MedAlerts Home
  Read the MedAlerts Blog Subscribe to the MedAlerts Blog 

Found 554176 cases in entire database

Case Details (Sorted by Age)

This is page 2479 out of 5542

Result pages: prev   2380 2381 2382 2383 2384 2385 2386 2387 2388 2389 2390 2391 2392 2393 2394 2395 2396 2397 2398 2399 2400 2401 2402 2403 2404 2405 2406 2407 2408 2409 2410 2411 2412 2413 2414 2415 2416 2417 2418 2419 2420 2421 2422 2423 2424 2425 2426 2427 2428 2429 2430 2431 2432 2433 2434 2435 2436 2437 2438 2439 2440 2441 2442 2443 2444 2445 2446 2447 2448 2449 2450 2451 2452 2453 2454 2455 2456 2457 2458 2459 2460 2461 2462 2463 2464 2465 2466 2467 2468 2469 2470 2471 2472 2473 2474 2475 2476 2477 2478 2479 2480 2481 2482 2483 2484 2485 2486 2487 2488 2489 2490 2491 2492 2493 2494 2495 2496 2497 2498 2499 2500 2501 2502 2503 2504 2505 2506 2507 2508 2509 2510 2511 2512 2513 2514 2515 2516 2517 2518 2519 2520 2521 2522 2523 2524 2525 2526 2527 2528 2529 2530 2531 2532 2533 2534 2535 2536 2537 2538 2539 2540 2541 2542 2543 2544 2545 2546 2547 2548 2549 2550 2551 2552 2553 2554 2555 2556 2557 2558 2559 2560 2561 2562 2563 2564 2565 2566 2567 2568 2569 2570 2571 2572 2573 2574 2575 2576 2577 2578   next


VAERS ID:221552 (history)  Vaccinated:1999-07-16
Age:6.0  Onset:2004-01-05, Days after vaccination: 1634
Gender:Female  Submitted:2004-05-14, Days after onset: 129
Location:Unknown  Entered:2004-05-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0401USA00120
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a physician concerning a 6 year old female pt who on 16Jul99 was vaccinated with a dose of varicella virus vaccine live. On 05Jan04 the pt experienced breakthrough case of mild chickenpox. The pt had 12-15 lesions, itchy rash and no treatment. It was noted that the outcome was not recovered at the time of the report. The physician also indicated that there is another chickenpox breakthrough case but he did not have any information at the time of the report. No product quality complaint was involved. Additional information has been requested.

VAERS ID:221576 (history)  Vaccinated:2004-02-17
Age:6.0  Onset:2004-03-15, Days after vaccination: 27
Gender:Female  Submitted:2004-04-02, Days after onset: 18
Location:Arizona  Entered:2004-05-24, Days after submission: 51
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: Family has to pay cash for all medical. Cannot afford testing ordered by Dr. yet. Saving for it.
CDC Split Type: AZ0401
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1016N2IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0841M1IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1229M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Ophthalmoplegia
SMQs:, Guillain-Barre syndrome (broad), Ocular motility disorders (narrow)
Write-up: 3/22/04 Interpreter for mother called office. Said child began experiencing some eyelid paralysis on L about 1 week ago (3/15/04). Says it is steadily getting worse & now L side of face is visibly different from the R, especially noticeable when she smiles. Child went to family friend (chiropractor) then to neurologist. 3/31/04. Dr. says to test for diabetes & do CT scan. 4/2/04 interpreter says face (recovering, not totally gone yet) is getting better on its own.

VAERS ID:221592 (history)  Vaccinated:1999-04-08
Age:6.0  Onset:2004-05-13, Days after vaccination: 1862
Gender:Male  Submitted:2004-05-17, Days after onset: 4
Location:Pennsylvania  Entered:2004-05-25, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.16560IMLL
Administered by: Private     Purchased by: Private
Symptoms: Rash erythematous, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Varicella like erythema/illness over 3-4 days. Symptomatic treatment.

VAERS ID:221611 (history)  Vaccinated:1999-02-01
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:2004-05-17
Location:Pennsylvania  Entered:2004-05-25, Days after submission: 8
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
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: About 200-240 pox marks, very itchy.

VAERS ID:221712 (history)  Vaccinated:2003-07-11
Age:6.0  Onset:2003-07-12, Days after vaccination: 1
Gender:Male  Submitted:2004-05-18, Days after onset: 311
Location:Pennsylvania  Entered:2004-05-25, 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: The patient''s medical history, concurrent conditions, and concurrent medications were not reported.
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS589A2 IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site reaction, Injection site warmth, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This case reported by a nurse and described the occurrence of limb swelling in a 6 year old male who received diphtheria and tetanus toxoids and acellular pertussis vaccine absorbed (Infanrix) for prophylaxis. On 11 July 2003, the patient received Infanrix. One day post-immunization on 12-July 2003, the patient experienced limb swelling and an injection site reaction characterized by redness and warmth. The events persisted as of 16 July 2003.

VAERS ID:221766 (history)  Vaccinated:1998-07-23
Age:6.0  Onset:2003-12-26, Days after vaccination: 1982
Gender:Male  Submitted:2004-05-14, Days after onset: 139
Location:New Jersey  Entered:2004-05-25, Days after submission: 11
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: WAES0401USA00882
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 2  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0644H0  
Administered by: Private     Purchased by: Private
Symptoms: Rash erythematous, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning a 6 year old white male with no past medical history on 23JUL1998 was vaccinated with a first dose of varicella virus vaccine live, in the right arm. Concomitant therapy that day included a third dose of hepatitis b virus vaccine rHBsAg, in the left arm. There was no illness at the time of vaccination. Between 26DEC2003 and 30DEC2003 the pt developed "red spots and some fluid filled." On 30DEC2003, the pt developed 20 scattered scabs on face, trunk, extremities. The pt sought medical attention and was treated symptomatically. There were no relevant diagnostic or laboratory tests performed. The pt recovered. It was reported that the pt did not have any adverse events following prior vaccinations. It was noted that the pt on 24OCT1998 received a fourth dose of Hib conj vaccine, in the right arm, and a first dose of measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live, in the left arm. It was also reported that on 24APR1998 the pt had a Mantoux test. No further information is expected.

VAERS ID:221784 (history)  Vaccinated:1998-10-16
Age:6.0  Onset:2004-01-17, Days after vaccination: 1919
Gender:Male  Submitted:2004-05-14, Days after onset: 117
Location:Kentucky  Entered:2004-05-25, Days after submission: 11
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: UNK
CDC Split Type: WAES0401USA01406
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.628404/1175H   
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.626960/0847H   
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection, Rash vesicular, Skin ulcer
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a certified medical assistant concerning a 6 year old black male with no pertinent medical history and no known allergies who on 16-Oct-1998 was vaccinated in the left arm with a dose of varicella virus vaccine live (Lot #626960/0847H). There was no illness at the time of vaccination. Concomitant therapy that day included a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (Lot #628404/1175H) administered in the right arm. On 18-Jan-20404 the patient presented to the physician''s office with a case of chickenpox breakthrough. The child was noted to have a papular, vesicular rash that first appeared on his stomach and then spread to the rest of his body. No fever was noted. The child was treated with acetaminophen (Tylenol), diphenhydramine hydrochloride (Benadryl), and rest. The outcome was reported as not recovered. Unspecified medical attention was sought. There was no product quality complaint. Follow-up information indicated that the adverse event onset was on 17-Jan-2004. Seventy-two percent of the lesions were on his stomach, with more lesions daily moving to his legs and arms. Treatment included diphenhydramine hydrochloride (Benadryl), acetaminophen (Tylenol), and rest. Additional follow up information indicated that the patient developed a rash with vesicles that started on the patient''s stomach and "spread all over" over several days. Additional follow-up information indicated that the patient recovered 5 days after onset. The reporter indicated that she had seen two other cases of breakthrough chickenpox in the last couple of months. No further information is expected.

VAERS ID:221805 (history)  Vaccinated:1999-09-09
Age:6.0  Onset:2004-01-20, Days after vaccination: 1594
Gender:Male  Submitted:2004-05-14, Days after onset: 114
Location:Missouri  Entered:2004-05-25, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Attention deficit disorder
Diagnostic Lab Data: UNK
CDC Split Type: WAES0401USA01998
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0700J SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blister, Drug ineffective, Pruritus, Rash, Viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received form a registered nurse concerning a 6 year old male with attention deficit disorder who on 09SeP1999 was vaccinated SC with a 0.5ml dose of varicella virus vaccine live. On 20JAN2004 the pt presented to the drs office with chickenpox. The child had an itchy rash with blisters and bumps, head to toe, for 3 days. The child was afebrile. Treatment was over the counter medication as needed. Subsequently, the pt recovered from chickenpox. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested.

VAERS ID:221811 (history)  Vaccinated:1998-04-21
Age:6.0  Onset:2003-08-28, Days after vaccination: 1955
Gender:Male  Submitted:2004-05-14, Days after onset: 260
Location:Massachusetts  Entered:2004-05-25, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Slight fever
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0402USA00100
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)CONNAUGHT LABORATORIES 3  
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)LEDERLE LABORATORIES 3PO 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Public
Symptoms: Herpes zoster, Rash vesicular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a nurse practitioner concerning a 6 year old black male with no known medical history who on 4/21/98 was vaccinated in the right arm with the first dose of varicella virus vaccine live. Concomitant vaccination on that same day included the fourth dose in the left arm of diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid (lot # 7L81673) and the fourth dose PO of poliovirus vaccine inactivated (lot #776A1). There was no illness at the time of vaccination except for a slight fever. The NP reported that on 8/28/03, the subject developed a vesicular rash on the right temporal area, laterally around the right eye and upper lid. It was noted that the vesicular rash did not cross the mid-line. A diagnosis of shingles was made. Unspecified medical attention was sought and the patient was treated on an outpatient basis with acyclovir. Within a couple of days, the vesicles crusted over and the patient''s shingles subsequently resolved. The NP also reported that another patient developed shingles after being vaccinated with varicella virus vaccine live. Additional information is not expected.

VAERS ID:221820 (history)  Vaccinated:1998-12-11
Age:6.0  Onset:2004-02-03, Days after vaccination: 1880
Gender:Female  Submitted:2004-05-14, Days after onset: 100
Location:Maryland  Entered:2004-05-25, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Body temp afebrile; Body weight: 39.75 lbs
CDC Split Type: WAES0402USA00595
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Private
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: Information has been received from a physician concerning a 6 year old white female who on 12/11/98 was vaccinated in the right arm with a first dose of varicella virus vaccine live. On 2/3/04, in the PM, the patient developed vesicles on the trunk, legs, and arms. It was noted that the patient was afebrile. There was no laboratory diagnostic tests performed. Follow up information indicated that on 2/3/04 in the PM the patient developed vesicles on her trunk, legs, and arms. The vesicles began to disappear on the fourth day. The outcome was reported was recovered on 2/8/04. No further information is expected.

VAERS ID:221837 (history)  Vaccinated:2000-11-07
Age:6.0  Onset:2004-01-23, Days after vaccination: 1172
Gender:Male  Submitted:2004-05-14, Days after onset: 111
Location:Wisconsin  Entered:2004-05-25, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Varicella (unknown mfr);;;11;In Sibling;;Varicella (unknown mfr);;;4;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Eczema; Drug hypersensitivity;
Diagnostic Lab Data: NONE
CDC Split Type: WAES0402USA01296
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1868J SC 
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a RN concerning a 6 year old female with allergies to "sulfa" and PCN and with a medical condition at 34 weeks gestation (mild eczema) who on 11/07/00 was vaccinated SC in the right arm with a first dose of varicella virus vaccine live (Lot # 634843/1868J). It was unknown if there was an illness at the time of vaccination. There was no concomitant medication. The pt developed mild varicella on approximately 01/16/04. Follow up information received from a RN indicated that on 01/23/04 the pt developed 2 pox bumps after being vaccinated against varicella (and after being exposed to varicella). No other symptoms were noted. The duration was unknown to the reporter. No treatment was ordered. There were no relevant diagnostic tests or lab data. The outcome was reported as recovered. The reporter also indicated tat 2 of the pt''s siblings developed mild varicella after vaccination with varicella virus vaccine live (WAES # 0401USA01995 & WAES # 0402USA01297). No further information is expected.

VAERS ID:221848 (history)  Vaccinated:2002-11-07
Age:6.0  Onset:2004-02-11, Days after vaccination: 461
Gender:Male  Submitted:2004-05-14, Days after onset: 92
Location:Iowa  Entered:2004-05-25, Days after submission: 11
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: Medical history: Ear infection; upper respiratory tract infection.
Diagnostic Lab Data: Tuberculin skin test 11/07/02 unknown.
CDC Split Type: WAES0402USA01490
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.642443/0339M1SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.641150/1177L0SC 
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Erythema, Infection, Pharyngolaryngeal pain, Pruritus, Rash papular, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a licensed practical nurse concerning a 6-year-old Bosnian male student with a history of ear infections and upper respiratory tract infections and with no known drug allergies who on 07-Nov-2003 was vaccinated SC with a first dose of a varicella virus vaccine live (Lot #641150/1177L). There was no illness at the time of vaccination. Concomitant therapy that day included a second dose of measles-mumps-rubella vaccine (Lot #642443/0339M) administered SC. He also was given a "TB" test. On 11-Feb-2004 the patient developed a papular rash with a red base. The child also had a red throat, upper respiratory tract infection, and itching with no fever. The number of lesions were not noted by the physician, but in his notes he called it mild chickenpox. He prescribed acyclovir and "hydroxazen hcl". It was also noted that on 07-Nov-2002, the patient had a TB test. Unspecified medical attention was sought. There was no product quality complaint. Follow-up information received from a licensed practical nurse indicated that on 11-Feb-2004 in the AM the patient developed a papular rash with red base that was scattered on the roof of his mouth, and his throat was red. His neck and chest were clear. He was noted to have a possible mild chickenpox. The outcome was reported as recovered. No further information is expected.

VAERS ID:221930 (history)  Vaccinated:2004-05-15
Age:6.0  Onset:2004-05-16, Days after vaccination: 1
Gender:Male  Submitted:2004-05-17, Days after onset: 1
Location:Ohio  Entered:2004-05-26, 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
Current Illness: NONE
Preexisting Conditions: NKDA; Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1288AA4IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0569N0SC 
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 days after 5th DTaP/Varivax given, temperature to 103, vomiting, rash on back of neck.

VAERS ID:221952 (history)  Vaccinated:1996-04-03
Age:6.0  Onset:2003-11-26, Days after vaccination: 2793
Gender:Male  Submitted:2004-05-14, Days after onset: 169
Location:Virginia  Entered:2004-05-26, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood pressure 12/09/03 stable, Chest X ray 12/09/03 negative, Diagnostic lab 11/29/03 complete metabolic panel normal, Pulse oximetry 12/09/03 98%, 11/29/03 negative mono, pulse oximetry 12/09/03 good, Eosinophil count 12/09/03 2.4 hemoglo
CDC Split Type: WAES0402USA01783
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0389B0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Dyspnoea, Infection, Rash, Red blood cell abnormality, Skin ulcer, Viral infection
SMQs:, Anaphylactic reaction (narrow), Lack of efficacy/effect (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 13 year old male who in approximately 1996, at the age of 5 years, was vaccinated with a dose of varicella virus vaccine live. On 24-Feb-2004 it was reported that the patient "recently" developed a case of full blown chicken pox. The number of lesions was not provided. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested. This is in follow up to report previously submitted on 05/14/2004, information has been received from office staff concerning a 13 year old male with no relevant medical history, no known allergies. Other immunization up to date, no previous hospitalizations or surgeries and no known family history of exposures to chickenpox or current illness who on Apr 3 1996, at 5 years of age, was vaccinated at 14:00 with a first IM dose of varicella virus vaccine live (lot 608578/0389B). There was no illness at the time of vaccination. The patient developed a rash which began on 11/26/2003 (also reported a 11/30/2003). He was seen in the ER on 11/29/2003 with a normal CBC and a negative mono. The patient was then seen by a physician on 12/01/2003 and was thought to have varicella (previously reported as a case of full blown chicken pox) One lesion appeared to be secondarily infected. The patient was started on Cephalexin (Keflex) PO. Since the visit, the rash had progressed and the patient complained of being short of breath. He denied vomiting, diarrhea, or fever with this current illness and had been eating relatively well. He was admitted to the hospital on Dec 9 2003, for a duration of 4 days (also reported as 48 hours and 2 days), with a severe progression of the rash ( also reported as severe varicella) and possibility of a varicella pneumonia. Upon physical exam, it was noted that the patient was alert, nontoxic, neurologically intact with pupils equal and reactive to light bilaterally and in no acute distress, however very anxious. His temperature was 97.7 pulse

VAERS ID:221955 (history)  Vaccinated:1995-06-06
Age:6.0  Onset:2004-02-13, Days after vaccination: 3174
Gender:Female  Submitted:2004-05-14, Days after onset: 90
Location:Nebraska  Entered:2004-05-26, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall Tablets
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: WAES0402USA01853
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0408B  UN
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Fatigue, Headache, Skin ulcer, Viral infection
SMQs:, Lack of efficacy/effect (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a health professional concerning an 14 yr old female pt who on 06Jun1995 was vaccinated with a dose of varicella virus vaccine live C508580/0406B). Concomitant medication included amphetamine aspartate (+) amphetamine sulfate (+) dextroamphetamine saccharate (+) dextroamphetamine sulfate (ADDERALL) daily. Over the past week, on approximately 13Feb04, the pt developed chickenpox. She developed only 7-8 lesions but reports a headache and tiredness. She was treated with diphenhydramine hcl (BENADRYL) over the counter orally and topically. Unspecified medical attention was sought. No product quality complaint was involved. The pt''s brother had a similar experience after vaccination with varicella virus vaccine live. Additional information has been requested. Follow up information indicated that approximately 9 years after receiving varicella virus vaccine live, on 2/13/2004, the child developed chicken pox. It was reported at 12:05pm that she had approximately 50 lesions. Her brother had chicken pox about 9 days earlier. No lobs or diagnostic studies were done. The child recovered on 02/18/2004. The patients brother (WAES0402USA01150) had a similar experience after vaccination with varicella virus vaccine live Lot 608580/0408B. Additional information is not expected.

VAERS ID:221964 (history)  Vaccinated:1999-12-16
Age:6.0  Onset:2004-02-20, Days after vaccination: 1527
Gender:Male  Submitted:2004-05-14, Days after onset: 83
Location:Unknown  Entered:2004-05-26, 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: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0403USA00164
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a nurse practitioner concerning a 6 year old male with no known drug allergies or medical history who on 16Dec1999 was vaccinated with a dose of varicella virus vaccine live. On 20Feb2004 the pt presented to a school nurse with a mild case of chickenpox. Unspecified medical attention was sought. It was noted that the school in this county had an outbreak of chickenpox. No product quality complaint was involved. It was also reported that 2 additional children were vaccinated with a dose of varicella virus vaccine live and developed a mild case of chickenpox. No additional information was available.

VAERS ID:221984 (history)  Vaccinated:1998-09-22
Age:6.0  Onset:2004-03-04, Days after vaccination: 1990
Gender:Female  Submitted:2004-05-14, Days after onset: 70
Location:Georgia  Entered:2004-05-26, 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: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0403USA00636
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0850H   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug ineffective, Rash vesicular, Viral infection
SMQs:, Lack of efficacy/effect (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning a 6 year old female patient with no pertinent medical history and no known allergies who on 22SEP1998 was vaccinated with a dose of varicella virus vaccine live. On 04MAR2004 the patient presented with varicella at the panty line, right shoulder and on her side. There was not treatment. The nurse reported that the patient experienced "chicken pox break through thru post vaccination with varicella virus vaccine live. It was noted at the time of the report that the patient was not recovered. Unspecified medical attention was sought. No product quality complaint was involved. Additional information has been requested.

VAERS ID:222004 (history)  Vaccinated:1998-07-27
Age:6.0  Onset:2004-03-02, Days after vaccination: 2045
Gender:Female  Submitted:2004-05-14, Days after onset: 72
Location:Ohio  Entered:2004-05-26, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0403USA01344
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.6237440506H0  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6250481575E0SC 
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection, Pyrexia
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a health professional concerning a 6 year old female who on 27Jul1998 was vaccinated SC in the right arm with a first dose of varicella virus vaccine live. Concomitant vaccination the same day included a first dose of measles virus vaccine live (Moraten) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) given in the left arm. On 02Mar2004 the pt developed chickenpox lesions greater than 57 with 17 scabbed over. Only a slight fever was noted at onset. The end of the virus was 11Mar2004 and the pt recovered. No further information is available.

VAERS ID:222037 (history)  Vaccinated:1995-06-16
Age:6.0  Onset:1997-05-17, Days after vaccination: 701
Gender:Female  Submitted:2004-05-14, Days after onset: 2554
Location:Illinois  Entered:2004-05-26, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES97051805
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Infection, Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning an otherwise healthy 6 year old Caucasian female with no allergies who on 6/16/95 was vaccinated with one dose of varicella virus vaccine live SC. On 5/17/97, the patient developed lesions all over her body. The reporter noted that causality is unknown. Additional information has been requested.

VAERS ID:222176 (history)  Vaccinated:2004-05-20
Age:6.0  Onset:2004-05-20, Days after vaccination: 0
Gender:Female  Submitted:2004-05-24, Days after onset: 4
Location:Texas  Entered:2004-06-01, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Headaches 12hrs prior
Preexisting Conditions: NONE
Diagnostic Lab Data: Urine. Increase in WBC''s. Increase Bacteria-Txid.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM777A21 RA
Administered by: Other     Purchased by: Public
Symptoms: Abnormal behaviour, Eye disorder, Pallor, Pyrexia, Urinary tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Corneal disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Within 15 min after receiving vaccine, child became frightened and scared. Child requested to stay in nurse office. Vaccine given at school. Within 1 hour child became pale. Glassy eyes. Temp 104: mother took child to emergency room at 3:15PM-- stayed in ER till 9:00 PM and diagnosed with UTI.

VAERS ID:222315 (history)  Vaccinated:2000-06-01
Age:6.0  Onset:2004-05-22, Days after vaccination: 1451
Gender:Female  Submitted:2004-05-26, Days after onset: 4
Location:Florida  Entered:2004-06-03, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 50-60 lesions for 4 days.

VAERS ID:222485 (history)  Vaccinated:1999-03-18
Age:6.0  Onset:2004-05-27, Days after vaccination: 1897
Gender:Female  Submitted:2004-06-01, Days after onset: 5
Location:Missouri  Entered:2004-06-08, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS4577933IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEUR796H63IMLL
Administered by: Private     Purchased by: Private
Symptoms: Blister, Headache, Nausea, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever 101.5 degrees- 22 vesicles, nausea. Pt. developed headache. Duration of adverse events- 5 days.

VAERS ID:222512 (history)  Vaccinated:2000-10-17
Age:6.0  Onset:2004-05-26, Days after vaccination: 1317
Gender:Male  Submitted:2004-06-02, Days after onset: 7
Location:West Virginia  Entered:2004-06-09, 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:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Infection
SMQs:
Write-up: Chickenpox

VAERS ID:222600 (history)  Vaccinated:1998-01-08
Age:6.0  Onset:2004-05-26, Days after vaccination: 2330
Gender:Female  Submitted:2004-06-01, Days after onset: 6
Location:Florida  Entered:2004-06-11, 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: PPD
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0743E  RL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1103E  LL
Administered by: Private     Purchased by: Private
Symptoms: Rash papular
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Papular rash covering trunk, legs, arms

VAERS ID:222607 (history)  Vaccinated:2004-05-12
Age:6.0  Onset:2004-05-12, Days after vaccination: 0
Gender:Female  Submitted:2004-06-09, Days after onset: 28
Location:Arizona  Entered:2004-06-11, Days after submission: 2
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: SEE Toxicologist/Pathologist Report
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS21896A20 LL
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS21896A20 LL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0341N0 RL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER21896A20 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0105N0 RL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1151M0 LL
Administered by: Private     Purchased by: Private
Symptoms: Decreased appetite, Dehydration, Eye pain, Fatigue, Nausea, Pain, Pharyngolaryngeal pain
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad)
Write-up: dehydrated, unusually tired, legs hurt, extreme sore throat, nausea, eyes hurt, reduced appetite.

VAERS ID:222662 (history)  Vaccinated:1998-07-10
Age:6.0  Onset:2004-05-28, Days after vaccination: 2149
Gender:Female  Submitted:2004-05-28, Days after onset: 0
Location:Arkansas  Entered:2004-06-15, Days after submission: 18
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: AR0431
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES76814893IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.0499H3IMRL
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)PFIZER/WYETH4495253PO 
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0233H0SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1575E0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Fatigue, Pyrexia, Rash, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 24 hour history of vesicular eruptions, fever, fatigue.

VAERS ID:222683 (history)  Vaccinated:2004-06-02
Age:6.0  Onset:2004-06-04, Days after vaccination: 2
Gender:Male  Submitted:2004-06-04, Days after onset: 0
Location:Washington  Entered:2004-06-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1612AA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX05553SCLA
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0821N1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Mom called to report pt has red area around injection area at 2 1/2 inches around, size of egg, not swollen, no fever.

VAERS ID:222760 (history)  Vaccinated:1999-05-18
Age:6.0  Onset:2004-06-03, Days after vaccination: 1843
Gender:Male  Submitted:2004-06-07, Days after onset: 4
Location:New York  Entered:2004-06-17, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Perinectal abscess 6/98- surg. drained 7/98.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1673H0 RA
Administered by: Private     Purchased by: Unknown
Symptoms: Blister, Body temperature increased, Drug ineffective, Infection, Pruritus
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed varicella rash at age 6 11/12 yr after receiving varicella vaccine at age 1 yr. Pt. with 20 spots, vesicles, itch, temp increased 101 2 days. Pt 111 7+ days.

VAERS ID:222776 (history)  Vaccinated:2004-06-09
Age:6.0  Onset:2004-06-10, Days after vaccination: 1
Gender:Male  Submitted:2004-06-10, Days after onset: 0
Location:Nebraska  Entered:2004-06-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1527AA4 RA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX07113 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0681N1 LA
Administered by: Private     Purchased by: Other
Symptoms: Feeling hot, Skin nodule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Lump under right arm-site slight red & slightly warm to touch. Amoxicillin given orally.

VAERS ID:222786 (history)  Vaccinated:1998-12-08
Age:6.0  Onset:2004-05-19, Days after vaccination: 1989
Gender:Unknown  Submitted:0000-00-00
Location:Massachusetts  Entered:2004-06-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Bananas, Marshmallows
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIES0928003 LL
HBPV: HIB POLYSACCHARIDE (HIBIMUNE)LEDERLE LABORATORIESM265AF3 LL
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash appeared on back and abdomen: pt presented also with temp 101 degrees.

VAERS ID:222833 (history)  Vaccinated:2004-05-03
Age:6.0  Onset:2004-05-17, Days after vaccination: 14
Gender:Male  Submitted:2004-05-17, Days after onset: 0
Location:Washington  Entered:2004-06-18, Days after submission: 32
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: WA042032
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS775B21IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1244N0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash developed one week after vaccine given. Left lower deltoid SC. Rash was at injection site. Pt complained of itching at site also. Advised to use Benadryl if needed. Seen on 05/17/04 and filled out this form.

VAERS ID:222984 (history)  Vaccinated:2004-06-10
Age:6.0  Onset:2004-06-11, Days after vaccination: 1
Gender:Male  Submitted:2004-06-16, Days after onset: 5
Location:New York  Entered:2004-06-22, 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: PPD (C1707AA), forearm, 2 previous doses
Current Illness: NONE
Preexisting Conditions: PCN Allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1698AA4 LA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Injection site erythema, Injection site induration
SMQs:, Severe cutaneous adverse reactions (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Developed redness and induration at vaccine site which increased to whole forearm. Then developed blisters over deltoid region. No temp.

VAERS ID:222990 (history)  Vaccinated:1999-01-28
Age:6.0  Onset:2004-03-01, Days after vaccination: 1859
Gender:Female  Submitted:0000-00-00
Location:Ohio  Entered:2004-06-22
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: Spina Bifida, VP Shunt, Club Feet, Arnold Chiari malformation
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4514983IMLL
HBPV: HIB POLYSACCHARIDE (HIBIMUNE)LEDERLE LABORATORIES402203A3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1516E0 RL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0665H0 RL
Administered by: Private     Purchased by: Unknown
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)
Write-up: + Vesicles, scattered on various body area. No fever.

VAERS ID:223226 (history)  Vaccinated:2004-05-14
Age:6.0  Onset:2004-05-15, Days after vaccination: 1
Gender:Male  Submitted:2004-06-15, Days after onset: 31
Location:California  Entered:2004-06-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS21923A21 LL
HIBV: HIB (ACTHIB)AVENTIS PASTEUR036AA1 RL
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4943091 RL
Administered by: Unknown     Purchased by: Other
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left leg 0.5x0.5mm lump. No tenderness, no redness.

VAERS ID:223261 (history)  Vaccinated:0000-00-00
Age:6.0  Onset:0000-00-00
Gender:Female  Submitted:2004-05-28
Location:Unknown  Entered:2004-06-23, Days after submission: 26
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: HIVES
Diagnostic Lab Data: NONE
CDC Split Type: WAES0312USA02353
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.6414590057M   
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a mother concerning her 6 year old daughter with no allergies who in May 2002, was vaccinated with a dose of measles virus vaccine live (Moraten) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) . There were no concomitant medications. Two weeks later, the pt broke out in hives all over her body. The pt was treated with diphenhydramine hydrochloride (BENADRYL) liquid and diphenhydramine hydrochloride (BENADRYL) cream on the sores. The pt recovered in approximately one week. It was reported that the pt had the same reaction two weeks after being vaccinated with poliovirus vaccine inactivated in Sept 1999. No further information is expected.

VAERS ID:223334 (history)  Vaccinated:0000-00-00
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Mississippi  Entered:2004-06-24
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
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Medication error, Unevaluable event
SMQs:, Medication errors (narrow)
Write-up: NONE. Vaccine was expired 05/15/2004 Pediarix

VAERS ID:223565 (history)  Vaccinated:2004-06-16
Age:6.0  Onset:2004-06-30, Days after vaccination: 14
Gender:Female  Submitted:2004-06-30, Days after onset: 0
Location:New Hampshire  Entered:2004-06-30
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
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1245N0SCLA
Administered by: Private     Purchased by: Public
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Pt received varivax on 6/14/04 . Now has pox on trunk

VAERS ID:223679 (history)  Vaccinated:2000-04-10
Age:6.0  Onset:2000-05-06, Days after vaccination: 26
Gender:Male  Submitted:2004-07-06, Days after onset: 1522
Location:Louisiana  Entered:2004-07-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Asthma;Vaccine not specified;;85;In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES4670142IMLL
HBPV: HIB POLYSACCHARIDE (HIBIMUNE)LEDERLE LABORATORIES5607532IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.R02472IMRL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anorexia, Croup infectious, Dysphonia, High-pitched crying, Hypersensitivity, Irritability, Lethargy, Pyrexia, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 5/8/2000 Emergency Room and Doctor Visit High Fever High Pitched Screaming Vomiting Lethargic No Appetite Viral Syndrome Diagnosis Spitting Up Breast Milk Real Sensitive To Noise 6/30/2000 Doctor Visit High Fever High Pitched Screaming Lethargic Cranky Croupy Rattling In Chest Hoarse Spitting Up Breast Milk

VAERS ID:223841 (history)  Vaccinated:2004-06-29
Age:6.0  Onset:2004-06-29, Days after vaccination: 0
Gender:Male  Submitted:2004-07-01, Days after onset: 2
Location:Massachusetts  Entered:2004-07-12, Days after submission: 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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURU1272BA5IMLA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1215N1IMRA
HIBV: HIB (ACTHIB)AVENTIS PASTEURUE064AA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0821N0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Erythema, Injection site 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: right arm swelling /erythema/induration reaction. Prescribed Keflex/ Benadryl/ Motrin and cold compresses PRN for Mild cellulitis.

VAERS ID:223849 (history)  Vaccinated:2004-06-21
Age:6.0  Onset:2004-06-22, Days after vaccination: 1
Gender:Male  Submitted:2004-06-29, Days after onset: 7
Location:Wisconsin  Entered:2004-07-12, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amox-Clav (Augmentin)
Current Illness: Dog bite
Preexisting Conditions: Congenital orthopedic deformity of lower limbs
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM616A24IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW15823SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0130N1SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)
Write-up: Progressive swelling of left upper arm starting 6/22/04. By the time she called on 6/24/04. Swelling over LD was size of baseball with redness warmth. Seen at ER 6/24/04. No treatment to observe. Recovering 6/29 swelling dramatically decreased.

VAERS ID:224168 (history)  Vaccinated:2003-12-11
Age:6.0  Onset:2003-12-16, Days after vaccination: 5
Gender:Female  Submitted:2004-05-18, Days after onset: 153
Location:New Jersey  Entered:2004-07-20, Days after submission: 63
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: Food allergy
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE350105APR04
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500033P0IN 
Administered by: Other     Purchased by: Private
Symptoms: Herpes simplex
SMQs:
Write-up: Follow up information received on 4/26/04, provided demographic information, medical history, administration of initial dose of Flumist and subsequent dosing information and date, lot number and site of herpes lesion. Information regarding Flumist was received from a physician regarding a 6 year old female patient who received a first dose on 12/11/03, and developed herpes. The patient''s concurrent illness includes food allergy. Indication for Flumist was immunization. Product was administered on 12/11/03. Dose regimen was 1 dose. Patient was not taking concomitant therapy. On 12/16/03, a 6 year old female patient developed herpes on top of lip, under nose, after receiving her first dose of Flumist on 12/11/03. Zovirax ointment was prescribed, and patient recovered. On 2/19/04, the child received a second dose of Flumist, and the reporter stated, no herpes outbreak, but 7 days later mom called to report that mom had herpes outbreak. The reporter also indicated that the mother received Zovirax and recovered.

VAERS ID:224236 (history)  Vaccinated:2004-07-07
Age:6.0  Onset:2004-07-08, Days after vaccination: 1
Gender:Female  Submitted:2004-07-20, Days after onset: 12
Location:Arizona  Entered:2004-07-21, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Viral culture negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS632A24IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX07724IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1035N1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Erythema multiforme, Pyrexia
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Vesicles, fever, erythema multiforme. Treatment with IV fluids, steroids. Hospitalized 7/9/04 to 7/11/04. Nurse follow up on 08/24/04 states: "Complete." Nurse follow up on 10/21/04 states: "Review of additional hospital records received on this already completed case confirms final diagnosis of erythema multiforme."

VAERS ID:224288 (history)  Vaccinated:2004-07-14
Age:6.0  Onset:2004-07-16, Days after vaccination: 2
Gender:Male  Submitted:2004-07-16, Days after onset: 0
Location:California  Entered:2004-07-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER632A23IMRA
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER0422N1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema, Pyrexia
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: RD redness and high temp, swollen area 17cm in circumference.

VAERS ID:224321 (history)  Vaccinated:2004-07-19
Age:6.0  Onset:2004-07-19, Days after vaccination: 0
Gender:Female  Submitted:2004-07-25, Days after onset: 6
Location:Washington  Entered:2004-07-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (ACEL-IMUNE)LEDERLE LABORATORIES    
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site warmth, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Itchy, hives in 6 inch area around the injection. hot to touch. 2 days after shot, returned to doctor and was given benadryl and a cream to help. the next day it started to clear up. then the next day from that it stablized and was not yet gone, so parents continued to give benadryl and cream. still itching and red. it is sat so monday if not gone we''ll take her back to the doctor. She has no difficulty breathing and does NOT appear to show any signs of needing immediate medical attention, from what we know of the serious reactions.

VAERS ID:224405 (history)  Vaccinated:2004-07-16
Age:6.0  Onset:2004-07-17, Days after vaccination: 1
Gender:Female  Submitted:2004-07-27, Days after onset: 10
Location:Illinois  Entered:2004-07-27
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: none
CDC Split Type: IL04010
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (DITANRIX)SMITHKLINE BEECHAM622A24IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW16193IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0819N1SCLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Feeling hot, Joint range of motion decreased, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Vx given @ 2pm. Child given Motrin that eve. Sat. a.m. child''s R. leg aching. Early afternoon, mild swelling on R. thigh. By eve., thigh twice normal size. Swelling extended fr. hip to knee. Child unable to bend knee. Skin hot, red and very hard. Dx cellulitis @ E.R. & placed on augmentin for 10 days.

VAERS ID:224485 (history)  Vaccinated:2004-07-28
Age:6.0  Onset:2004-07-28, Days after vaccination: 0
Gender:Female  Submitted:2004-07-28, Days after onset: 0
Location:Utah  Entered:2004-07-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lovenox 40 mg SC BID Reglan 10 mg IV q 6 hrs Hytrocortixone cream to leg Nystatin cream to leg Pink swizzle cream to leg levaquin 750 mg IV q 24 hrs Prevacid 30 mg IV BID
Current Illness: Postoperative bowel obstruction secondary to extrinsic high small bowel mass. Resolved, went home today.
Preexisting Conditions: Lobectomy, previous pneumonia, a-fib, pacemaker, arthritis, colon cancer, back surgeries
Diagnostic Lab Data: EKG normal sinus rhythm with possible left atrial enlaragement, low voltage QRS, and nonspecific ST and T wave abnormality. Pt has a pacer and history of a-fib.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0113P0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chest pain, Dyspnoea, Flushing, Laboratory test abnormal, Nausea
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: 2 minutes after administration pt reported nausea, appeared flushed in face, then reported shortness of breath and chest pain. There was no blood when aspirated syringe prior to administration. Pt had no known allergies. 02 applied, EKG ordered, MD paged. VS stable, sp02 95% on 4 liters. Pain subsided within next 10 minutes, sp)2 94% on RA. PT''s DC home was delayed 1 hour.

VAERS ID:224676 (history)  Vaccinated:2004-07-14
Age:6.0  Onset:2004-07-15, Days after vaccination: 1
Gender:Female  Submitted:2004-07-21, Days after onset: 6
Location:Alabama  Entered:2004-08-03, 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: NONE
CDC Split Type: AL0419
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS632A24IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1037N1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site mass, 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: Red and swollen 4 1/4" x 3 1/2" (redness) c/o pain, hard area to right thigh (received Dtap)

VAERS ID:225069 (history)  Vaccinated:2004-07-21
Age:6.0  Onset:2004-07-24, Days after vaccination: 3
Gender:Female  Submitted:2004-07-30, Days after onset: 6
Location:New York  Entered:2004-08-06, 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: PPD Shot
Current Illness: Bee sting right hand
Preexisting Conditions: amoxicillin: rash
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1301DA4IM 
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX07063SC 
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: DTAP given 7/21/04: pt seen on 7/23/04 site of injection red, swollen. Pt given Keflex. Seen in office 7/26/04. Pt recovered .

VAERS ID:225207 (history)  Vaccinated:2004-08-03
Age:6.0  Onset:2004-08-04, Days after vaccination: 1
Gender:Female  Submitted:2004-08-05, Days after onset: 1
Location:Unknown  Entered:2004-08-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: DTaP (unknown mfr);;5;4;In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1625AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW12333SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0177N1SCRA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Injection site reaction, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Moderate local reaction to left deltoid with erythema and swelling ~8.0x7.0cm

VAERS ID:225256 (history)  Vaccinated:2004-07-29
Age:6.0  Onset:2004-07-29, Days after vaccination: 0
Gender:Female  Submitted:2004-07-30, Days after onset: 1
Location:North Carolina  Entered:2004-08-10, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nizoral 200mg 1/2 tab 3 times a day.
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NC04074
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1300BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX05543SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0816N1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Generalized hives within 12 hours. Given Benadryl and Prelone.

VAERS ID:225260 (history)  Vaccinated:2004-07-29
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:2004-08-04
Location:Indiana  Entered:2004-08-10, 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: Zyrtec; Rhinocort AQ;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1696AA4IMUN
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX07073SCUN
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1187N1SCLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Softball size reddened, swollen area x1 week-compresses right hip.

VAERS ID:225344 (history)  Vaccinated:2004-08-02
Age:6.0  Onset:2004-08-03, Days after vaccination: 1
Gender:Male  Submitted:2004-08-05, Days after onset: 2
Location:Ohio  Entered:2004-08-12, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Allergic Rhinitis
Preexisting Conditions: Allergic Rhinitis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSA633A24 RA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX07073 LA
Administered by: Private     Purchased by: Private
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 3"x5" reddened area on right arm.

VAERS ID:225366 (history)  Vaccinated:2004-08-04
Age:6.0  Onset:2004-08-05, Days after vaccination: 1
Gender:Male  Submitted:2004-08-10, Days after onset: 5
Location:Indiana  Entered:2004-08-12, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS612A94IDLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pyrexia, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Erythema, swelling, minimal tenderness, and increased temperature.

VAERS ID:225404 (history)  Vaccinated:2004-06-23
Age:6.0  Onset:2004-06-24, Days after vaccination: 1
Gender:Female  Submitted:2004-06-30, Days after onset: 6
Location:Texas  Entered:2004-08-13, Days after submission: 44
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
RAB: RABIES (RABAVERT)CHIRON CORPORATION3170110IMLA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Erythema, Eye oedema, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Temp (101.7), headache, abdominal pain, redness in face puffy eyes. Tx 2tsp of ibuprofen every six hours. Duration was about 24 hours.

VAERS ID:225506 (history)  Vaccinated:0000-00-00
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:2004-08-07
Location:Colorado  Entered:2004-08-17, Days after submission: 10
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 (TRIPEDIA)AVENTIS PASTEURU1028CA3 RL
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1103M3 LL
HEPA: HEP A (VAQTA)MERCK & CO. INC.0123P0 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0810N0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1351N0 LA
Administered by: Public     Purchased by: Public
Symptoms: Dysphagia, Lymphadenopathy
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Nontender, swollen anterior and posterior cervicle nodes, began the evening vaccine administered, enlarged over 203 days, have remained same size for past 2 days. (+) Dysphagia, neck with FROM, no headaches. Largest node 3x4cm, post 2x4cm.

VAERS ID:225566 (history)  Vaccinated:2004-08-09
Age:6.0  Onset:2004-08-10, Days after vaccination: 1
Gender:Female  Submitted:1990-08-11, Days after onset: 5113
Location:Arizona  Entered:2004-08-18, Days after submission: 5121
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Septra;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS634A24 LA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 6x4cm redness, warm, tenderness.

VAERS ID:225591 (history)  Vaccinated:1999-05-26
Age:6.0  Onset:2004-05-16, Days after vaccination: 1817
Gender:Female  Submitted:2004-05-20, Days after onset: 4
Location:Maryland  Entered:2004-08-18, Days after submission: 90
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
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.00241M0SCLA
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)UNKNOWN MANUFACTURER458402PO 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1325M0SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Blister, Drug ineffective, Pyrexia, Rash erythematous, Rash macular
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Temp 100 degrees F on 5/17/04. Several erythematous macules and papules. Some clear fluid filled blisters on trunk, face, left majora, arms and legs.

VAERS ID:225593 (history)  Vaccinated:1998-10-29
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:2004-05-20
Location:Maryland  Entered:2004-08-18, Days after submission: 90
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: Hx: chronic OME and hearing loss. PE tube placement in March 04.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.119540SCLA
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)LEDERLE LABORATORIES0790E2PO 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1054N0SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Drug ineffective, Pyrexia, Rash erythematous, Rash macular, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5/20/04: Temp 97F. Several erythematous macules and vesicles on trunk and legs. No lesions of face. 1 scab. Developed 2 days prior to visit.

VAERS ID:225599 (history)  Vaccinated:0000-00-00
Age:6.0  Onset:2004-04-19
Gender:Male  Submitted:2004-05-25, Days after onset: 36
Location:Maryland  Entered:2004-08-18, Days after submission: 85
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia, Rash erythematous, Rash macular, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Temp 98 degrees F on 4/19/04. Erythematous macules, vesicles, some scabs seen on scalp, trunk, legs, penis.

VAERS ID:225785 (history)  Vaccinated:2004-08-12
Age:6.0  Onset:2004-08-13, Days after vaccination: 1
Gender:Male  Submitted:2004-08-19, Days after onset: 6
Location:New Mexico  Entered:2004-08-24, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURC1699AA  RA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0485P  LA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW0869 SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (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: On Friday evening , pt had "bad swollen right arm of injection site" , itching. Was seen in ER 5ml Prelone x 3 doses and Benadryl

VAERS ID:225882 (history)  Vaccinated:1999-01-12
Age:6.0  Onset:2004-08-18, Days after vaccination: 2045
Gender:Female  Submitted:2004-08-20, Days after onset: 2
Location:Missouri  Entered:2004-08-26, 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: Hydrocortisone
Current Illness: Eczema on face
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES4566423 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1004H0 LL
OPV: POLIO VIRUS, ORAL (NO BRAND NAME)LEDERLE LABORATORIES4578422PO 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1659140 RL
Administered by: Private     Purchased by: Private
Symptoms: Rash papular, Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Scattered 2-3mm papulovesicular, excoriated lesions groin (1 vesicular mons pubis), neck, behind ears, scalp, trunk (few), arms and legs.

VAERS ID:225896 (history)  Vaccinated:0000-00-00
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:2004-08-25
Location:Colorado  Entered:2004-08-26, 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 (TRIPEDIA)AVENTIS PASTEURU0997DA4IMLA
Administered by: Private     Purchased by: Unknown
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: Swelling, erythema at upper arm.

VAERS ID:225913 (history)  Vaccinated:2004-08-19
Age:6.0  Onset:2004-08-20, Days after vaccination: 1
Gender:Male  Submitted:2004-08-21, Days after onset: 1
Location:Nebraska  Entered:2004-08-27, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1663224IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX10063IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1035N1SCRL
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, Injection site induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 24 hours after shots left leg had small red area. 48 hours after shots area had increased to 9cm x 7 cm, hard, red, warm to touch: treated with Augmentin x 10 days in case of cellulitis.

VAERS ID:225927 (history)  Vaccinated:2004-06-08
Age:6.5  Onset:2004-06-08, Days after vaccination: 0
Gender:Male  Submitted:2004-06-24, Days after onset: 16
Location:Arkansas  Entered:2004-08-27, Days after submission: 64
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: Eczema since birth
Diagnostic Lab Data:
CDC Split Type: AR0449
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS21919B92IMRL
HIBV: HIB (ACTHIB)AVENTIS PASTEURU5168AA2IMLL
Administered by: Public     Purchased by: Unknown
Symptoms: Condition aggravated, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Father said: had rash appear on trunk (mild on rash). None on extremities, appeared about 6 hours after immunizations. This child has had rashes since birth worsened after immunizations.

VAERS ID:225938 (history)  Vaccinated:2004-08-19
Age:6.0  Onset:2004-08-20, Days after vaccination: 1
Gender:Male  Submitted:2004-08-24, Days after onset: 4
Location:Indiana  Entered:2004-08-27, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Heart murmur
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1698AA3IMLL
HBHEPB: HIB + HEP B (COMVAX)MERCK & CO. INC.1289N2 RL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX07064 RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1051N1 LL
Administered by: Private     Purchased by: Private
Symptoms: Injection site mass, Injection site reaction, 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, reaction size of man''s hand left hip. Knot on right side.

VAERS ID:225976 (history)  Vaccinated:2004-08-13
Age:6.0  Onset:2004-08-14, Days after vaccination: 1
Gender:Male  Submitted:2004-08-24, Days after onset: 10
Location:Iowa  Entered:2004-08-30, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, Sed Rate, Wound culture all negative.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1007CA4IMGM
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW14403SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1040N1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left buttock; large area of erythema and induration around DTaP site. Also had blistering of skin and a small ulcerative type area at site of injection. Erythema spread rapidly despite oral antibiotics. CBC, Sed Rate, wound culture all negative. Thus, suspicion of localized reaction rather than cellulitis. Nonetheless, was treated with 2 days of IV antibiotics and sent home on oral course. Nurse follow up on 09/13/04 states: "No new information."

VAERS ID:225990 (history)  Vaccinated:2004-08-18
Age:6.0  Onset:2004-08-18, Days after vaccination: 0
Gender:Male  Submitted:2004-08-20, Days after onset: 2
Location:Oklahoma  Entered:2004-08-30, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Office visit;
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1614AA4  
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local reaction to arm injection site, warm, red, swollen around injection site 2x3 inches.

VAERS ID:226040 (history)  Vaccinated:2004-08-25
Age:6.0  Onset:2004-08-26, Days after vaccination: 1
Gender:Female  Submitted:2004-08-30, Days after onset: 4
Location:Illinois  Entered:2004-08-30
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 BIOLOGICALSDTPA622A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURX070623SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1036N1SCRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site inflammation, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Received Immunizations on 8/25/04. Reported to H.D. on 8/27/04 due to swelling and soreness and inflammation in vaccine site on left arm. Community Clinic physician sent patient to Emergency Room.

VAERS ID:226053 (history)  Vaccinated:1998-11-23
Age:6.0  Onset:2004-08-23, Days after vaccination: 2100
Gender:Male  Submitted:2004-08-23, Days after onset: 0
Location:Texas  Entered:2004-08-31, 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: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Pt received vaccine on 11/23/98 and on this date 8/23/04 with a mild case of chicken pox.

VAERS ID:226132 (history)  Vaccinated:2004-08-18
Age:6.0  Onset:2004-08-18, Days after vaccination: 0
Gender:Female  Submitted:2004-08-20, Days after onset: 2
Location:Idaho  Entered:2004-09-01, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS632B23IMRL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS816A21IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW08693IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1070N2SCLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site rash, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 8/19/04 pt received DTaP and IPV on right thigh. Pt had a red itchy rash to the left of injection site.

VAERS ID:226140 (history)  Vaccinated:1999-08-17
Age:6.0  Onset:2004-08-23, Days after vaccination: 1833
Gender:Male  Submitted:2004-08-26, Days after onset: 3
Location:Pennsylvania  Entered:2004-09-01, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Varicella (unknown mfr);;1;8;In Sibling
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.0710J0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Drug ineffective, Erythema, Pyrexia, Viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother called our office on 8/24/04 to report chicken pox. Child developed rash evening of 8/23. Had approx 40 lesions on trunk, head, face, and genitals. Lesions described as red dots with fluid filled blisters. Temp 99 on 8/23 afebrile after that. Sibling was seen in our office on 8/12/2004 with modified varicella post immunization.

VAERS ID:226180 (history)  Vaccinated:2004-08-11
Age:6.0  Onset:2004-08-26, Days after vaccination: 15
Gender:Female  Submitted:2004-09-02, Days after onset: 7
Location:Arizona  Entered:2004-09-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: AZ0405
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0725K1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0326N0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Acne, Injection site rash, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: "rash" on L arm @ site of vaccine, like a "pimple" with small dots around it, also same rash on both legs. Slight fever.

VAERS ID:226206 (history)  Vaccinated:2004-08-23
Age:6.0  Onset:2004-08-24, Days after vaccination: 1
Gender:Female  Submitted:2004-08-25, Days after onset: 1
Location:Oregon  Entered:2004-09-03, Days after submission: 9
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 (TRIPEDIA)AVENTIS PASTEURU1314AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX05553SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0950N1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left arm deltoid mild erythema and swelling. Normal use of arm.

VAERS ID:226338 (history)  Vaccinated:2002-08-27
Age:6.0  Onset:2002-08-28, Days after vaccination: 1
Gender:Female  Submitted:2004-09-01, Days after onset: 735
Location:California  Entered:2004-09-08, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS728C90 LL
Administered by: Other     Purchased by: Other
Symptoms: Lethargy, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Rash, fever, vomiting and lethargy occurred within 24 hours of shot. Symptoms subsided in 2 days.

VAERS ID:226543 (history)  Vaccinated:1998-10-13
Age:6.0  Onset:2004-09-07, Days after vaccination: 2156
Gender:Male  Submitted:2004-09-07, Days after onset: 0
Location:Missouri  Entered:2004-09-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gantrisin 1 1/2 tsp PO daily started at time of vaccine.
Current Illness: Residual Serious Otitis Media
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HIBV: HIB (HIBTITER)LEDERLE LABORATORIES360753A3IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0222H0SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0845H0SCRL
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Rash papular, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Multiple excoriated pap lesions, some crusting on ankles. Scattered erythema pap vesic lesions-trunk, few on arms and in scalp. Keflex 250/5 200ml 2 tsp PO Bid x 10d. Atarax 10/5 4 on 1 1/2 tsp PO every 6 hours prn itching rx 2.

VAERS ID:226544 (history)  Vaccinated:2004-08-27
Age:6.0  Onset:2004-08-28, Days after vaccination: 1
Gender:Female  Submitted:2004-08-30, Days after onset: 2
Location:North Dakota  Entered:2004-09-13, 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:
CDC Split Type: ND0417
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1996AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX1006 IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1187N1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Injection site mass, 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: Phone call 8/29/04-developed red, hard area left deltoid region. Itching. Advised ice, Advil, Cortaid, Benadryl prn.

VAERS ID:226546 (history)  Vaccinated:2004-08-23
Age:6.0  Onset:2004-08-29, Days after vaccination: 6
Gender:Female  Submitted:2004-08-27, Days after onset: 2
Location:North Dakota  Entered:2004-09-13, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ND0415
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1700AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX100623IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1188N1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Injection site mass, Oedema, Pruritus
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: Developed swollen, red upper left arm, some hardness and itching. Redness spread to upper elbow. Advised ice, Advil, Cortaid, Benadryl PRN.

VAERS ID:226601 (history)  Vaccinated:2004-08-17
Age:6.0  Onset:2004-08-18, Days after vaccination: 1
Gender:Female  Submitted:2004-08-20, Days after onset: 2
Location:Oregon  Entered:2004-09-14, 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: Used ABX two weeks ago.
Current Illness: Had varicella one month ago.
Preexisting Conditions: Allergy to amoxicillin. Born with PDA and with Pseudo obstruction.
Diagnostic Lab Data: NONE
CDC Split Type: OR200429
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1272BA4IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0482P0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW10023IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0099N1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Rxn. in left arm starting Wed. 8/18/04 area below injection became red, swollen and hot to the touch very tender.

VAERS ID:226683 (history)  Vaccinated:2004-07-21
Age:6.0  Onset:2004-07-23, Days after vaccination: 2
Gender:Male  Submitted:2004-09-14, Days after onset: 53
Location:Illinois  Entered:2004-09-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone, iron, Topamax
Current Illness: no
Preexisting Conditions: seizure disorder, mental delay, autism, brain damage (birth mother had no prenatal care)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (DITANRIX)SMITHKLINE BEECHAMDTPA622A24IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW10023SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Condition aggravated, Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Child''s adoptive mother reports on 9/9/04 that child is having "cluster seizures" since 7/23/04. Prior to vx, child was on Topamax 50 mg, increased to 75 mg. States previous last known seizure 3 yrs ago. States child has not seen MD, but reporting status by phone.

VAERS ID:226652 (history)  Vaccinated:2004-09-07
Age:6.0  Onset:2004-09-07, Days after vaccination: 0
Gender:Male  Submitted:2004-09-09, Days after onset: 2
Location:Nebraska  Entered:2004-09-15, 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: Depakote; Rispendal; Addenal;
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1698AA4IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt received immunization on 09/07/04. Area was little red that evening. Next day was worse, by 09/09/04, area was 5x4.5 inches, red, warm to touch, swollen and painful. Pt was given Zyrtec and to follow up if got worse.

VAERS ID:226653 (history)  Vaccinated:2004-09-01
Age:6.0  Onset:2004-09-01, Days after vaccination: 0
Gender:Female  Submitted:2004-09-08, Days after onset: 7
Location:Kansas  Entered:2004-09-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Seasonal and food allergies;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1780AA4 LA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX10063 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1187N1 LL
Administered by: Private     Purchased by: Private
Symptoms: Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left arm swelled, became hot and warm. Entire left arm.

VAERS ID:226660 (history)  Vaccinated:2004-08-31
Age:6.0  Onset:2004-09-01, Days after vaccination: 1
Gender:Male  Submitted:2004-09-09, Days after onset: 8
Location:Pennsylvania  Entered:2004-09-15, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair;
Current Illness: Allergic;
Preexisting Conditions: Allergic;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIES4924090 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right lateral bicep red, swollen, hot, spread to elbow.

VAERS ID:226694 (history)  Vaccinated:2004-08-20
Age:6.0  Onset:2004-08-20, Days after vaccination: 0
Gender:Male  Submitted:2004-08-31, Days after onset: 11
Location:Ohio  Entered:2004-09-15, Days after submission: 15
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: Infantile history of croup. Elevated liver enzymes of unknown etiology apx. 3 yrs ago. Possible hypertension (being observed by MD for this currently).
Diagnostic Lab Data: Unknown what, if any, were ran at ER.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0954N1SCLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Anaphylactic reaction, Face oedema, Lethargy, Nausea, Tongue oedema, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: 2 minutes after MMR administered, client''s tongue and lips began to swell. Client became lethargic and nausea was noted. Adm. 1cc Benadryl. 10 minutes after adm. client vomited. 20 min. after adm., client was transported to ER for treatment and observation. At ER, client was treated as if anaphylactic reaction occured, observed for 2 hours and released to home.

VAERS ID:226702 (history)  Vaccinated:2004-08-20
Age:6.0  Onset:2004-08-21, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Wisconsin  Entered:2004-09-16
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 BIOLOGICALS627A24IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0808N1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 104 temp x 3 days. Starting on 8/21/04. Then 27th-29th 101 fever. Pt c/o aching all over, these dates.

VAERS ID:226791 (history)  Vaccinated:2004-09-07
Age:6.0  Onset:2004-09-07, Days after vaccination: 0
Gender:Male  Submitted:2004-09-09, Days after onset: 2
Location:New York  Entered:2004-09-20, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 12hrs
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1700AA4 LA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX08003 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0820N1 RA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: UNK

VAERS ID:226853 (history)  Vaccinated:2004-08-26
Age:6.0  Onset:2004-08-27, Days after vaccination: 1
Gender:Male  Submitted:2004-08-27, Days after onset: 0
Location:Montana  Entered:2004-09-21, 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: NONE
Current Illness: NONE
Preexisting Conditions: Asthma, Previous reaction to bee sting
Diagnostic Lab Data:
CDC Split Type: MT0410
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1258CA3IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX077222SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.09621SCLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Injection site mass, Oedema
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)
Write-up: Child woke up AM of 8/27/04 with upper right arm swollen, hot and hard. Swelling from shoulder to just above elbow. Mom giving Tylenol for relief of pain. No other sx. Advised mom to continue with Tylenol or Ibuprofen for swelling and cold compresses and to call MD if sx worsen or don''t get better over next 7 days. 9/8/04 TC: child is fine arm swelling lasted 6 days from onset.

VAERS ID:226899 (history)  Vaccinated:2004-09-14
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:2004-09-16
Location:California  Entered:2004-09-22, 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: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1290DA2IM 
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5461A21IM 
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX03132SCLA
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 at injection site.

VAERS ID:226901 (history)  Vaccinated:2004-09-07
Age:6.0  Onset:2004-09-07, Days after vaccination: 0
Gender:Male  Submitted:2004-09-15, Days after onset: 8
Location:Colorado  Entered:2004-09-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humulen N, Humulog
Current Illness: Diabetes
Preexisting Conditions: Diabetes
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0038P0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.09260IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, 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: Patient was given adult pneumo vaccinine 9/7/04. Mother of child reported he started running high fever with redness and swelling in left deltoid area where Pneumo immunization was given IM.

VAERS ID:226909 (history)  Vaccinated:2004-08-12
Age:6.0  Onset:2004-08-18, Days after vaccination: 6
Gender:Female  Submitted:2004-08-19, Days after onset: 1
Location:Colorado  Entered:2004-09-22, Days after submission: 34
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: Heart Murmur
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS632B24IM 
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURX01463IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0396N1SC 
Administered by: Military     Purchased by: Military
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: Red ring around injection site 1 week later. Pt c/o itching in area. Tx. Benadryl and Hydrocortisone.

VAERS ID:226950 (history)  Vaccinated:2004-09-07
Age:6.0  Onset:2004-09-08, Days after vaccination: 1
Gender:Female  Submitted:2004-09-22, Days after onset: 14
Location:Illinois  Entered:2004-09-22
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)AVENTIS PASTEURU1288CA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX0566-23SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1039N1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Oedema, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Itching, redness, and swelling in left arm; 2x3 inches in diameter; warm to touch; No fever

VAERS ID:226990 (history)  Vaccinated:2004-09-13
Age:6.0  Onset:2004-09-14, Days after vaccination: 1
Gender:Male  Submitted:2004-09-15, Days after onset: 1
Location:Michigan  Entered:2004-09-24, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM616A23 RA
Administered by: Unknown     Purchased by: Public
Symptoms: Erythema, Feeling hot
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5" x 4" erythema, heat right deltoid.

VAERS ID:226999 (history)  Vaccinated:2004-08-20
Age:6.0  Onset:2004-08-21, Days after vaccination: 1
Gender:Female  Submitted:2004-08-23, Days after onset: 2
Location:Texas  Entered:2004-09-24, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TB Test (Parkdale 00154P)
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1301CA4 LL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX08003 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1032N1 LA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness, swelling, fever. Tylenol q 4 hours. Cool pack to leg q 4 hours. RTC PRN if necessary.

VAERS ID:227009 (history)  Vaccinated:2004-09-10
Age:6.0  Onset:2004-09-11, Days after vaccination: 1
Gender:Male  Submitted:2004-09-24, Days after onset: 13
Location:Missouri  Entered:2004-09-24
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 (TRIPEDIA)AVENTIS PASTEURU1301DA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX05533IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0963N1SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Hypersensitivity, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother reported that on 9/11/04 child had reddened, raised "hive" and c/o "itching". Saw FNP on 9/13/04. Was told possible allergic reaction to immunizations or could have had allergic reaction to something else he had came in contact with. Child had three days of itching. Hives diminished over ten day period. Child followed up with primary care physician on 9/22/04. He agreed it was allergic reaction to something and could have possibly been an immunization.

VAERS ID:227074 (history)  Vaccinated:2004-09-20
Age:6.0  Onset:2004-09-21, Days after vaccination: 1
Gender:Male  Submitted:2004-09-22, Days after onset: 1
Location:Massachusetts  Entered:2004-09-28, Days after submission: 6
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 (TRIPEDIA)AVENTIS PASTEURU1314AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX07993SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left arm swollen, red, warm to touch with 3cm in diameter. No Tx except ice and Motrin for pain if needed.

VAERS ID:227077 (history)  Vaccinated:2004-09-15
Age:6.0  Onset:2004-09-16, Days after vaccination: 1
Gender:Female  Submitted:2004-09-17, Days after onset: 1
Location:New York  Entered:2004-09-28, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD (002D3 P) on 9/15/04
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC: PNEUMO (PREVNAR)LEDERLE LABORATORIESA57553D2IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling hot, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Severe swelling at deltoid area warm to touch, slightly red, no pain.

VAERS ID:227119 (history)  Vaccinated:2004-09-27
Age:6.0  Onset:2004-09-27, Days after vaccination: 0
Gender:Female  Submitted:2004-09-28, Days after onset: 1
Location:Indiana  Entered:2004-09-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives, paralysis-one side, swelling of face. Lasted one day.;DTP (unknown mfr);4;18;In Sibling
Other Medications: Tylenol just before vaccination.
Current Illness: Cough in AM. Temperature at time of vaccination was 99.2.
Preexisting Conditions: Allergy to Sulfa
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1301AA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX07073SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1187N1SCLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Small hives by 4:30 PM on 9-27-04. Stomach, legs and ankles. Fever, judged by mother, 101.

VAERS ID:227135 (history)  Vaccinated:2004-08-03
Age:6.0  Onset:2004-08-04, Days after vaccination: 1
Gender:Male  Submitted:2004-09-23, Days after onset: 50
Location:Texas  Entered:2004-09-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin; Robitussin
Current Illness: Pharyngitis; Otitis Media
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1614AA3IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0458P0IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX08003SCRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Ecchymosis, Injection site oedema
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Developed cellulitis of upper arm after immunizatino requiring hospitalization and IV antibiotics. Nurse follow up on 10/13/04 states: "Swelling of L upper extremity and ecchymosis in center of L deltoid - DTaP injection site. "

VAERS ID:227210 (history)  Vaccinated:2004-09-07
Age:6.0  Onset:2004-09-08, Days after vaccination: 1
Gender:Male  Submitted:2004-09-10, Days after onset: 2
Location:Oregon  Entered:2004-09-30, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OR200432
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)MASS. PUB HLTH BIOL LABU1314AA IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0482P IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX0555 IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0099N SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Feeling hot, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, slight swelling, hot to touch of entire upper left arm. Approximately 4" x 4"

VAERS ID:227434 (history)  Vaccinated:2004-10-01
Age:6.0  Onset:0000-00-00
Gender:Male  Submitted:2004-10-04
Location:Maryland  Entered:2004-10-07, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)SMITHKLINE BEECHAM632A24IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW03633 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1229N1 LL
Administered by: Private     Purchased by: Public
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 3" x 4" area of erythema left thigh. Post immunization on 10/01/2004

VAERS ID:227499 (history)  Vaccinated:1975-09-24
Age:6.0  Onset:1975-10-04, Days after vaccination: 10
Gender:Male  Submitted:2004-10-01, Days after onset: 10590
Location:Unknown  Entered:2004-10-08, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: NONE
Diagnostic Lab Data: Diagnostic lab: Viral serology, normal; Head CT: normal; Skull x-ray: normal; Visual field test: see narrative; FTA-ABS: normal; Blood chemistry: normal; Urinalysis: normal; Serum protein: normal; Cerebrospinal fluid: see narrative; CBC: normal;
CDC Split Type: WAES0409USA01416
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER   UN
Administered by: Other     Purchased by: Other
Symptoms: Blindness, CSF test abnormal, Eye pain, Laboratory test abnormal, Malaise, Optic discs blurred, Optic neuritis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (narrow), Optic nerve disorders (narrow), Demyelination (narrow), Retinal disorders (broad), Ocular infections (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: It was reported in a published article, concerning a 6 year old male with no allergies, an unremarkable medical and surgical history with no family history of multiple sclerosis, Leber''s optic neuritis, or other ocular or central nervous system disease who on 09/24/1975 during a routine physical examination was vaccinated with a dose of MMRII (manufacturer unknown). There was no concomitant medication. 11 days after vaccination on 10/04/75, the child developed an oral temperature of 39.4 degrees C, which lasted for one day. The child was otherwise well until 10/12/75, when he developed general malaise, left orbital pain on horizontal gaze and inability to see with his left eye. It was noted that he was examined on 10/13/75, for bilateral optic disc swelling and decreased visual acuity. It was also noted that the pt had developed bilateral simultaneous optic neuritis 18 days after vaccination. A physical examination on admission was unremarkable except for ocular findings. Visual acuity was OD: 6/7.5 (20/25); OS: finger counting at one foot. The left pupil had an afferent defect. The right optic disc was elevated and spontaneous venous pulsations were present. In the left fundus there were elevation of the optic disc, congestion of the nerve fiber layer, scattered splinter hemorrhages and no spontaneous venous pulsations. Quantitative visual field testing was normal on the right and not obtainable on the left eye because of poor fixation. Extra ocular muscle function, anterior segment, the vitreous, macula, and the peripheral retina were all normal for each eye. Studies included computed axial tomography of the brain, which was normal. A routine skull x-ray film series, coned down views of the sella, orbital apices, sinuses and optic foramina were also normal. The diagnosis of bilateral optic neuritis complicating the vaccination made. Complete blood cell count, serum chemistry, serum protein electrophoresis, fluorescent treponemal antibody tests, viral serology and urology were normal. Cerebral spinal fluid analysis revealed a glucose of 88mg/100ml; protein, 11.6mg/100ml; and chlorise 119mg/100m. The spinal tap was traumatic with many red blood cells present. No inflammatory cells were reported and cultures of this fluid were negative for pathogens. The pt was given 40mg of prednisone orally each day. Five days later the visual acuity improved to OD: 6/6 (20/20) on the tenth day. Spontaneous venous pulsations were present bilaterally at that time. After 10 days the dosage of oral prednisone was gradually reduced during the ensuing several weeks. The visual acuity returned to 6/6 (20/20) in each eye within several weeks, but the afferent conduction defect persisted on the left. Visual fields remained normal on the right, but showed a persistent irregular inferior defect on the left. The pt''s condition has remained stable for 14 months. The authors noted an additional pt with adverse events after vaccination with MMRII (manufacturer unknown)(WAES# 0409USA01386). No further information is available. A copy of the published article is attached as further documentation of the pt''s experience. Upon further review of the literature article (WAES # 0409USA01386), it was noted in the reference that the above mentioned pt (WAES # 0409USA01416) experienced adverse events after vaccination with MMRII (manufacturer unknown). WAES # 0409USA01416 was created with a date learned of 12/08/78. Follow up 03/03/05: Patient''s recovery status is unknown.

Result pages: prev   2380 2381 2382 2383 2384 2385 2386 2387 2388 2389 2390 2391 2392 2393 2394 2395 2396 2397 2398 2399 2400 2401 2402 2403 2404 2405 2406 2407 2408 2409 2410 2411 2412 2413 2414 2415 2416 2417 2418 2419 2420 2421 2422 2423 2424 2425 2426 2427 2428 2429 2430 2431 2432 2433 2434 2435 2436 2437 2438 2439 2440 2441 2442 2443 2444 2445 2446 2447 2448 2449 2450 2451 2452 2453 2454 2455 2456 2457 2458 2459 2460 2461 2462 2463 2464 2465 2466 2467 2468 2469 2470 2471 2472 2473 2474 2475 2476 2477 2478 2479 2480 2481 2482 2483 2484 2485 2486 2487 2488 2489 2490 2491 2492 2493 2494 2495 2496 2497 2498 2499 2500 2501 2502 2503 2504 2505 2506 2507 2508 2509 2510 2511 2512 2513 2514 2515 2516 2517 2518 2519 2520 2521 2522 2523 2524 2525 2526 2527 2528 2529 2530 2531 2532 2533 2534 2535 2536 2537 2538 2539 2540 2541 2542 2543 2544 2545 2546 2547 2548 2549 2550 2551 2552 2553 2554 2555 2556 2557 2558 2559 2560 2561 2562 2563 2564 2565 2566 2567 2568 2569 2570 2571 2572 2573 2574 2575 2576 2577 2578   next

New Search

Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=2479&PERPAGE=100&ESORT=AGE


Copyright © 2016 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166