|
VAERS ID: |
605655 (history) |
Form: |
Version 1.0 |
Age: |
10.0 |
Sex: |
Unknown |
Location: |
Nevada |
Vaccinated: | 2015-10-08 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
2015-10-28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. |
FJ2073 / 2 |
NS / IN |
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
L016428 / 2 |
LA / UN |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
L13514 / 1 |
LA / UN |
Administered by: Private Purchased by: Public Symptoms: Headache,
Nausea,
Pyrexia,
Streptococcus test negative,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
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: Clonidine Current Illness: None Preexisting Conditions: Allergies: Diagnostic Lab Data: Strep Rapid Test, (-); Strep culture, negative CDC Split Type:
Write-up: Nausea, headache, fever. Left clinic with extreme frontal headache. Came into clinic next day with fever 102. Strep test (-). Vomiting and nausea. |
|
VAERS ID: |
605951 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: | 2015-10-27 |
Onset: | 2015-10-27 |
Days after vaccination: | 0 |
Submitted: |
2015-10-29 |
Days after onset: | 2 |
Entered: |
2015-10-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
59CK3 / UNK |
LA / IM |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
L016429 / 1 |
LA / IM |
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
148901 / 1 |
LA / IM |
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
M15023 / 2 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Muscle tightness,
Pain,
Pain in extremity SMQs:, Dystonia (broad), Tendinopathies and ligament disorders (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: Current Illness: Slight sore throat Preexisting Conditions: Allergy to penicillins; Allergy to shrimp Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Shortly after receiving vaccines patient experienced jaw tightness predominantly on right side this decreased/resolved by 10-28-15 but then patient complained of shooting pains in left leg. Doing much better today (10-29-15). |
|
VAERS ID: |
606455 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 2015-10-08 |
Onset: | 2015-10-09 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2015-10-31 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UI493AB / 5 |
RA / UN |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J29203 / 1 |
LA / UN |
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
A15023 / 2 |
LA / UN |
Administered by: Private Purchased by: Private 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)
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: None Preexisting Conditions: Allergies: Diagnostic Lab Data: None CDC Split Type:
Write-up: 17 yo girl with 4-extremity paralysis and tingling sensation on 10/9/15 the day after receiving above vaccines. 911 called from school. Given SOLU-MEDROL, BENADRYL en route to ER. By the time she arrived at ER after NS bolus, she started to move extremities again. |
|
VAERS ID: |
606562 (history) |
Form: |
Version 1.0 |
Age: |
25.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2015-10-12 |
Onset: | 2015-10-12 |
Days after vaccination: | 0 |
Submitted: |
2015-10-30 |
Days after onset: | 18 |
Entered: |
2015-11-02 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
UI444AA / 2 |
RA / IM |
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
148901A / 1 |
LA / IM |
Administered by: Public Purchased by: Public Symptoms: Asthenia,
Fatigue,
Presyncope SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: Current Illness: No Preexisting Conditions: Anxiety Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Initial vasovagal, about 12 hours later developed "extreme fatigue and weakness". "Somewhat improved" 12 days later. |
|
VAERS ID: |
608701 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Female |
Location: |
Connecticut |
Vaccinated: | 2015-10-28 |
Onset: | 2015-10-28 |
Days after vaccination: | 0 |
Submitted: |
2015-11-10 |
Days after onset: | 13 |
Entered: |
2015-11-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J29757 / 2 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Chills,
Dizziness,
Fatigue,
Nausea,
Pain in extremity SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (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: Current Illness: None Preexisting Conditions: Leukemia Allergies: Diagnostic Lab Data: CDC Split Type: CT201506
Write-up: Nausea, lightheaded, sore arm, fatigue. Pt reported had soreness, fatigue and chills after first dose on 8/26/15. Sxs more severe after 2nd dose given. |
|
VAERS ID: |
611629 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Male |
Location: |
Connecticut |
Vaccinated: | 2015-11-19 |
Onset: | 2015-11-19 |
Days after vaccination: | 0 |
Submitted: |
2015-11-20 |
Days after onset: | 1 |
Entered: |
2015-11-20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J29757 / 2 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Chills,
Headache,
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? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: None CDC Split Type:
Write-up: Severe headache, fever 102 per mom, chills, relief from MOTRIN. |
|
VAERS ID: |
611174 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
2015-11-19 |
Entered: |
2015-11-23 |
Days after submission: | 4 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
- / UNK |
UN / UN |
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Blindness,
Dizziness,
Hyperhidrosis,
Nausea,
Pallor,
Peripheral coldness SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: No other medications Current Illness: Unknown Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 2015390253
Write-up: This is a spontaneous report from a contactable physician via Pfizer sales representative. A 18-year-old male patient of an unspecified ethnicity received TRUMENBA, via an unspecified route of administration, on unspecified date single dose and MENACTRA, via an unspecified route of administration on an unspecified date. The patient medical history and the patient''s concomitant medications were not reported. On unknown date the patient experienced could not see, face was pale, sweaty, dizzy, cold hands and nauseous. The outcome of the events was reported as unknown. |
|
VAERS ID: |
611208 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 2015-11-23 |
Onset: | 2015-11-23 |
Days after vaccination: | 0 |
Submitted: |
2015-11-23 |
Days after onset: | 0 |
Entered: |
2015-11-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
U1441AA / 7+ |
LA / IM |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J29203 / 1 |
RA / IM |
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U5244AA / 2 |
RA / IM |
TDAP: TDAP (ADACEL) / SANOFI PASTEUR |
U5247BA / 2 |
LA / IM |
Administered by: Unknown Purchased by: Private Symptoms: Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), 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: Apri, vitamin D Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: None CDC Split Type:
Write-up: Generalized hives all over chest, neck and legs and scalp. |
|
VAERS ID: |
612035 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Female |
Location: |
New Hampshire |
Vaccinated: | 2015-11-16 |
Onset: | 0000-00-00 |
Submitted: |
2015-11-17 |
Entered: |
2015-11-24 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
J28923 / 3 |
LA / IM |
Administered by: Private Purchased by: Unknown Symptoms: Headache,
Injection site pain,
Laboratory test,
Neck pain,
Vomiting SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: 2013, Mannose-Binding Lectin, < 50 CDC Split Type:
Write-up: Headache, neck pain 2 hours after injection. C/O (L) deltoid being sore. Next AM/day, vomiting. |
|
VAERS ID: |
611714 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
2015-11-11 |
Entered: |
2015-11-25 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
RA / UN |
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
- / 1 |
LA / UN |
Administered by: Other Purchased by: Other Symptoms: Arthralgia,
Chest pain,
Facial pain,
Injected limb mobility decreased,
Neck pain,
Pain,
Pain in extremity,
Rash macular SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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: No other medications Current Illness: Unknown Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: 2015340141
Write-up: This is a spontaneous report from a contactable physician via Pfizer sales representative. A 17-year-old female patient received the first dose of TRUMENBA via an unspecified route of administration in the left deltoid as single dose, and influenza vaccine (unspecified trade name) in the right arm, both on the same unknown date. Relevant medical history and concomitant medications were not reported. That evening and the next day, the patient reported to her mother that her left arm was very sore and she could not lift above her head when she went to sleep and her whole left side of body was sore and in pain. The next day (2nd day after vaccination), the mother called her doctor to report pain in the whole arm down to forearm, pain in left side of face, pain in left side of neck, and pain in left side of trunk from chest, back down to hip for the patient. The pain on the left side of body lasted approximately 24 hours. The patient declined to come to the doctor''s office to be examined. There was no numbness or tingling. The left arm was a little blotchy, but not warm and red. The outcome of all events was unknown. Follow-up (14Oct2015): New information received from a contactable physician via Pfizer sales representative includes: patient''s age: vaccine dose number, administration date and anatomical location; concomitant vaccine; clinical course; ''pain in left side of face'', ''pain in left side of neck'', ''pain in left side of trunk from chest, back down to hip'' and ''left arm was a little blotchy'' added as events. |
|