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VAERS ID:478394 (history)  Vaccinated:2012-11-09
Age:0.2  Onset:2012-11-09, Days after vaccination: 0
Gender:Unknown  Submitted:2012-11-21, Days after onset: 12
Location:Michigan  Entered:2012-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA006091
Vaccination
Manufacturer
Lot
Dose
Route
Site
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC. 0PO 
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: This spontaneous report as received from a medical assistant that refers to a 4 weeks old patient and unknown gender. On 09-NOV-2012, the patient was inadvertently vaccinated with a single dose of ROTATEQ, oral, (Lot number was not reported)orally. No other co-suspects were reported. Concomitant medications were not reported. No adverse effect reported. Additional information has been requested.

VAERS ID:478395 (history)  Vaccinated:0000-00-00
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2012-11-21
Location:Unknown  Entered:2012-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA003828
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H011332 UNUN
Administered by: Other     Purchased by: Other
Symptoms: No adverse event, Product reconstitution issue
SMQs:
Write-up: This spontaneous report was received from a registered pharmacist concerning to multiple patients of unknown age and gender. On an unknown date, the patients were vaccinated with ZOSTAVAX (dose and route not reported) (Lot#H011332, no exp. date given). No other co-suspects were reported. No concomitant medications were reported. The pharmacist reported that when reconstituting ZOSTAVAX it bubbles too much. The pharmacist was administering vaccine after this occurred. Also stated that she was able to get the bubbles out prior to injection into patient(s). No adverse effect reported. Additional information has been requested.

VAERS ID:478396 (history)  Vaccinated:2012-10-28
Age:62.0  Onset:2012-11-13, Days after vaccination: 16
Gender:Male  Submitted:2012-11-21, Days after onset: 8
Location:Arizona  Entered:2012-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline hydrochloride; Atorvastatin; Fluticasone
Current Illness: Rhinitis allergic; Hypercholesterolaemia
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA007644
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H011052 SCUN
Administered by: Other     Purchased by: Other
Symptoms: Blister, Herpes zoster, Neuropathy peripheral
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)
Write-up: This spontaneous report as received from a licensed practical nurse refers to a 62 years old male patient with hypercholesterolemia, allergic rhinitis and no drug reactions/allergies. The patient was vaccinated subcutaneously with a dose of 0.65 ml ZOSTAVAX (lot number reported as H011052, expiration date 05-SEP-2013) on 28-OCT-2012. Concomitant medications included amitriptyline, atorvastatin and fluticasone nasal spray. The patient developed shingles, started on 13-NOV-2012. He was examined on 16-NOV-2012 by a physician who confirmed that he had an outbreak of vesicles on his right lower back. The patient was also experiencing peripheral neuropathy. The patient consulted the physician for medical attention. No laboratory diagnostics studies were performed. Acyclovir, acetaminophen, PERCOCET and hydroxyzine were given for treatment. The outcome of the events was reported as not recovered/not resolved. Additional information has been requested.

VAERS ID:478397 (history)  Vaccinated:2012-07-01
Age:  Onset:2012-07-01, Days after vaccination: 0
Gender:Unknown  Submitted:2012-11-21, Days after onset: 143
Location:Unknown  Entered:2012-11-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA005105
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect drug dosage form administered, No adverse event
SMQs:
Write-up: This spontaneous report as received from a physician assistant via company representative. The physician assistant reported that then doses of RECOMBIVAX HB (40 mcg)(lot number, expiration date and route not provided) dialysis formulation had been administered to up to ten unspecified non-dialysis patients on unspecified dates since July, 2012. Company representative did not know if any of the patients could have received more than one dose of RECOMBIVAX HB dialysis formulation. No adverse effects reported. It was unspecified if the patients had sought medical attention. Additional information has been requested.

VAERS ID:478398 (history)  Vaccinated:2012-11-06
Age:71.0  Onset:2012-11-07, Days after vaccination: 1
Gender:Female  Submitted:2012-11-22, Days after onset: 15
Location:Unknown  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Drug allergy to PENICILLIN
Preexisting Conditions: Penicillin, Drug hypersensitivity
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA004510
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H013022 SCLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This spontaneous report as received from a pharmacist refers to a 71 years old female patient with no pertinent medical history and with drug allergy to penicillin. The patient was subcutaneously vaccinated with a single dose of ZOSTAVAX (lot number reported as H013022, expiry date: 09-OCT-2013) into the left arm on 06-NOV-2012. No other co-suspects were reported. There were no concomitant medications. On 07-NOV-2012 the patient developed a large, red, raised, itchy, hard area at the injection site. The patient had sought medical attention via coming to pharmacy. No treatment was prescribed. No lab test was done. The outcome of developed a large, red, raised, itchy, hard area at the injection site was reported as recovering/resolving. Additional information is not expected.

VAERS ID:478399 (history)  Vaccinated:2012-10-01
Age:  Onset:2012-10-01, Days after vaccination: 0
Gender:Female  Submitted:2012-11-22, Days after onset: 52
Location:Unknown  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA003270
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IMAR
Administered by: Other     Purchased by: Other
Symptoms: Culture, Erythema, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: This spontaneous report as received from a pharmacist refers to a female patient. The patient was vaccinated intramuscularly or subcutaneously with a 0.5 ml dose of PNEUMOVAX 23 (Lot # not reported) about a month ago in October 2012. In October 2012, 2 days after receiving PNEUMOVAX 23, the patient developed swelling, pain and redness in her injection site arm. Patient went to a clinic and saw a doctor who said that the symptoms on the arm looked like cellulitis, but was not. Patient''s arm was swabbed, but no result was reported. Patient received pain reliever for treatment, but no antibiotics. At the time of this report patient had recovered. Additional information is not expected.

VAERS ID:478400 (history)  Vaccinated:0000-00-00
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2012-11-22
Location:Unknown  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA008203
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: This spontaneous report as received from a medical assistant refers to a patient of unknown age. It was reported that "recently" the patient was vaccinated with a dose of VARIVAX (Merck) (lot # not reported) that expired in 2009. It was unspecified whether the patient sought for medical attention. The outcome was unknown. Additional information has been requested.

VAERS ID:478401 (history)  Vaccinated:0000-00-00
Age:  Onset:0000-00-00
Gender:Unknown  Submitted:2012-11-22
Location:Unknown  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA006549
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report was received from a pharmacist regarding an unknown number of patients of unknown age and gender. On an unknown date, the pharmacist reported that an unknown number of doses of PNEUMOVAX23 (lot# and expiry not reported) were exposed to 70 degrees Fahrenheit(F) for a 2 week period may have been administered. No adverse effect was reported. It was unspecified if the patients had sought medical attention. Additional information has been requested.

VAERS ID:478402 (history)  Vaccinated:2012-11-15
Age:1.0  Onset:2012-11-15, Days after vaccination: 0
Gender:Unknown  Submitted:2012-11-22, Days after onset: 7
Location:Colorado  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA008349
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  UNUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  UNUN
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: This spontaneous report was received from a physician regarding a 12 months old infant. The physician reported that an unspecified 12 month old infant was vaccinated with a dose of PNEUMOVAX23 (lot#, expiry, route and dose not reported) on 15-NOV-2012. On the same day on 15-NOV-2012, the patient was concomitantly vaccinated with a dose of M-M-R II (lot# and expiry not reported), VARIVAX (lot# and expiry not reported) and ROTATEQ (Oral) (lot# and expiry not reported). No adverse effects were reported. It was unspecified if the patient had sought medical attention. This is 1 of 2 reports regarding the same patient. Additional information is not expected.

VAERS ID:478403 (history)  Vaccinated:0000-00-00
Age:66.0  Onset:2012-11-06
Gender:Male  Submitted:2012-11-22, Days after onset: 16
Location:Unknown  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA006208
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  SCLA
Administered by: Other     Purchased by: Other
Symptoms: Facial pain, Herpes zoster, Paraesthesia, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypersensitivity (broad)
Write-up: This spontaneous report as received from a consumer refers to a 66 years old male patient with no drug reactions or allergies. The patients medical history was not specified by the reporter. The patient was vaccinated (dosing route unknown) with ZOSTAVAX (lot number and expiry date were not provided) on 2006. No other co-suspects were reported. Concomitant medications included: aspirin and TYNALON. On 06-NOV-2012 the patient nose stated to get soar, later on he did start getting in upper lip, right hand side of the face, and on the roof of the mouth. Did develop a case of the shingles. No treatment information was reported. The outcome of nose started to get soar, did develop a case of shingles, he did start getting tingling on the roof of the mouth, he did start getting tingling right had side of the face and start getting tingling in upper lip is unknown. The relatedness for nose started to get soar, did develop a case of the shingles, he did start getting tingling on the roof of the mouth, he did start getting right hand side of the face and start getting tingling in upper lip is unknown for ZOSTAVAX. The patient did not receive any treatment for the event. No additional information is not expected.

VAERS ID:478404 (history)  Vaccinated:2012-10-04
Age:48.0  Onset:2012-10-04, Days after vaccination: 0
Gender:Female  Submitted:2012-11-22, Days after onset: 49
Location:South Carolina  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole
Current Illness: Gastrooesophageal reflux disease; Prophylaxis
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA006249
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEUR  UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1723AA IMRA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Injection site erythema, Injection site pain, Injection site swelling, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)
Write-up: Information has been received from a registered nurse concerning a 48 years old female patient with no drug reactions/allergies and gastroesophageal reflux disease (GERD) who on 04-OCT-2012, was vaccinated with a dose of PNEUMOVAX23 0.5 ml IM, at right arm (lot #672366/1723AA, Exp: 27-JUL-2013). No other co-suspects were reported. Concomitant medications included: unspecified flu vaccine (manufacturer Sanofi) given on the same day (left arm), and omeprazole. On 04-OCT-2012, the patient experienced dizziness and nausea, and soreness, redness and swelling of her right arm at the injection site after receiving PNEUMOVAX23. The patient made phone call to office and was advised to use ice packs and to elevate her arm. The outcome of the events was reported as recovered/resolved (in 2012 exact date unspecified). No diagnostic laboratory studies were performed. The relatedness for the events was unknown for PNEUMOVAX23. This is one of several reports received from the same source (related MARRS # 1211USA005870). Additional information has been requested.

VAERS ID:478405 (history)  Vaccinated:0000-00-00
Age:  Onset:0000-00-00
Gender:Female  Submitted:2012-11-22
Location:Unknown  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA008798
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  SCUN
Administered by: Other     Purchased by: Other
Symptoms: Pain in extremity, Skin lesion
SMQs:
Write-up: This spontaneous report as received from a pharmacist refers to a female patient of unknown age who was wife of an employee of the pharmacy. The patient was vaccinated with ZOSTAVAX (lot number, route and dose not reported) on an unknown date. No other co-suspects were reported. No concomitant medications were reported. The patient developed painful lesions on her leg after administration of ZOSTAVAX. It was unspecified if the patient had sought medical attention. No treatment information was reported. The outcome of the painful lesions was unknown. This is one of reports from the same source. Additional information has been requested.

VAERS ID:478406 (history)  Vaccinated:0000-00-00
Age:  Onset:0000-00-00
Gender:Male  Submitted:2012-11-22
Location:Unknown  Entered:2012-11-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WAES1211USA007642
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Rash, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: This spontaneous report as received from a pharmacist refers to a male patient of unknown age who was an employee of the pharmacy. The patient was vaccinated with ZOSTAVAX (lot number, route and dose not reported) on an unknown date. No other co-suspects were reported. No concomitant medications were reported. The patient developed a rash after the administration of ZOSTAVAX. The patient subsequently developed scattered pink, raised lesions on his left arm and on his face. The lesions were not painful or itchy. The patient was evaluated by his unspecified physician and was prescribed an unspecified topical ointment for treatment. The patient fully recovered from the events (date unspecified). This is one of reports from the same source. Additional information has been requested.

VAERS ID:478407 (history)  Vaccinated:2012-12-06
Age:44.0  Onset:2012-12-07, Days after vaccination: 1
Gender:Male  Submitted:2012-12-17, Days after onset: 10
Location:Pennsylvania  Entered:2012-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen; Gabapentin; Seroquel; ER; Elavil
Current Illness: No
Preexisting Conditions: History of head injury, chronic headache
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH716AD0IMAR
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVC010AB0UNAR
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB459BB0UNAR
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0133990IMAR
Administered by: Public     Purchased by: Public
Symptoms: Hallucination, visual
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Hallucination while at home: "saw" two other men arguing in his room but they were not actually there. Duration a few minutes, resolved spontaneously.

VAERS ID:478408 (history)  Vaccinated:2012-11-27
Age:0.6  Onset:0000-00-00
Gender:Female  Submitted:2012-12-17
Location:Michigan  Entered:2012-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALS    
HIBV: HIB (ACTHIB)SANOFI PASTEUR    
Administered by: Private     Purchased by: Public
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:
Write-up: Patient was administered Kinrix prior to manufacturer recommended age of 4 yrs. No adverse results noted.

VAERS ID:478409 (history)  Vaccinated:2012-12-12
Age:56.0  Onset:2012-12-13, Days after vaccination: 1
Gender:Female  Submitted:2012-12-17, Days after onset: 4
Location:Texas  Entered:2012-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone nasal spray, furosemide
Current Illness: NO
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH717AB IMLA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.H016766 SCRA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, warmth, swelling 4cm diameter.

VAERS ID:478410 (history)  Vaccinated:2012-12-03
Age:0.5  Onset:2012-12-03, Days after vaccination: 0
Gender:Male  Submitted:2012-12-17, Days after onset: 14
Location:Idaho  Entered:2012-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ml 1.1 cc BID
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: CBC, CMP, Brain MRI, EEG
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B351BA2IMLL
HIBV: HIB (ACTHIB)SANOFI PASTEURUH628AA2IMRL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHF657342IMRL
RV5: ROTAVIRUS (ROTATEQ)MERCK & CO. INC.H0118102PO 
Administered by: Private     Purchased by: Public
Symptoms: Convulsion, Electroencephalogram, Full blood count, Irritability, Metabolic function test, Nuclear magnetic resonance imaging brain, Screaming
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Was very fussy the night of vaccinations, stopped screaming and had a seizure. Per ER report and doctor.

VAERS ID:478411 (history)  Vaccinated:2012-11-16
Age:65.0  Onset:2012-11-17, Days after vaccination: 1
Gender:Female  Submitted:2012-12-17, Days after onset: 30
Location:Colorado  Entered:2012-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Other
Symptoms: Pruritus, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives, facial swelling; injection of methylprednisolone sodium succinate and Rx for prednisone. Some itching still present.

VAERS ID:478412 (history)  Vaccinated:2012-12-14
Age:72.0  Onset:2012-12-15, Days after vaccination: 1
Gender:Female  Submitted:2012-12-17, Days after onset: 2
Location:Iowa  Entered:2012-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.H0126501IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site inflammation, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The patient experienced pain at the injection site after administration. Redness and inflammation appeared around the injection site on Saturday evening (12/15). The pain worsened and she visited the ED and was sent home and instructed to take Benadryl. She felt better on Sunday (12/16) and even better today (12/17).

VAERS ID:478413 (history)  Vaccinated:2012-12-11
Age:57.0  Onset:2012-12-12, Days after vaccination: 1
Gender:Female  Submitted:2012-12-17, Days after onset: 5
Location:Michigan  Entered:2012-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness at time of vaccination
Preexisting Conditions: Latex Allergy
Diagnostic Lab Data: Started on prednisone to relieve allergic reaction.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4278AA IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site inflammation, Pyrexia, Urticaria, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Hard pnk wheal around site of injection. As day and into next day reaction was from shoulder to elbow. Inflammation, hardness, fever.

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