as birth control pills). Following the first vaccination, the pt did not experience any adverse reactions. On 10/2/06, the pt was vaccinated with the second dose of HPV vaccine. On 10/2/06, 12 hours after the vaccination, the pt woke up in the middle of the night with right red, itchy hands and feet (also reported as soaked them in ice). It was reported that the symptoms were better the afternoon of the vaccination. On 10/3/06, the pt took Benadryl. The pt sought unspecified medical attention. On 10/4/06, the registered nurse spoke with the pt in the afternoon and all symptoms had resolved. The medical assistant note that the pt had no immediate severe symptoms. The medical assistant reported that there was no mention of seriousness of events in the pts chart and reported that the events did not look like they were serious. The registered nurse further reported that she would not classify the events as serious. Additional information has been requested. |
|