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Case Details (Sorted by Age)

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VAERS ID:322009 (history)  Vaccinated:2008-08-01
Age:11.0  Onset:2008-08-02, Days after vaccination: 1
Gender:Female  Submitted:2008-08-04, Days after onset: 2
Location:Michigan  Entered:2008-08-13, Days after submission: 9
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: bronchial asthma, allergic rhinitis, allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0315X1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, warm, swollen, painful area 24 hours after injection over injection site.

VAERS ID:322014 (history)  Vaccinated:2008-07-22
Age:11.0  Onset:2008-07-26, Days after vaccination: 4
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:2008-08-13
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
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF)BERNA BIOTECH, LTD300113912PO 
Administered by: Private     Purchased by: Unknown
Symptoms: Body temperature increased, Feeling of body temperature change, Gait disturbance, Headache
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad)
Write-up: First headache & wobbly legs - "hot to the touch & cold to the bone" on day 5. Day 6 temperature of 101.5 degrees F. Day 7 temp of 103.4 degrees F. Gave MOTRIN. Delayed 4th dose.

VAERS ID:322045 (history)  Vaccinated:2008-08-11
Age:11.0  Onset:2008-08-12, Days after vaccination: 1
Gender:Female  Submitted:2008-08-13, Days after onset: 1
Location:Washington  Entered:2008-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fever, crying,~ ()~NULL~4~In Patient
Other Medications: None
Current Illness: NO
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B020AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1994U1SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Induration, 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: Right arm red, warm, hard to touch, tender, swollen.

VAERS ID:322047 (history)  Vaccinated:2008-08-11
Age:11.0  Onset:2008-08-11, Days after vaccination: 0
Gender:Female  Submitted:2008-08-13, Days after onset: 2
Location:Connecticut  Entered:2008-08-13
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC525B028AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Fall, Head injury, Hypotension, Loss of consciousness, Muscle twitching, Nausea, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: vasovagal syncope approximately 3 minutes after injection. No warning signs such as nausea or dizziness beforehand, she explained everything just went "black" slumped off table and I caught her before she hit floor. She had rapid loss of blood pressure and her muscles were severely twitching in her arms and legs while unconscious for about 10 seconds (it looked similar to a seizure). Her blood pressure remained low for 10 minutes or so before beginning to climb again, she also had nausea & dizziness after event. She did hit her head during fall, but it caused only a small bump on the back of her head, and was not serious. The doctor''s refused to consider a link with vaccine, except possibly "nervousness" over getting a shot- which was NOT the case. Another report will show my son also fainted immediately thereafter at the same time with a different vaccine----I asked if these new vaccines possibly have inactive ingredients that they could possibly have allergies to at the time and was told that he passed out simply because his sister did. (he is 17 and has never passed out)---but the reports of vasovagal syncope show a higher incidence among these 2 vaccines...and perhaps there is a link with a particular ingredient? Or with a certain bloodtype? There is something about these vaccines that caused my children to have a very serious reaction. The nurse told me that my daughter must have been hyperventalating without me being aware of it, which is totally ridiculous. Both kids were calm and chatting pleasantly about the day ahead when my daughter suddenly slumped over and passed out. This was NOT normal and they were NOT children having some sort of panicked reaction.

VAERS ID:322049 (history)  Vaccinated:2006-08-24
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-13
Location:Minnesota  Entered:2008-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Children''s multivitamin, one daily
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B053BA IMRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0812F1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Vaccine given beyond recommended age guideline of 7 years

VAERS ID:322050 (history)  Vaccinated:2008-08-12
Age:11.0  Onset:2008-08-12, Days after vaccination: 0
Gender:Female  Submitted:2008-08-12, Days after onset: 0
Location:North Carolina  Entered:2008-08-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Seizure~ ()~NULL~1~In Sibling1
Other Medications:
Current Illness: none
Preexisting Conditions: seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS 2 RA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS 1 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.   RA
Administered by: Private     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash 12hr after shot administered --called md and went in for visit.

VAERS ID:322058 (history)  Vaccinated:2008-08-13
Age:11.0  Onset:2008-08-13, Days after vaccination: 0
Gender:Male  Submitted:2008-08-13, Days after onset: 0
Location:North Carolina  Entered:2008-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta 27mg daily
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2354AA5IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Wrong drug administered
SMQs:
Write-up: Prescriber ordered "DTaP" vaccination for this patient when "Tdap" is what should have been order. The nurse administered the "DTaP" as was ordered by the physician.

VAERS ID:322060 (history)  Vaccinated:2008-08-11
Age:11.0  Onset:2008-08-12, Days after vaccination: 1
Gender:Male  Submitted:2008-08-13, Days after onset: 1
Location:Kansas  Entered:2008-08-13
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: Special needs (MR)
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB243AH0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0101X1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: area where vaccine was given ( back of right upper arm, subcutaneous) started getting red,tender and warm 24 hrs. after vaccination. Mom states area is larger today, but less red. 35 mm circular area measured today.

VAERS ID:322062 (history)  Vaccinated:2008-08-11
Age:11.0  Onset:2008-08-12, Days after vaccination: 1
Gender:Male  Submitted:2008-08-13, Days after onset: 1
Location:Oregon  Entered:2008-08-13
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: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2385BA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B009AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0269X1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, Pain in extremity, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt developed pain over Lt arm, hot totouch, no fever or chills. Erythema and warmth over the L upper arm/deltoid triceps area 8cm by 3cm. Cellulitis. Rx Keflex 500mg QID x7days.

VAERS ID:322087 (history)  Vaccinated:2008-08-07
Age:11.0  Onset:2008-08-08, Days after vaccination: 1
Gender:Female  Submitted:2008-08-12, Days after onset: 4
Location:New York  Entered:2008-08-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~DTaP (no brand name)~3~2~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVAB284CA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2640AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0271X1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Fever over 103 -104 for 3 days, ice extremity and Ibuprofen for fever.

VAERS ID:322093 (history)  Vaccinated:2008-07-18
Age:11.0  Onset:2008-08-08, Days after vaccination: 21
Gender:Female  Submitted:2008-08-11, Days after onset: 3
Location:Michigan  Entered:2008-08-13, Days after submission: 2
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB235BA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1968U0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2644AA4IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0333X1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Rash generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 8-8-08 AM woke up in AM with hives/rash on face which progressed to neck and arms. Pt went to an urgent care and got Rx for zyrtec which is not helping. F/U at medical center 8/12/08 now has "bumps on legs".

VAERS ID:322124 (history)  Vaccinated:2008-08-11
Age:11.0  Onset:2008-08-12, Days after vaccination: 1
Gender:Female  Submitted:2008-08-13, Days after onset: 1
Location:Delaware  Entered:2008-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair; Zyrtec; Flovent; Xopenex; Zantac; Nasonex
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2641AA UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2997AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Has erythema, warm to touch and swelling.

VAERS ID:322219 (history)  Vaccinated:2008-08-12
Age:11.0  Onset:2008-08-12, Days after vaccination: 0
Gender:Female  Submitted:2008-08-14, Days after onset: 2
Location:California  Entered:2008-08-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: 8-6-08 Pt. had visit to MD DX: Exposure to chemical fumes/pain product. S/S: Headache, Occasional Respiratory irritation and no respiratory difficulty
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2666AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Activities of daily living impaired, Headache, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Pain behind knees down back of legs into calves, arms weak, headache started around 2200 on evening of vaccine and continues to 8-13-2008 at 9:35 am time of MD visit. MEDICATION PRESCRIBED: Analgesic antipyretics, also stay home 8-13-08 and 8-14-08 11/04 Phone call w/reporter reveals patient had completely recovered from rash by 9/2008. No further evidence of any AE.

VAERS ID:322253 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-14
Location:New Jersey  Entered:2008-08-15, Days after submission: 1
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: WAES0808USA01173
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic cerebrovascular conditions (narrow), Haemorrhagic cerebrovascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)
Write-up: Information has been received from a physician concerning a 11 year old female patient who was vaccinated with GARDASIL. The lot number was not provided. The physician reported that a neurologist asked her if she had heard about a patient who had a stroke with GARDASIL. It was unspecified whether or not this patient was of the neurologist. Upon internal review, stroke was determined to be an other important medical event. Additional information has been requested.

VAERS ID:322264 (history)  Vaccinated:2008-08-04
Age:11.0  Onset:2008-08-05, Days after vaccination: 1
Gender:Female  Submitted:2008-08-06, Days after onset: 1
Location:Texas  Entered:2008-08-15, 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: TB Test
Current Illness:
Preexisting Conditions: 061808 Diarrhea
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2604U0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2572AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site induration, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling, warmth, induration, pain left arm at injection site.

VAERS ID:322271 (history)  Vaccinated:2008-08-06
Age:11.0  Onset:2008-08-09, Days after vaccination: 3
Gender:Female  Submitted:2008-08-11, Days after onset: 2
Location:Kentucky  Entered:2008-08-15, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Autism
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2581AA0  
TDAP: TDAP (ADACEL)SANOFI PASTEURC2996AA0  
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Injection site bruising, Injection site erythema, Injection site irritation, Injection site mass
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Red irritated area on right arm where varicella was given. Bruised round knot on left arm were MENACTRA was given.

VAERS ID:322302 (history)  Vaccinated:2008-08-13
Age:11.0  Onset:2008-08-13, Days after vaccination: 0
Gender:Female  Submitted:2008-08-15, Days after onset: 2
Location:California  Entered:2008-08-15
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: PT ALLERGIC TO BACTRIM
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1968U0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2583AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSC2997AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Immunes were given to the pt. Two days ago, immune site appears midly sollen, warm to touch, and per pt it itches, it was recomended to put warm compresses on the affected site and a Rx was given for Benadryl and Tylenol to treat the symptoms.

VAERS ID:322311 (history)  Vaccinated:2008-08-14
Age:11.0  Onset:2008-08-14, Days after vaccination: 0
Gender:Female  Submitted:2008-08-15, Days after onset: 1
Location:Virginia  Entered:2008-08-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type: VA08014
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB284CA1IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B021AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0088X1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient experienced mild reddness and itching at injection site only. Cool compress applied to site. patient waited 30 min after incident & symptoms improved prior to discharge.

VAERS ID:322334 (history)  Vaccinated:2008-08-12
Age:11.0  Onset:2008-08-14, Days after vaccination: 2
Gender:Female  Submitted:2008-08-15, Days after onset: 1
Location:Unknown  Entered:2008-08-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR42656M0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2995BA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0432X1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, swelling to right arm.

VAERS ID:324549 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2007-10-15
Location:Florida  Entered:2008-08-15, Days after submission: 305
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: MEDI0006077
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: A non-serious spontaneous report was received from a consumer of hives concerning an 11-year-old male. No relevant medial and drug history information has been reported for this patient. The patient initiated FluMist therapy on an unreported date in October of 2007. Twenty-fours following administration of FluMist therapy, the patient broke out with hives all over his body required treatment with Benadryl to relieve symptoms. The reporter indicated that the patient did not experience fever or breathing problems. The symptoms persisted 24 to 48 hours. There was no indication of action taken regarding FluMist. The reporter did not provided a causality assessment for the adverse event reported. The reporting source of this case is spontaneous, thus the sponsor''s comment is not applicable.

VAERS ID:324650 (history)  Vaccinated:2007-10-24
Age:11.0  Onset:2007-10-24, Days after vaccination: 0
Gender:Male  Submitted:2007-11-06, Days after onset: 13
Location:Massachusetts  Entered:2008-08-15, Days after submission: 282
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLERGY SHOT
Current Illness: Multiple allergies; 2) Sulfonamide allergy; 3) ADHD
Preexisting Conditions: Child with no allergy to eggs. Received the following allergy shots at the same time as FluMist: 1) cat-dog; 2) birch-maple-oak-grass-ragweed; 3) dust-mite- mold; Child in 6th year of receiving allergy shots; Has frequent infections
Diagnostic Lab Data:
CDC Split Type: MEDI0006112
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500486P IN 
Administered by: Private     Purchased by: Public
Symptoms: Anaphylactic reaction, Eye swelling, Heart rate increased, Oxygen saturation normal, Sneezing, Throat tightness, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: A serious, spontaneous case of anaphylactic reaction, throat tightness, swollen eyes, hives, wheezing and sneezing has been received from a nurse in an 11-year-old male. Drug and medical history indicated the child was in his sixth year of receiving a series of allergy shots for cat, dog, birch, maple, oak, ragweed, duct, mite and mold. The child has had mild reactions to the allergy shots in the past. It was reported the child had no allergy to eggs but is allergic to sulfa drugs. He has had frequent ear infections and has ADHD. The patient received FluMist intranasally as well as allergy shots at approximately the same time on 24-Oct-2007. The reporter indicated that twenty minutes after administration the child had an anaphylactic reaction including tightness of the throat, swollen eyes, hives, wheezing and sneezing. The child was administered epinephrine and Benadryl; 20 minutes after the treatment his oxygen saturation was 99% and heart rate 105, his chest was clear and the hives resolved. He was transported to the ER where he was observed and released later the same day. The reporter indicated the events resolved the same day. No further information is available on FluMist dosing. The reporter indicated the child''s physician and his allergist both thought the reaction was due to FluMist. The reporting source of this case is spontaneous, thus the sponsor''s thus the sponsor''s comment is not applicable.

VAERS ID:322414 (history)  Vaccinated:2008-07-29
Age:11.0  Onset:2008-07-31, Days after vaccination: 2
Gender:Male  Submitted:2008-08-06, Days after onset: 6
Location:Unknown  Entered:2008-08-18, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None well visit
Preexisting Conditions: Latex, hx RAD
Diagnostic Lab Data: strep test, 8-4-08, negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2663AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Pharyngolaryngeal pain, Pyrexia, Streptococcus identification test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Hx latex allergy; received MENACTRA 7-29-08. Mom questioning reaction to MENACTRA due to latex in stopper. Child had fever, sore throat, ?difficulty swallowing. Spoke with medical person at Sanofi who advised pt. be seen.

VAERS ID:322429 (history)  Vaccinated:2008-08-09
Age:11.0  Onset:2008-08-12, Days after vaccination: 3
Gender:Female  Submitted:2008-08-14, Days after onset: 2
Location:Pennsylvania  Entered:2008-08-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2685AA0UNRA
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: Red and swollen around injection site.

VAERS ID:322438 (history)  Vaccinated:2008-08-07
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-11
Location:North Carolina  Entered:2008-08-18, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURAC14B051AA IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Wrong drug administered
SMQs:
Write-up: Pt has had no adverse reaction as of 8-11-08, called CDC upon their advice. Pt is not to be given the ADACEL she was supposed to receive.

VAERS ID:322466 (history)  Vaccinated:2008-07-29
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-11
Location:Connecticut  Entered:2008-08-18, 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: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0072X1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Mom reported the child complained of joint pain and rash after receiving GARDASIL. Lasted a few days then went away.

VAERS ID:322499 (history)  Vaccinated:2008-03-24
Age:11.0  Onset:2008-06-24, Days after vaccination: 92
Gender:Female  Submitted:2008-08-05, Days after onset: 42
Location:Arkansas  Entered:2008-08-18, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1522U1IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vomiting X 2-3 days.

VAERS ID:324928 (history)  Vaccinated:2008-06-04
Age:11.0  Onset:2008-06-04, Days after vaccination: 0
Gender:Male  Submitted:2008-08-14, Days after onset: 71
Location:Indiana  Entered:2008-08-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0806USA01507
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1740U0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B021CB0IMUN
Administered by: Public     Purchased by: Public
Symptoms: Ear pain, Injection site pain, Wrong drug administered
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Initial and follow-up information has been received from a registered nurse concerning a now 12 year old male who on 04-JUN-2008 was vaccinated IM in the left arm with a dose GARDASIL (lot# 659962/1740U) 0.5 ml. Concomitant therapy included BOOSTRIX. The nurse had indicated that the patient had inadvertently received the GARDASIL vaccine. No adverse effects were reported at the time. Follow-up information from the nurse indicated that on 05-JUN-2008, the patient complained of pain at the injection site for 2-3 days and complained of earache of the left ear for a day following the injections. The patient did not seek medical attention. The patient recovered on 08-JUN-2008. Follow-up information from a phone call was received on 01-AUG-2008. The nurse had clarified that the patient had inadvertently received the GARDASIL due to wrong drug being administered. The nurse also stated that "the family stated he has had earaches before." No other information is available. No further information is available.

VAERS ID:325154 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-14
Location:New Jersey  Entered:2008-08-18, Days after submission: 4
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: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0807USA03394
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  IMUN
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a physician concerning an approximately 11 year old female who was vaccinated IM with a dose of GARDASIL. Concomitant therapy included tetanus toxoid (manufacturer unknown) received within the same visit. Unspecified medical attention was sought. Patient recovered on an unspecified date, swelling healed on its own with ice. Additional information has been requested.

VAERS ID:325291 (history)  Vaccinated:2008-06-30
Age:11.0  Onset:2008-06-30, Days after vaccination: 0
Gender:Female  Submitted:2008-08-14, Days after onset: 45
Location:New York  Entered:2008-08-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Blood urine present
Diagnostic Lab Data: None
CDC Split Type: WAES0807USA04061
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Immediate post-injection reaction, Rash erythematous, Rash papular, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 11 year old female with a history of blood in urine -cause unknown who on 30-JUN-2008 was vaccinated intramuscularly with 0.5 ml first dose of GARDASIL in her arm (not specified). There was no concomitant medication. On 30-JUn-2008, within one minute of vaccination, the patient developed a red, raised and warm rash on her left arm, and spread to her face, trunk and other limbs in physician''s office. No laboratory diagnostics studies were performed. The patient was treated with BENADRYL. On 30-JUN-2008 the patient recovered. Additional information has been requested.

VAERS ID:325719 (history)  Vaccinated:2007-09-05
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-14
Location:New York  Entered:2008-08-18, 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:
Current Illness: Graves'' disease
Preexisting Conditions: 10/01/08-records received-PMH: Graves disease.
Diagnostic Lab Data: diagnostic laboratory - Head scan with dye: negative, diagnostic laboratory - Head scan without dye: negative
CDC Split Type: WAES0807USA05685
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1061U0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Fatigue, Headache, Malaise, Onychoclasis, Photophobia, Scan with contrast normal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad)
Write-up: Information has been received from a pharmacist concerning a 12 year old female with graves'' disease and no known allergies, who on 05-SEP-2007 was vaccinated with a first dose of GARDASIL vaccine (yeast) 0.5 ml intramuscularly. On 06-NOV-2007 and on 08-MAR-2008 was vaccinated with a second and a third dose of GARDASIL vaccine (yeast) respectively. There was no concomitant medication prior to vaccination with GARDASIL vaccine (yeast). The pharmacist mentioned that the patient had experienced headaches since the first dose of GARDASIL vaccine (yeast). She had already completed the series. The headaches had persisted since September 2007, the degrees of the pain changed from dull to severe pain, but had never fully resolved. The patient had been seen by a neurologist. Scans of her head were performed and all results were negative. The pharmacist mentioned that the neurologist believed that the headaches are "tension headaches". The patient had been on several medications and pain medications without relief. Her endocrinologist took her off all the medications and prescribed her a muscle relaxer at bed time. This also did not seem to provide the patient with relief. The patient sought medical attention. She contacted the pharmacist. There was no product quality complaint. Additional information has been requested. 10/1/08 Reviewed PCP medical records of 8/11-9/2/08. FINAL DX: Records reveal patient experienced chronic HAs. 10/17/08-records received for DOS 2/5-10/6/08-follow-up visits for Grave''s disease diagnosed 1/8/07. Visit on 2/5/08-headache waxes and wanes began in early September 2007-occurring daily ever since. Visit on 5/6/08- C/O feeling tired and malaise worse in morning. Intermittent headache per another physician they are tension headaches. Intermittent tremor. Brittle nails. Visit 10/6/08-Continues with headaches for last 13 months. No longer feeling tired or malaise. 11/6/08-records received-DOS 1/2/08-C/O continued headaches since 11/7/07-CT scan of head and sinuses normal. Some sensitivity to light. 1st Gardasil received 9/8/07-lot#1061U. 2nd dose 11/6/07-lot#1267U. 10/08/08 This is in follow-up to report(s) previously submitted on 8/14/2008. The nurse stated the patient described her headache as centrally located pushing out towards ears. She also experienced some dizziness. In follow up information the nurse provided the lot numbers for GARDASIL: first dose (658558/1061U), second dose (659439/1267U) and third dose (659964/1978U). The patient sought medical attention: She contacted the pharmacist. There was no product quality complaint. Follow up information was received from a pharmacist concerning a 12 year old female with grave''s disease. The patient experienced persistent and chronic headache since first week of September 2007. The AE required ER/DR visit. At the time of reporting the patient had not recovered. No further information is available.

VAERS ID:325945 (history)  Vaccinated:2008-02-07
Age:11.0  Onset:2008-02-07, Days after vaccination: 0
Gender:Female  Submitted:2008-08-14, Days after onset: 188
Location:Texas  Entered:2008-08-18, Days after submission: 4
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: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0807USA01613
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.0929U0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Inappropriate schedule of drug administration, Pallor
SMQs:, Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a physician concerning a 12 year old female who on 07-FEB-2008 was vaccinated with the first dose of GARDASIL vaccine (yeast) (lot # 658282/0929U) 0.5ml IM at the same office visit. Concomitant therapy included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid, MENACTRA vaccine (dip toxoid) and varicella virus vaccine live (MSD). On 07-FEB-2008 the patient experienced pale and weak. Therapy with human papillomavirus vaccine was discontinued. The patient''s mother took her to the emergency room. On an unspecified date the patient recovered from pale and weak. Additional information has been requested.

VAERS ID:326050 (history)  Vaccinated:2007-07-01
Age:11.0  Onset:2007-10-01, Days after vaccination: 92
Gender:Female  Submitted:2008-08-14, Days after onset: 318
Location:Illinois  Entered:2008-08-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Attention deficit/hyperactivity disorder
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0807USA02523
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0515U1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Skin papilloma
SMQs:
Write-up: Information has been received from a consumer concerning her daughter with a history of attention deficit/hyperactivity disorder and no drug reactions/allergies who in July 2007 and in January 2008, was vaccinated with first and third doses, respectively, of GARDASIL vaccine (yeast) (lot#s unspecified). Concomitant therapy included CONCERTA. Date and lot # of the second dose was unspecified. It was reported that in October 2007, (three months after the firse dose), the patient developed warts on her hands and fingers. It was also reported that the warts were treated and disappeared, but returned four times worse in March 2008. Unspecified medical attention was sought. At the time of this report, the patient''s warts persisted. Additional information has been requested. Follow up the patient didn''t seek medical attention. At the time of this report, the patient''s warts persisted. Additional information has been requested.

VAERS ID:326091 (history)  Vaccinated:2008-07-15
Age:11.0  Onset:2008-07-15, Days after vaccination: 0
Gender:Female  Submitted:2008-08-14, Days after onset: 30
Location:Texas  Entered:2008-08-18, 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:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0807USA03014
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Headache, Injection site reaction, Peripheral coldness
SMQs:
Write-up: Information has been received from a physician concerning an 11 year old female patient who on 15-JUL-2008 was vaccinated with the first dose of GARDASIL vaccine (yeast). Concomitant vaccination included meningococcal ACYW conj vaccine (dip toxoid) (MENACTRA) and diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). The physician reported that post-vaccination, the patient complained of headache and that her arm was cold at the injection site. The patient was given ibuprofen (ADVIL) and felt better. The patient was sent home. At the time of the report the patient was recovering. The patient sought medical attention at the physician''s office. Additional information has been requested.

VAERS ID:322556 (history)  Vaccinated:2008-08-12
Age:11.0  Onset:2008-08-12, Days after vaccination: 0
Gender:Female  Submitted:2008-08-18, Days after onset: 6
Location:Illinois  Entered:2008-08-19, Days after submission: 1
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: Convulsion; Hospitalisation
Diagnostic Lab Data: None
CDC Split Type: WAES0808USA02422
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1060U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNRA
Administered by: Other     Purchased by: Other
Symptoms: Condition aggravated, Petit mal epilepsy
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow)
Write-up: Information has been received from a registered nurse concerning a 11 year old female with a history of hospitalization in 2005 due to convulsion who on 12-AUG-2008 was vaccinated at 16:30 with a first dose of GARDASIL (lot # 658556/1060U), 0.5 mL, IM, into the left deltoid. At the same visit, the patient also received ADACEL and MENACTRA into the right deltoid. On 12-AUG-2008, after getting her first dose of GARDASIL, the patient experienced a petit mal seizure lasted for about 15 seconds. No lab tests were performed. The patient recovered at the office and was released. Upon internal review, petit mal seizure was determined to be an other medical event. Additional information has been requested.

VAERS ID:322590 (history)  Vaccinated:2008-08-14
Age:11.0  Onset:2008-08-14, Days after vaccination: 0
Gender:Male  Submitted:2008-08-14, Days after onset: 0
Location:New York  Entered:2008-08-19, 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: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2582AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2888AA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1270U SCLA
Administered by: Private     Purchased by: Public
Symptoms: Flushing, Nasal congestion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: One hour after vaccines, child returns to clinic c/o extremely stuffy and congested nose, and flushed face. No chest pain, no wheezing, no edema. Vital signs - within normal limits. Gave Benadryl, observation. Mother requested ER, mother frantic, so 911 was called. Child was given Prednisone in ER, and discharged home.

VAERS ID:322610 (history)  Vaccinated:2008-08-13
Age:11.0  Onset:2008-08-14, Days after vaccination: 1
Gender:Female  Submitted:2008-08-19, Days after onset: 5
Location:Georgia  Entered:2008-08-19
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 BIOLOGICALSAHAVB284DA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B024EA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0514X1SCLA
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: marked swelling and redness at injection site, quite warm, extending ~ 4 cm. centered around L arm upper area, at site of varivax

VAERS ID:322641 (history)  Vaccinated:2008-08-07
Age:11.0  Onset:2008-08-07, Days after vaccination: 0
Gender:Male  Submitted:2008-08-18, Days after onset: 11
Location:Arizona  Entered:2008-08-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 10/3/08-records received-C/O headaches for few years, left temporal, pulsating usually in morning.
Diagnostic Lab Data: 10/3/08-records received- CBC normal white count. Complete metabolic profile normal. CT head normal. MRI scan of head normal. LP protein 26.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.AHABVB345AA0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2666AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2998BA0UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Amblyopia, Back pain, Benign intracranial hypertension, CSF protein normal, Computerised tomogram normal, Cranial nerve paralysis, Diplopia, Dysstasia, Headache, Hypertension, Metabolic function test normal, Neck pain, Nuclear magnetic resonance imaging normal, Papilloedema, Paraesthesia, Vision blurred, White blood cell count normal
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (narrow), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Arthritis (broad)
Write-up: Pt reported back pain, HA, neck pain, 1 week after immunizations. At 10-11 days post vaccine pt began to experience blurry vision, (B) Amblyopia, and was unable to sit or stand $g 5 min D/T back pain. Pt was sent to hosp and is currently in Peds ICU with idiopathic intracranial hypertension. 10/3/08-records received for DOS 8/20-8/22/08-DX: Pseudotumor cerebri unknown etiology. Headache 30 minutes after vaccination and headaches preceding vaccination by several weeks or years. CSF removed only 4ml doubt that pressure was reduced by LP although symptomatic relief afterwards. After vaccination had paresthesia of arms and neck pain. Subsequently became pale and C/O double vision. Blurry vision. PE:sixth cranial nerve palsy, bilateral papilledema.

VAERS ID:322643 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-19, Days after onset: 1
Location:Wisconsin  Entered:2008-08-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 105 fever~DTaP (no brand name)~2~1~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B023AA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0088X1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Nervousness, Pain, Restlessness, Sleep disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: "Achy" am after vaccinations. Given Motrin by parent at 4:30 pm and 11:00 pm on 8-18-08. Also complained of feeling "nervous, restless" at 10:30 pm on 8-18-08. Did not fall asleep until 2:30 am. Slept through night until 9:00 am on 8-19-08. On 8-19-08, feels o.k. - no restlessness. Plans to inform physician.

VAERS ID:322714 (history)  Vaccinated:2008-08-07
Age:11.0  Onset:2008-08-08, Days after vaccination: 1
Gender:Male  Submitted:2008-08-19, Days after onset: 11
Location:Illinois  Entered:2008-08-20, 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: Had similar episode 2 years ago related to gastroenteritis
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B024CA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Altered state of consciousness, Diarrhoea, Dizziness, Syncope
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), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow)
Write-up: Patient nl exam received Tdap around noon on 8/7/08. Early am of 8/8/08 woke up from sleep feeling dizzy, had 1 episode diarrhea and then fainted. Altered consciousness for about 1 hour and then resolved; No sequelae or further episodes

VAERS ID:322716 (history)  Vaccinated:2008-08-11
Age:11.0  Onset:2008-08-11, Days after vaccination: 0
Gender:Female  Submitted:2008-08-11, Days after onset: 0
Location:California  Entered:2008-08-20, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1991CA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2997AA0UNRA
Administered by: Public     Purchased by: Public
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: Child received Tdap and Dtap inadvertently instead of Tdap and MCV4. At this time no reactions, no local tissue changes. 2 hours afterwards child is well, he changes in health status.

VAERS ID:322718 (history)  Vaccinated:2008-07-29
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-19
Location:New York  Entered:2008-08-20, 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:
Current Illness: None
Preexisting Conditions: von Willibrands
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0391X0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Pt developed multiple vesiculated lesion on arm which had injection and back & shoulder area. Occurred approx. 2 wks after vaccination.

VAERS ID:322851 (history)  Vaccinated:2008-08-12
Age:11.0  Onset:2008-08-13, Days after vaccination: 1
Gender:Male  Submitted:2008-08-14, Days after onset: 1
Location:Virginia  Entered:2008-08-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB163AB0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B024CA5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1031U1SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Headache, Muscle spasms, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad)
Write-up: Receive vaccines on 8-12-08, Tdap, Hepatitis A, Varicella. Received call from babysitter, pt. c/o headache, leg cramps, fever 102.0. Tepid bath & TYLENOL 325 given to client per nurse line per babysitter. Also consult pediatrician. Have been calling to f/u no response to calls. Babysitter returned called-client doing fine. Fever broke that evening. States it took 2 day for fever to return to to normal.

VAERS ID:322853 (history)  Vaccinated:2008-08-06
Age:11.0  Onset:2008-08-08, Days after vaccination: 2
Gender:Female  Submitted:2008-08-18, Days after onset: 10
Location:Wisconsin  Entered:2008-08-21, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: NKA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2567AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2899AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1974U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: On date of injection left deltoid sensitive. By Friday arm was very red: Hot and swollen from site to elbow. This lasted till 8/11/08 client was on vacation - Did not seek medical attention: Iced area and was given Tylenol and Benadryl by parent.

VAERS ID:322875 (history)  Vaccinated:2008-08-19
Age:11.0  Onset:2008-08-20, Days after vaccination: 1
Gender:Male  Submitted:2008-08-21, Days after onset: 1
Location:North Carolina  Entered:2008-08-21
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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER?0IDRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Injection site pain, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: High fever (over 102), headache, lathargic, pain in shot area

VAERS ID:322879 (history)  Vaccinated:2008-05-05
Age:11.0  Onset:2008-05-05, Days after vaccination: 0
Gender:Male  Submitted:2008-08-21, Days after onset: 108
Location:Texas  Entered:2008-08-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: rhinocort, zyrtec
Current Illness: none
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2613AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2454AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.176301SCRA
Administered by: Private     Purchased by: Public
Symptoms: Excoriation, Face injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Tdap, MCV4, and VZ were adminstered without problems. Patient up in clinic chose treat and left clinic. Patient had a syncopal episode in the parking lot and suffered abrasions to face. Patient treated in clinic and recovered BP and HR in less than 20 minutes. Minor abrasions cleansed and treated. Patient left clinic ambulatroy.

VAERS ID:322914 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-21
Location:Pennsylvania  Entered:2008-08-21
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2421AA IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B02DA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0131X1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 5cm x 3cm irregular area of erythema. Mildly tender and warm. Mild edema. No drainage from needle site. All noted at site of varicella vaccine; Recommended cool compresses and Tylenol or Motrin for discomfort.

VAERS ID:323021 (history)  Vaccinated:2008-08-19
Age:11.0  Onset:2008-08-19, Days after vaccination: 0
Gender:Female  Submitted:2008-08-20, Days after onset: 1
Location:Virginia  Entered:2008-08-22, Days after submission: 2
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: No patient history was reported.
Diagnostic Lab Data: None reported
CDC Split Type: 200802661
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2550A0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2904A0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Loss of consciousness, Syncope, Vision blurred
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), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Initial information was received from a health care professional on 19 August 2008. An 11 year old female patient with no reported past medical history received an injection of MENACTRA (U2550AA) intramuscularly in the left deltoid and an injection of ADACEL (C2904AA) intramuscularly in the right deltoid on 19 August 2008. "Two minutes after receiving the MENACTRA injection she was found in the exam room with her head down. She woke up after two minutes and was wringing her hands. She complained of blurred vision." Her blood pressure and pulse pre and post vaccination were 80/40 and 68. No other symptoms were reported according to the physician. The patient "fainted" and was "unconscious". The patient''s recovery status was unknown.

VAERS ID:323107 (history)  Vaccinated:2008-08-19
Age:11.0  Onset:2008-08-19, Days after vaccination: 0
Gender:Male  Submitted:2008-08-22, Days after onset: 3
Location:Michigan  Entered:2008-08-22
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2606AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2644AA5IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Fatigue, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Father describes fever 99-100 F, c/o tiredness, s/ nausea. Gave Tylenol.

VAERS ID:323110 (history)  Vaccinated:2008-08-05
Age:11.0  Onset:2008-08-06, Days after vaccination: 1
Gender:Female  Submitted:2008-08-22, Days after onset: 16
Location:Unknown  Entered:2008-08-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Seasonal allergies - on Claritin as needed
Diagnostic Lab Data: Sent for CBC, CRP, Mono test, CMP
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.00271UNUN
Administered by: Private     Purchased by: Private
Symptoms: C-reactive protein, Fatigue, Full blood count, Genital cyst, Metabolic function test, Mononucleosis heterophile test
SMQs:
Write-up: Mother claims that a cyst developed on her genital area the day after 2nd GARDASIL shot was given. All summer long - been tired.

VAERS ID:323113 (history)  Vaccinated:2008-08-21
Age:11.0  Onset:2008-08-22, Days after vaccination: 1
Gender:Male  Submitted:2008-08-22, Days after onset: 0
Location:Washington  Entered:2008-08-22
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: PCN
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2565AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2774AA0UNLA
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Dizziness, headache, vomiting.

VAERS ID:323135 (history)  Vaccinated:2008-08-19
Age:11.0  Onset:2008-08-21, Days after vaccination: 2
Gender:Male  Submitted:2008-08-22, Days after onset: 1
Location:California  Entered:2008-08-22
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:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU265AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC29363BA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0604X1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient''s left arm is swollen from shoulder to elbow hot to touch and red.

VAERS ID:323091 (history)  Vaccinated:2008-08-13
Age:11.0  Onset:2008-08-15, Days after vaccination: 2
Gender:Female  Submitted:2008-08-23, Days after onset: 8
Location:Florida  Entered:2008-08-23
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: Dr. performed physical exam,testing patient''s reflexes. Later e.r. blood draws were unsuccessful, due to medical error. No blood tests were completed.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER 2  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Balance disorder, Diagnostic procedure, Hypoaesthesia, Overdose, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: Overdose of tetanus inoculation. 1st booster given October,2007. Due to error in medical record keeping,repeated booster mistakenly given Wednesday, August 13, 2008. By Friday, 2 days later, patient had a low fever, and said her lower legs were numb and felt "wobbly." Dr. initially suspected Guillaume-Barre'' syndrome. About 2 hours later, patient stated that she could no longer feel her thighs. Doctor then ordered that patient go to the emergency room. ER doctors did not agree with Guillaume-Barre'' diagnosis. Blood draws were "compromised" twice due to medical professional error. Since the doctors were ready to rule out Guillaume-Barre'', it was agreed not to draw any more blood, and to discharge patient.

VAERS ID:323167 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2008-08-22
Location:California  Entered:2008-08-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CSF WBC = 21; Neg gram Stain; CSF culture - No growth LABS: CSF: neutros 92%, lymphs 3%, monos 5%; protein 23, glucose 66.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2420AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: CSF culture negative, CSF glucose normal, CSF protein normal, CSF white blood cell count increased, Enterovirus infection, Gram stain negative, Headache, Meningitis viral, Pyrexia, Respiratory rate increased, Sick relative, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Admit to hospital 8/21/08. Fever, vomiting x 2 days - HA after receiving vaccine. Brother admitted with meningitis to same hospital 8/20/08. He also received vaccine 8/18/08. 9/26/07 Reviewed hospital medical records of 8/21-8/23/2008. FINAL DX: enterococcal viral meningitis Records reveal patient experienced HA x 2 days. Seen in outlying ER where LP (+). Older sibling admitted w/same. Fever, increased respiratory rate. Tx w/IV antibiotics & antivirals. Improved & d/c to home.

VAERS ID:323171 (history)  Vaccinated:2008-08-20
Age:11.0  Onset:2008-08-21, Days after vaccination: 1
Gender:Male  Submitted:2008-08-22, Days after onset: 1
Location:Wisconsin  Entered:2008-08-25, 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: Zyrtec 2 wks ago
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2996AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0130X1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 8/21/08 - at night - itching/swelling/firmness and redness noted at site where Varicella vaccine given on 8/20/08 (5 1/2 cm x 7 cm post left deltoid). Recommend Benadryl as needed.

VAERS ID:323173 (history)  Vaccinated:2008-06-23
Age:11.0  Onset:2008-06-23, Days after vaccination: 0
Gender:Female  Submitted:2008-08-20, Days after onset: 58
Location:Maryland  Entered:2008-08-25, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2429AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2638AA0UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Fall, Headache, Loss of consciousness, Muscle contracture, Syncope
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), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient recovered MENACTRA and ADACEL. She then walked out into the waiting room and fainted. She stated her head hurt and she was on the floor. Mom witnessed her falling backwards and believes she hit her head on the office chair. She thinks she was unconscious for about 5-8 secs. when she opened her eyes then were both turned to the right for 3 secs. and she thinks her right arm had tonic arthritis. She had no further issues/symptoms

VAERS ID:323179 (history)  Vaccinated:2008-08-12
Age:11.0  Onset:2008-08-14, Days after vaccination: 2
Gender:Female  Submitted:2008-08-14, Days after onset: 0
Location:Colorado  Entered:2008-08-25, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cerebral palsy
Preexisting Conditions: Global dev delay; Constipation; Scoliosis; Seizures; Cataracts
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2994BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0604X1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Moaning, Pyrexia, Scab
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Mother noted that she was febrile and moaning 24 hrs after immunizations were given and discovered 3x2 cm red, warm induration inferior to scabbed VZV site.

VAERS ID:323180 (history)  Vaccinated:2008-03-24
Age:11.0  Onset:2008-03-24, Days after vaccination: 0
Gender:Female  Submitted:2008-08-18, Days after onset: 147
Location:Oklahoma  Entered:2008-08-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1446U1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site urticaria, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Hives around injection site. Fever, vomiting day of injection.

VAERS ID:323205 (history)  Vaccinated:2008-07-11
Age:11.0  Onset:2008-08-21, Days after vaccination: 41
Gender:Female  Submitted:2008-08-25, Days after onset: 4
Location:Illinois  Entered:2008-08-25
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2621AA1IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B009AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypoaesthesia, Muscle spasms, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad)
Write-up: Mom reported c/o numbness and feeling like both legs were going to sleep, also cramping which started on Thurs. 8/21/2008. At this time has not seen MD.

VAERS ID:323208 (history)  Vaccinated:2008-08-21
Age:11.0  Onset:2008-08-22, Days after vaccination: 1
Gender:Male  Submitted:2008-08-25, Days after onset: 3
Location:Oklahoma  Entered:2008-08-25
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 known
Preexisting Conditions: asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BO28AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0422X1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Injection site discharge, Injection site vesicles, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Patient noted to have slight swelling and redness to left upper arm 8-22-08 per mom''s report. Was seen by Dr. on 8-23-08 and given omnicef with little improvement. Mom then took him to ER where he was seen by Dr. due to no improvement. Child noted to have blister to injection site, with redness and swelling to upper arm. Was given rocephin injection in ER and TMC ointment to apply to area. Into Health Department on 8-25-08, blister noted to be open and draining, swelling to arm improved from pictures mom had taken in ER.

VAERS ID:323220 (history)  Vaccinated:2008-08-21
Age:11.0  Onset:2008-08-22, Days after vaccination: 1
Gender:Male  Submitted:2008-08-25, Days after onset: 3
Location:Oregon  Entered:2008-08-25
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 BIOLOGICALSAHAVB239AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2583AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B009AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: LARGE RED SWOLLEN AREA WITH PAIN, WARM TO TOUCH THE DAY AFTER THE INJECTION. PATIENTS CAREGIVER CALLED THE CLINIC TO REPORT. WAS INSTRUCTED TO USE ICE, BENADRYL, IBUPROFEN.

VAERS ID:323244 (history)  Vaccinated:2008-08-19
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2008-08-22
Location:South Carolina  Entered:2008-08-25, 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:
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.0787X1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Local reaction, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Local reaction where vaccine was administered in the left SQ area of the posterior arm. Redness, swelling and heat - increasing in size.

VAERS ID:323256 (history)  Vaccinated:2008-08-14
Age:11.0  Onset:2008-08-18, Days after vaccination: 4
Gender:Female  Submitted:0000-00-00
Location:California  Entered:2008-08-25
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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0334X SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Cold compress therapy, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling at injection site treated and Benadryl and cool compress

VAERS ID:323287 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-18, Days after onset: 0
Location:Arizona  Entered:2008-08-26, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB291AA0UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2552AA0UNUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC2994BA UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0391X0UNUN
Administered by: Military     Purchased by: Military
Symptoms: Dizziness, Pallor, Visual disturbance
SMQs:, Anticholinergic syndrome (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: She felt light headed and became pale after her fourth shot. She said that all the colors in the room started blending together. She felt light headed. She never passed out.

VAERS ID:323297 (history)  Vaccinated:2008-08-07
Age:11.0  Onset:2008-08-08, Days after vaccination: 1
Gender:Female  Submitted:2008-08-19, Days after onset: 11
Location:Wisconsin  Entered:2008-08-26, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2580AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2889AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0270X1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Injection site swelling, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Rash and fever x3 days-rash & swelling of L arm at injection site (varicella).

VAERS ID:323308 (history)  Vaccinated:2008-08-11
Age:11.0  Onset:2008-08-12, Days after vaccination: 1
Gender:Male  Submitted:2008-08-15, Days after onset: 3
Location:West Virginia  Entered:2008-08-26, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None other than seasonal allergies
Diagnostic Lab Data: 8/15 still has knots and swelling but decreased in size - not warm to touch.
CDC Split Type: WV0826
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1899U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Mass, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 2 dark red separate knots, 1" diameter, (cherry red). Started cool compresses. 8/13 orig knots surrounded by baseball size area swelling, warm to touch. Started PO Benadryl and continue compresses.

VAERS ID:323314 (history)  Vaccinated:2008-08-15
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Iowa  Entered:2008-08-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA08054IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0454X2SCUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0320X0SCLA
Administered by: Private     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: "none"

VAERS ID:323320 (history)  Vaccinated:2008-08-15
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2008-08-20
Location:North Carolina  Entered:2008-08-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2356CA5IMRA
Administered by: Private     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:
Write-up: Dtap given; Tdap was ordered. No signs, symptoms reported.

VAERS ID:323322 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2008-08-26
Location:Virginia  Entered:2008-08-26
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
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Local reaction
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: (The report was received at the Health Dept on 8-26-2008 on an Epi-1 form.) 7.5 X 13.5 cm red reaction on Left upper arm

VAERS ID:323340 (history)  Vaccinated:2008-08-04
Age:11.0  Onset:2008-08-15, Days after vaccination: 11
Gender:Male  Submitted:2008-08-26, Days after onset: 11
Location:Massachusetts  Entered:2008-08-26
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: Tremor, nonspecific
Diagnostic Lab Data: Lyme IgM/IgG positive
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2622AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BO23AA/G IM 
Administered by: Private     Purchased by: Private
Symptoms: Borrelia burgdorferi serology, Borrelia burgdorferi serology positive, Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Isolated Bell''s Palsy occurred 10 days after patient received Menactra. Patient also had positive Lyme titers, drawn with this episode.

VAERS ID:323346 (history)  Vaccinated:2008-08-25
Age:11.0  Onset:2008-08-26, Days after vaccination: 1
Gender:Male  Submitted:2008-08-26, Days after onset: 0
Location:Virginia  Entered:2008-08-26
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: wbc wnl, chem wnl, flu negative
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Headache, Inappropriate schedule of drug administration, Influenza like illness, Influenza serology negative, Laboratory test normal, Malaise, Myalgia, Nausea, Pyrexia, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad)
Write-up: flu-like illness with fever 101-102, myalgias, headache, malaise, nausea and vomitinh

VAERS ID:323348 (history)  Vaccinated:2008-08-25
Age:11.0  Onset:2008-08-26, Days after vaccination: 1
Gender:Male  Submitted:2008-08-26, Days after onset: 0
Location:California  Entered:2008-08-26
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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
TD: TETANUS DIPHTHERIA (NO BRAND NAME)UNKNOWN MANUFACTURER 5  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Chills, Fatigue, Headache, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient had 3 vaccines: hep A, Meningococcal, and Tdap. symptoms:pain in arms, fever, chill, headache, tiredness, and nausea.

VAERS ID:323352 (history)  Vaccinated:2008-08-25
Age:11.0  Onset:2008-08-26, Days after vaccination: 1
Gender:Female  Submitted:2008-08-26, Days after onset: 0
Location:Arizona  Entered:2008-08-26
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2660BA UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B024DB UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0638X UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site cellulitis, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Cellulitis left arm round 2cm x 2cm, hot, swollen, tender area at site of vaccine - IM Rocephin + PO Bactrim.

VAERS ID:323361 (history)  Vaccinated:2008-08-19
Age:11.0  Onset:2008-08-20, Days after vaccination: 1
Gender:Male  Submitted:2008-08-26, Days after onset: 6
Location:Texas  Entered:2008-08-26
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.0630X1SCLA
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 arm red, swollen and warm to touch at injection site.

VAERS ID:323482 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Female  Submitted:2008-08-27, Days after onset: 0
Location:Pennsylvania  Entered:2008-08-27
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
HPV4: HPV (GARDASIL)MERCK & CO. INC.0229X0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU264CAA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2995BA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Blood pressure, Dizziness, Malaise
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Patient was given 3 vaccines she described feeling sick after Tdap and MENACTRA had been given and then dizzy after GARDASIL was given BP was 70/50 at that time

VAERS ID:323490 (history)  Vaccinated:2008-08-14
Age:11.0  Onset:2008-08-15, Days after vaccination: 1
Gender:Male  Submitted:2008-08-27, Days after onset: 12
Location:North Carolina  Entered:2008-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: NO~ ()~NULL~~In Patient|NO~ ()~NULL~~In Sibling1
Other Medications: NO
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: CBC, CXR, UA WNL WHILE IN ER
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2997AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Cellulitis, Chest X-ray normal, Cough, Dyspnoea, Full blood count normal, Injected limb mobility decreased, Injection site cellulitis, Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth, Nausea, Neck pain, Pain in extremity, Palpitations, Pyrexia, Urine analysis normal, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad)
Write-up: ON 8-14-08 PT RECEIVED VAR, TDAP AND MCV4. ON 8-15-08 AT 430 PT AWOKE WITH C/O NAUSEA, RT ARM PAIN, LIMITED ROM, FEVER, WEAKENSS, COUGHING, HEART POUNDING, SOB, PT WAS TAKEN TO CMC-LINCOLN ER. WHILE IN THE ER PT DX. WITH TDAP INJECTION REACTION. ON 8-16-08 PT REMAINS WITH WEAKNESS, FEVER RESOLVED, IN AFTERNOON MOTHER NOTED FEVER,NECK PAIN, SEVERE REDNESS AND EDEMA FROM INJECTION SITE TO ELBOW. ALSO NOTED AREA TO BE WARM TO TOUCH, PAINFUL AT TDAP INJECTION SITE. MOTHER CALLED MD ON CALL AND INFORMED TO TAKE PT TO ER. ON 8-16-08 PT RETURNED AGIAN TO CMC-LINCOLN ER - PT DX WITH CELLULITIS RT. ARM DUE TO TDAP INJECTION. PT RETURNED TO OFFICE ON 8-18-08 AND S/S HAD IMPROVED.

VAERS ID:323501 (history)  Vaccinated:2008-08-19
Age:11.0  Onset:2008-08-26, Days after vaccination: 7
Gender:Female  Submitted:2008-08-27, Days after onset: 1
Location:Georgia  Entered:2008-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0070X1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Dysarthria, Hypoaesthesia, Neurological examination normal, Paraesthesia, Presyncope
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 1st inj on 6/17/2008;2nd inj 8/19/2008; on 8/26/2008 pt presented to office with dizzines, tingling in hands to numbness and then slurred speech that happened while at school; when she presented to the office within 1 hour of onset, she had completely recovered from s/s; due to these s/s family defers further vaccination8/28/08-records received for DOS 8/26/08-Chief complaint-dizzy spells/tingling in hands and not able to speak well. C/O dizziness while getting up from sitting position. Neurologic exam, no focal deficit, normal cranial nerves-II-XII sensory and motor WNL. DTR 2 plus, gait normal, no cerebellar signs, no focal signs, normal strength, tone and reflexes, sensory test normal. Assessment: Near-syncope. Suspect orthostatic hypotonia trigger with possible hyperventilation as secondary. Follow-up as needed.

VAERS ID:323505 (history)  Vaccinated:2008-08-25
Age:11.0  Onset:2008-08-26, Days after vaccination: 1
Gender:Female  Submitted:2008-08-27, Days after onset: 1
Location:Maryland  Entered:2008-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: BROTHER~Tetanus Diphtheria (no brand name)~1~11~In Sibling1
Other Medications: FOCALIN XR 10 MG DAILY
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF452CA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site reaction, Local reaction
SMQs:
Write-up: LOCAL REACATION TO ADACEL 6CM X 6 CM

VAERS ID:323508 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Male  Submitted:2008-08-27, Days after onset: 9
Location:Michigan  Entered:2008-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: ALLERGIES HEART MURMUR
Diagnostic Lab Data: CBC COMP METABOLIC PANEL CRP STSH MONO ESR EBV BLOOD CULTURE08
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB264AA1IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2889AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Blood culture, Blood thyroid stimulating hormone, C-reactive protein, Epstein-Barr virus antibody, Full blood count, Laboratory test, Liver function test abnormal, Pyrexia, Rash, Red blood cell sedimentation rate, Urticaria
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: HIVE LIKE RASH FEVER ELEVATED LFT

VAERS ID:323509 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:2008-08-27, Days after vaccination: 0
Gender:Male  Submitted:2008-08-27, Days after onset: 0
Location:Wisconsin  Entered:2008-08-27
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2417AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2864AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1911U1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Fall, Head injury, Joint injury, Nausea, Neck pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad)
Write-up: 11 year old male patient was administered 3 immunizations as stated below. His 2 sisters and mother were in the room with him. After his shots were done, the youngest sister (8 y.o) fainted. She had not had any shots. Shortly after his sister fainted the patient said he felt somewhat queasy. We kept him under observation for the next 15-20 minutes, he said he was feeling better. We moved the family into another waiting room and told them to remain seated for another 15-20 minutes. About 10 minutes later the mother called out as the patient fainted. He was seated at the time so his chair ended up tipping to the left and he fell to the ground. He aroused quickly, pulse and respirations were WNL and regular. He was alert and oriented x3 once aroused. He stated that the side of his left temple and his knees hurt and his neck was a little sore from when he fell. It appeared that he may have had small "rug burns" on the side of his left temple and on both knees. We had him stay with us in the office for another 30 minutes under our observation. He ate a granola bar and after a while stated he felt better. We discussed the signs/symptoms of concussion with mother, advised her to follow-up with MD if he exihibits s/s or any other unusual behavior. Escorted family to car w/out incident.

VAERS ID:323519 (history)  Vaccinated:2008-08-04
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2008-08-27
Location:Tennessee  Entered:2008-08-27
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: Environmental allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2771AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Left BELL''S PALSY-Patient has received a course of oral steroids, but the palsy has not resolved. May not be related to vaccine, but it was a new neurologic finding after vaccine.

VAERS ID:323591 (history)  Vaccinated:2008-08-14
Age:11.0  Onset:2008-08-14, Days after vaccination: 0
Gender:Female  Submitted:2008-08-18, Days after onset: 4
Location:Oregon  Entered:2008-08-28, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: OR200823
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB245AA1IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1486U0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR02560AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B015AA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: After receiving HPV # 1 client waited in reception area for 10-15 minutes and with departure in hall vomited.

VAERS ID:323599 (history)  Vaccinated:2008-08-21
Age:11.0  Onset:2008-08-22, Days after vaccination: 1
Gender:Female  Submitted:2008-08-22, Days after onset: 0
Location:Georgia  Entered:2008-08-28, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0093X SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Nodule, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swollen red knot

VAERS ID:323653 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-19, Days after vaccination: 1
Gender:Male  Submitted:2008-08-28, Days after onset: 9
Location:North Carolina  Entered:2008-08-28
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: ADHD, RAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB238AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2422AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1894U1SCRA
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: R arm swollen, red and warm to touch around injection site

VAERS ID:323661 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-20, Days after vaccination: 2
Gender:Male  Submitted:2008-08-28, Days after onset: 8
Location:Illinois  Entered:2008-08-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None noted Hx Asthma
Preexisting Conditions: Hx of Asthma, Adenoids
Diagnostic Lab Data: CBC, BMP, allergy panel
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB223AA1IM 
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B016BA0IM 
Administered by: Public     Purchased by: Public
Symptoms: Allergy test, Full blood count, Laboratory test, Pain in extremity, Pruritus, Rash, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Per mom facial rash started 2 days after immunizations. Today 8/28/08, papular/macule rash to face, left forearm, palms itchy and rash on palms painful. Medication prescribed today diphenhydramine 12.5 mg = 5CC every 6 hours prn; hydrocortisone 2.5 % ointment TID follow-up in 1 week.

VAERS ID:323693 (history)  Vaccinated:2008-06-30
Age:11.0  Onset:2008-07-01, Days after vaccination: 1
Gender:Male  Submitted:2008-07-02, Days after onset: 1
Location:Georgia  Entered:2008-08-29, Days after submission: 58
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: GA08040
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSC52B024EA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1101U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site irritation, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: TDAP given IM LD and VZV SQ LA 6-30-08. 7-2-08 child returned to clinic with large, red, swollen area noted on LD and LA at injection site. Complained of "burning and itching." Mom states onset started 7-1-08. Instructed mom to con''t Ibuprofen and Benadryl - po if no allergies and to apply cool compress. Instructed to see MD.

VAERS ID:323727 (history)  Vaccinated:2008-08-26
Age:11.0  Onset:2008-08-27, Days after vaccination: 1
Gender:Male  Submitted:2008-08-28, Days after onset: 1
Location:Texas  Entered:2008-08-29, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2664AA0 LA
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: Redness and swelling a injection site.

VAERS ID:323736 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-25, Days after onset: 7
Location:Wisconsin  Entered:2008-08-29, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TOPICORT OINTMENT
Current Illness: None
Preexisting Conditions: Eczema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0843X0 LL
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Dizziness- followed-up by syncope & pallor. TRENDELENBURG position, after approximately 2 minutes color back. Kept patient approximately 1/2 hour for observation.

VAERS ID:323791 (history)  Vaccinated:2008-08-25
Age:11.0  Onset:2008-08-25, Days after vaccination: 0
Gender:Female  Submitted:2008-08-29, Days after onset: 4
Location:North Carolina  Entered:2008-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR 0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Diarrhoea, Erythema, Local reaction, Pyrexia, Swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow)
Write-up: Fever : 101-102 F x 3 days (starting same evening as vaccination); Mild diarrhea, occasional vomitting x 3 days; Localized redness & swelling x 3 days- Local ice packs, motrin as needed & benadryl as needed

VAERS ID:323931 (history)  Vaccinated:2008-07-22
Age:11.0  Onset:2008-07-23, Days after vaccination: 1
Gender:Male  Submitted:2008-07-25, Days after onset: 2
Location:Georgia  Entered:2008-08-29, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: GA08064
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1859U1SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mom reports swelling at site, child taken to PCP on 7/23/08 and BENADYL along with ibuprofen ordered. Please see phone message taken per RN.

VAERS ID:323803 (history)  Vaccinated:2008-08-18
Age:11.0  Onset:2008-08-18, Days after vaccination: 0
Gender:Female  Submitted:2008-08-31, Days after onset: 13
Location:Minnesota  Entered:2008-08-31
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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAUB243AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Epistaxis, Sneezing
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (broad)
Write-up: Bloody Noses 2 to 3 times per day, starting the evening after the vaccine was administered, still ongoing. There were two very bad ones today, the second one caused by sneezing once.

VAERS ID:323810 (history)  Vaccinated:2008-08-19
Age:11.0  Onset:2008-08-21, Days after vaccination: 2
Gender:Male  Submitted:2008-09-01, Days after onset: 11
Location:Texas  Entered:2008-09-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: fever first noted approx. 42 hrs after vaccines given. fever as high as 104.3. fever lasted 4 days. fever responded to Ibuprofin, but continued to hover between 100-101 until the fifth day.

VAERS ID:323865 (history)  Vaccinated:2008-01-30
Age:11.0  Onset:2008-01-30, Days after vaccination: 0
Gender:Female  Submitted:2008-07-30, Days after onset: 181
Location:New Hampshire  Entered:2008-09-02, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 50 days
    Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: History derived from review of medical record, several of my prior exams and visits, and discussion with PCP; Seasonal allergies.'' PMH: Asthma. Allergic to Augmentin and Benadryl.
Diagnostic Lab Data: Blood lactate 6.6, followed by 5.4 both in free flowing blood, without tourniquet; Pyruvate, requested but not obtained; CPK 103; Blood mitochondrial mutations, normal 14 mutations and 3 deletions, including MERRF mutations; Urine spot HVA: 3.1 ug/mg Cr normal <7.0; Urine spot VMA: 6.0 ug/mg Cr normal <12.0; MIBG and octreatide scans are normal; IgG 1484; IgA 118; IgM 213 high; IgE 638 high; NeoCerebellar degeneration paraneoplastic profile with Recombx, at labs, negative; Recombx Hu negative; Ma1; Ma2; Yo; Ri; CV2; Zio4; All normal; Mycoplasma studies: IgG elevated at 3.48 (normal <0.9); IgM 0.42; normal (<0.9); suggests old prior exposure; ANA positive; $g1:80; ADNA negative; ADNA titre not performed; CANCA neg; PANCA neg; MPO2.8; myeloper
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1266U1IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2549AA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Abasia, Abdominal pain upper, Anger, Angiotensin converting enzyme increased, Antibody test normal, Antineutrophil cytoplasmic antibody negative, Antineutrophil cytoplasmic antibody positive, Antinuclear antibody negative, Antinuclear antibody positive, Asthenia, Ataxia, Atrophy, Blood creatine phosphokinase normal, Blood electrolytes normal, Blood heavy metal normal, Blood immunoglobulin A normal, Blood immunoglobulin E increased, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactic acid increased, Blood product transfusion, Blood pyruvic acid increased, Blood thyroid stimulating hormone normal, Borrelia burgdorferi serology negative, CSF test normal, Cardiolipin antibody negative, Cerebellar syndrome, Depression, Dizziness, Electroencephalogram normal, Electromyogram normal, Eye movement disorder, Full blood count, Haemoglobin normal, Herpes simplex serology positive, Hyperglycaemia, Hyperreflexia, Hyporeflexia, Laboratory test normal, Malaise, Mood altered, Motor dysfunction, Muscular weakness, Mycoplasma serology positive, Myoclonus, Nausea, Nerve conduction studies normal, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Opsoclonus myoclonus, Oropharyngeal pain, Platelet count normal, Sensory loss, Social avoidant behaviour, Thyroxine free normal, Tremor, Ultrasound abdomen normal, Vertigo, Wheelchair user, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Lactic acidosis (narrow), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Hypertension (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (narrow), Vasculitis (broad), Ocular motility disorders (narrow), Hypersensitivity (narrow)
Write-up: In December of 2007 and January of 2008, patient became withdrawn and concerned that she did not lose weight despite diet and exercise, and she started having opsoclonus. She had no illnesses around the time of onset of those symptoms. Brother had been quite ill (thought initially to be meningitis, but turned out to be unknown) and is now better. She had a meningitis vaccine and HPV vaccine at the time that she started to be withdrawn. Over the course of 1-2 weeks she became ataxic, and had very "jumpy arms". This myoclonus spread to her legs such that she could not walk. She denied headaches, nausea, and or vomiting. No muscle aches or leg pain. No tinnitus or hearing loss. At the time of a February 11, 2008 admission she had severe opsoclonus, myoclonus, dysmetria, and perhaps a wide amplitude tremor. An extended evaluation was started looking for a neuroblatoma and a ganglioneuromal, mitochondrial disease, inflammatory diseases, and other diseases. There were a few abnormal lab results, which normalized later. The lactate normalized only after starting mitochondrial vitamins. No evidence of a ganglioneuroma or neuroblastoma was found. Blood mitochondrial mutations were sent and later returned as normal. Because the lactate was high, we added Thiamine 25 mg twice daily and riboflavin 50mg twice daily, CoQ, and Keppra was started later at 1mg/kg/day, and advanced as tolerated, then lowered when she started feeling nauseated. She received steroid x 1 week courses, with marked hyperglycemia, but no improvement. She received IVIG, then sent to hospital. She was discharged from hospital with improved opsoclonus, but still unable to walk or reach easily. She returned to hospital for a second course of IVIG. After that, the mitochondrial meds were stopped, she remained unable to walk, and had variable but usually less opsoclonus. Physical therapists noted some weakness and atrophy, and she had one episode when she would fall to the left side when the tuning fork was put near her left ear. She had had no convulsions and had a normal EEGs, including a normal 24 hour EEG; no emesis; no headache; no deterioration of affect or bizarre behavior. She has had no trouble eating and she can use a fork, but has some difficulty using her knife to cut. She was seen by doctor, who, mother says, gave a cursory exam, stated that patient''s strength was adequate to walk, and that Mother should stand her up, make her walk, and she will be walking in several months. 12/1/08 MR received for 2 admissions: DOS 2/11-29/2008 with D/C DX: Post-infectious myoclonus and opsoclonus with lower extremity weakness. Depression. DOS: 4/17-19/2008 with D/C DX: Upper extremity weakness. Opsoclonus-myoclonus. Two months prior to admission pt noticed new onset of mood changes-depression and anger. One month prior pt noticed abnormal eye movements which resulted in vertigo. Pt presented with worsening eye movements with dizziness and shakiness. Unable to walk unassisted, feeling unwell with sore throat and stomach ache. Some arm tremors. PE (+) for abnormal eye movements, 4/5 strength in lower extremities, ataxia, UE and knee DTRs brisk, difficult to elicit at ankles. Ophth, Rheum and Psych consults. Started on anti-depressant. D/C to inpt rehab. Developed new myoclonus in legs and R arm despite steroids and IVIG. Returned for admission 4/17/08 with new complaint of upper extremity weakness. Now using a w/c and difficult to transition from w/c to bed. New truncal weakness and difficulty with fine motor skills. Unable to stand due to lack of sensation in feet. Again tx with IVIG without resolution of sx.

VAERS ID:323869 (history)  Vaccinated:2008-08-26
Age:11.0  Onset:2008-08-26, Days after vaccination: 0
Gender:Female  Submitted:2008-08-26, Days after onset: 0
Location:Georgia  Entered:2008-09-02, 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: Seizure disorder
Diagnostic Lab Data: None of note patient followed by neurologist for seizure disorder; takes Trileptol.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0843X0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUFU52AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0629X1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Crying, Gaze palsy, Musculoskeletal stiffness
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad)
Write-up: Patient was having vaccines administered- HPV, then ADACEL, then VARIVAX - all left arm. During last injection (VARIVAX), patient stated, "I''m going to have a seizure" then all four extremities stiffened -$g eyes rolled back about 15 seconds -$g immed. recovered alert, crying

VAERS ID:323871 (history)  Vaccinated:2008-08-20
Age:11.0  Onset:2008-08-21, Days after vaccination: 1
Gender:Male  Submitted:2008-08-22, Days after onset: 1
Location:California  Entered:2008-09-02, Days after submission: 11
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 BIOLOGICALSAHAVB222AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2428AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2844AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1772U1SCRA
Administered by: Private     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: R deltoid swelling with redness.

VAERS ID:323876 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2008-08-27
Location:Wisconsin  Entered:2008-09-02, 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 Sibling|none~ ()~~0~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB2529AA3IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2425AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B0125AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: BOOSTRIX given today - but he also had one 5/2/07. (No symptoms/signs) (this simply acknowledges that this given too soon past DTaP)

VAERS ID:323894 (history)  Vaccinated:2008-09-02
Age:11.0  Onset:2008-09-02, Days after vaccination: 0
Gender:Female  Submitted:2008-09-02, Days after onset: 0
Location:New York  Entered:2008-09-02
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
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500543P0IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2726AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF452AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted about 5 minutes after vaccine administration

VAERS ID:323916 (history)  Vaccinated:2008-08-22
Age:11.0  Onset:2008-08-24, Days after vaccination: 2
Gender:Male  Submitted:2008-08-29, Days after onset: 5
Location:Michigan  Entered:2008-09-02, 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:
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB246AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2616AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2844AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0320X0SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Bumps and itching behind ear and scalp. Loratadine 10mg 1 x daily and observation.

VAERS ID:323917 (history)  Vaccinated:2008-08-22
Age:11.0  Onset:2008-08-28, Days after vaccination: 6
Gender:Female  Submitted:2008-09-02, Days after onset: 5
Location:Vermont  Entered:2008-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ~DTaP (no brand name)~5~4~In Patient
Other Medications:
Current Illness: None
Preexisting Conditions: ?Tetanus toxoid
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0381X0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2686AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Pharyngolaryngeal pain, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Please see hospital notes - skin rash. Patient has developed a rash over the last 2 hours on her arms and left knees. She is now complaining of throat pain. She got her first GARDASIL shot and her meningitis vaccine about 7 days ago and her mom says when patient was five she had a reaction to a tetanus shot 6 days after she got the vaccine. Mom is concerned.

VAERS ID:323940 (history)  Vaccinated:2008-08-26
Age:11.0  Onset:2008-08-27, Days after vaccination: 1
Gender:Female  Submitted:2008-08-28, Days after onset: 1
Location:Michigan  Entered:2008-09-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0737X2SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site nodule, Injection site pain, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Large local reaction at immunization site - first noted <24 hours after injection, increasing in size. At ~48 hours - ~6cm erythematous, warm patch with ~2cm tender, underlying nodule. Red: BENADRYL, cool compresses.

VAERS ID:323904 (history)  Vaccinated:2008-08-27
Age:11.0  Onset:2008-09-01, Days after vaccination: 5
Gender:Female  Submitted:2008-09-03, Days after onset: 2
Location:New Jersey  Entered:2008-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None. Routine vaccination
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR   RA
Administered by: Private     Purchased by: Unknown
Symptoms: Back pain, Renal pain
SMQs:, Retroperitoneal fibrosis (broad)
Write-up: Patient has lower back pain, in the kidney area. Will contact physician on 3-Sept-08 for follow-up.

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