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Case Details (Sorted by Age)

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VAERS ID:290565 (history)  Vaccinated:2007-09-13
Age:7.0  Onset:2007-09-13, Days after vaccination: 0
Gender:Female  Submitted:2007-09-13, Days after onset: 0
Location:Texas  Entered:2007-09-13
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: Failure to thrive
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Grand mal 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: 1 hour after vaccine administration patient had generalized seizure tonic-clonic for 1 minute that self-resolved. She has no history of seizures and a normal neurodevelopmental history.

VAERS ID:290994 (history)  Vaccinated:2007-09-13
Age:7.0  Onset:0000-00-00
Gender:Female  Submitted:2007-09-19
Location:Minnesota  Entered:2007-09-20, Days after submission: 1
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB211A0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: None stated

VAERS ID:291445 (history)  Vaccinated:2007-06-15
Age:7.0  Onset:2007-06-15, Days after vaccination: 0
Gender:Male  Submitted:2007-06-28, Days after onset: 13
Location:New York  Entered:2007-09-20, Days after submission: 84
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: No known allergies.
Diagnostic Lab Data:
CDC Split Type: 200702227
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR  IMLA
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Oedema peripheral, Pain in extremity, Paraesthesia, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Initial report received from a parent of a patient on 16 June 2007. A 7 year old male patient (with no known allergies) developed hives on his face, neck, arms and lower back, 3 1/2 to 4 hours after is received Adacel (lot number unknown intramuscularly in the left deltoid on 15 June 2007. He was treated with Benadryl and it resolved. He also complained of pain and swelling in the left arm and pain from the left clavicle extending to the right clavicle. He also complained of pins and needles in the "LLE" radiating from the hip. The patient did not have any illness and was not on any medications at the time of the vaccination. At the time of the report, he had not recovered.

VAERS ID:291277 (history)  Vaccinated:2007-09-18
Age:7.0  Onset:2007-09-19, Days after vaccination: 1
Gender:Female  Submitted:2007-09-21, Days after onset: 2
Location:North Carolina  Entered:2007-09-24, 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
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB182AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1105U1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Heat therapy, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Grapefruit size redness to left arm, warm to touch. Benadryl 2 tsp q 6-8hrs prn/ warm compress.

VAERS ID:291279 (history)  Vaccinated:2007-08-07
Age:7.0  Onset:2007-08-08, Days after vaccination: 1
Gender:Female  Submitted:2007-09-10, Days after onset: 33
Location:North Carolina  Entered:2007-09-24, 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: None
Current Illness: None
Preexisting Conditions: Sickle cell disease
Diagnostic Lab Data: Hgb 7.9/22.9 Hct
CDC Split Type: NC07093
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0496U0 RL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0721U1 LL
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Haematocrit decreased, Haemoglobin decreased, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hypersensitivity (broad)
Write-up: Patient received vaccine on 8/7/07. The afternoon of 8/8/07 patient started complaining of itching in area vaccine given in the left leg. The next morning mom noted red, warm area to touch. Patient still complaining of itching. Mom brought patient to our office at 4pm - 9cm x 9cm redness, swelling and area, warm to touch. Patient denied pain.

VAERS ID:291280 (history)  Vaccinated:2007-08-06
Age:7.0  Onset:2007-08-07, Days after vaccination: 1
Gender:Female  Submitted:2007-09-10, Days after onset: 34
Location:North Carolina  Entered:2007-09-24, 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: Metadate
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Hgb -12.9 Hct 39.4
CDC Split Type: NC07094
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0496U0 RL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0721U1 LL
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Haematocrit normal, Haemoglobin normal, Mass, Oedema peripheral, Pruritus, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient received vaccine - next morning patient awake - left leg swollen, warm to touch and hard knot under skin. Patient complained of lots of itching. Leg was swollen approximately 15cm area and raised with redness. Swelling and redness after 24 hours on Benadryl.

VAERS ID:291294 (history)  Vaccinated:2007-01-01
Age:7.0  Onset:2007-01-01, Days after vaccination: 0
Gender:Male  Submitted:2007-09-24, Days after onset: 265
Location:Florida  Entered:2007-09-25, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: blood culture - negative, wound culture 09/19/07 - pending, WBC count - increased, serum C-reactive - increased
CDC Split Type: WAES0709USA03403
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Abscess, Abscess drainage, Blood culture negative, C-reactive protein increased, Cellulitis, Culture wound, Headache, Injection site abscess, Injection site swelling, Injection site warmth, Pyrexia, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (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)
Write-up: Information has been received from a physician, concerning a 7 year old male child, who on 2007 was vaccinated with the first dose of Pneumovax 23 (lot # not provided). Approximately 12 hours after the vaccination, the child developed swelling and warmth at the injection site. Two days later, he developed a fever of 104 F, with vomiting and a headache. He also had an increased white blood cell count (WBC) and increased c-reactive protein (CSF) (values not specified), and was hospitalized (date not specified). Treatment during hospitalization included antibiotics (not specified), and the physician indicated the child had a diagnosis of cellulitis. Cultures during the hospitalization were negative, and the child was discharged to home. On 19-SEP-2007, the child was seen in follow up at the Infectious Disease department and found to have an abscess at the injection site. a total of 3cc of pus was drained from the site, and a culture of the abscess was pending. At the time of this report, the outcome of the events was unknown. The reporting physician considered the events to be serious due to hospitalization and as an other important medical event. The physician also reported that since March 2007, an 18 year old male patient developed cellulitis after vaccination with Pneumovax 23 (lot # not provided (WAES #0707USA03967); and 3 other patients had serious injection site reactions following vaccination Pneunomax 23 (lot # not provided) (WAES #0707USA04149). Additional information has been requested.

VAERS ID:291352 (history)  Vaccinated:2007-04-25
Age:7.0  Onset:2007-09-20, Days after vaccination: 148
Gender:Male  Submitted:2007-09-20, Days after onset: 0
Location:Florida  Entered:2007-09-25, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.00174 IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.01256 SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Rash, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Few bumps on back, arms. Child feels well happen 2 days go kids in class with chicken pox. This is Varivax #2.

VAERS ID:294332 (history)  Vaccinated:2007-06-19
Age:7.0  Onset:2007-06-19, Days after vaccination: 0
Gender:Male  Submitted:2007-09-24, Days after onset: 97
Location:Unknown  Entered:2007-09-27, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0706USA03456
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0461U IMUN
Administered by: Other     Purchased by: Other
Symptoms: No adverse reaction, Wrong drug administered
SMQs:
Write-up: Information has been received from a physician concerning a 7 year old health male child who on 19-JUN-2007 was vaccinated with Zostavax (Oka/Merck) (lot # 657558/0461U) instead of booster for Varivax (Oka/Merck) (MSD). No symptoms were reported. The physician noted that these cases of human error, not product confusion. This is one of 2 reports received from the same source. Additional information has been requested.

VAERS ID:295296 (history)  Vaccinated:2007-07-06
Age:7.0  Onset:2007-07-06, Days after vaccination: 0
Gender:Female  Submitted:2007-09-24, Days after onset: 80
Location:Missouri  Entered:2007-09-27, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0707USA01096
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.1406F SCUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: Information has been received from a healthcare worker concerning a 7-year-old female who on 06-JUL-2007 was vaccinated subcutaneously with "one vial" of Zostavax (Oka/Merck) (lot# 654604/1406F) instead of Varivax. Medical attention was not sought. The outcome was not provided. No product quality complaint was involved. Additional information has been requested.

VAERS ID:291636 (history)  Vaccinated:2007-09-18
Age:7.0  Onset:2007-09-19, Days after vaccination: 1
Gender:Male  Submitted:2007-09-20, Days after onset: 1
Location:South Carolina  Entered:2007-09-28, 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: None
Current Illness: Well care
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1071U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: See picture

VAERS ID:291754 (history)  Vaccinated:2007-09-26
Age:7.0  Onset:2007-09-26, Days after vaccination: 0
Gender:Male  Submitted:2007-09-26, Days after onset: 0
Location:Connecticut  Entered:2007-10-01, Days after submission: 5
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: Asthma
Diagnostic Lab Data: 2nd dose Epi, IV Benadryl, and Decadron in ED
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1011U1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Cough, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Acute onset of cough, SOB, facial swelling w/i 5 minutes of receiving vaccine. Received Epi-pen, Benadryl, O2 in office. Transferred to ED via ambulance.

VAERS ID:291911 (history)  Vaccinated:2007-09-25
Age:7.0  Onset:2007-09-26, Days after vaccination: 1
Gender:Female  Submitted:2007-09-26, Days after onset: 0
Location:California  Entered:2007-10-02, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0729U1 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Injection site swelling/ redness right deltoid developed 24 after vaccination.

VAERS ID:292208 (history)  Vaccinated:2007-10-03
Age:7.0  Onset:2007-10-03, Days after vaccination: 0
Gender:Male  Submitted:2007-10-04, Days after onset: 1
Location:New York  Entered:2007-10-04
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: Asthma, Pierre-Robin (S/P Cleft palate repair)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2476HA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1268U1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Eyelid oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow)
Write-up: Large swelling of Right lower eyelid, apparently with clear fluid. No erythema. No respiratory symptoms-within 15 minutes of shots given 0.4 Epi IM (1:1000) and 40 mg Benadryl p.o. swelling decreased over PM. Observed in ED over 4 hours

VAERS ID:292231 (history)  Vaccinated:2007-08-29
Age:7.0  Onset:2007-08-29, Days after vaccination: 0
Gender:Female  Submitted:2007-08-30, Days after onset: 1
Location:Texas  Entered:2007-10-04, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins, Extenderol, Nasonex, Advair, Zyrtec, Singulair, Xopenex, HFA inhaler
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1018U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site discharge, Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: redness, hot and hurting (R) UA from Varivax immunization, 1/2 dollar size on 8/29/07 at 3.25. On 8/30/07 size 3 1/4" long red-warm to touch and oozing clear fluid

VAERS ID:292307 (history)  Vaccinated:2007-10-05
Age:7.0  Onset:2007-10-05, Days after vaccination: 0
Gender:Unknown  Submitted:2007-10-05, Days after onset: 0
Location:Michigan  Entered:2007-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Was treated in ER on 10/02/2007 for croup. Received IV solumedrol.
Preexisting Conditions: allergic to Eggs, milk & nuts
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1116U1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Erythema, Lip swelling, Rash macular, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Patient presented for 9 yr PE at 10:00 am. Approx 10:30 am, Varivax was given SC in Left arm. 1105 Pt returned to office with c/o swollen lips, red face, red macular rash on trunk, anterior and posterior, dizziness stating "I don''t feel good". No respiratory distress. BP 104/60 Benadryl 50mg given IM. 1125 BP 100/72 pulse 84, O2 sat 92%. Face swollen and red. Ambulance called, patient transported to Hospital ER in stable condition

VAERS ID:292453 (history)  Vaccinated:2001-02-02
Age:7.0  Onset:2007-10-07, Days after vaccination: 2438
Gender:Female  Submitted:2007-10-08, Days after onset: 1
Location:Missouri  Entered:2007-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: resolving gastroenteritis
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0253K0SCRA
PNC: PNEUMO (PREVNAR)PFIZER/WYETH4733421IMRL
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Rash papular, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Eryth mac papules ~ 1/2cm size trunk pubic area few vesicular.

VAERS ID:292522 (history)  Vaccinated:2007-10-08
Age:7.0  Onset:2007-10-09, Days after vaccination: 1
Gender:Female  Submitted:2007-10-09, Days after onset: 0
Location:Indiana  Entered:2007-10-09
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 (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB288AA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0416U0SCLA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1704A3IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0854U0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Cold compress therapy, Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pain, redness at injection site Rt arm. Denies fever. Father states child did not go to school today. Recommended child be given either Tylenol or Ibuprofen for pain. Cool compresses to site; may use warm compresses for relief if cool not helpful.

VAERS ID:292664 (history)  Vaccinated:2007-09-25
Age:7.0  Onset:2007-09-25, Days after vaccination: 0
Gender:Male  Submitted:2007-09-26, Days after onset: 1
Location:Wyoming  Entered:2007-10-10, 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: Albuterol MDI
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1282F1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1104U0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Mom called on Wed., 9-26-07 in the am and stated that child was very nauseated, fatigued and had a low grade fever. Advised mom to give Tylenol and take child to Dr if no better by Fri - 9-28-07. Mom verbalized understanding. 9-28-07 TC to mom for follow up - no answer. 10-1-07 TC to mom - no answer.

VAERS ID:292731 (history)  Vaccinated:2007-10-09
Age:7.0  Onset:2007-10-09, Days after vaccination: 0
Gender:Female  Submitted:2007-10-11, Days after onset: 2
Location:California  Entered:2007-10-11
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2443AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0860U0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Pain, fever to 103.7 tx - cool compress - PRN Tylenol with Codeine - PRN pain q 4-6 hrs.

VAERS ID:293171 (history)  Vaccinated:2007-10-10
Age:7.0  Onset:2007-10-11, Days after vaccination: 1
Gender:Female  Submitted:2007-10-15, Days after onset: 4
Location:Rhode Island  Entered:2007-10-15
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1225U1SCLA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: (L) upper arm erythematous macular spot after 24 hours. Placed on Keflex.

VAERS ID:293295 (history)  Vaccinated:2007-09-24
Age:7.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-16
Location:Ohio  Entered:2007-10-16
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
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2289BA3IMRA
Administered by: Public     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Client rec''d a DTaP instead of a Td vaccine

VAERS ID:293551 (history)  Vaccinated:2007-09-13
Age:7.0  Onset:2007-09-13, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:2007-10-17
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: RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1003U1SCUN
Administered by: Private     Purchased by: Private
Symptoms: Cough, Erythema, Hypersensitivity, Lip swelling, Ocular hyperaemia, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Hypersensitivity (narrow)
Write-up: Acute allergic rxn, cough, red swollen eyes, and face, "throat felt funny" tightness, lips swollen. Benadryl, Epi-pen Jr, ER observation for several hrs.

VAERS ID:293748 (history)  Vaccinated:2007-08-07
Age:7.0  Onset:2007-08-07, Days after vaccination: 0
Gender:Male  Submitted:2007-10-15, Days after onset: 69
Location:Missouri  Entered:2007-10-19, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness:
Preexisting Conditions: The patient has a history of PDD (Pervasive Development Disorder) and environmental allergies (not specified). The patient had no illness at the time of vaccination. The patient had no other vaccinations within four weeks prior to 07 August 2007. Claritin and Cogentin were reported as ''Other medications''; however, Cogentin was also reported as a treatment medication.
Diagnostic Lab Data: None
CDC Split Type: 200703413
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dyskinesia, Excessive eye blinking, Tardive dyskinesia, Tic
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Ocular motility disorders (narrow)
Write-up: Initial report received from a patient''s parent on 08 October 2007. An 7-year-old male with history of Pervasive Development Disorder and unspecified environmental allergies received a left deltoid intramuscular injection of Daptacel (Lot number C2657AA) on 07 August 2007. By that evening, the patient began showing signs of eye blinking, facial tics and uncontrolled movement which was more pronounced by the next day. The parent reported that the patient was suffering from possible tardive dyskinesia. The patient was seen by a physician and was referred to a neurologist whom he has seen three to four times. The patient was treated with Cogentin. Outcome was reported as ''not recovered''. No additional information had been provided at the time of this report.

VAERS ID:293784 (history)  Vaccinated:2007-10-17
Age:7.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-19, Days after onset: 1
Location:California  Entered:2007-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2463AA UNLL
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: Left thigh red and swollen on injection site, warm to touch. Seen by Dr. today at 10:00 am.

VAERS ID:293849 (history)  Vaccinated:2007-10-08
Age:7.0  Onset:2007-10-12, Days after vaccination: 4
Gender:Male  Submitted:2007-10-19, Days after onset: 7
Location:Georgia  Entered:2007-10-19
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: prematurity EGA 31 wk, allergic rhinitis
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500487P0IN 
Administered by: Private     Purchased by: Private
Symptoms: Cough, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: wheeing and cough, started about 4 days after administration of flumist

VAERS ID:293890 (history)  Vaccinated:2007-09-20
Age:7.0  Onset:2007-09-20, Days after vaccination: 0
Gender:Male  Submitted:2007-10-05, Days after onset: 15
Location:Georgia  Entered:2007-10-19, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: `
CDC Split Type: GA07050
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB163AB0IMRA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1590IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1102U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Red spots noted to right upper arm after receiving Hep A. Bled at site, informed would have bruise. Bandaid removed, redness noted under bandaid. Area warm to touch. No itching, swelling or SOB noted. Had appt with private MD after left facility.

VAERS ID:294081 (history)  Vaccinated:2007-10-18
Age:7.0  Onset:2007-10-20, Days after vaccination: 2
Gender:Male  Submitted:2007-10-22, Days after onset: 2
Location:Massachusetts  Entered:2007-10-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1256U1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Localized swelling, redness and itching at injection site.

VAERS ID:294424 (history)  Vaccinated:2007-10-10
Age:7.0  Onset:2007-10-10, Days after vaccination: 0
Gender:Male  Submitted:2007-10-25, Days after onset: 15
Location:North Dakota  Entered:2007-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight cold
Preexisting Conditions: None
Diagnostic Lab Data: Mom reports blood work was drawn.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0852U1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dysphonia, Dyspnoea, Erythema, Hypersensitivity, Increased upper airway secretion, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Mom reports 10 minutes after leaving clinic site, child was experiencing wheezing, hoarsenss, shortness of breath, phlem, and difficulty breathing. He was very red in color. No rash present. Mom took him immediately to the local emergency room, which was within 30 minutes. She reports patient received Benadryl and she thinks Zyrtec po X1 dose. She states the doctor diagnosed the episode as an allergic reaction. They remained in the ER for 3 hours. She reports patient has not experienced any further problems.

VAERS ID:294438 (history)  Vaccinated:2007-09-21
Age:7.0  Onset:2007-09-22, Days after vaccination: 1
Gender:Female  Submitted:2007-10-25, Days after onset: 33
Location:Pennsylvania  Entered:2007-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol and Motrin prn for pain
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.083541SCLA
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: Erythema, swelling and pain at the injection site. Supportive care instructions given- no antibiotics required.

VAERS ID:294497 (history)  Vaccinated:2007-10-18
Age:7.0  Onset:2007-10-25, Days after vaccination: 7
Gender:Male  Submitted:2007-10-25, Days after onset: 0
Location:Pennsylvania  Entered:2007-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ROBITUSSIN
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0855U1SCUN
Administered by: Private     Purchased by: Private
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: 1 Week after Varivax #2 erythema multiforme rash on trunk also has mild URI Rx Benadryl and observation

VAERS ID:294617 (history)  Vaccinated:2007-09-12
Age:7.0  Onset:2007-09-13, Days after vaccination: 1
Gender:Female  Submitted:2007-09-17, Days after onset: 4
Location:Utah  Entered:2007-10-27, Days after submission: 40
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
HEPA: HEP A (VAQTA)MERCK & CO. INC.0798U0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1023U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient, age 7, received Hep A and Varicella in her left arm. The next morning her mother noticed that the deltoid area was swollen, red, and hard. Mom states it feels like a "knot" 2 1/2 inches in diameter but is not warm to the touch. Child has no fever and states it only hurts if it is pushed on. On 9/17/07 mother stated child had marked improvement and was feeling better.

VAERS ID:294768 (history)  Vaccinated:2007-10-17
Age:7.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-19, Days after onset: 1
Location:Pennsylvania  Entered:2007-10-29, 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: Takes Zyrtec for allergies last dose 10-16-07
Current Illness: None
Preexisting Conditions: Environmental / Seasonal allergies
Diagnostic Lab Data: As of 10/19/07 1000 no tests ordered
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB143BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.072441SCLA
Administered by: Public     Purchased by: Public
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: At approximately 0900 on 10/18/07 fine pinpoint rash over body. Rash more red body not itchy no itchy no drainage no trouble breathing or swallowing has appointment at 4:15 with doctor on 1019.

VAERS ID:294772 (history)  Vaccinated:2007-10-15
Age:7.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-19
Location:Missouri  Entered:2007-10-29, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD skin test given
Current Illness:
Preexisting Conditions: Increase lead; Ecchymosis; Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1338U1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Patient returned to clinic on 10/17/07 for PPD skin test reading right upper arm noted to be redness with rash. Antibiotics given for cellulitis. Patient to return for follow up in 2 days.

VAERS ID:294864 (history)  Vaccinated:2007-10-27
Age:7.0  Onset:2007-10-28, Days after vaccination: 1
Gender:Female  Submitted:2007-10-30, Days after onset: 2
Location:Georgia  Entered:2007-10-30
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: Asthma; PCN allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1106U1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site papule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient had erythematous papules at injection site and on abdomen area. Patient was given .3cc dex and 12.5mg of Diphenhydramine injection. Patient was given rx for Prapred 15/5cc 1tsp BID x 5 days. Patient is to RTC in 1 week.

VAERS ID:295074 (history)  Vaccinated:2007-10-22
Age:7.0  Onset:2007-10-22, Days after vaccination: 0
Gender:Female  Submitted:2007-10-22, Days after onset: 0
Location:California  Entered:2007-10-31, 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB18AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1249U0SCRA
Administered by: Private     Purchased by: Public
Symptoms: Anxiety, Dizziness, Injection site pain, Pallor
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt felt dizzy, anxious 10 min after administration of vaccines. Reported 2/10 pain in (L) arm radiating to hand. Facial pallor. BP=84/60; pulse 90. Observed pt in clinic for 15 mins. All sx resolved.

VAERS ID:295193 (history)  Vaccinated:2007-10-24
Age:7.0  Onset:2007-10-26, Days after vaccination: 2
Gender:Female  Submitted:2007-11-01, Days after onset: 6
Location:Oregon  Entered:2007-11-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known.
Preexisting Conditions: Frequent history of pheumonia and respiratory problems.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2476JA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.O554U0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature increased, Erythema, Limb discomfort, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad)
Write-up: Mother reports extreme left arm discomfort from time of injection for 3 days. Day after injection had temp of 101.2 for 4 hours. 2 days after injection arm bright red, hot area 3" x 3"; lasted 48 hours.

VAERS ID:295518 (history)  Vaccinated:2007-10-31
Age:7.0  Onset:0000-00-00
Gender:Male  Submitted:2007-11-05
Location:Ohio  Entered:2007-11-05
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2289BA0IMLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0152U0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration, Wrong drug administered
SMQs:
Write-up: none--given wrong vaccine for age

VAERS ID:295572 (history)  Vaccinated:2007-10-17
Age:7.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-10-24, Days after onset: 7
Location:Tennessee  Entered:2007-11-05, 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: Zyrtec one tsp qd
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2510AA2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Pain, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Lt. upper arm red, hot and indurated 8x6.5 cm on 10-18-07 14.5 x 11 cm on 10-19-07 Rx: Augmentin 1 1/2 tsp BID x 10 d; Tylenol with QOD prn. Redness and pain started decreasing 10-19-07 p.m.

VAERS ID:295763 (history)  Vaccinated:2007-10-19
Age:7.0  Onset:2007-10-22, Days after vaccination: 3
Gender:Male  Submitted:2007-10-30, Days after onset: 8
Location:New Jersey  Entered:2007-11-06, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Quick Strep and throat culture (-), bloodwork, ASO + Lyme were (-) but total CK 5554
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500487P0IN 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1015U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Asthenia, Blood creatine phosphokinase increased, Borrelia burgdorferi serology negative, Culture throat negative, Myalgia, Myositis, Pain in extremity, Pyrexia, Streptococcus identification test, Streptococcus identification test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: vaccines administered on 10/19/07, seen on 10/22/07 with muscle aches and fever. Quick strep and throat culture (-), mother states on 10/24/07 c/o severe calf pain and still has fever up to 103 deg, seen in office again on 10/25/07 with muscle pain and weakness and sent for bloodwork. ASO + Lyme were (-) but total CK 5554, diagnosed with acute benign myositis

VAERS ID:295787 (history)  Vaccinated:2007-10-18
Age:7.0  Onset:2007-10-19, Days after vaccination: 1
Gender:Male  Submitted:2007-10-23, Days after onset: 4
Location:Oregon  Entered:2007-11-06, 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: None
Current Illness: None
Preexisting Conditions: Child has history of reactive airway disease
Diagnostic Lab Data:
CDC Split Type: OR200745
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2499AA2IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Child c/o itching the next AM. Mom looked at the site and noted redness of approx "slightly larger than a 50 cent piece with swelling noted at that time. Given 10 mg (1 1/2 tsp) Benadryl. By that afternoon the erythema and swelling had progressed down to elbow and was spreading to the underside of the arm. Given 2nd dose of Benadryl. Areas also flat to touch and was swollen with what appeared as one large contiguous hive. By Saturday AM 10/20/07, color fading, Sunday 10/21, no longer hot to touch, could see border on where red rash had been on Monday. Today appears as a bruise of smaller rxn.

VAERS ID:296244 (history)  Vaccinated:2007-10-30
Age:7.0  Onset:2007-10-30, Days after vaccination: 0
Gender:Male  Submitted:2007-11-02, Days after onset: 3
Location:Arizona  Entered:2007-11-09, 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: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURV2490AA UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1031V SCUN
Administered by: Private     Purchased by: Public
Symptoms: Injection site cellulitis
SMQs:
Write-up: Cellulitis around site of injection - Started on Clindamycin

VAERS ID:296378 (history)  Vaccinated:2007-11-12
Age:7.0  Onset:2007-11-12, Days after vaccination: 0
Gender:Male  Submitted:2007-11-12, Days after onset: 0
Location:Tennessee  Entered:2007-11-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nasonex and Zyrtec
Current Illness: viral infection
Preexisting Conditions: migranes
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS800740IMRA
Administered by: Private     Purchased by: Private
Symptoms: Loss of consciousness, Pallor
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)
Write-up: Patient received influenza vaccination and while walking to waiting room patient passed out. Patient turned pale and mother carried him back to a room. Vitals were monitored and legs elevated.

VAERS ID:296517 (history)  Vaccinated:2004-12-21
Age:7.0  Onset:2004-12-22, Days after vaccination: 1
Gender:Female  Submitted:2007-11-13, Days after onset: 1056
Location:South Carolina  Entered:2007-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Viral Induced Asthma~Influenza (no brand name)~3~7~In Patient
Other Medications:
Current Illness: Well Visit check up
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURERU1516AA0IDRA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Asthma, Influenza like illness, Nasopharyngitis, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Patient went to Doctors office for seven year well visit. Patient was healthy with no symptons of cold or flu. Flu shot was offered and given to patient. Patient developed cold and flu like symptons overnight and begin weezing. The following day went back to doctor and he prescribed pulmicort and Xopenex to help with the viral induced asthma. Overnight developed pain in joints. Went back on third day and treated joint pain with Motrin. Ashtma cleared after two weeks of treatments of pulmicort and Xopenex. Each time patient gets a cold, an asthma attack occurs and breathing treatments are given (pulmicort and xopenex.) The patient never had asthma or any related symptons prior to the flu shot.

VAERS ID:299508 (history)  Vaccinated:2006-10-31
Age:7.0  Onset:2006-11-03, Days after vaccination: 3
Gender:Female  Submitted:2007-03-12, Days after onset: 128
Location:Tennessee  Entered:2007-11-14, Days after submission: 247
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC
Current Illness:
Preexisting Conditions: No illness at vaccination time, no medical conditions, no concomitant vaccinations were given, unsure of any adverse events occurred post prior vaccinations. Allergic to amoxicillin.
Diagnostic Lab Data:
CDC Split Type: 200603007
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2239AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: Initial report received from a health care professional, on 08 November 2006. A 7 year old female patient, received on 31 October 2006 Fluzone (lot number U2239AA) (multidose vial), intra-muscular, into the right deltoid. On 03 November 2006, three days later, she experienced red raised rash and itchiness at injection site. No systemic reaction was reported. The patient required a doctor visit. Corrective treatment was not reported. The patient''s outcome was unknown. No concomitant vaccinations were given. No information on prior exposure to Fluzone was reported. The patient had allergy to amoxicillin and no other medical conditions. The patient''s concomitant medications included "Zertec" as needed (PRN). No illness at vaccination time were reported. Follow-up information received on 12 March 2007 from a health care professional. Number of previous doses of Fluzone SV 2006-2007 was none. Concomitant medication was amended to Zyrtec (previously reported as Zertec). At the time of this report, the patient had recovered.

VAERS ID:296820 (history)  Vaccinated:2007-11-13
Age:7.0  Onset:2007-11-15, Days after vaccination: 2
Gender:Female  Submitted:2007-11-15, Days after onset: 0
Location:Wisconsin  Entered:2007-11-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LANTUS, NOVOLOG
Current Illness: TYPE 1 DM
Preexisting Conditions: ALLERGIC TO CINNAMON
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2502AA1IMLL
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0200U0IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1343U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site reaction, Local reaction
SMQs:
Write-up: LOCALIZED REACTION ON RIGHT THIGH 7X7 CM LARGER ON DAY 2 THAN DAY ONE POST INJECTION TREATED WITH ZYRTEC 10 MG PO DAILY FOR A WEEK

VAERS ID:296977 (history)  Vaccinated:2007-11-07
Age:7.0  Onset:2007-11-07, Days after vaccination: 0
Gender:Male  Submitted:2007-11-12, Days after onset: 5
Location:Washington  Entered:2007-11-15, 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: none
Current Illness: none
Preexisting Conditions: none, nka
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS80958 IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1174U2SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Warm, red, Swollen 3" erythemia 2 inches induration on left upper arm.

VAERS ID:297348 (history)  Vaccinated:2007-10-31
Age:7.0  Onset:2007-11-03, Days after vaccination: 3
Gender:Female  Submitted:2007-11-09, Days after onset: 6
Location:California  Entered:2007-11-19, 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: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB200AA0IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0417U1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1358U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth, Scratch
SMQs:, Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: noted today 3" red warm patch where varicella was given on 10/31 - patient scratched area - parent did not report to me until today during physical exam

VAERS ID:297350 (history)  Vaccinated:2007-09-17
Age:7.0  Onset:2007-09-17, Days after vaccination: 0
Gender:Male  Submitted:2007-09-27, Days after onset: 10
Location:Pennsylvania  Entered:2007-11-19, Days after submission: 53
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 10/27/05~Measles + Mumps + Rubella (no brand name)~2~5~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: Previous reaction to DTap and MMR/ h/o hypospadias
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0036F1IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1009U1SCUN
Administered by: Private     Purchased by: Private
Symptoms: Lip swelling, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Lip swelling/hives/wheezing; Rx Epinephrine(1:1000) 0.2ml IM; Zyrtec 10mg po x1./ Recovered <30

VAERS ID:297464 (history)  Vaccinated:0000-00-00
Age:7.0  Onset:0000-00-00
Gender:Female  Submitted:2007-09-10
Location:Texas  Entered:2007-11-20, Days after submission: 71
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
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1014U1SCLA
Administered by: Private     Purchased by: Public
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: Redness, swelling, warmth at site of injection and pt of arm.

VAERS ID:297517 (history)  Vaccinated:2007-11-15
Age:7.0  Onset:2007-11-17, Days after vaccination: 2
Gender:Male  Submitted:2007-11-21, Days after onset: 4
Location:South Dakota  Entered:2007-11-21
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: NA
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2502AA4IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Infection, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 11-15-07 1553 Client received flu shot at 1553 Sanofi Lot U2502AA in left deltoid IM. 11-19-07 Mom came into office in afternoon and told clerical the patient had to go to the Dr. on Saturday November 17, 2007 because the spot where he got the flu shot was all red. The Dr. told her it was an infection. 11-20-07 1120 Left message at client''s house for mom to return my call and let me know details of what happened. 11-20-07 Saw client''s mom in evening at flu clinic and she reported details to me. She stated on Friday November 16 her son (client) told her that his arm itched. On Saturday November 17 her son was getting dressed and felt a bump on his arm. He went to show his mom and she stated it was red, warm and sore. No fever was present. Mom felt the redness was the size of an orange or a grapefruit. She took him to acute care in the am and he saw a PA. He was given an antibiotic. Mom is unsure of the name but knew it started with a ''C''. He was prescribed 10 days worth for three times a day. She gave him two doses on Saturday and by Sunday the redness was the size of a dime.

VAERS ID:297568 (history)  Vaccinated:2007-10-06
Age:7.0  Onset:2007-10-31, Days after vaccination: 25
Gender:Female  Submitted:2007-11-21, Days after onset: 21
Location:Maryland  Entered:2007-11-21
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: granuloma annularre (skin condition), seasonal sinus problems
Diagnostic Lab Data: She was admitted to the Hospital on November 7, 2007. She was tested for everything from cancer to lupus, of which all tests were negative. She also was tested for infectious diseases and several viruses, that also had negative results. She had a chest x-ray before being hospitalized on Tuesday, November 6th. She had another chest x-ray on Wednesday, November 7, at Hospital - both results were normal. Labs and Diagnostics: CBC with WBCs 8.7, H/H 10.5/31.9, platelets 16,000. CMP with Na 133, AST 81-314, ALT 34-64. LDH 606-1024. Platelets down to 7,000. Sed rate 71. UA (+) for sediment. Blod cx (-). Lupus labs (ANA, ds DNA, anti-Sm, RNP, SSA, SSB) all (-). CK 893, complement WNL. PT 16.7, UA with trace protein, EBV IgG (+). CMV IgG and
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR  IM 
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSALTAVB207AA IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.11830 7/24/09 SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Alopecia, Anaemia, Antinuclear antibody negative, Arthralgia, Aspartate aminotransferase increased, Blood blister, Blood creatine phosphokinase increased, Blood culture negative, Blood lactate dehydrogenase increased, Blood sodium decreased, Chest X-ray normal, Complement factor, Computerised tomogram normal, Constipation, Cough, Cytomegalovirus antibody positive, Dizziness, Double stranded DNA antibody, Ecchymosis, Epistaxis, Epstein-Barr virus antibody positive, Evans syndrome, Exfoliative rash, Fatigue, Gingival bleeding, Granuloma annulare, Haematocrit decreased, Haemoglobin decreased, Immunoglobulins, Laboratory test, Laboratory test normal, Lip blister, Liver function test abnormal, Nausea, Platelet count decreased, Presyncope, Prothrombin time prolonged, Purpura, Pyrexia, Rash, Red blood cell count decreased, Red blood cell sedimentation rate increased, Rhinorrhoea, Skin exfoliation, Syncope, Thrombocytopenia, Ultrasound abdomen, Ultrasound abdomen normal, Urine analysis abnormal, Vision blurred, White blood cell count
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Haemolytic disorders (narrow), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gingival disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Within a week of the vaccination, she was tired, and she had a few nose bleeds (that were hard to stop). Her gums started bleeding when brushing her teeth a few weeks after the vaccine. She then started having high fevers around October 31, 2006,(103, 104, 105)and was eventually hospitalized on November 7, 2007, after a blood test revealed that her blood platelet count was down to 16,000. She had two chest x-rays that were normal. She was diagnosed as having high fever, a low platelet count (platelets got as low as 7,000), and low red blood cells count (which resulted in anemia). While hospitalized, she was twice treated with IVIG that caused her platelet count to rise. She also received intravenous antibiotic treatments that she did not respond to. She was also given Tylenol and later Motrin while hospitalized to control the fever. She is now taking Prednisone for a short period. In addition, she is taking iron pills and Protonix (to protect her stomach from the affects of the steroid medicine). While hospitalized, she also had a CAT Scan (of the head) and ultrasounds of her abdominal area (tests were normal). 12/06/2007 MR received for DOS 11/7-17/2007 with D/C DX: Evan''s Syndrome. Presented to local ED with fever x days, thrombocytopenia and anemia. Pt initially developed cough, rhinorrhea, fatigue and fever. Treated symptomatically for suspected viral infection. Pt developed increasing fatigue and difficulty leaving bed. Seen again by PCP with labs and CXR done. Admitted for further w/u of FUO and thromobcytopenia. PE (+) for purpura of the external ear, lip ecchymosis (blood blisters), violaceous scaly skin patches involving the malar eminence, and upper extremities. Started on abx and IVIG PMH: Skin disorder x 1.5-2 yrs c/w granuloma annulare. Rash on face/cutaneous lesions c/w Lupus. Constipation. Recurrent sinus infections. Pt developed nausea, dizziness and blurred vision and had a near syncopal episode. New onset RUQ pain on day 8 with increased LFTs. Multiple consults by Heme/Onc, Rheum, GI, Neuro and ID. DX of Evan''s Syndrome on Day 10 and tx with steroids begun to be continued and F/U as outpt. Per 60 day follow up: She is still experiencing low platelets, which is being controlled by steroid usage (presnisone). 1/15/2010 Patient rec''d other vaccine, hep A on 7/31/08 and she had to be readmitted to the hospital she experienced hair loss, skin rash, fevers, low plackets and joint pain.

VAERS ID:297711 (history)  Vaccinated:2007-11-19
Age:7.0  Onset:2007-11-22, Days after vaccination: 3
Gender:Male  Submitted:2007-11-26, Days after onset: 4
Location:Ohio  Entered:2007-11-26
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
HEPA: HEP A (VAQTA)MERCK & CO. INC.1280F1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Diet refusal, Pain, Pyrexia, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Received vaccine on Monday, November 19, 1007. Became ill with fever, vomiting and aches on Thursday, November 22, 2007. Symptoms continued on Friday, November 23, 2007. Mom reports child felt "better" on Saturday, but was sleepy on Sunday. Still refusing food on Monday, November 26. Advised by nurse completing report to contact child''s pediatrician.

VAERS ID:297723 (history)  Vaccinated:2007-11-16
Age:7.0  Onset:2007-11-17, Days after vaccination: 1
Gender:Female  Submitted:2007-11-26, Days after onset: 9
Location:Nebraska  Entered:2007-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Amoxicillin
Current Illness: Ear infection
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2528AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1355U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Nodule, Oedema peripheral, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Mother called clinic day after (11-17) vaccines were given to repot a 2 inch bump underneath the arm the vaccines were given. No fever at that time. Patient was scheduled to be seen in the office that day. Evaluated by a provider and area of approx. 3cm in diameter of redness and swelling that was warm to touch noted. Area is posterior area of R) arm. Parent instructed to apply cool pack and observe. Mother called back the next day (11-18) and patient is seen again by provider. Redness has spread outside the area of a line drawn the day before. Overall however there is less intense redness and the hardness int he middle and swelling seems improved. No drainage or skin breakdown noted. Area is more warm and tender than is was yesterday. Patient was started on Amoxil the day of the immunizations due to an ear infection. Amoxil is stopped and patient is started on Augmentin.

VAERS ID:297821 (history)  Vaccinated:2007-11-10
Age:7.0  Onset:2007-11-11, Days after vaccination: 1
Gender:Male  Submitted:2007-11-19, Days after onset: 8
Location:Texas  Entered:2007-11-26, 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: Strattera
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2493AA6IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: N 26 hours after Flu vaccine right arm felt like it was "on fire", stinging. Had well demarcated raised very erythematous 5cm X 8cm (prox-distal) hot to touch area over most of the upper lateral arm starting at sire of injection. 36 hours later decreased symptoms with redness, swelling, fading. Benadryl given PRN

VAERS ID:297836 (history)  Vaccinated:2007-11-10
Age:7.0  Onset:2007-11-10, Days after vaccination: 0
Gender:Female  Submitted:2007-11-24, Days after onset: 14
Location:Texas  Entered:2007-11-26, Days after submission: 2
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2460CA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site urticaria, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Mom Called approx 90 min after vaccine and reported hives beginning at vaccine site and spreading to legs and trunk. TX with Benadryl and Baking soda baths.

VAERS ID:297874 (history)  Vaccinated:2007-10-16
Age:7.0  Onset:2007-10-17, Days after vaccination: 1
Gender:Male  Submitted:2007-11-12, Days after onset: 26
Location:Indiana  Entered:2007-11-27, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec, Flonase
Current Illness:
Preexisting Conditions: Past Disease: Allergic rhinitis
Diagnostic Lab Data: CXR normal
CDC Split Type: MEDI0006101
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500488P0IN 
Administered by: Private     Purchased by: Private
Symptoms: Chest X-ray normal, Respiratory distress, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow)
Write-up: A serious report of respiratory distress and wheezing was received from a physician concerning a seven-year-old male. The patient had a history of allergic rhinitis but did not have a history of wheezing or asthma. Concomitant medications include Zyrtec and Flonase nasal spray, both taken once a day for allergic rhinitis since Aug 2007. The patient received FluMist on 16-Oct-2007. On 18-Oct-2007, the patient presented to the reporting physician''s office complaining of respiratory distress and wheezing, which started on 17-Oct-2007. The patient''s chest x-ray was normal. Per the reporter, the patient "cleared" with Xopenex but returned later in the day with increased distress. The patient was admitted to the hospital for 24 hours and was discharged on oral steroids and Xopenex treatments. The patient recovered from the wheezing. No outcome was provided for the event of respiratory distress. The discharge summary has not been received. Rechallenge is not applicable. The reporter did not provide an assessment of causality for the events. The reporting source of this case is spontaneous, thus the sponsor''s comment is not applicable.

VAERS ID:297961 (history)  Vaccinated:2007-11-26
Age:7.0  Onset:2007-11-27, Days after vaccination: 1
Gender:Male  Submitted:2007-11-27, Days after onset: 0
Location:California  Entered:2007-11-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Guanfacine 1mg
Current Illness: ADHD
Preexisting Conditions: ADHD
Diagnostic Lab Data: vaccine adverse effect
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0414U1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1357U1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Induration, Oedema peripheral, Pruritus, Vaccination complication
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Left upper outter arm red, hard and swollen, itchy seen by PCP 11/27/07 TX: Tylenol and Benadryl, Follow-up visit in 1 week.

VAERS ID:298002 (history)  Vaccinated:2007-11-26
Age:7.0  Onset:2007-11-26, Days after vaccination: 0
Gender:Female  Submitted:2007-11-28, Days after onset: 2
Location:California  Entered:2007-11-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Had MMR 10/23/06; Varicella 7/26/04
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0986U0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site discharge, Injection site erythema, Injection site pain, Injection site pruritus, Injection site scab, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: erythma at site of vaccination right deltoid about 12 hrs after shot. It progressed to vesicles in center. I saw her at 9 pm 11/27/2007.4" erythmatous ring with raised edge central vesicles with on about 1"x1/3" denuded oozing slightly brown scabbed surrounded by slightly mor intnse red. Area very itchy not much pain

VAERS ID:298046 (history)  Vaccinated:2007-11-14
Age:7.0  Onset:2007-11-15, Days after vaccination: 1
Gender:Male  Submitted:2007-11-16, Days after onset: 1
Location:Georgia  Entered:2007-11-28, Days after submission: 12
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2476HA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1120U2UNLA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Arm swollen and red, vesicle x 2 on arm.

VAERS ID:298119 (history)  Vaccinated:2007-10-05
Age:7.0  Onset:2007-10-05, Days after vaccination: 0
Gender:Female  Submitted:2007-11-29, Days after onset: 55
Location:Massachusetts  Entered:2007-11-29
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1179U1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient developed achiness, then diffuse swelling at immunization site within 24 hours of administration. When seen in office 48 hours later area of overlying erythema consistent with large local reaction to immunization vs cellulitis. Placed on course of Keflex and improved.

VAERS ID:298167 (history)  Vaccinated:2007-11-08
Age:7.0  Onset:2007-11-10, Days after vaccination: 2
Gender:Female  Submitted:2007-11-29, Days after onset: 19
Location:Illinois  Entered:2007-11-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 15mg/day, Lexapro 5mg/day
Current Illness: none
Preexisting Conditions: none (autism spectrum disorder)
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2528AA4UNRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Pruritus, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Patient received flu vaccine in thigh on Thursday, 11/8/07, around 3pm. Friday afternoon, 11/9, he complained that his "feet were itchy". Saturday morning 11/10 he awoke with fever (101.6 F) headache, and HIVES all over his thighs, calves, ankles, and feet. We were out of town called our pediatrician who advised giving him oral Benedryl and taking him to an acute care center. We did so. Patient responded to the Benedryl (hives began to fade) and Tylenol for headache and fever. Felt bad for the day. Hives faded in two days.

VAERS ID:298497 (history)  Vaccinated:2007-10-30
Age:7.0  Onset:2007-10-30, Days after vaccination: 0
Gender:Female  Submitted:2007-11-13, Days after onset: 14
Location:Puerto Rico  Entered:2007-12-03, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: Hermansky Pudlak
Diagnostic Lab Data:
CDC Split Type: PR0712
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2490AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0880F0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Injection site inflammation, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: The patient''s mother referred that after vaccination her daughter had fever for 3 days, inflammation in the injection site (left arm), seizures and vomiting.

VAERS ID:298690 (history)  Vaccinated:2007-12-03
Age:7.0  Onset:2007-12-03, Days after vaccination: 0
Gender:Female  Submitted:2007-12-04, Days after onset: 1
Location:Oregon  Entered:2007-12-04
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500488P1IN 
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Dizziness, Headache, Pharyngolaryngeal pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: FEVER 103 LESS THAN 12 HOURS AFTER FLUMIST ADMINISTERED. ALSO COMPLAINED OF SORE THROAT, STOMACH ACHE, DIZZINESS, HEADACHE.

VAERS ID:298781 (history)  Vaccinated:2007-11-27
Age:7.0  Onset:2007-12-01, Days after vaccination: 4
Gender:Female  Submitted:2007-12-05, Days after onset: 4
Location:Texas  Entered:2007-12-05
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: amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.5004483P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Asthenia, Dizziness, Dysphonia, Glossodynia, Pallor, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient woke-up up with a fever of 103.1. She was shaking and was weak, dizzy, & a little pale. She complained that her tongue was burning. This was on the 1st of December. I took her to the weekend doctor and had forgot that she had this vaccination, so did not inform them of it. They said they found nothing wrong with her, but again, I did not inform them of this vaccination, because I forgot that she had it. On Sunday, December 2nd, she was hoarse the whole day. To my knowledge she is ok, but I will call to possibly set up another appointment, if they want to see her. She had this vaccine done at her school. They sent home a note with the vaccine information, but I cannot tell the name of the person who administered it.

VAERS ID:298942 (history)  Vaccinated:2007-11-01
Age:7.0  Onset:2007-11-01, Days after vaccination: 0
Gender:Female  Submitted:2007-11-19, Days after onset: 18
Location:Illinois  Entered:2007-12-06, Days after submission: 17
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.   UN
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pyrexia, Rash macular, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Big red hive on left cheek which was hot and to touch, then migrated to the ear 2 days later. Cheek was then blotchy with a red mark across the upper lip. Physical symptoms ceased on 11-19-07. Later ran a fever for 6 days on and off.

VAERS ID:298948 (history)  Vaccinated:2007-11-12
Age:7.0  Onset:2007-11-25, Days after vaccination: 13
Gender:Male  Submitted:2007-11-28, Days after onset: 3
Location:California  Entered:2007-12-06, 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:
Current Illness: None
Preexisting Conditions: Healthy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2476HAAR  LA
Administered by: Private     Purchased by: Unknown
Symptoms: Eye disorder, Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: 13 days after the flu vaccine, patient developed Bell Palsy right side of face. Patient recovered p.o. steroid. 12/18/07 Reviewed ER medical records which reveal patient experienced acute onset right sided facial droop, unable to close right eye or furow forehead. Tx w/steroids & antiviral meds & to tape eye at night. PMH: seasonal allergies FINAL DX: Bell''s palsy.

VAERS ID:299006 (history)  Vaccinated:2007-09-13
Age:7.0  Onset:2007-09-13, Days after vaccination: 0
Gender:Female  Submitted:2007-12-03, Days after onset: 81
Location:New York  Entered:2007-12-06, 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: Resolved with Prednisone and oral meds
Current Illness: None
Preexisting Conditions: Asthma, eczema
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAV06AB0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1104U1UNRA
Administered by: Public     Purchased by: Public
Symptoms: Anaphylactic reaction, Eye swelling, Pruritus, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Anaphylactic reaction. -wheezing -swelling of eyes -Body itch (-) rash

VAERS ID:299044 (history)  Vaccinated:2007-12-06
Age:7.0  Onset:2007-12-06, Days after vaccination: 0
Gender:Male  Submitted:2007-12-07, Days after onset: 1
Location:Texas  Entered:2007-12-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unknown~ ()~NULL~~In Patient|unknown~ ()~NULL~~In Sibling1|unknown~ ()~NULL~~In Sibling2
Other Medications: Ibuprofen syrup 2 tsp., Zyrtec 7.5 ml.
Current Illness: None
Preexisting Conditions: Seasonal allergies, history of hives
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.50049080IN 
Administered by: Unknown     Purchased by: Public
Symptoms: Condition aggravated, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Had Intranasal Flu vaccine at around 2:00 p.m. and went back to school, after receiving 2 tsp. Ibuprofen syrup. Mother brought him back about 4 p.m. saying he got off the bus itching and with hives on neck, chest, abdomen, back, no difficulty breathing. We gave him Zyrtec 7.5 ml. and kept him about 40 minutes. He developed no further symptoms but remained with hives. Sent him home with Benadryl chewable tablets to take at bedtime for hives. Called mother this morning, she said he was fine, hives were gone by time they got home yesterday.

VAERS ID:299187 (history)  Vaccinated:2007-12-07
Age:7.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:New Hampshire  Entered:2007-12-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metamucil, MVI, Albuterol PRN
Current Illness: Well
Preexisting Conditions: Stable asthma
Diagnostic Lab Data: N/A
CDC Split Type: NH0746
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2524AA4UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1559U2UNLA
Administered by: Private     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Inadvertently administered three doses of varicella (2/14/03) (12/01/06). No known s/sx.

VAERS ID:299332 (history)  Vaccinated:2007-12-10
Age:7.0  Onset:2007-12-10, Days after vaccination: 0
Gender:Female  Submitted:2007-12-11, Days after onset: 1
Location:Minnesota  Entered:2007-12-11
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2502AA0  
Administered by: Private     Purchased by: Unknown
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash and itchiness within one hour after administration of influenza vaccine. Patient given Benadryl 25 mg by mouth per mother.

VAERS ID:299338 (history)  Vaccinated:2007-11-26
Age:7.0  Onset:2007-11-27, Days after vaccination: 1
Gender:Female  Submitted:2007-11-28, Days after onset: 1
Location:North Carolina  Entered:2007-12-11, 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: None
Diagnostic Lab Data: CBC - WBC 13.6; Strep test neg
CDC Split Type: NC07121
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB213AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1495U1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Cough, Erythema, Headache, Pyrexia, Skin warm, Streptococcus identification test negative, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Rt arm (on back of arm) redness 4x5 cm and warm. Fever 101.7. H/A, cough. Tx: Augmentin, Xopenex.

VAERS ID:299427 (history)  Vaccinated:2007-11-19
Age:7.0  Onset:2007-11-20, Days after vaccination: 1
Gender:Female  Submitted:2007-12-06, Days after onset: 16
Location:New York  Entered:2007-12-12, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~0~In Patient|None~ ()~~0~In Sibling
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1354U1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Rash, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: On 11/20/07 mom called office to inform Dr. pt. had 4 1/2 x 4 1/2cm erythematosis, swollen, warm area. Benadryl/warm compresses recommended. On 11/21 pt. in to office with 11x11cm rash & erythemic area. Tx with Omnicef 250mg po BID. On 12/3/07 pt. in for follow up- resolved.

VAERS ID:300458 (history)  Vaccinated:2007-11-12
Age:7.0  Onset:2007-11-13, Days after vaccination: 1
Gender:Female  Submitted:2007-12-19, Days after onset: 36
Location:Pennsylvania  Entered:2007-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: EKG, EEG, CTS - normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR42526AA3IMLA
Administered by: Private     Purchased by: Private
Symptoms: Computerised tomogram normal, Electrocardiogram, Electroencephalogram, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Questionable syncopal episode.

VAERS ID:300820 (history)  Vaccinated:2007-12-11
Age:7.0  Onset:2007-12-12, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Oregon  Entered:2007-12-21
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS0741F1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1509U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site swelling, Pyrexia, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Received immunizations Varivax & Hep A #2 in L delt. Following a.m. had fever & arm swelling with redness L injection site. Symptoms stable until 24 hrs after injection, developed lip tingling & throat tightness with pain & arm. This occurred after a nap. He was given Benadryl & presented to office with resolution of symptoms. Exam was normal except for erythema around injection. Some residual h/a. Was prescribed Albuterol inhaler although no wheeze on exam. Completely resolved 12/17/07.

VAERS ID:301001 (history)  Vaccinated:2007-12-18
Age:7.0  Onset:2007-12-21, Days after vaccination: 3
Gender:Female  Submitted:2007-12-21, Days after onset: 0
Location:Virginia  Entered:2007-12-26, Days after submission: 5
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0005U0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA01693SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0869U1SCRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1958DA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1119U0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Erythema, Injection site erythema, Injection site induration, Injection site mass, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Client''s aunt discovered swollen red arm this morning before bathing child. Egg shaped lump at site of Td, L arm vaccination. Red and firm upon palpation observed by RN at TST skin test reading. Ice applied and client referred to urgent care to treat or r/o cellulitis.

VAERS ID:301663 (history)  Vaccinated:2007-07-19
Age:7.0  Onset:2007-07-19, Days after vaccination: 0
Gender:Male  Submitted:2007-12-21, Days after onset: 155
Location:California  Entered:2007-12-28, 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: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0707USA03631
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0163U0SCUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: Information has been received from a nurse concerning a 7-year-old patient (gender unknown), who on 19-JUL-2007 was vaccinated with Zostavax. The patient was vaccinated due to human error. It was reported that the patient had no symptoms. At the time of the report, the patient''s outcome was unknown. No product quality complaint was involved. Follow-up information received from the registered nurse (R.N.) indicates that the patient is a healthy male with no pre-existing allergies, birth defects or medical conditions who was vaccinated in the right arm with a first subcutaneous dose of Zostavax (lot# 656607/0163U) instead of a dose of Varivax at 11:47 AM. (It was previously reported that he was to receive a dose of Gardasil, which was reported in error). There was no illness at the time of vaccination. There were no concomitant medications given. On 20-Jul-2007, the doctor notified the mother of the error in immunization. The mother reported that the child had no fever or rash. On 26-Jul-2007, the patient came in for a follow-up clinic visit and it was noted that there was no reaction to the Zostavax. There were no laboratory or diagnostic tests performed. It is reported that the patient has never had an adverse event following prior vaccinations. Additional information is not expected.

VAERS ID:302099 (history)  Vaccinated:2007-09-20
Age:7.0  Onset:2007-09-20, Days after vaccination: 0
Gender:Female  Submitted:2007-12-21, Days after onset: 92
Location:Indiana  Entered:2007-12-28, 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:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA01697
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0462U SCLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site warmth, Wrong drug administered
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a physician and a medical assistant concerning a 7 year old female who on 20-SEP-2007 was vaccinated subcutaneously in her left arm with a dose of Zostavax (Oka/Merck) (Lot #657559/0462U) instead of Varivax (Oka/Merck). The medical assistant confirmed this was staff error. No product quality complaint was involved. In follow-up, the medical assistant reported the patient did have any side effects from receiving Zostavax (Oka/Merck) and she will not be vaccinated again with Varivax (Oka/Merck). It was also reported that the patient''s brother received a dose of Zostavax (Oka/Merck) (WAES# 0709USA03490) instead of Varivax (Oka/Merck). Additional information is not expected. This is in follow-up to report(s) previously submitted on 12/21/2007. Information has been received from a physician and a medical assistant concerning a 7 year old female who on 20-SEP-2007 was vaccinated subcutaneously in her left arm with a dose of ZOSTAVAX (Lot #657559/0462U) instead of VARIVAX. The medical assistant confirmed this was staff error. No product quality complaint was involved. In follow-up, the medical assistant reported the patient did not have any side effects from receiving ZOSTAVAX and she will not be vaccinated again with VARIVAX. It was also reported that the patient''s brother received a dose of ZOSTAVAX (WAES# 0709USA0349U) instead of VARIVAX. Follow-up information received by the medical assistant providing patient demographics. The patient experienced erythema, induarartion, warmth, and pain at the injection site. The site was greater than 4 inches in diameter. The patient recovered on an unknown date. Additional information is not expected.

VAERS ID:301762 (history)  Vaccinated:2008-01-04
Age:7.0  Onset:2008-01-05, Days after vaccination: 1
Gender:Female  Submitted:2008-01-05, Days after onset: 0
Location:Massachusetts  Entered:2008-01-05
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: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1IDLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Injection site erythema, Injection site urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Within 12 hours after flu vaccine given my daughter started to vomit and complain of a severe headache. She is still having these symptoms 18 hours later. She has a huge welt and redness where the shot was given on her arm also.

VAERS ID:301800 (history)  Vaccinated:2007-12-03
Age:7.0  Onset:2007-12-24, Days after vaccination: 21
Gender:Male  Submitted:2008-01-07, Days after onset: 14
Location:Massachusetts  Entered:2008-01-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma in the past
Diagnostic Lab Data: Na 129, K 6.1, CO2 15, BUN 12, Cr 0.5, Gluc 609, VBG pH 7.25 pCO2 46, pO2 38 1/17/08-records received- Glucose 609. Urine positive for ketones, glucose and protein. Sodium 129, potassium 6.06.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1272U1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood creatine phosphokinase normal, Blood creatinine normal, Blood gases abnormal, Blood glucose increased, Blood potassium increased, Blood sodium decreased, Blood urea normal, Carbon dioxide abnormal, Diabetes mellitus, Diabetic ketoacidosis, Fatigue, Glucose urine present, Polydipsia, Polyuria, Protein urine present, Urine ketone body present, Weight decreased
SMQs:, Acute renal failure (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad)
Write-up: Patient presented on 12/24/2007 with fatigue, polyuria and polydypsia for 3-4 days. Blood glucose was found to be elevated at 474 mg/dL. He was referred and admitted to Hospital with a diagnosis of new onset diabetic ketoacidosis. He was treated with IV fluid resuscitation and insulin, and he was discharged on 12/27/2007. 1/17/08-records received for DOS 12/24-12/27/07-DC DX: Diabetes. Presented to ED with 5 day history of polydipsia and polyuria and fatigue. Ten pound weight loss.Mild diabetic ketoacidosis.

VAERS ID:302031 (history)  Vaccinated:2008-01-03
Age:7.0  Onset:2008-01-03, Days after vaccination: 0
Gender:Male  Submitted:2008-01-04, Days after onset: 1
Location:Arizona  Entered:2008-01-09, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0412U0SCUN
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0964U0UNRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)
Write-up: Benadryl q 4 hr x 48 hr. Swelling, redness, painful to Rt bicep measurements 5" long 3" wide 7" circ. Reaction to PPV23.

VAERS ID:302571 (history)  Vaccinated:2007-10-10
Age:7.0  Onset:2007-10-14, Days after vaccination: 4
Gender:Female  Submitted:2008-01-04, Days after onset: 82
Location:Unknown  Entered:2008-01-09, 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:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA03075
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0302U UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETH  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Irritability, Pyrexia, Rash generalised
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning his 7 year old daughter who on 10-Oct-2007, was vaccinated with PROQUAD (lot #657186/0302U). Concomitant vaccination included PREVNAR (batch 3 B26510D. On 14-Oct-2007, developed a rash all over, low grade fever, and was cranky. It was reported that the vaccinating pediatrician was aware and the patient recovered. A product quality complaint was not reported. Further information was not available. Additional information has been requested.

VAERS ID:302330 (history)  Vaccinated:2001-01-30
Age:7.0  Onset:2007-08-02, Days after vaccination: 2375
Gender:Male  Submitted:2008-01-07, Days after onset: 158
Location:California  Entered:2008-01-10, 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: None
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.1093L1 RA
Administered by: Private     Purchased by: Private
Symptoms: Varicella
SMQs:
Write-up: Varicella despite vaccination 1/30/01, 2/13/07.

VAERS ID:302341 (history)  Vaccinated:2008-01-09
Age:7.0  Onset:2008-01-10, Days after vaccination: 1
Gender:Female  Submitted:2008-01-10, Days after onset: 0
Location:Pennsylvania  Entered:2008-01-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Varicella (Varivax)~1~1~In Sibling
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1495U1SCLA
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: Pt received Varivax 1/10/08. Woke up with swollen red area around injection site 4cm x 4.5 cm.

VAERS ID:302485 (history)  Vaccinated:2007-12-20
Age:7.0  Onset:2007-12-21, Days after vaccination: 1
Gender:Female  Submitted:2008-01-07, Days after onset: 17
Location:Wisconsin  Entered:2008-01-11, Days after submission: 4
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500489P1IN 
Administered by: Private     Purchased by: Unknown
Symptoms: Bronchospasm, Cough
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Bronchospastic cough that persisted for 2 weeks, worse at night. No other symptoms - gave 5 day course of 1mg/kg steroid.

VAERS ID:302605 (history)  Vaccinated:2008-01-08
Age:7.0  Onset:2008-01-11, Days after vaccination: 3
Gender:Male  Submitted:2008-01-14, Days after onset: 3
Location:Virginia  Entered:2008-01-14
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
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08733IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1217F0SCRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1923HA3IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Eye swelling, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 01-11-2008 pm developed fever (low grade most of time except on 01-13-2008 temp. went to 102), complaint of being itchy since 01-11-2008 (no rash), Right eye swollen. Has a bad cough. Has not sought medical treatment.

VAERS ID:302791 (history)  Vaccinated:0000-00-00
Age:7.0  Onset:0000-00-00
Gender:Female  Submitted:2008-01-09
Location:California  Entered:2008-01-15, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: 4-6 hours after immunization
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1363U1IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: No adverse reaction
SMQs:
Write-up: No adverse events

VAERS ID:302792 (history)  Vaccinated:2008-01-02
Age:7.0  Onset:2008-01-02, Days after vaccination: 0
Gender:Male  Submitted:2008-01-02, Days after onset: 0
Location:Tennessee  Entered:2008-01-15, 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:
Preexisting Conditions: Has been on medicines for ADHD, not currently taking
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB211AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1508U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Cough, Flushing, Rash macular, Sneezing, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: 10-15 minutes after giving vaccines child started to sneeze numerous times, began coughing c/o with throat itching began crying c/o with throat, Benadryl 25 mg liquid given by mouth, skin Blotchy c/o with intermittent abd pain, 30 mins after po Benadryl no coughing or throat itching, skin very flushed advised Dr, advised foster mom to continue with po Benadryl every 4 hours and seek ER if symptoms worsened.

VAERS ID:302839 (history)  Vaccinated:2008-01-14
Age:7.0  Onset:2008-01-14, Days after vaccination: 0
Gender:Female  Submitted:2008-01-16, Days after onset: 2
Location:Massachusetts  Entered:2008-01-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: PMH- Complex including Trisomy 21, Tetralogy of Fallot status post surgical repair, myopia, for which she wears eyeglasses, idiopathic arthritis, and mild intermittent asthma
Diagnostic Lab Data: CBC and blood cx done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1759U1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister, Blood culture, Erythema, Eschar, Full blood count, Induration, Skin warm
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: 3.5 cm x 6 cm area of induration, erythema and warmth w/ numerous clustered vesicles and sm. eschar formation.

VAERS ID:302980 (history)  Vaccinated:2008-01-15
Age:7.0  Onset:2008-01-16, Days after vaccination: 1
Gender:Male  Submitted:2008-01-17, Days after onset: 1
Location:Iowa  Entered:2008-01-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cough
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B127AA2IM 
HEPA: HEP A (VAQTA)MERCK & CO. INC.0442U0IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0148F0  
PNC: PNEUMO (PREVNAR)PFIZER/WYETHUK2444610IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1503U0  
Administered by: Public     Purchased by: Public
Symptoms: Cough, Nasopharyngitis, Pruritus, Rash
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (narrow)
Write-up: Mother called to report patient has rash on trunk, arms, complained of itching last evening 1/16/08. Took OTC Benadryl last evening. 1/17/08, still has rash but no itching. Also medicated with Tylenol. Did have residual cough from cold but needed immunizations in order to get into school.

VAERS ID:303043 (history)  Vaccinated:2007-12-12
Age:7.0  Onset:2008-01-10, Days after vaccination: 29
Gender:Male  Submitted:2008-01-11, Days after onset: 1
Location:California  Entered:2008-01-18, 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:
Current Illness: Allergic Rhinitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1341U UNLA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Received Varivax #1) 1/26/01 #2) 12/12/07 Onset Varicella vesicles-entire body-itchy-afebrile Tx: supportive ie Aveeno baths. Anti-itch topical Benadryl oral prn.

VAERS ID:303207 (history)  Vaccinated:2008-01-09
Age:7.0  Onset:2008-01-10, Days after vaccination: 1
Gender:Female  Submitted:2008-01-22, Days after onset: 12
Location:Ohio  Entered:2008-01-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1494U1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Local reaction to varicella vaccine; right posterior arm had a silver dollar sized area of redness at injection site; no pain; afebrile; was seen at PCP on 01/12/08 (3 days after vaccination)-- doctor suggested cool compresses and to watch for infection.

VAERS ID:303501 (history)  Vaccinated:2008-01-22
Age:7.0  Onset:2008-01-23, Days after vaccination: 1
Gender:Male  Submitted:2008-01-24, Days after onset: 1
Location:Washington  Entered:2008-01-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no present illnesses
Preexisting Conditions: none
Diagnostic Lab Data: Site Reaction (local)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2509AA IM 
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB214AA IM 
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ1069 SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1514U SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Site swelling and redness to the Upper Left Arm (back of arm). Ibuprofen was given to child by his parent along with using cool compresses to injection site. The injection was given at 10:45am.

VAERS ID:303502 (history)  Vaccinated:2008-01-24
Age:7.0  Onset:2008-01-24, Days after vaccination: 0
Gender:Male  Submitted:2008-01-24, Days after onset: 0
Location:Washington  Entered:2008-01-24
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 needed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS808221IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Received 2nd flu vaccine dose when already received on 11/01/07. No reaction noted.

VAERS ID:303652 (history)  Vaccinated:2008-01-17
Age:7.0  Onset:2008-01-17, Days after vaccination: 0
Gender:Female  Submitted:2008-01-17, Days after onset: 0
Location:Georgia  Entered:2008-01-25, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1761U UNLL
Administered by: Private     Purchased by: Public
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Itching of the hands. Sent to ER.

VAERS ID:303873 (history)  Vaccinated:2007-11-21
Age:7.0  Onset:2008-01-16, Days after vaccination: 56
Gender:Female  Submitted:2008-01-21, Days after onset: 5
Location:Ohio  Entered:2008-01-29, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: flu~Influenza (no brand name)~2~9~In Sibling|flu~Influenza (no brand name)~4~2~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: NP swab for influenza Ag
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2527AA1UNLA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Influenza, Influenza serology positive, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Influenza symptoms (cough, fever) with positive nasopharyngeal test for influenza despite influenza vaccine (inadequate total # of immunizations).

VAERS ID:303957 (history)  Vaccinated:2008-01-03
Age:7.0  Onset:2008-01-05, Days after vaccination: 2
Gender:Female  Submitted:2008-01-30, Days after onset: 25
Location:Florida  Entered:2008-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data: Abnormal EEG reading 2 days after.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSATTAVB218BA1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow)
Write-up: 60 hours after 2nd Hep A vaccine patient had a severe grand mal seizure lasting about 3-4 minutes. No fever, SHe did vomit. Happened about 20 minutes after falling asleep. Rushed to Hospital 911

VAERS ID:303962 (history)  Vaccinated:2008-01-28
Age:7.0  Onset:2008-01-29, Days after vaccination: 1
Gender:Female  Submitted:2008-01-30, Days after onset: 1
Location:Washington  Entered:2008-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS809561IMRL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB171AA0IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1764U1SCRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt came home from school on 1/29 c/o pain @ injection site. Pt had swelling, 1" long by 1/2" wide.

VAERS ID:304023 (history)  Vaccinated:2008-01-26
Age:7.0  Onset:2008-01-27, Days after vaccination: 1
Gender:Female  Submitted:2008-01-31, Days after onset: 4
Location:North Carolina  Entered:2008-01-31
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: CBC drawn 3 days after vaccine was normal (normal WBC, normal cell counts).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1763U1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anorexia, Cough, Fatigue, Full blood count normal, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever of 102 degrees F started 24 hours after administration and continued for 4 days after administration. There was also associated anorexia and fatigue. 48 hours after administration, patient developed a cough that was productive. Examination of pt revealed pyrexia and fatigue but no ENT or Lung abnormalities.

VAERS ID:304273 (history)  Vaccinated:2008-02-01
Age:7.0  Onset:2008-02-01, Days after vaccination: 0
Gender:Female  Submitted:2008-02-04, Days after onset: 3
Location:Florida  Entered:2008-02-04
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.MSD16631SCRA
Administered by: Unknown     Purchased by: Military
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: CLUSTER OF BLISTERS, NON TENDER, NON ERYTHEMATOUS, NON CELLULITIS FROM RUE.

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