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Case Details (Sorted by Age)

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VAERS ID:289019 (history)  Vaccinated:2007-08-15
Age:5.0  Onset:2007-08-15, Days after vaccination: 0
Gender:Female  Submitted:2007-08-20, Days after onset: 5
Location:Ohio  Entered:2007-08-24, 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURERU2289AA4UNUN
MMR: MEASLES + MUMPS + RUBELLA (MMR I)MERCK & CO. INC.0428U1UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0722U1UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Welts on face, arms, and abdomen. Patient was given .2 of Epi, she waited in office for 20 minutes and was sent home with Benadryl.

VAERS ID:289022 (history)  Vaccinated:2007-07-23
Age:5.0  Onset:2007-07-25, Days after vaccination: 2
Gender:Unknown  Submitted:0000-00-00
Location:Texas  Entered:2007-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: TX07071
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1141F1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythema and induration at injection site approximately 30 mm diameter.

VAERS ID:288994 (history)  Vaccinated:2007-08-21
Age:5.0  Onset:2007-08-22, Days after vaccination: 1
Gender:Male  Submitted:2007-08-25, Days after onset: 3
Location:Pennsylvania  Entered:2007-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Autism~Measles + Mumps + Rubella (no brand name)~1~1~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Autism Spectrum Disorder - thought to be caused by previous vaccinations as well and reported back in 2004.
Diagnostic Lab Data: The ER did a CBC, CRP, and a CMP, all which were unremarkable.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER12344IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER12343IMLL
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER12341IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: C-reactive protein normal, Febrile convulsion, Full blood count normal, Metabolic function test normal, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Patient received a Dtap, IPV, and MMR the afternoon of August 21, 2007. One the morning of August 22, 2007 he had a fever. By 8:15 AM he was unresponsive and had seizure activity. After a full ER workup and evaluation it was determined that he had a febrile seizure due to the previous days vaccinations.

VAERS ID:289023 (history)  Vaccinated:2007-04-02
Age:5.0  Onset:2007-04-03, Days after vaccination: 1
Gender:Female  Submitted:2007-08-24, Days after onset: 143
Location:Kentucky  Entered:2007-08-27, Days after submission: 3
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: None
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA00816
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.024840IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR 4UNUN
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Injection site rash, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 5 year old female with no remarkable medical history who on 02-APR-2007 at 3:20pm was vaccinated with a first 0.5ml intramuscular dose of VAQTA (Lot # "02484:) in the right thigh. Concomitant vaccine administered on the same day included a fifth dose of IPOL. There was no illness at the time of vaccination and no adverse events following prior vaccination. The following day after receiving VAQTA, on 03-APR-2007, the patient developed a large rash at the injection site. The patient was treated with BENADRYL for the reaction. Unspecified medical attention was sought. There was no laboratory or diagnostic tests performed. No further information was provided at the time of this report. No product quality complaint was involved. Additional information has been requested. Follow-up information received from a physician stated that the patient experienced severe redness and swelling of the right thigh from the right anterior superior iliac spine down to the knee. The patient recovered, however, the reporter "can not recall" the date. The event of redness and swelling of the right thigh was determined to be an other important medical event by the investigator.

VAERS ID:289047 (history)  Vaccinated:2007-08-17
Age:5.0  Onset:0000-00-00
Gender:Female  Submitted:2007-08-27
Location:Pennsylvania  Entered:2007-08-27
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: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0329U SCUN
Administered by: Private     Purchased by: Private
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Pt ordered to receive 4-6 yo Varivax (routine booster) but received Zostavax by staff in error. Pt was doing fine when reached for f/u 3d later (given on Friday PM, reached Monday AM).

VAERS ID:289064 (history)  Vaccinated:2007-08-15
Age:5.0  Onset:0000-00-00
Gender:Female  Submitted:2007-08-21
Location:Utah  Entered:2007-08-27, 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 known
Preexisting Conditions: None
Diagnostic Lab Data: + MRSA wound culture from ear
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B035AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURY10303SCLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0652U0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site cellulitis, Injection site pain, Injection site swelling, Wound
SMQs:, Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt came in 8/17/07 with swollen left leg. No fever, mild tenderness at site. hx of previous culture +. MRSA wound. Presumed MRSA cellulitis at site of IPV injection.

VAERS ID:289066 (history)  Vaccinated:2007-08-07
Age:5.0  Onset:2007-08-07, Days after vaccination: 0
Gender:Female  Submitted:2007-08-15, Days after onset: 8
Location:Minnesota  Entered:2007-08-27, 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:
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC148046AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ09243SCLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0773U1SCRL
Administered by: Private     Purchased by: Unknown
Symptoms: Torticollis
SMQs:, Dystonia (narrow), Ocular motility disorders (broad)
Write-up: Torticollis

VAERS ID:289081 (history)  Vaccinated:2007-08-06
Age:5.0  Onset:2007-08-06, Days after vaccination: 0
Gender:Female  Submitted:2007-08-23, Days after onset: 17
Location:Ohio  Entered:2007-08-27, 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: Benadryl after stat of rxn
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2651AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08733SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.1482F1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:289104 (history)  Vaccinated:2007-08-09
Age:5.0  Onset:2007-08-11, Days after vaccination: 2
Gender:Female  Submitted:2007-08-27, Days after onset: 16
Location:Illinois  Entered:2007-08-27
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B044BA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ02403SCRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0982F2SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cold compress therapy, 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: AT 36 HOURS POST VACCINATION, CHILDS RIGHT ARM, AT THE SITE OF Dtap INJECTION BECAME VERY RED, HOT AND SWOLLEN. CHILDS PMD WAS NOTIFIED AND DUE TO SEVERITY AND WEEKEND DAY, THE CHILD WAS ADVISED TO BE SEEN AT LOCAL ER. PATIENT WAS SEEN AT ER. COLD COMPRESSES AND ANTIBIOTICS WERE INITIATED. 2 DAYS LATER THE REACTION RESOLVED.

VAERS ID:289114 (history)  Vaccinated:2007-07-20
Age:5.0  Onset:2007-08-25, Days after vaccination: 36
Gender:Male  Submitted:2007-08-27, Days after onset: 2
Location:Texas  Entered:2007-08-27
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SCUN
Administered by: Private     Purchased by: Unknown
Symptoms: Varicella
SMQs:
Write-up: Had varicella IZ 8/11/03 - booster IZ 7/20/07. Pt with mild varicella blisters starting on 8/25/07 - doubt rxn to vaccine.

VAERS ID:289119 (history)  Vaccinated:2007-08-22
Age:5.0  Onset:2007-08-23, Days after vaccination: 1
Gender:Female  Submitted:2007-08-27, Days after onset: 4
Location:California  Entered:2007-08-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056CA4IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema, Pruritus, Pyrexia, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local reaction of: itching, erythema 3"x5", edema of 1 3/4" $g than opposite arm, warm to the touch - onset = 24 hours after immunization given, low-grade fever x 24 hours after vaccine; no limited range of motion, no decreased activity level

VAERS ID:289127 (history)  Vaccinated:2007-08-14
Age:5.0  Onset:2007-08-15, Days after vaccination: 1
Gender:Female  Submitted:2007-08-21, Days after onset: 6
Location:Unknown  Entered:2007-08-27, Days after submission: 6
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0605U1SCRL
Administered by: Public     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: 08/15/07 Woke up with redness, swelling to site, approximately 5cm. Circumference went to doctor - area was marked. 8/16/07 area was larger, but less red. Size was approximately 10cm - circumference warm. No pain at site. Patient taking Benadryl every 6 hours - no itching.

VAERS ID:289142 (history)  Vaccinated:2007-08-20
Age:5.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Male  Submitted:2007-08-23, Days after onset: 2
Location:North Dakota  Entered:2007-08-27, 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: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056BA4IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0494U0IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ03063SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0807F1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Child had shots 8/20/07; on 8/21, right arm (at shot areas were painful. Then 8/22 areas became itchy and somewhat reddened. Through that day swelled up and became quite red and swollen from elbow thru deltoid area. Mother gave Benadryl. 8/23/07 Mother says it''s not as red.

VAERS ID:289163 (history)  Vaccinated:2007-08-08
Age:5.0  Onset:2007-08-08, Days after vaccination: 0
Gender:Female  Submitted:2007-08-20, Days after onset: 12
Location:North Carolina  Entered:2007-08-28, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nizoral cream and shampoo for Tenia corpis
Current Illness: Tenia corpis
Preexisting Conditions: NKDA; H/O Febrile seizure, admitted 1/4/04
Diagnostic Lab Data: On 8/10/07 - Labs were advised - Basic chemistry, CBC with Diff, UA, T4 TSH
CDC Split Type: NC07087
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2289CA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05273SCLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0487U0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Blood thyroid stimulating hormone, Febrile convulsion, Full blood count, Laboratory test, Rash generalised, Thyroxine, Urine analysis, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt received immunisation on 8/8/07 in the morning. Same day evening, was seen at Emergency Room for urticaria, rash - all over the body. Pt was given Benadryl and Orapred - Pt was seen at office on 8/10/07 - intermittent rash - resolved urticaria - Benadryl and Orapred continued. Recovering rash.

VAERS ID:289164 (history)  Vaccinated:2007-08-13
Age:5.0  Onset:0000-00-00
Gender:Male  Submitted:2007-08-21
Location:Washington  Entered:2007-08-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURAC52B013AA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05483SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0952F0SCRA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0461U0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)
Write-up: No reaction after 48 hr per father

VAERS ID:289178 (history)  Vaccinated:2007-08-20
Age:5.0  Onset:2007-08-23, Days after vaccination: 3
Gender:Male  Submitted:2007-08-28, Days after onset: 5
Location:California  Entered:2007-08-28
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:
Diagnostic Lab Data: Esterose level & RAST pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2650AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05483SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0910U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: C1 esterase inhibitor test, Generalised oedema, Radioallergosorbent test, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: urticaria widespread anasarca x 3d No pulmonary and cardiovascular problems Resolved with Benadryl

VAERS ID:289206 (history)  Vaccinated:2007-08-14
Age:5.0  Onset:2007-08-16, Days after vaccination: 2
Gender:Male  Submitted:2007-08-22, Days after onset: 6
Location:Iowa  Entered:2007-08-28, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None reported
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2570AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ03244SCRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.1549F1SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Injection site erythema
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Parents brought back to PH - stated just noted this AM lg red area on lt upper arm approx 4cm in size - encouraged to go to doctor to have checked.

VAERS ID:289218 (history)  Vaccinated:2007-08-22
Age:5.0  Onset:2007-08-23, Days after vaccination: 1
Gender:Male  Submitted:2007-08-24, Days after onset: 1
Location:North Carolina  Entered:2007-08-28, 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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2059BA0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05270IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.105380SCLA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mom states swelling right arm with redness associated with pain started next day. No treatment necessary. Mom called back Monday 8/27/07 patient doing good. No symptoms patient went to school.

VAERS ID:289223 (history)  Vaccinated:2007-06-11
Age:5.0  Onset:2007-06-12, Days after vaccination: 1
Gender:Male  Submitted:2007-06-15, Days after onset: 3
Location:Hawaii  Entered:2007-08-28, Days after submission: 74
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B051BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURY06383SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1323F1SCLL
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURERC2551AA2IDLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site inflammation, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large localized redness, swelling and inflammation extending to entire upper arm and to scapular region of back.

VAERS ID:289236 (history)  Vaccinated:2007-08-23
Age:5.0  Onset:2007-08-24, Days after vaccination: 1
Gender:Female  Submitted:2007-08-28, Days after onset: 4
Location:Wisconsin  Entered:2007-08-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, multivitamin, albuterol prn
Current Illness: no
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056CA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ0873-23SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0617F1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0451U1SCLL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness and puffiness size of softball. Itchy, warm.

VAERS ID:289241 (history)  Vaccinated:2007-08-28
Age:5.0  Onset:2007-08-28, Days after vaccination: 0
Gender:Male  Submitted:2007-08-28, Days after onset: 0
Location:Minnesota  Entered:2007-08-28
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: anaphylaxis to gummy bears, unknown substance.Caniosynostosis.
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURC2606AA4IMRL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB182AA0IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURZ10093IMRL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0787U3062U0SCLL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Eye swelling, Lip swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient was given DTAP, MMR/Varicella (combined vaccine), IPV and Hepatitis A. Approximately 15min after injections developed swelling of eyes and lips. He developed hives and diffuse erythema. No skin changes at the local sites of injections.

VAERS ID:289248 (history)  Vaccinated:2007-08-20
Age:5.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Female  Submitted:2007-08-23, Days after onset: 2
Location:Oregon  Entered:2007-08-28, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2650AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05483IMLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Injection site swelling, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Given DTaP #5, IPV #4 (L) thigh on 8/20/07, next AM had hives all over, injection site splotchy rash Benadryl helped. Day 2, Hives again in am, itchy rash on face, swollen at site. Day 3 improved, no hives.

VAERS ID:289254 (history)  Vaccinated:2007-08-15
Age:5.0  Onset:2007-08-15, Days after vaccination: 0
Gender:Male  Submitted:2007-08-24, Days after onset: 9
Location:New Jersey  Entered:2007-08-28, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: Evaluation in ER at 12:09 PM - no rash seen - resp stable given Benadryl and discharged
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ01693IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0498F1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Rash, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mom called about 30 minutes following administration of vaccines to report rash and complaint of itchy throat. Patient came back to office had an urticarial rash around ears, neck, upper chest. C/O itchy feet - no rash seen. POX 97%, Lungs CTA, throat without ant erythema - patient stable - sent to ER for observation.

VAERS ID:289257 (history)  Vaccinated:2007-08-20
Age:5.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Male  Submitted:2007-08-21, Days after onset: 0
Location:Michigan  Entered:2007-08-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1/8/2006~Influenza (no brand name)~1~4~In Patient|8/15/2006~DTaP (no brand name)~5~4~In Sibling
Other Medications:
Current Illness: Molluscum contagiosum
Preexisting Conditions: allergic rhinitis, asthma, ASD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB1001AA0 LL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.100241 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother presents to office with c/o rash noted this a.m. on child. Initially began on lips now spreading to arms, chest?, lower lip. Afebrile, denies pain or pruritus.

VAERS ID:289327 (history)  Vaccinated:2007-07-09
Age:5.0  Onset:2007-07-10, Days after vaccination: 1
Gender:Female  Submitted:2007-07-18, Days after onset: 8
Location:Kansas  Entered:2007-08-29, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type: KS2007014
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0246Y1IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0532Y1SCLL
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 1" x 1" warm, reddened area on left thigh in area where Varicella vaccination was received.

VAERS ID:289346 (history)  Vaccinated:2007-08-22
Age:5.0  Onset:2007-08-27, Days after vaccination: 5
Gender:Male  Submitted:2007-08-29, Days after onset: 2
Location:Texas  Entered:2007-08-29
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: No.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0246U1IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Ear pain, Headache, Pyrexia, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 08/29/07 1115 Received phone call from client;s mother who stated "Patient has not been feeling well and we were wondering if it was from the vaccine he was given." Mother stated patient complained of a headache on Monday and had a slight fever. She took to the doctor and he stated it was a viral infection. Mother stated today patient is off balance and complaining of right ear pain. Encouraged mother to take patient to doctor and explain symptoms and that he received Hepatitis A vaccine on 08/22/07.

VAERS ID:289347 (history)  Vaccinated:2007-08-28
Age:5.0  Onset:2007-08-28, Days after vaccination: 0
Gender:Female  Submitted:2007-08-29, Days after onset: 1
Location:Texas  Entered:2007-08-29
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Milk and egg allergies, extreme sensitivity. Cold induced Asthma. PMH: prior allergic reaction, anaphylaxis, asthma Allergies: dairy, egg, septra, omnicef, Pcn.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657AA4IDLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB181AA1IDRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURZ10O91IDRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1006U1IDLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anaphylactic reaction, Chest pain, Cough, Hypersensitivity, Increased upper airway secretion, Pharyngeal oedema, Pyrexia, Urticaria, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Anaphylaxis, throat swelling causing coughing, wheezing, chest pain, mucous drainage within 10 minutes of the shots given. Patient recieved Epi jr., albuterol through a spacer and two tablets of benadryl. Then she had xeponex through a nebulizer. She stabilzed. Enroute to ER to be observed, Anaphlaxis occured again, with body hives, wheezing, coughing and she also had a high fever. She recieved another breathing treatment with ALbuterol and an Epi Jr once again. Oxygen was then given and she was admitted to ER. She was then give IV steroids and Motrin for fever. She was evaluated 6 hours and released. She is still running high fever and is on antihistimines. 8/31/07 Received vax record from pcp which corrected vax info. VAERS database updated w/same. 10/26/07 Received hospital medical records which reveal patient experienced coughing, vomited, wheezing , & increased phlegm. Seen in ER 8/27/07 from pcp office. Had already received repeat epi pen prior to arrival along with orapred, nebs, O2 & benadryl. Tx w/additional IV steroids & benadryl. Improved & d/c to home from ER. FINAL DX: acute allergic reaction.

VAERS ID:289348 (history)  Vaccinated:2007-08-17
Age:5.0  Onset:0000-00-00
Gender:Female  Submitted:2007-08-29
Location:Florida  Entered:2007-08-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B046AA3IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ0872-23SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0283U0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling abnormal, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient returned to clinic on 8/28/2007 with a red rash to face, torso and arms. Pts mother states the rash was worse and child ran a fever and felt bad for a few days.

VAERS ID:289922 (history)  Vaccinated:2006-08-25
Age:5.0  Onset:2006-08-26, Days after vaccination: 1
Gender:Female  Submitted:2006-10-25, Days after onset: 60
Location:Utah  Entered:2007-08-29, Days after submission: 308
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: The patient had no illness at the time of vaccination and had no pre-existing medical conditions.
Diagnostic Lab Data:
CDC Split Type: 200602362
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2627AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURY09913IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0615F SCLL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Local reaction, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report received on 06/Sep/2006 from a health care provider. A 5-year-old female patient, with no pre-existing medical history, had received an intramuscular, right thigh fourth dose injection of IPOL, lot number Y0991-2, an intramuscular, left thigh, fifth dose injection of Daptacel, lot number C2627AA, and a subcutaneous, left thigh injection of MMR, lot number 0615F; on 25/Aug-2006. The next day, the patient developed a large local reaction of redness, swelling and itching from the front of the right thigh to her knee. She was evaluated by a physician and treated with Benadryl and Augmentin. No diagnostic testing was performed, and the patient recovered from the event. Follow-up information received on 10 October 2006 from a health care provider. The adverse reaction involved the entire R upper thigh. Additional medically relevant information was not provided.

VAERS ID:289929 (history)  Vaccinated:2007-03-16
Age:5.0  Onset:2007-03-17, Days after vaccination: 1
Gender:Male  Submitted:2007-04-26, Days after onset: 40
Location:Ohio  Entered:2007-08-29, Days after submission: 125
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MMR
Current Illness:
Preexisting Conditions: Follow-up information received on 23 April 2007. The patient had no known allergies and did not have any illness at the time of the vaccinations.
Diagnostic Lab Data:
CDC Split Type: 200700843
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2521AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ04563UNLA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Oedema peripheral, Pain in extremity, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial report received on 20 March 2007, from a healthcare professional. A 5 year old male patient received on 16 March 2007 (at morning time) the fourth dose of Daptacel (lot# C2521AA), intra-muscular, into the left arm; third dose of IPOL (lot# Z0456-2), into the left arm; and a dose of MMR (lot# 1025F-9308), into the right arm. On 17 March 2007 (at morning time), a day post vaccination, the left arm was swollen and painful with a rash. The patient returned into the (doctor''s) office, unspecified time after vaccination with "cellulitis". The patient was treated with an unknown injection. The patient''s outcome was unknown. The patient had no illness and medical condition at the time of vaccination and was not taking other medications. Follow-up information received on 23 April 2007. The patient had no known allergies, did not have any illness at the time of the vaccinations and did not have any additional vaccines within 4 weeks. It was reported the patient recovered.

VAERS ID:289360 (history)  Vaccinated:2007-08-20
Age:5.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Male  Submitted:2007-08-21, Days after onset: 0
Location:New Jersey  Entered:2007-08-30, 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: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.1532F0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Itchy red raised rash at injection site 3x3 in.

VAERS ID:289366 (history)  Vaccinated:2007-08-09
Age:5.0  Onset:2007-08-09, Days after vaccination: 0
Gender:Female  Submitted:2007-08-14, Days after onset: 5
Location:Virginia  Entered:2007-08-30, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2627AA3IMLA
HIBV: HIB (ACTHIB)SANOFI PASTEURUF085AA2IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05473SCRA
Administered by: Public     Purchased by: Public
Symptoms: Anorexia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Grandmother states had fever, vomiting, no appetite, which continued through to noon of next day after receiving vaccines. (Grandmother did not actually check temp.)

VAERS ID:289369 (history)  Vaccinated:2007-08-23
Age:5.0  Onset:2007-08-24, Days after vaccination: 1
Gender:Male  Submitted:2007-08-28, Days after onset: 4
Location:Virginia  Entered:2007-08-30, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2749BA5IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0285U SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: local redness at site of DTaP inj. warm to the touch 3: diam. at inj. site itchiness (L) arm.

VAERS ID:289370 (history)  Vaccinated:2007-08-21
Age:5.0  Onset:2007-08-21, Days after vaccination: 0
Gender:Male  Submitted:2007-08-28, Days after onset: 7
Location:Virginia  Entered:2007-08-30, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Food allergies/Asp. reflex; Dev. delays; Allergy to Cipro
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2749BA4IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local redness at site left arm after DTaP vaccination, itchiness a lot.

VAERS ID:289371 (history)  Vaccinated:2007-08-22
Age:5.0  Onset:2007-08-24, Days after vaccination: 2
Gender:Male  Submitted:2007-08-28, Days after onset: 4
Location:Virginia  Entered:2007-08-30, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin/Vit.
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2749BA4IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0285U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local redness at site 2" around inject. site, warm to the touch, itchiness. Left arm reaction to DTaP.

VAERS ID:289372 (history)  Vaccinated:2007-08-22
Age:5.0  Onset:2007-08-24, Days after vaccination: 2
Gender:Male  Submitted:2007-08-28, Days after onset: 4
Location:Virginia  Entered:2007-08-30, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2749BA4IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0285U1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site urticaria, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: (L) thigh Local redness at site-developed "hives" warm to the touch itchiness reaction to DTaP "large area of thigh"

VAERS ID:289373 (history)  Vaccinated:2007-08-27
Age:5.0  Onset:2007-08-29, Days after vaccination: 2
Gender:Male  Submitted:2007-08-28, Days after onset: 1
Location:Virginia  Entered:2007-08-30, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec; Flovent
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2749BA4IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0285U1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Pain, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local redness at site left arm, warm to the touch - size - palm of his hand, itchiness and soreness.

VAERS ID:289381 (history)  Vaccinated:2007-08-10
Age:5.0  Onset:2007-08-11, Days after vaccination: 1
Gender:Male  Submitted:2007-08-15, Days after onset: 4
Location:Missouri  Entered:2007-08-30, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cold, stuffy nose, no fever, no cough
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MO200726
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2655AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ03263IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0094F1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0491F1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cold compress therapy, Feeling abnormal, Injection site erythema, Injection site oedema
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mother reports that on 8-11-97 in the a.m. child complained left arm felt "funny". On the a.m. of 8-12-07, left arm had edema and erythema, not hot to the touch. Mother gave child Tylenol and applied ice pack to left arm with relief. Mother called and reported to HD on 8/13/07.

VAERS ID:289384 (history)  Vaccinated:2007-08-27
Age:5.0  Onset:2007-08-29, Days after vaccination: 2
Gender:Female  Submitted:2007-08-30, Days after onset: 1
Location:Wisconsin  Entered:2007-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC141B049AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10693SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0612U1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal pain upper, Decreased appetite, Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother stated that she started having left arm swelling and redness on 8/29/2007. Arm was swollen and red from shoulder to elbow. She also had low grade fever, decrease appetite and stomach ache

VAERS ID:289414 (history)  Vaccinated:2007-08-28
Age:5.0  Onset:2007-08-30, Days after vaccination: 2
Gender:Female  Submitted:2007-08-30, Days after onset: 0
Location:California  Entered:2007-08-30
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
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B049AA4UNRL
HEPA: HEP A (VAQTA)MERCK & CO. INC.0800U0UNUN
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ106923UNLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0417U1UNLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0829U1UNRL
Administered by: Other     Purchased by: Other
Symptoms: Cold compress therapy, Erythema, Induration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness, swelling, induration 13x15 cm. Advised cold compresses and Tylenol.

VAERS ID:289420 (history)  Vaccinated:2007-08-30
Age:5.0  Onset:2007-08-30, Days after vaccination: 0
Gender:Male  Submitted:2007-08-30, Days after onset: 0
Location:Illinois  Entered:2007-08-30
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: Well-child
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657AA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10093SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0426U1SCLL
Administered by: Private     Purchased by: Private
Symptoms: Eye rolling, Hypotonia, Musculoskeletal stiffness, Pallor, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Received PPD, IPV 4, DTaP 4, and MMR 2. Selected stickers as reward after shots - about 1-2 minutes after shots turned pale, eyes rolled up in head, body stiffened, then went limp and unresponsive. Laid flat with legs elevated, MD in to eval, by which time pt responding appropriately to questions. HR 70, POX 97-98%. Rested and observed x 15 minutes with no further episodes. D/C home alert and playful. HR 98-100s, POX 94%, BP 90/50.

VAERS ID:289421 (history)  Vaccinated:2007-08-28
Age:5.0  Onset:2007-08-30, Days after vaccination: 2
Gender:Female  Submitted:2007-08-30, Days after onset: 0
Location:Georgia  Entered:2007-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2744BA4UNLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10693UNRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0424U1UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1028U1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Red, swollen spot on left arm.

VAERS ID:289422 (history)  Vaccinated:2007-08-02
Age:5.0  Onset:2007-08-09, Days after vaccination: 7
Gender:Female  Submitted:2007-08-30, Days after onset: 21
Location:Pennsylvania  Entered:2007-08-30
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
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056CA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ054823IMLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.054190SCLL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 1 1/2" DIAMETER, RED,RAISED,WARM,TENDER, ITCHY AREA ON RIGHT THIGH.

VAERS ID:289424 (history)  Vaccinated:2007-08-28
Age:5.0  Onset:2007-08-30, Days after vaccination: 2
Gender:Female  Submitted:2007-08-30, Days after onset: 0
Location:California  Entered:2007-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B044BA4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURZ0324-23SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0615U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left arm very red swollen hard and hot to touch.

VAERS ID:289565 (history)  Vaccinated:2007-08-23
Age:5.0  Onset:2007-08-24, Days after vaccination: 1
Gender:Female  Submitted:2007-08-27, Days after onset: 3
Location:Ohio  Entered:2007-08-31, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergic to Zithromax and Prednisone - common variable immune deficiency disease
Diagnostic Lab Data: None done
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU1813AB4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURY10683SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.1559F1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Hypokinesia, Muscle swelling, Musculoskeletal stiffness, Skin warm
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt mom called Friday 8/24/07 stating patient''s left shoulder and arm at shoulder muscle is red, raised and hot, size of shoulder muscle and pt. arm is stiff and hard to move. PHN advised mom to call pt. pediatrician for follow up and PHN will call back to complete VAERS. 8/27/07 PHN called to pt mom and pt seen at doctor''s office 8/24/07. Pt placed on Keflex 1tsp x 2 daily (250 mg/5 preparation). Pt has another reddened area above shots. Today pt. to follow up with doctor today. Antibiotics completed x 3 days. Area on left shoulder reddened, swelling has decreased.

VAERS ID:289582 (history)  Vaccinated:2007-08-08
Age:5.0  Onset:2007-08-08, Days after vaccination: 0
Gender:Male  Submitted:2007-08-10, Days after onset: 2
Location:Virginia  Entered:2007-08-31, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B046AA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURV10323UNLL
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Received DTaP #5 for kindergarten physical. The next day parents noticed injection site with 5 1/4" x 4" erythematous patch, warm to touch. No nodule, no pain.

VAERS ID:289605 (history)  Vaccinated:2007-08-23
Age:5.0  Onset:2007-08-24, Days after vaccination: 1
Gender:Female  Submitted:2007-09-03, Days after onset: 10
Location:North Carolina  Entered:2007-08-31, 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: None
Preexisting Conditions: OBESITY, ELEVATED BP
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)SANOFI PASTEURU2290AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08733SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1053R1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0851U1SCRL
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient came for WCV 8/23/07 AM - had immunizations, on 8/28/07 - Mother called to report (L) leg with redness and swelling was treated by on call MD. Patient came for f/u visit 8/27/07 - sxs improving.

VAERS ID:289606 (history)  Vaccinated:2007-07-31
Age:5.0  Onset:2007-08-03, Days after vaccination: 3
Gender:Unknown  Submitted:0000-00-00
Location:Hawaii  Entered:2007-08-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Well child
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU1985AB4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ03243SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0213F1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Induration, Injection site erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness around shot area, a little hardness/ swelling on left arm.

VAERS ID:289611 (history)  Vaccinated:2007-08-28
Age:5.0  Onset:2007-08-28, Days after vaccination: 0
Gender:Male  Submitted:2007-08-30, Days after onset: 2
Location:Illinois  Entered:2007-08-31, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2650AA4 LA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10693 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.085441 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Urticaria generalised, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Within 15 - to 20 minutes, generalized urticaria and wheezing. Treated with Epinephrine 0.2ml of 1:100U and 50mg Benadryl IM.

VAERS ID:289711 (history)  Vaccinated:2007-08-09
Age:5.0  Onset:2007-08-09, Days after vaccination: 0
Gender:Female  Submitted:2007-08-10, Days after onset: 1
Location:Texas  Entered:2007-09-04, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Pulse Ox 100%
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657AA UNLL
HEPA: HEP A (VAQTA)MERCK & CO. INC.0250U UNRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURC21009 UNLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0617U UNRL
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), Hypoglycaemia (broad)
Write-up: Syncope event within 5 minutes after administration. Full recovery. No intervention needed.

VAERS ID:289725 (history)  Vaccinated:2007-08-31
Age:5.0  Onset:2007-08-31, Days after vaccination: 0
Gender:Female  Submitted:2007-08-31, Days after onset: 0
Location:California  Entered:2007-09-04, 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: None
Preexisting Conditions: Cerebral palsy. PMH: Cerebral palsy, resolved pulmonary hypertension of the newborn.
Diagnostic Lab Data: Glucose 99
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB149AA1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Blood glucose normal, Bradycardia, Cyanosis, Fluid replacement, Hypotonia, Oxygen supplementation, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)
Write-up: 5 y.o. girl who presented with cyanosis, unresponsiveness, bradycardia HR =40 approx 5-10 minutes after HepA. 1 mg Epi, 4L O2, IVF were given with response. 09/06/2007 Progress note received for DOS 8/31/2007 at 11:35 am. Approximately 10 minutes after receiving Hep A vax (2nd dose) child was returned to clinic floppy and not responding. Pt was cyanotic, not responding to verbal stimuli, and hypotonic with HR in the 40''s. Was treated with Epi, O2, and IV fluids. Pt became responsive and back to baseline after ~2 minutes with HR increase to 90''s and then 120''s. Spoke with RN in clinic. Child was not hospitalized. DXd with syncope in ER and released.

VAERS ID:289736 (history)  Vaccinated:2007-08-28
Age:5.0  Onset:2007-08-28, Days after vaccination: 0
Gender:Male  Submitted:2007-08-28, Days after onset: 0
Location:Oregon  Entered:2007-09-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2059AA3IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ030623IMLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0911U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Cough, Eye irritation, Eye swelling, Ocular hyperaemia, Sneezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Glaucoma (broad), Corneal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 6:30 pm coughing, sneezing-p 88 res no redness swelling warmth 6:45 pm P 88R, Reg unlabored breathing. No change 25 mg po Benadryl po given 7:10 pm 82/58, 90R, unlabored resp-started sneezing, rubbing eyes, eyes puffy and blood shot. 2.5 ml Epinephrine SC (L) arm. Improvement with redness in minutes. Paramedics arrived no further meds given at health department

VAERS ID:289747 (history)  Vaccinated:2007-08-14
Age:5.0  Onset:2007-08-16, Days after vaccination: 2
Gender:Male  Submitted:2007-08-16, Days after onset: 0
Location:Tennessee  Entered:2007-09-04, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: TN07027
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B044A4 RA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0800U0 LA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ010693SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1181F1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 8/16/07 Made by mother who stated child''s left arm was redden swollen (in deltoid) area stated she did not see the child on 8/15/07 but the a.m. of 8/16/07 she noticed the swelling and redness.

VAERS ID:289832 (history)  Vaccinated:2007-08-20
Age:5.0  Onset:2007-08-21, Days after vaccination: 1
Gender:Male  Submitted:2007-08-27, Days after onset: 6
Location:Utah  Entered:2007-09-05, 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: None stated at time of vaccination
Current Illness: None stated
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2630AA4IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0798U1IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08723IMRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0652U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient, age 5, received vaccinations on 8/20/07. That night he complained his arm hurt and his parents gave Tylenol. The next morning, 8/21/07, his mother noticed his arm was red and swollen. He had a slight fever and the redness seemed to be spreading from his left shoulder to elbow. Child was brought back to the health department and advised to see their doctor. The mother provided a phone number for the health department to do a follow up call however both that # and the one given at the time of service are invalid. No contact has been made.

VAERS ID:289833 (history)  Vaccinated:2007-08-13
Age:5.0  Onset:2007-08-14, Days after vaccination: 1
Gender:Female  Submitted:2007-08-22, Days after onset: 8
Location:Utah  Entered:2007-09-05, Days after submission: 14
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEUR19973UNLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.20601UNRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.20100UNRA
Administered by: Public     Purchased by: Public
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm swollen 2 times normal size. Antibiotic treatment started.

VAERS ID:289864 (history)  Vaccinated:2007-08-10
Age:5.0  Onset:2007-08-17, Days after vaccination: 7
Gender:Female  Submitted:2007-08-22, Days after onset: 5
Location:North Carolina  Entered:2007-09-05, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: NC07088
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2290AA4UNLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05273UNLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.13241UNRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Red raised area at site of MMR II injection

VAERS ID:289999 (history)  Vaccinated:2007-08-27
Age:5.0  Onset:2007-08-28, Days after vaccination: 1
Gender:Male  Submitted:2007-09-05, Days after onset: 8
Location:Illinois  Entered:2007-09-06, 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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056DA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR210093SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0913U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Hypersensitivity, Injection site erythema
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Marked erythema at site of DTaP; ? allergic rxn.

VAERS ID:290022 (history)  Vaccinated:2007-09-04
Age:5.0  Onset:2007-09-05, Days after vaccination: 1
Gender:Male  Submitted:2007-09-06, Days after onset: 1
Location:Oregon  Entered:2007-09-06
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
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU1965AB4IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB149AA1IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ00183IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1249F1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site vesicles, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt. presented to clinic two days after recieving immunizations with very red, swollen left arm. Also noted blistering at injection site, over the deltoid, the site was very warm to the touch. Advised mom to give Ibuprofen every 6-8hrs, apply cold compress to arm. Motrin with proper dosing instructions given. See PMD if no improvement, or if arm gets worse. Child had no previous adverse reactions with immunizations.

VAERS ID:290045 (history)  Vaccinated:2007-08-28
Age:5.0  Onset:2007-08-30, Days after vaccination: 2
Gender:Female  Submitted:2007-08-30, Days after onset: 0
Location:New York  Entered:2007-09-06, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B033AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR0425F3SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.Z03241IMRL
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: erythema, increased warmth, sl. tender at injection site: left upper lat. arm/deltoid injected 2 days ago; tx: antibiotics NSAID, ice prn

VAERS ID:290046 (history)  Vaccinated:2007-07-30
Age:5.0  Onset:2007-08-01, Days after vaccination: 2
Gender:Female  Submitted:2007-08-24, Days after onset: 23
Location:Ohio  Entered:2007-09-06, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicil 2/day x 7 days start 7-27
Current Illness: Strep throat Dx 7-27-07
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Other
Symptoms: Body temperature increased, Chest pain, Dyspnoea, Injection site irritation, Pain in extremity, Pharyngolaryngeal pain, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Picture was taken Thursday evening and by Friday her rash was starting to coalesce to the point it looked like a raised sunburn. Patient was sick on July 26th, 2007. She had a high temp and was c/o a sore throat. On Friday July 27th, she was seen by her pediatrician. It was at that point that she was Dx with having strep. She was placed on Amoxicil 2x a day for 7 dys. On July 30th she received her required vaccines for school. She immediately c/o burning on the left side where the DTaP was given and even the next day she said that arm really hurt. On August 1st, 2007 she developed the patchy rash that was seen in the first email I sent to you on her left arm. I dropped her off to my mom at 7:00 am on August 2nd. There was no sign of a rash at that time. I notified the doctor when they opened and the office wanted her to come in so that they could document the reaction in her chart. She was scheduled to be seen by the pediatrician on August 3rd, 2007 at 3:15 pm. I received a phone call from my mom at 10:30 on August 2nd, 2007 stating that patient had a rash on her face. Immediately called the doctors office back and she was seen at 11:30 on August 2nd. The rash began progressing from her face and chest to her abdomen, arms, and legs to her palms of her hands and the soles of her feet. As we were waiting in the office she began c/o of her chest hurting and having problems breathing. The doctor placed her on Benadryl 1 6 hours and then steroids q 12 hours for 5 days with a taper. She had a follow-up the next day with Dr. Please let me know if you need any other information with regards to this. Mother.

VAERS ID:290051 (history)  Vaccinated:2007-08-27
Age:5.0  Onset:2007-08-27, Days after vaccination: 0
Gender:Male  Submitted:2007-08-29, Days after onset: 2
Location:Indiana  Entered:2007-09-06, 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: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC27496A4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10093IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0527U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Immunizations given on 8-27-07 Mom called on 8-27-07 reported increased swelling at injection site. Area red and hot to touch. Seen by MD on 8-29-07" Lt deltoid 3 cm induration, inj. point visible overlying. Total induration 12 cm sup to inf and 5-6 cm ant post. No streaking, No discharge, No crusting, mild ant edema no erythema

VAERS ID:290058 (history)  Vaccinated:2007-08-14
Age:5.0  Onset:2007-08-15, Days after vaccination: 1
Gender:Female  Submitted:2007-08-17, Days after onset: 2
Location:Texas  Entered:2007-09-06, Days after submission: 20
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
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB175AA1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0723U1SCUN
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Injection site necrosis, Injection site nodule, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Day 1 after vaccine, hard nodule formed at site of injection, nodule resolved then erythema spread over back of arm from axilla to elbow. Pt seen 7/18/07 - tx''d for possible cellulitis w/ Keflex PO and oral Benadryl. Follow-up Information 29-OCT-2007: 8/14/07 - received varicella and Hepatitis A vaccines - site where varicella vaccine was given, localized erythema with firm nodule appeared the next day with erythma firmness, warmth spreading over back of upper arm to elbow - Tx''d for possible cellulitis - Pt did not return for follow-up.

VAERS ID:290067 (history)  Vaccinated:2007-08-22
Age:5.0  Onset:0000-00-00
Gender:Male  Submitted:2007-08-27
Location:California  Entered:2007-09-06, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2651AA4IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling over shot area

VAERS ID:290097 (history)  Vaccinated:2007-09-04
Age:5.0  Onset:2007-09-05, Days after vaccination: 1
Gender:Female  Submitted:2007-09-06, Days after onset: 1
Location:California  Entered:2007-09-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Hyperaesthesia, Injection site erythema, Injection site vesicles, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever to 101, large erythema at vaccine site with single vesicle and pain to touch. Erythema measuring 10x8 inches.

VAERS ID:290112 (history)  Vaccinated:2007-08-25
Age:5.0  Onset:2007-08-25, Days after vaccination: 0
Gender:Male  Submitted:2007-09-06, Days after onset: 12
Location:Pennsylvania  Entered:2007-09-07, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness: Reactive airways disease
Preexisting Conditions: Premature birth
Diagnostic Lab Data: None
CDC Split Type: WAES0708USA05205
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0285U1IMUN
Administered by: Other     Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Erythema, Eyelid oedema, No reaction on previous exposure to drug, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning a 5 year old male with reactive airway disease (since December 2002), history of premature birth and no allergies who in January 2003, was vaccinated IM with a first 0.5 ml dose of MMR II and on 25-AUG-2007 was vaccinated IM with second 0.5 ml dose of MMR II (Lot# 656527/0285U). Concomitant therapy included albuterol as needed. On 25-AUG-2007, soon after vaccination the patient experienced hives on face, wheezing, dyspnea, chest tightness, swollen eyelids and erythema on face, hands and back. It was reported that the patient was immediately treated with Benadryl IM, Decadron IM, epinephrine IM and nebulizer treatment. The patient was also given prednisone and albuterol as needed. On 25-AUG-2007, after soon vaccination the patient experienced hives on face, wheezing, dyspnea, chest tightness, swollen eyelids and erythema on face, hands and back. It was reported that the patient was immediately treated with Benadryl IM, Decadron IM, epinephrine IM and nebulizer treatment. The patient was also given prednisone and albuterol inhaler. Flovent was later added as needed. It was reported that the patient did not experience any adverse event with first dose of the vaccination. No diagnostic laboratory test was undertaken. At the time of report the patient had recovered. A product quality complaint was not involved. The patient''s experiences were considered to be life threatening and an other important medical event by the reporter. A lot check has been initiated. Additional information has been requested.

VAERS ID:290137 (history)  Vaccinated:2007-08-13
Age:5.0  Onset:2007-08-26, Days after vaccination: 13
Gender:Male  Submitted:2007-09-07, Days after onset: 12
Location:North Dakota  Entered:2007-09-07
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 (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B033AA5IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ-032U4SCRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0384U1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia, Rash, Varicella, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Presented to the office with daycare provider for note to return to school due to chickenpox. Daycare provider reported patient received chickenpox vaccine on 8-13-07 and had high fever on 8-26 and 8-27. Broke out with rash on face after that. Today has reddened raised non fluid filled areas on face. Dime size area on lower chin area that is red and raised. Also small pox on upper chest and on left elbow. Daycare provider reported that he does have areas on back of legs and buttocks.

VAERS ID:290150 (history)  Vaccinated:2007-09-05
Age:5.0  Onset:2007-09-06, Days after vaccination: 1
Gender:Male  Submitted:2007-09-07, Days after onset: 1
Location:California  Entered:2007-09-07
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: Follow up with Provider.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2570AA5IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURZ052724SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Right upper arm red with swelling, hot to touch, and itching.

VAERS ID:290160 (history)  Vaccinated:2007-09-07
Age:5.0  Onset:2007-09-07, Days after vaccination: 0
Gender:Male  Submitted:2007-09-07, Days after onset: 0
Location:California  Entered:2007-09-07
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
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B044BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURY10313IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1182F1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.078241SCRA
Administered by: Other     Purchased by: Public
Symptoms: Chest discomfort, Paraesthesia, Skin warm, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 9:50 am- patient''s mother called school office to report that he had an allergic reaction to vaccines that were given on HRE today around 9:15. Patient had IPV #4, DTaP #5, MMR II, Var #2, and PPD today. Left message for mom to call us re: his status. 12:15 pm-patient''s mom brought him back to medical center to report what happened. He developed chest tightness, tingling in his fingers, and "hot" hands, and swollen face about 20 minutes after immunization. Mo. took him to medical center where they gave him Epi Pen injection, O2 and called 911. Paramedics took him to hospital where they observed him and discharged him home with Benadryl po and recommended that he be evaluated by an allergist. Mo. states they do have insurance and will go to PCP to get an allergic referral.

VAERS ID:290161 (history)  Vaccinated:2007-08-30
Age:5.0  Onset:2007-08-31, Days after vaccination: 1
Gender:Male  Submitted:2007-09-07, Days after onset: 7
Location:California  Entered:2007-09-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056CA4IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Oedema peripheral, Pallor
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: DTaP #5 given on 8/30/07; on 8/31/07 the DTaP site became red from top of shoulder to just above elbow (4 3/4" long), local pallor, no fever, no c/o local discomfort, no limited range of motion, no decreased activity; the upper arm was swollen 9" circumference vs non-affected arm of 7 1/4" circumference.

VAERS ID:290173 (history)  Vaccinated:2001-08-21
Age:5.0  Onset:2001-08-31, Days after vaccination: 10
Gender:Female  Submitted:2007-08-28, Days after onset: 2188
Location:California  Entered:2007-09-07, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: chicken pox~Varicella (Varivax)~1~5~In Patient|chicken pox~Varicella (Varivax)~1~8~In Sibling|chicken pox~Varicella (Varivax)~1~
Other Medications: None
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 1  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Unknown
Symptoms: Blister, Varicella
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Broke out with a terrible case of chicken pox. Missed over the first week and half if school. Ended up with scars from blisters. All children in family was given the Varivax on the same day and all ended up with chicken pox.

VAERS ID:290210 (history)  Vaccinated:2007-07-30
Age:5.0  Onset:2007-07-31, Days after vaccination: 1
Gender:Male  Submitted:2007-08-20, Days after onset: 20
Location:Idaho  Entered:2007-09-10, Days after submission: 21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: ID07031
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0246U1IMRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0727U1IMRL
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Induration, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 8-1 large local reaction in left thigh with erythema and edema increased 7-8 cm oral, central induration, no fever, erythema decreased to 3-4 cm on 8-2, decreased edema, decreased pain

VAERS ID:290215 (history)  Vaccinated:2007-07-25
Age:5.0  Onset:2007-07-26, Days after vaccination: 1
Gender:Male  Submitted:2007-07-31, Days after onset: 5
Location:Idaho  Entered:2007-09-10, Days after submission: 41
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: ID07025
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B036AA4UNRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURY10313UNRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1031F1UNLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Skin necrosis, Skin warm
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient''s father brought him to the clinic on the morning of 7/27. Stated his (Rt) upper arm was very red the evening of 7/26. At this AM was hard and warm to touch. No lymph nodes were palpated. Started on warm soaks 15" tid and Augmentin 200mg BID.

VAERS ID:290224 (history)  Vaccinated:2007-09-04
Age:5.0  Onset:2007-09-05, Days after vaccination: 1
Gender:Female  Submitted:2007-09-06, Days after onset: 1
Location:Ohio  Entered:2007-09-10, 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: Pulmicort
Current Illness: allergic rhinitis
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2291BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08723IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0425U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased, Pneumonia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 9-4-07 Follow up on pneumonia, lungs clear 9-5-07 Woke up during night vomiting and low grade temp. Started Zofran Vomiting that morning and wouldn''t eat

VAERS ID:290225 (history)  Vaccinated:2007-09-05
Age:5.0  Onset:2007-09-05, Days after vaccination: 0
Gender:Female  Submitted:2007-09-06, Days after onset: 1
Location:Wisconsin  Entered:2007-09-10, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B042BA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ03263SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1410F1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0847U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Hypotonia, Injection site erythema, Injection site rash, Pyrexia, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Pt received vaccines at approx 9:00 am on 9/5/07 at our clinic. By 1:00 pm she was running a fever of 102 deg axillary. Tylenol did not affect fever. Mom came back to us with child, child appeared limp and barely responsive. Mom took pt to the ER. Fever treated with Advil, came down to 100.2 deg. Pt is better next day. Mom also reports a "pimple like" reaction at the injection site on Rt. arm; reddened with white center.

VAERS ID:290231 (history)  Vaccinated:2007-08-31
Age:5.0  Onset:2007-08-31, Days after vaccination: 0
Gender:Male  Submitted:2007-09-01, Days after onset: 1
Location:Oregon  Entered:2007-09-10, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Saw provider 9/1/07
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2655AA4 LA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05483 LA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0652U1 RA
Administered by: Other     Purchased by: Public
Symptoms: Cough, Erythema, Injection site reaction, Rhinorrhoea
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After multiple vaccines 8/31 patient started with cough, runny nose 2 hours later. On 9/1 with T 38.5 - very red cheeks, large left arm where DTaP was injection.

VAERS ID:290239 (history)  Vaccinated:0000-00-00
Age:5.0  Onset:0000-00-00
Gender:Female  Submitted:2007-09-06
Location:Washington  Entered:2007-09-10, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: high fever, redness~DTaP (no brand name)~3~0~In Patient
Other Medications:
Current Illness: None noted
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657AA4IMLL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER 3IMRL
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1SCLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: See chart note attached.

VAERS ID:290242 (history)  Vaccinated:2007-08-06
Age:5.0  Onset:2007-08-06, Days after vaccination: 0
Gender:Female  Submitted:2007-08-14, Days after onset: 8
Location:Florida  Entered:2007-09-10, Days after submission: 27
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: Mother stated that she gets lage swollen areas like that when child is bitten by mosquitoes.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC148044AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ05473IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1216F1SCLA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0674U1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site erythema, Injection site swelling, Injection site warmth, Wrong drug administered
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)
Write-up: on 8/8/07 mother called the HD stating her child developed a red warm swollen area to LDT where shot was administered. Mother took the child to the ER. DX. cellultis. TX.Keflex and Benadryl,ane tylenol.

VAERS ID:290252 (history)  Vaccinated:2007-09-07
Age:5.0  Onset:2007-09-08, Days after vaccination: 1
Gender:Female  Submitted:2007-09-10, Days after onset: 2
Location:Indiana  Entered:2007-09-10
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
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS14B0564IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR100921SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.04181SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.08551SCLL
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: swelling at injection site, reddness the size of palm of hand

VAERS ID:290255 (history)  Vaccinated:2007-08-30
Age:5.0  Onset:2007-09-01, Days after vaccination: 2
Gender:Unknown  Submitted:2007-09-10, Days after onset: 9
Location:Ohio  Entered:2007-09-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE08
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B046AA4IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.09501SCRA
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: SWELLING LT UPPER ARM APPROX 1/2 SIZE OF ARM, CICULAR, ITCHY. NO FEVER OR RESPIRTOR DISTRESS.

VAERS ID:290260 (history)  Vaccinated:2007-09-07
Age:5.0  Onset:2007-09-07, Days after vaccination: 0
Gender:Male  Submitted:2007-09-10, Days after onset: 3
Location:Louisiana  Entered:2007-09-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: flovent; zyrtec; singulair
Current Illness: no
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2396AA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURY1049-23SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0617F1SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.12041SCLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives that spread over body

VAERS ID:290297 (history)  Vaccinated:2007-08-13
Age:5.0  Onset:2007-08-16, Days after vaccination: 3
Gender:Female  Submitted:2007-09-11, Days after onset: 26
Location:Missouri  Entered:2007-09-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056CA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10093IMRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.054541SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 10 cm Lge. indurated, sl. warm area to (L) deltoid

VAERS ID:290298 (history)  Vaccinated:2007-08-27
Age:5.0  Onset:2007-08-30, Days after vaccination: 3
Gender:Female  Submitted:2007-09-11, Days after onset: 12
Location:Missouri  Entered:2007-09-11
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC12B56DA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10093IMRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0545U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4x6 cm pink in color - mildly warm to (R) upper arm. Benadryl and if no improvement or increased S/S to start Keflex 250/5 1/2 tsp. BID for 7 days.

VAERS ID:290319 (history)  Vaccinated:2007-09-05
Age:5.0  Onset:2007-09-06, Days after vaccination: 1
Gender:Female  Submitted:2007-09-11, Days after onset: 5
Location:California  Entered:2007-09-11
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: Asthma, Eczema, dental caries
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ032623SCRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0775U0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Injection site induration, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: PT RETURNED TO CLINIC 2 DAYS AFTER RECEIVING VACCINE WITH SIGNIFICANT SWELLING ON LEFT UPPER ARM, REDDNESS AND WARMTH. APROXIMATELY 4 X 4 INCHES AREA OF INDURATION COVERING SITE OF BOTH INTRAMUSCULAR AND SUBCUTANEOUS VACCINES.

VAERS ID:290404 (history)  Vaccinated:2007-08-29
Age:5.0  Onset:2007-08-29, Days after vaccination: 0
Gender:Male  Submitted:2007-08-31, Days after onset: 2
Location:Georgia  Entered:2007-09-12, 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: None
Current Illness: None
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER2284AA1UNLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB163AA1UNRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08721UN 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0616F1UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Body temperature increased, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left arm swollen, red and warm to touch low grade 99.4

VAERS ID:290406 (history)  Vaccinated:2007-08-29
Age:5.0  Onset:2007-08-31, Days after vaccination: 2
Gender:Female  Submitted:2007-08-29, Days after onset: 2
Location:Nebraska  Entered:2007-09-12, Days after submission: 14
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2657AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURA01103SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0807F1SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.101841SCRL
Administered by: Public     Purchased by: Other
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: (L) thigh, redness, swelling, warm to touch 4 in. x 4 in.

VAERS ID:290439 (history)  Vaccinated:2007-08-27
Age:5.0  Onset:2007-08-28, Days after vaccination: 1
Gender:Male  Submitted:2007-08-29, Days after onset: 1
Location:North Carolina  Entered:2007-09-12, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2290AA4UNLL
HEPA: HEP A (VAQTA)MERCK & CO. INC.0496U0UNRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ054723UNRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1003F1UNLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Patient developed rash on left thigh-warm, erythematous 12 x 22 cm-began approx 24 hrs post vaccination.

VAERS ID:290440 (history)  Vaccinated:2007-08-29
Age:5.0  Onset:2007-08-31, Days after vaccination: 2
Gender:Female  Submitted:2007-08-31, Days after onset: 0
Location:California  Entered:2007-09-12, Days after submission: 12
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
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2570AA4UNRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB163AB1UNLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ02403UNLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0952F1UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0730U1UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site inflammation
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Local inflammation at injection site. (R) UE 9x14cm, (L) 3x4 cm.

VAERS ID:290447 (history)  Vaccinated:2007-09-10
Age:5.0  Onset:2007-09-10, Days after vaccination: 0
Gender:Female  Submitted:2007-09-11, Days after onset: 1
Location:Minnesota  Entered:2007-09-12, Days after submission: 1
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
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B051AA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR210093SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.018341SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vaccinated 9/10/07. 9/10 Evening (R) arm swollen/red/hot and tender. Worse 9/11 AM. No itching. Rx: ice packs/NSAIDS/Keflex for possible cellulitis.

VAERS ID:290448 (history)  Vaccinated:2007-07-03
Age:5.0  Onset:2007-08-21, Days after vaccination: 49
Gender:Female  Submitted:2007-09-12, Days after onset: 22
Location:South Dakota  Entered:2007-09-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Molluscum contagiosum
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0596U1IMUN
Administered by: Public     Purchased by: Public
Symptoms: Vaccination failure, Varicella
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Chicken Pox secondary to varicella booster

VAERS ID:290450 (history)  Vaccinated:2007-09-10
Age:5.0  Onset:2007-09-11, Days after vaccination: 1
Gender:Male  Submitted:2007-09-12, Days after onset: 1
Location:Georgia  Entered:2007-09-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TAC cream apply BID x 7 days.
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB206AB0IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1020U1SCRL
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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After Varicella shot leg got red. By last night, swollen and red. Came in 9-12-07 (R) leg red, hot, swollen 2"x2" round diameter.

VAERS ID:290477 (history)  Vaccinated:2007-09-10
Age:5.0  Onset:2007-09-12, Days after vaccination: 2
Gender:Male  Submitted:2007-09-12, Days after onset: 0
Location:Florida  Entered:2007-09-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mother reported recovering from sore throat, antibiotic completed.
Preexisting Conditions: Child has cerebral palsy.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B046AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left upper arm red, swollen. Mother giving Motrin. Noticed by mother 9/12/07.

VAERS ID:290512 (history)  Vaccinated:2007-05-21
Age:5.0  Onset:2007-05-23, Days after vaccination: 2
Gender:Female  Submitted:2007-05-23, Days after onset: 0
Location:Florida  Entered:2007-09-13, Days after submission: 113
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 (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B044BA4IMLL
HEPA: HEP A (VAQTA)MERCK & CO. INC.024940IMRL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR205483SCLL
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.023040SCRL
Administered by: Military     Purchased by: Military
Symptoms: Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left leg patch of angioedema at 48 hours of DTaP location.

VAERS ID:290589 (history)  Vaccinated:2007-09-10
Age:5.0  Onset:2007-09-11, Days after vaccination: 1
Gender:Female  Submitted:2007-09-14, Days after onset: 3
Location:Massachusetts  Entered:2007-09-14
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:
Preexisting Conditions: PMH: recurrent otitis media
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURU2289CA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08723SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1218F1SCRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site cellulitis, Injection site erythema, Injection site pruritus, Injection site rash, Injection site warmth, Local reaction, Pallor, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient presented 9/11/07 with a local reaction at vaccination site, on left thigh. She had a 3cm x 5cm red, slightly raised area, + blanching, slightly warm to touch, non-tender. Patient was well, in no pain and active. She had no fever. 9/28/07 Reviewed hospital medical records which reveal patient experienced fever with progressively increasing injection site redness, warmth, rash & itching on left leg DTaP site. Failed outpatient treatment w/oral antibiotics. Admitted 9/14-9/16/2007. Tx w/IV antibiotics. Progressed well & d/c to home on continued oral antibiotics FINAL DX: left leg cellulitis s/p immunizations.

VAERS ID:290618 (history)  Vaccinated:2007-08-31
Age:5.0  Onset:2007-09-01, Days after vaccination: 1
Gender:Male  Submitted:2007-09-14, Days after onset: 13
Location:Vermont  Entered:2007-09-14
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 (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B046AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08733IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling, itching at injection site.

VAERS ID:290623 (history)  Vaccinated:2007-09-10
Age:5.0  Onset:2007-09-11, Days after vaccination: 1
Gender:Female  Submitted:2007-09-13, Days after onset: 2
Location:Connecticut  Entered:2007-09-14, 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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B056DA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ09243IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0215F1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site induration, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5 1/2 x 7cm induration began 24 hours after administration at site of DTaP #4 mild pruritus. No systemic sx otherwise.

VAERS ID:290644 (history)  Vaccinated:2007-09-10
Age:5.0  Onset:2007-09-12, Days after vaccination: 2
Gender:Female  Submitted:2007-09-14, Days after onset: 2
Location:Montana  Entered:2007-09-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALSAC21B129AA1IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0185U1SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Injection site pain, Injection site reaction, Pruritus, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: grandmother reports mild fever in first 48 hours, typical soreness at site. Day 2 after immunization itching and redness increased. Seen 9/14/07 1100, at clinic, 4 days after immz , Left arm redness with warmth. Redness from deltoid area to elbow on frontal aspect. Received Pediarix in L deltoid at 1600 9/10/07. No treatment, monitor, increased site reaction. Consider benadryl prior to future immunz.

VAERS ID:290695 (history)  Vaccinated:2007-09-04
Age:5.0  Onset:2007-09-04, Days after vaccination: 0
Gender:Female  Submitted:2007-09-04, Days after onset: 0
Location:Oregon  Entered:2007-09-17, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: OR200733
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B027AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ03063SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0651U1SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Fall, Hyperhidrosis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Approximately 1320 hrs, I gave child DTaP #5, IPV # 4, and MMR #2. Child was sitting in a chair on my left. I gave child''s mom a PPD plant and picked up a syringe for another IMMI. Child fell forward onto the floor, face first. Mom and I picked her up and she was conscious but extremely pale. I called for assistance and placed a cold pack on the back of her neck. Pulse 64, resp. 20. I moved child (carried) to an exam room and laid her on the exam table with a cold pack under her neck. Nursing supervisor assisted. Child''s pulse 72, resp. 20. Child was slightly diaphoretic, cold cloth applied to face and forehead. Mom became "faint" and pale in color. I talked to mom and had her take deep breaths while child sipped juice and ate crackers. Child''s color returned, pulse 84, resp 20. I stayed with child about 15 min and deferred mom''s other vaccination. Child stayed in room until 1410 hrs and was walked to the front desk for checkout. Injection sites showed no redness or swelling. No bruising noted on child''s face or arms. At 1942 hrs., I called mom and she said the child played normally today and was tired this evening but had no other signs/symptoms.

VAERS ID:290699 (history)  Vaccinated:2007-08-15
Age:5.0  Onset:2007-08-16, Days after vaccination: 1
Gender:Male  Submitted:2007-08-28, Days after onset: 12
Location:Pennsylvania  Entered:2007-09-17, Days after submission: 20
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: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC2605AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ08723SCLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0299U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain upper, Diarrhoea, Headache, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (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), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 8/16/07 - Fever 102, stomach ache, diarrhea and headache. Called HC. Referred to FMD. On 8/17/07 stomach ache and headache gone. In the evening (R) upper arm swollen "big as a baseball. No fever. 8/18/07 Referred to FMD who advised ice packs every hour and Tylenol. 08/19/07 - no swelling. To see FMD 8/21/07.,

VAERS ID:290704 (history)  Vaccinated:2007-08-31
Age:5.0  Onset:2007-09-04, Days after vaccination: 4
Gender:Female  Submitted:2007-09-12, Days after onset: 8
Location:Wisconsin  Entered:2007-09-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin PRN for Allergies (Seasonal)
Current Illness: None
Preexisting Conditions: Seasonal spring allergies; tonsillar hypertrophy
Diagnostic Lab Data: ESR = 28; CRP = 15.5; BUN = 10/0.5; WBC = 11.3; Electrolytes normal; Seg/21 Band/2 meta/+ Dohle bodies.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B051AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ10093UNRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0299U0UNRA
Administered by: Private     Purchased by: Private
Symptoms: C-reactive protein increased, Joint swelling, Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Serum sickness, Urticaria, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)
Write-up: 5 days after vaccines given, a rash developed at first light several dots,l coalesced and progressed to large raised welts with central clearing, pruritus and arm/wrist/ankle swelling and moderately severe edema with fevers, pain. See at PMD/ER/Consulted with dermatologist. Dx''d "serum sickness"; Rx - Benadryl, Atarax

VAERS ID:290773 (history)  Vaccinated:2007-09-11
Age:5.0  Onset:2007-09-11, Days after vaccination: 0
Gender:Male  Submitted:2007-09-13, Days after onset: 2
Location:New York  Entered:2007-09-18, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURU2290BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ09233SCRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.0986U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Ear discomfort, Erythema, Eye swelling, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approx. 45 min after vaccines were administered pt c/o ears burning. Mom noted both outer ears bright red and he started to breakout in hives. Left eye very swollen face puffy. Lungs clear in all lobe when returned to office in 10 minutes. .15cc epi given and 40 mg Kenalog

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