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Case Details (Sorted by Age)

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VAERS ID:372127 (history)  Vaccinated:2009-12-07
Age:12.0  Onset:2009-12-07, Days after vaccination: 0
Gender:Male  Submitted:2009-12-08, Days after onset: 1
Location:Puerto Rico  Entered:2009-12-08
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': PR0936
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP021AA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache
SMQs:
Write-up: PATIENT REFERS HEADACHE AFTER VACCINATION.

VAERS ID:372145 (history)  Vaccinated:2009-11-23
Age:12.0  Onset:2009-11-23, Days after vaccination: 0
Gender:Female  Submitted:2009-12-07, Days after onset: 14
Location:California  Entered:2009-12-08, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0912USA00455
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Information has been received from a physician concerning a 12 year old female who on 23-NOV-2009 was vaccinated with a second 0.5 ml dose of GARDASIL (route, site and lot # not reported). Concomitant vaccine included a dose of MENACTRA and a dose of H1N1 on the same day (23-NOV-2009). The physician reported that the patient experienced fainting and seizure for 15 seconds after getting the second dose of GARDASIL on 23-NOV-2009. At the time of the report the outcome of the patient was recovered on an unspecified date. The patient sought unspecified medical attention. Upon internal review, seizure was determined to be an other important medical event. Additional information has been requested.

VAERS ID:372192 (history)  Vaccinated:2009-12-07
Age:12.0  Onset:2009-12-07, Days after vaccination: 0
Gender:Male  Submitted:2009-12-08, Days after onset: 1
Location:Florida  Entered:2009-12-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICSUP042AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Eye pruritus, Eye swelling, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow)
Write-up: Eyes, itchy, swollen. 10 minutes post vaccination. Skin flushed, sweaty. BENADRYL given. Child sent home with mom

VAERS ID:372207 (history)  Vaccinated:2009-12-07
Age:12.0  Onset:2009-12-08, Days after vaccination: 1
Gender:Male  Submitted:2009-12-08, Days after onset: 0
Location:New Jersey  Entered:2009-12-08
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: Thyroxine Binding Globulin Deficiency at birth
Diagnostic Lab Data: Referred to ER
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypoaesthesia, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Right arm weakness and numbness.

VAERS ID:372234 (history)  Vaccinated:2009-12-08
Age:12.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Female  Submitted:2009-12-08, Days after onset: 0
Location:Washington  Entered:2009-12-08
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS100738040IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Nervousness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: At 11:00 AM, patient reports feeling shaky and dizzy. Patient denies shortness of breath. No rash; no reports of itching, burning, or pain. Vitals stable.At 11:20 AM, patient denies any symptoms and ambulated with steady gait noted. Patient discharged at 11:35 AM.

VAERS ID:373188 (history)  Vaccinated:2008-05-16
Age:12.0  Onset:2009-05-18, Days after vaccination: 367
Gender:Female  Submitted:2009-11-13, Days after onset: 179
Location:Ohio  Entered:2009-12-08, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: B pertussis serology 19 May 2009 DNA detected
CDC 'Split Type': A0788636A
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B024AA UNLL
Administered by: Private     Purchased by: Private
Symptoms: Cough, Pertussis, Pertussis identification test positive
SMQs:, Anaphylactic reaction (broad)
Write-up: This case was reported by a healthcare professional, via a GSK representative and described the occurrence of pertussis in a subject of unspecified age and gender who was vaccinated with BOOSTRIX (Glaxosmithkline). On 16 May 2008 the subject received unspecified dose of BOOSTRIX (details unknown). On 18 May 2009, 12 months after vaccination with BOOSTRIX, the subject developed pertussis. It was reported that others in the subject''s family may also be infected and that the health department has been contacted. The family was being treated. At the time of reporting the outcome of the event was unspecified. Follow-up information received on 18 June 2009 indicated that the subject was a 12 year old female. She received BOOSTRIX and developed pertussis, whooping cough and or cough. The events resolved and were considered by the reported to be unrelated to treatment with BOOSTRIX. MENACTRA was administered concurrently on 16 May 2008.+

VAERS ID:372448 (history)  Vaccinated:2009-12-09
Age:12.0  Onset:2009-12-09, Days after vaccination: 0
Gender:Male  Submitted:2009-12-09, Days after onset: 0
Location:New York  Entered:2009-12-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500777P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Swollen lips

VAERS ID:372594 (history)  Vaccinated:2009-12-08
Age:12.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Male  Submitted:2009-12-09, Days after onset: 1
Location:Virginia  Entered:2009-12-10, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500849P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)
Write-up: Student received H1N1 LAIV at 1:20 at school. Complained of tingling in mouth and tongue at 1:50. No swelling, hives or wheezing. Vital signs stable. Student observed for 1 hour, mother contacted . Student remained stable and went home with mother at 3:30pm.

VAERS ID:372768 (history)  Vaccinated:2009-11-23
Age:12.0  Onset:2009-11-23, Days after vaccination: 0
Gender:Male  Submitted:2009-12-07, Days after onset: 14
Location:Florida  Entered:2009-12-11, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to milk and eggs; Hematuria; Asthma
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3047AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3356AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1160Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad)
Write-up: Had mild respiratory difficulty after immunization. Resolved with administration of BENADRYL. Also allergic to milk and eggs.

VAERS ID:372873 (history)  Vaccinated:2009-12-09
Age:12.0  Onset:2009-12-09, Days after vaccination: 0
Gender:Female  Submitted:2009-12-09, Days after onset: 0
Location:Ohio  Entered:2009-12-11, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma allergies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS102736P1A0IMRA
Administered by: Public     Purchased by: Other
Symptoms: Dizziness, Headache, Muscular weakness, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)
Write-up: Shot given, 5-10 minutes became dizzy c/o HA, stomach, legs shaky. When tried to walk, almost fell because legs weak & shaky.

VAERS ID:372918 (history)  Vaccinated:2009-11-25
Age:12.0  Onset:2009-12-06, Days after vaccination: 11
Gender:Male  Submitted:2009-12-12, Days after onset: 6
Location:Tennessee  Entered:2009-12-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500785P IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Facial nerve disorder, Facial palsy, Facial paresis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Patient received H1N1 vaccine on 11/25/9 per father. Pt face on left side became paralyzed Dec 6, 2009. Today is 1st time patient seen by provider since onset of paralysis. Vaccine given by State Health Department at school. Dx: Bell''s palsy.

VAERS ID:373096 (history)  Vaccinated:2009-12-11
Age:12.0  Onset:2009-12-11, Days after vaccination: 0
Gender:Female  Submitted:2009-12-14, Days after onset: 3
Location:Maryland  Entered:2009-12-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Eczema; Family hx asthma
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP013AA0IMLA
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500745P1IN 
HEPA: HEP A (VAQTA)MERCK & CO. INC.1100Y0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0087Y2IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Syncope, Throat irritation, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient to lab for blood draw post vaccine, syncopal episode outside lab, patient alert c/o abdominal pain, ringing in ears, throat "feels like bleeding". Patient stayed at office for observation x30 minutes v/s monitored, patient denied sx and released home with parent.

VAERS ID:373129 (history)  Vaccinated:2009-12-01
Age:12.0  Onset:2009-12-01, Days after vaccination: 0
Gender:Male  Submitted:2009-12-14, Days after onset: 13
Location:Alaska  Entered:2009-12-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: Headache and no appetite the morning that the vaccine was administered.
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500784P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Body temperature increased, Decreased appetite, Headache
SMQs:, Neuroleptic malignant syndrome (broad)
Write-up: Did have a headache and no appetite the morning of 12/01/2009. He did go to school and received a nasal H1N1 in the early morning. He did take Tylenol sometime during the morning, but his headache was worse by noon. His temp by mid afternoon was 101 degrees. No complaints of headache. He was given more Tylenol and went to sleep. His temp between 8 pm and 9 pm was taken again and was 104.4 degrees. He was given ibuprofen which did not bring his temp down. He was given another dose of Tylenol and went to sleep. His temp the morning of 12/02/2009 was normal.

VAERS ID:373326 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-15, Days after onset: 5
Location:Washington  Entered:2009-12-15
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP031AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: None Stated. 200 Dec 10 WTW Gave 200 H1N1 FLU SHOT. PT APPARENTLY FAINTED/SEIZED WITHIN 30 SECONDS AND REVIVED WITHIN ANOTHER 30 SECONDS. MOM SAID PT HAD EGG ALLERGY AS BABY, BUT HAS OUTGROWN IT AND HAS HAD SEASONAL FLU SHOT. MOM ALSO SAID PT BUMPED HEAD TWO WEEKS PRIOR. PARAMEDCS SUSPECTED VASO-VAGAL REACTION. PT ROUGHT TO EMERGENCY DEPT FOR CHECK-UP. ASSISTANT MANAGER, TOOK PT NAME AND PHONE NUMBER FOR FOLLOW-UP AND INCIDENT REPORT

VAERS ID:373469 (history)  Vaccinated:2009-07-08
Age:12.0  Onset:2009-07-09, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:New Hampshire  Entered:2009-12-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Mathematic dyscalculia
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF460BA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Headache, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient & brother had similar sx following vaccination - nausea/vomiting headache, low grade fever.

VAERS ID:373481 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-10, Days after onset: 0
Location:Kansas  Entered:2009-12-16, 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: Unknown
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P UNRA
Administered by: Other     Purchased by: Public
Symptoms: Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: C/O sitting in class writing when arm became weak. No other SX (equal grasp bilat; 1-2 sec cap refill bilat). Monitored for approx. 1 hr. SX continued with change. Telephone call to mom informed of SX. Mom started to send back to class, she would watch and contact PCP if sx persist.

VAERS ID:373486 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-10, Days after onset: 0
Location:Kentucky  Entered:2009-12-16, 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: Unknown
Current Illness: No
Preexisting Conditions: allergic to bee stings.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500757P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Dysphonia, Hypoaesthesia facial
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad)
Write-up: C/O face feeling numb, hard to talk. Denies SOA, itching. Able to move face into multiple expressions, speech clear. Monitored for approx 30 min. T.C. to mom- mom wanted child to return to class. Mom called 5min later and stated would pick child up and call PCP.

VAERS ID:373488 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-10, Days after onset: 0
Location:Kentucky  Entered:2009-12-16, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: hx: appendectomy
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10UNLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain, Body temperature increased, Dizziness, Headache, Heart rate irregular
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)
Write-up: C/O head ache, dizzy, abd pain, given juice, crackers, water, monitored, parent called to pick up related to irregular HR and increased temp. Father came and picked up child, stated would call pediatrician.

VAERS ID:373491 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-10, Days after onset: 0
Location:Kentucky  Entered:2009-12-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10UNLA
Administered by: Other     Purchased by: Public
Symptoms: Limb discomfort, Pain
SMQs:
Write-up: (L) arm. C/o arm "feels weird", hurts to move hand and arm. Equal grip & 1-2 sec cap refill bilat. TC to parent advising of situation-She stated child could go back to class. She would watch arm & contact PCP if sx cont.

VAERS ID:373495 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Female  Submitted:2009-12-10, Days after onset: 0
Location:Kentucky  Entered:2009-12-16, 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: Unknown
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10IMRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: C/O redness and itching at site. Denies any SOA or itching elsewhere. Monitored for approx 1 hr. Pt called and mom is coming to pick her up after calling pediatrician.

VAERS ID:373499 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-10, Days after onset: 0
Location:Kentucky  Entered:2009-12-16, 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: Fluoxetine; ADDERAL
Current Illness: No
Preexisting Conditions: ADHD
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10UNLA
Administered by: Other     Purchased by: Public
Symptoms: Headache, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: C/O L arm tingling down to finger tips. (equal grip bilat and 1-2 sec cap refill). C/O headache, facial expressions symmetrical, clear speech. Mom called, states pt ok to stay in class. Mom will call pediatrician.

VAERS ID:373501 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-10, Days after onset: 0
Location:Kentucky  Entered:2009-12-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10IMLA
Administered by: Other     Purchased by: Public
Symptoms: Immediate post-injection reaction, Pain in extremity
SMQs:, Hypersensitivity (narrow)
Write-up: C/o left arm pain after injection. Denies numbness, SOA, dizzy. Patient has full ROM, equal grips, brisk cap refill. VSS. Patient states ok to return to class after being evaluated and monitored 30 min.

VAERS ID:373540 (history)  Vaccinated:2009-12-08
Age:12.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Male  Submitted:2009-12-08, Days after onset: 0
Location:Kentucky  Entered:2009-12-16, 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: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102123P10UNLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: C/o local itching after receiving inj in (L) deltoid. Denies any difficulty breathing. Approx 3 inch area of redness around inj site. No hives noted. Ice pack placed at site for approx 15 min. Child cont to deny any systemic symptom and stated itching has stopped. Area around inj cont to be red but no hives or swelling noted. Released to class with instructions to return if difficulty breathing, itching or other symptoms occur.

VAERS ID:373560 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-16, Days after onset: 6
Location:Massachusetts  Entered:2009-12-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: Allergies: Azithromycin and Amoxicillin
Diagnostic Lab Data: throat culture negative
CDC 'Split Type':
Vaccination
Manufacturer
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Culture throat negative, Influenza like illness, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: Patient received H1N1 nasal spray at clinic. One hour after administration, pt reported sore throat and fever. Patient was seen in our office on 12/12/09 with continued sore throat, fever, and body aches. Throat culture was negative. Patient was treated for mild ILI with rest and hydration.

VAERS ID:373675 (history)  Vaccinated:2009-12-14
Age:12.0  Onset:2009-12-14, Days after vaccination: 0
Gender:Female  Submitted:2009-12-15, Days after onset: 1
Location:Oregon  Entered:2009-12-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Epilepsy
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500785P0IN 
TDAP: TDAP (ADACEL)SANOFI PASTEURC2966AA5IMRA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Started feeling nauseated around 4:00 PM and increased fatigue. Vomited a total of 3 times starting at 5:00 PM. No chills or fever noted. Recovered fully by next day.

VAERS ID:373859 (history)  Vaccinated:2009-12-08
Age:12.0  Onset:2009-12-09, Days after vaccination: 1
Gender:Male  Submitted:2009-12-10, Days after onset: 1
Location:Rhode Island  Entered:2009-12-17, 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: Eczema
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IMUN
Administered by: Other     Purchased by: Public
Symptoms: Arthralgia, Body temperature increased, Headache, Nausea, Oropharyngeal pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Pt received H1N1 vaccine on 12/8/09 at school. On 12/9/09 pt developed nausea, low grade temp S/T, HA & joint pains.

VAERS ID:373926 (history)  Vaccinated:2009-12-16
Age:12.0  Onset:2009-12-16, Days after vaccination: 0
Gender:Male  Submitted:2009-12-16, Days after onset: 0
Location:New York  Entered:2009-12-17, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: T- 97.8, P - 100, R - 20, BP - 100/70
CDC 'Split Type':
Vaccination
Manufacturer
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Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3351AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1388X1SCLA
Administered by: Other     Purchased by: Unknown
Symptoms: Body temperature normal, Fall, Incoherent, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient was administered VARIVAX s.c. into left arm, and the Tdap im into left arm. Patient was noted to be incoherent and fell to the floor. No Hx of seizure activity. Pt recovered within 30-40 sec. Most likely syncopal episode.

VAERS ID:373935 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-10, Days after onset: 0
Location:Virginia  Entered:2009-12-17, 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: none known
Diagnostic Lab Data: Says allergic to amoxicillin
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102143P1 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Drug hypersensitivity
SMQs:, Angioedema (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Pt received the H1N1 injection was observed for 15 min, and went back to class. He c/o feeling dizzy, so he was sent back to observation area. His color was fair skin warm and dry. He was placed in a recumbent position until school nurse transported him her clinic via wheel chair.

VAERS ID:373938 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Female  Submitted:2009-12-10, Days after onset: 0
Location:Virginia  Entered:2009-12-17, 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: inhaler prn
Current Illness:
Preexisting Conditions: chronic asthma - Had TAMIFLU 6 NOV 2009
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102143P1 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Abdominal discomfort, Dizziness
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Patient''s mother left the school after patient received her injection. While in 15 min observation, patient c/o feeling dizzy & mild stomach discomfort. She was put in recumbent position on a floor mat. BP 88/66 skin warm & dry. No c/o dyspnea. School nurse transferred her via whchr to clinic to call her mother.

VAERS ID:373952 (history)  Vaccinated:2009-12-16
Age:12.0  Onset:2009-12-17, Days after vaccination: 1
Gender:Female  Submitted:2009-12-17, Days after onset: 0
Location:Wisconsin  Entered:2009-12-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500833P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Vomited 2-3 times per hour and experienced diarrhea 3 times, no fever.

VAERS ID:374052 (history)  Vaccinated:2009-11-06
Age:12.0  Onset:2009-11-06, Days after vaccination: 0
Gender:Female  Submitted:2009-12-18, Days after onset: 42
Location:Florida  Entered:2009-12-18
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: Unk
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1008136P0IDUN
Administered by: Public     Purchased by: Public
Symptoms: Dysphagia, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow)
Write-up: Person developed slight rash and itch at 11:25 AM. BP 118/80. 11:40 developed diffaculty swallowing. 11:50 EMS arrived and took charge of management. Follow-up attempted. Phone not in service.

VAERS ID:374086 (history)  Vaccinated:2009-12-01
Age:12.0  Onset:2009-12-05, Days after vaccination: 4
Gender:Male  Submitted:2009-12-18, Days after onset: 13
Location:Wisconsin  Entered:2009-12-18
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: Asthma; Allergic Rhinitis
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
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Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1008142P0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Headache
SMQs:
Write-up: 4 days after vaccine headache for 1 day.

VAERS ID:374107 (history)  Vaccinated:2009-12-14
Age:12.0  Onset:2009-12-14, Days after vaccination: 0
Gender:Male  Submitted:2009-12-14, Days after onset: 0
Location:North Carolina  Entered:2009-12-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Duchenne''s Muscular Dystrophy
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102133P10IMUN
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Received vaccine at approximately 0930 during school vaccination clinic. Stated headache, nausea, dizziness started after eating lunch. Teacher assistant notified mom. Student''s temp was 98.5. No vomiting. Denied SOB, scratchy throat, itching, feeling of edema to tongue or throat, no difficulty breathing. Mom took student home. At 1400, spoke with mom. Student resting in bed, no rash, no changes in above symptoms.

VAERS ID:374121 (history)  Vaccinated:2009-11-30
Age:12.0  Onset:2009-11-30, Days after vaccination: 0
Gender:Female  Submitted:2009-12-15, Days after onset: 15
Location:Virginia  Entered:2009-12-18, 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: Outgrew Asthma at age 4-none since
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
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Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500727P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Oropharyngeal pain, Sensation of foreign body, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: 6 pm c/o sore throat, then something stuck in throat. At 11 pm wheezing noted-Mom administered her own Rx Albuterol 2 puffs to patient with subsequent relief of Sx. No return of wheezing.

VAERS ID:374259 (history)  Vaccinated:2009-11-20
Age:12.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Female  Submitted:2009-12-21, Days after onset: 31
Location:South Carolina  Entered:2009-12-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: asthma.
Diagnostic Lab Data: none reported
CDC 'Split Type': SC0924Pan
Vaccination
Manufacturer
Lot
Dose
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Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102046R0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dyspnoea, Hypoaesthesia, Rash, Stridor, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: rash on chest and shoulders c/o tightening of throat & S.O.B. Benadryl, Epi per standing orders, then transported to hospital via ems and released later that day.

VAERS ID:374357 (history)  Vaccinated:2009-11-20
Age:12.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Male  Submitted:2009-11-20, Days after onset: 0
Location:Rhode Island  Entered:2009-12-21, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP022AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Anxiety, Feeling abnormal
SMQs:, Dementia (broad)
Write-up: Felt funny and anxious while sitting in observation area. Brought to litter listened to lungs no wheezing, rales or rhonchi, no stridor. Gave 25 mg Benadryl PO after 15 mins patient felt normal ate a cookie and went home with mom to eat dinner and be observed. Call 911 if difficulty returns.

VAERS ID:374364 (history)  Vaccinated:2009-12-11
Age:12.0  Onset:2009-12-11, Days after vaccination: 0
Gender:Female  Submitted:2009-12-11, Days after onset: 0
Location:North Carolina  Entered:2009-12-21, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102129P10IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: rash to L forearm and R forearm. rash appears streaked, student stating jacket lining causing area feel itchy area washed cool water and soap itching stopped parent contacted.

VAERS ID:374372 (history)  Vaccinated:2009-12-01
Age:12.0  Onset:2009-12-01, Days after vaccination: 0
Gender:Female  Submitted:2009-12-01, Days after onset: 0
Location:Rhode Island  Entered:2009-12-21, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None known
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P10IMUN
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient reported dizziness and had pallor.

VAERS ID:374377 (history)  Vaccinated:2009-11-13
Age:12.0  Onset:2009-11-13, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 0
Location:Rhode Island  Entered:2009-12-21, Days after submission: 38
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
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FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP013AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: itchiness injection arm, given PO BENADRYL

VAERS ID:374386 (history)  Vaccinated:2009-12-18
Age:12.0  Onset:2009-12-18, Days after vaccination: 0
Gender:Female  Submitted:2009-12-21, Days after onset: 3
Location:Colorado  Entered:2009-12-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
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FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500822P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Dehydration, Dizziness, Dysarthria, Epistaxis, Fatigue, Lethargy, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: At 11:00 AM on 12/18/2009 five minutes after receiving H1N1 flu mist client had a bloody nose. Bleeding stopped within a few minutes, but client reported she was becoming very tired. Client struggled to keep eyes open. She became faint, and her speech became slurred. Nurse laid client on the floor and elevated legs. Lethargic condition increased in state. 911 was called. Paramedics arrived at 11:10 AM and took the client to the ER. There it was determined client recently had a sibling die and may have an adjustment disorder. Client was treated for syncope and dehydration and then discharged.

VAERS ID:374409 (history)  Vaccinated:2009-12-04
Age:12.0  Onset:2009-12-04, Days after vaccination: 0
Gender:Male  Submitted:2009-12-04, Days after onset: 0
Location:North Carolina  Entered:2009-12-21, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Stuffy nose
Preexisting Conditions: Allergies dust, pollen
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP039AA0UNRA
Administered by: Other     Purchased by: Public
Symptoms: Abdominal discomfort, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Says upset stomach, queasy. BP 90/60. P 80. No other complaints. Says he is feeling better.

VAERS ID:374420 (history)  Vaccinated:2009-12-11
Age:12.0  Onset:2009-12-11, Days after vaccination: 0
Gender:Female  Submitted:2009-12-11, Days after onset: 0
Location:North Carolina  Entered:2009-12-21, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500832P0IN 
Administered by: Other     Purchased by: Public
Symptoms: Headache
SMQs:
Write-up: States she has a headache which started about 15 minutes after she received the intranasal vaccine. State headache has remained the same

VAERS ID:374434 (history)  Vaccinated:2009-11-16
Age:12.0  Onset:2009-11-16, Days after vaccination: 0
Gender:Male  Submitted:2009-11-16, Days after onset: 0
Location:Rhode Island  Entered:2009-12-21, Days after submission: 35
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP022AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Itchy abdomen on R side not itchy prior to vaccination. Given 50 mg BENADRYL elixir PO at 5:27 pm. By 6 pm no longer itchy. Will go home w/mom to eat. Call 911 if prob reoccurs.

VAERS ID:374447 (history)  Vaccinated:2009-11-17
Age:12.0  Onset:2009-11-17, Days after vaccination: 0
Gender:Female  Submitted:2009-11-17, Days after onset: 0
Location:Rhode Island  Entered:2009-12-21, Days after submission: 34
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102040P10 LA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Pt had hives on face after H1N1 shot. No SOB noted. Lung sound clear Bi Lat. 122/80 Pules 88 RR 20. No swelling of tongue. 50ML 9.55 Hydramine liquid adm. by

VAERS ID:374457 (history)  Vaccinated:2009-11-10
Age:12.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Male  Submitted:2009-11-10, Days after onset: 0
Location:Rhode Island  Entered:2009-12-21, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP022AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Vomited & lightheaded 5 min after injected. Resolved with rest.

VAERS ID:374504 (history)  Vaccinated:2009-12-16
Age:12.0  Onset:2009-12-16, Days after vaccination: 0
Gender:Female  Submitted:2009-12-16, Days after onset: 0
Location:Vermont  Entered:2009-12-21, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: KNA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102140P10IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Headache, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Felt faint @ 10:05. Palms sweaty. Nausea. Headache. Took student to a mat to lie down. Improved. Refused water. 10:20 escorted back to classroom.

VAERS ID:374508 (history)  Vaccinated:2009-12-16
Age:12.0  Onset:2009-12-16, Days after vaccination: 0
Gender:Male  Submitted:2009-12-16, Days after onset: 0
Location:Vermont  Entered:2009-12-21, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102139P10IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)
Write-up: vertigo, light headed, pulse about 80, resp about 16/18, improved after 25 minutes

VAERS ID:374568 (history)  Vaccinated:2009-12-11
Age:12.0  Onset:2009-12-11, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:California  Entered:2009-12-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500779P0IN 
Administered by: Public     Purchased by: Public
Symptoms: Diplopia, Dry mouth, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad)
Write-up: Patient reports feeling dizzy, double/blurry vision and cotton mouth. Not felling ill earlier today. BP 130/90 HR 92 School counselor called her mother.

VAERS ID:374605 (history)  Vaccinated:2009-11-10
Age:12.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Female  Submitted:2009-11-10, Days after onset: 0
Location:Rhode Island  Entered:2009-12-21, Days after submission: 41
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP022AA UNUN
Administered by: Public     Purchased by: Public
Symptoms: Asthma, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Asthmatic, own MDI, ALBUTEROL transported to hospital with audible wheezes. S/p o2 2L, nebulizer ALBUTEROL. 11/19/09 TC home, spoke to child and asked mother to call back - child reported she was fine, back to school. 12/1/09 - no call back from parent

VAERS ID:374607 (history)  Vaccinated:2009-12-07
Age:12.0  Onset:2009-12-07, Days after vaccination: 0
Gender:Female  Submitted:2009-12-07, Days after onset: 0
Location:Unknown  Entered:2009-12-21, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102432P1 UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 1 hive (Lg) above injections.

VAERS ID:374608 (history)  Vaccinated:2009-12-07
Age:12.0  Onset:2009-12-07, Days after vaccination: 0
Gender:Female  Submitted:2009-12-07, Days after onset: 0
Location:Rhode Island  Entered:2009-12-21, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102132P1 UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Rash macular, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: Scratchy throat; hives, red blotchy skin on chest.

VAERS ID:374610 (history)  Vaccinated:2009-12-09
Age:12.0  Onset:2009-12-09, Days after vaccination: 0
Gender:Male  Submitted:2009-12-09, Days after onset: 0
Location:Hawaii  Entered:2009-12-21, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': HI0958
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102124P11UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Flushing, Hernia, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: C/o tingling in abd (unilateral area) lightheaded and hernia. Rit to mom head but knees 60--- rash to had P 60 RPR--- resp CTA- unresolved- s1 flushed facial. recovered in 6 mins.

VAERS ID:374809 (history)  Vaccinated:2009-10-27
Age:12.0  Onset:2009-10-27, Days after vaccination: 0
Gender:Male  Submitted:1962-12-17, Days after onset: 17115
Location:Pennsylvania  Entered:2009-12-23, Days after submission: 17173
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500779P0IN 
Administered by: Other     Purchased by: Private
Symptoms: Periorbital oedema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow)
Write-up: Peri-orbital edema, itching, rash.

VAERS ID:374925 (history)  Vaccinated:2009-12-17
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2009-12-17
Location:Virginia  Entered:2009-12-24, 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 reported
Preexisting Conditions: None reported
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102133P10IMRA
Administered by: Public     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Client fainted after receiving injectable H1N1 vaccine.

VAERS ID:375132 (history)  Vaccinated:2009-12-08
Age:12.0  Onset:2009-12-08, Days after vaccination: 0
Gender:Female  Submitted:2009-12-28, Days after onset: 20
Location:Texas  Entered:2009-12-28
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: ALLERGY TO AMOXICILLIN
Diagnostic Lab Data: VITAL SIGNS: BP 94/62, HR 64, RR 32
CDC 'Split Type': TX20090100
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS10214P10IMLA
Administered by: Other     Purchased by: Public
Symptoms: Convulsion, Fall, Loss of consciousness, Musculoskeletal stiffness, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad)
Write-up: STUDENT FAINTED AND OR HAD A SEIZURE AFTER RECEIVING H1N1 VACCINE AT SCHOOL. STUDENT EPISODE APPROX 20 SECONDS ARMS TURNED INWARD AND STIFFNESS AFTER FALLING, URINARY INCONTINENCE OCCURRED. STUDEN QUICKLY REGAINED CONSCIOUSNESS, ALERT AND AMBULATORY. ACCORDING TO STUDENT: NO HISTORY OF SEIZURE. PARENTS WILL FOLLOW UP WITH DOCTOR. VACCINATIONS GIVEN AT SCHOOL.

VAERS ID:375392 (history)  Vaccinated:2009-12-16
Age:12.0  Onset:0000-00-00
Gender:Male  Submitted:2009-12-21
Location:Pennsylvania  Entered:2009-12-29, 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: none
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3027AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF4B4CA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6004Y SCRA
Administered by: Private     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: None stated

VAERS ID:375446 (history)  Vaccinated:2009-12-28
Age:12.0  Onset:2009-12-29, Days after vaccination: 1
Gender:Male  Submitted:2009-12-30, Days after onset: 1
Location:Indiana  Entered:2009-12-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3030AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF551BA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1109Y0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Body temperature increased, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Temp 99''O'' 2 inch diameter reddened raised area, warm to touch on R deltoid. Motrin given per parent.

VAERS ID:375476 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2009-12-14, Days after onset: 4
Location:Kentucky  Entered:2009-12-30, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102133P10IJRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Dry skin, Skin warm
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Pt c/o being hot light headed @ 15-20 min after injection VS WNL. Drank soft drink without difficulty. Skin pink/dry. Child back to class (no further distress).

VAERS ID:375618 (history)  Vaccinated:2009-11-30
Age:12.0  Onset:0000-00-00
Gender:Male  Submitted:2009-12-04
Location:California  Entered:2009-12-31, Days after submission: 27
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: Labs done-normal
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP026AA1UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Headache, Laboratory test normal, Pain in extremity
SMQs:
Write-up: Head and leg pains after H1N1 vaccine.

VAERS ID:375670 (history)  Vaccinated:2009-12-31
Age:12.0  Onset:2009-12-31, Days after vaccination: 0
Gender:Female  Submitted:2010-01-02, Days after onset: 2
Location:Texas  Entered:2009-12-31, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Vitals only
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500833P0IN 
Administered by: Other     Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Approximately 10 minutes after receiving live H1n1 intranasal vaccine patient was with parents at front entrance and fainted. She regained consciousness upon sitting. Paramedics checked her vital signs and released her with no treatment. Parents say she faints at shot but never at Flu Mist as she had it before.

VAERS ID:375658 (history)  Vaccinated:2009-12-31
Age:12.0  Onset:2010-01-01, Days after vaccination: 1
Gender:Male  Submitted:2010-01-02, Days after onset: 1
Location:North Carolina  Entered:2010-01-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER 0IJLA
Administered by: Private     Purchased by: Other
Symptoms: Chills, Diarrhoea, Malaise, Nausea, Oropharyngeal pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Frequent loose Bowel Movements throughout day, chills, sore throat, malaise, slight nausea.

VAERS ID:375692 (history)  Vaccinated:2009-12-31
Age:12.0  Onset:2010-01-01, Days after vaccination: 1
Gender:Female  Submitted:2010-01-03, Days after onset: 2
Location:Texas  Entered:2010-01-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic sinusitis
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IMRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling of upper right arm with reddness around vaccine site; vaccine given was Pneumovax.

VAERS ID:375754 (history)  Vaccinated:2009-12-18
Age:12.0  Onset:2009-12-18, Days after vaccination: 0
Gender:Female  Submitted:2009-12-18, Days after onset: 0
Location:Missouri  Entered:2010-01-04, Days after submission: 17
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: Asthma
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102130P10IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pharyngeal oedema, Pyrexia, Throat irritation
SMQs:, Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)
Write-up: 1050 am c/o of thickness in throat, denied SOB and cough - T97.1, ZYRTEC 5mg PO liquid administered 1110am continues to c/o slight tickle in throat, ZYRTEC 5mg PO liquid administered (second dose) 1120am reported that she felt also fever, no SOB and cough reported.

VAERS ID:375760 (history)  Vaccinated:2009-12-30
Age:12.0  Onset:2010-01-02, Days after vaccination: 3
Gender:Female  Submitted:2010-01-04, Days after onset: 2
Location:Iowa  Entered:2010-01-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1100Y0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0672X1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Movement disorder, Musculoskeletal stiffness, Neck pain
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: Stiff and sore neck, unable to turn head

VAERS ID:375792 (history)  Vaccinated:2009-12-09
Age:12.0  Onset:2009-12-20, Days after vaccination: 11
Gender:Female  Submitted:2009-12-22, Days after onset: 2
Location:Connecticut  Entered:2010-01-04, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unsure
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1076Y1UNRA
Administered by: Other     Purchased by: Unknown
Symptoms: Pain, Rash, Rash pruritic, Rash vesicular, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Pt seen at Health Center with c/o facial rash. Pt noted to have vesicular like lesions around both nostrils and above top lip with 1 sm lesion to L cheek. Mother says pt received varicella vaccine on 12/9/09. Rash started 12/20/09. Itchy and painful. ATARAX ordered for itching.

VAERS ID:375937 (history)  Vaccinated:2009-10-07
Age:12.0  Onset:2009-10-07, Days after vaccination: 0
Gender:Male  Submitted:2010-01-05, Days after onset: 90
Location:New Jersey  Entered:2010-01-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Gluten sensitivity
Diagnostic Lab Data: CBC, Lymes, chronic fatigue
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   LA
Administered by: Unknown     Purchased by: Private
Symptoms: Blood test normal, Borrelia burgdorferi serology, Chills, Full blood count, Headache, Injection site pain, Injection site warmth, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: At site of injection hot and tender... headache, body chills over all malaise, patient continues every day having episodes of general malaise and severe headaches. Doctor ordered blood tests results negative.

VAERS ID:375953 (history)  Vaccinated:2009-11-30
Age:12.0  Onset:2009-11-30, Days after vaccination: 0
Gender:Male  Submitted:2010-01-05, Days after onset: 36
Location:South Carolina  Entered:2010-01-05
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': SC1005Pan
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP024AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dyspnoea, Malaise, Myalgia, Pyrexia, Vaccination complication, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)
Write-up: H1N1 vaccination at school. At 11:45 a.m. child experienced elevated temperature of 102.4 degrees, extreme malaise, muscle aching. Gradually progressed to SOB, fever of 104 degrees with vomiting at 4 p.m. on 11/30/09. Parents instructed by school nurse to transport child via EMS to Hospital. Parents of child said that doctor at hospital said child had reaction to vaccine. Attempted to obtain more information from hospital but unsuccessful.

VAERS ID:375974 (history)  Vaccinated:2010-01-05
Age:12.0  Onset:2010-01-05, Days after vaccination: 0
Gender:Female  Submitted:2010-01-05, Days after onset: 0
Location:California  Entered:2010-01-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pale, lightheaded, dizzy, pain at site of inj
Preexisting Conditions: NKDA/none
Diagnostic Lab Data: BP 96/70
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Erythema, Feeling hot, Hyperhidrosis, Immediate post-injection reaction, Injection site pain, Pain, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: At time of Garasil vaccine injection to LD IM pt immediately felt severe pain at site of injection, felt dizzy lighthead, hot and sweaty. Pain 6/10. Within 15 mins time pts color return to lips and face completely. Slight darken redness noted to skin below eyes.

VAERS ID:376083 (history)  Vaccinated:2009-12-15
Age:12.0  Onset:2009-12-15, Days after vaccination: 0
Gender:Female  Submitted:2010-01-06, Days after onset: 22
Location:South Carolina  Entered:2010-01-06
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': SC1006Pan
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102142P10IMRA
Administered by: Other     Purchased by: Public
Symptoms: Eye pruritus, Oedema peripheral, Rash erythematous
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Sl. swelling in R hand 9:48 a.m.; sl. itching L eye at 9:53 a.m.; rash under L eye-red and sl. raised. No itching at 10:14 a.m. Benadryl 50 mg IM administered L deltoid at 10:15 a.m. Monitored and released back to class with no swelling in hand; less redness of rash under eye. Follow up with mother today who states patient is doing fine. No problems. Did not have to take child to doctor or ER.

VAERS ID:376184 (history)  Vaccinated:2009-12-16
Age:12.0  Onset:2009-12-23, Days after vaccination: 7
Gender:Female  Submitted:2010-01-07, Days after onset: 15
Location:New Jersey  Entered:2010-01-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER   AR
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 2 AR
Administered by: Unknown     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Upper back appeared breakout

VAERS ID:376293 (history)  Vaccinated:2009-12-14
Age:12.0  Onset:2009-12-14, Days after vaccination: 0
Gender:Female  Submitted:2010-01-08, Days after onset: 25
Location:Puerto Rico  Entered:2010-01-08
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: TEMP - 97 F
CDC 'Split Type': PR0969
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP053AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Asthenia, Body temperature decreased, Chills, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: PATIENT REFERS DIZZINESS WITH WEAKNESS, CHILL AND PALENESS. DIDN''T EAT ANYTHING FOR A WHILE BEFORE VACCINATION.

VAERS ID:376302 (history)  Vaccinated:2009-12-16
Age:12.0  Onset:2009-12-18, Days after vaccination: 2
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:2010-01-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1198Y1SCRA
Administered by: Unknown     Purchased by: Public
Symptoms: Injection site cellulitis, Injection site swelling, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling (cellulitis) at site of injection.

VAERS ID:376371 (history)  Vaccinated:2010-01-03
Age:12.0  Onset:2010-01-06, Days after vaccination: 3
Gender:Female  Submitted:2010-01-10, Days after onset: 4
Location:Ohio  Entered:2010-01-10
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: pollen allergies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: hives over entire body

VAERS ID:376513 (history)  Vaccinated:2009-12-10
Age:12.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Male  Submitted:2010-01-11, Days after onset: 32
Location:New Mexico  Entered:2010-01-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURSP3060AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Mobility decreased, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Several hrs after injection, arm became red and swollen. Swelling increased to the point he could only move shoulder up 90 degrees, trouble flexing elbow wrist and fingers. Took 2 - 3 weeks to resolve no fever.

VAERS ID:376582 (history)  Vaccinated:2009-12-17
Age:12.0  Onset:2009-12-24, Days after vaccination: 7
Gender:Male  Submitted:2010-01-06, Days after onset: 13
Location:Georgia  Entered:2010-01-12, 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: none
Preexisting Conditions: unknown
Diagnostic Lab Data: MRI, CAT scan, EEG
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102131P10IMRA
Administered by: Other     Purchased by: Public
Symptoms: Computerised tomogram normal, Electroencephalogram normal, Epilepsy, Foaming at mouth, Full blood count normal, Gaze palsy, Grand mal convulsion, Laboratory test normal, Nuclear magnetic resonance imaging normal, Postictal state, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Client received H1N1 injection on 12-17-09 at school. One week after on Christmas Eve client started having seizures. Mother stated she took her son to the medical center for treatment. Diagnostic test done, MRI and CAT scan normal. EEG was abnormal. Client was placed on seizure meds. No history of known seizures. Mother states neurologist is adjusting meds for therapeutic level.

VAERS ID:376662 (history)  Vaccinated:2010-01-11
Age:12.0  Onset:2010-01-11, Days after vaccination: 0
Gender:Female  Submitted:2010-01-12, Days after onset: 1
Location:South Carolina  Entered:2010-01-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: none known; pt reports having blood tests done periodically but unsure of reason
Diagnostic Lab Data:
CDC 'Split Type': SC1009Pan
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1009221P0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: After receiving H1N1 vaccine in the gym at school clinic, pt returned to class. Approximately 15-20 minutes later, she returned to the gym and reported that she had "passed out" in class. She was alert and oriented, had walked to the gym on her own, and reported no ill feelings at that time. She reported that she had not eaten that day. Observed for 15 minutes by school nurse and provided with juice and crackers. Returned to class/lunch. Pt stated that she has had past episodes of "passing out" upon venipuncture.

VAERS ID:376798 (history)  Vaccinated:2010-01-11
Age:12.0  Onset:2010-01-13, Days after vaccination: 2
Gender:Male  Submitted:2010-01-13, Days after onset: 0
Location:Louisiana  Entered:2010-01-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: ADHD
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3011AA0 RA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF499BA0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1047Y1 RA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling to right deltoid area and complaint of pain to right upper arm. Keflex 500 mg every 12 hours for 10 days prescribed. Send to ER for worsening symptoms such as worsening pain, fever, nausea, vomited, increase in swelling or redness.

VAERS ID:376845 (history)  Vaccinated:2010-01-05
Age:12.0  Onset:2010-01-05, Days after vaccination: 0
Gender:Male  Submitted:2010-01-14, Days after onset: 9
Location:Maryland  Entered:2010-01-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported
Preexisting Conditions: unknown
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP048CZ0IM 
Administered by: Other     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: H1N1 vaccine administration done in the school. Child developed rash on face. One 25mg Benadryl administered. Child taken to health room. Parent notified and to pick up student

VAERS ID:376988 (history)  Vaccinated:2009-12-18
Age:12.0  Onset:2009-12-18, Days after vaccination: 0
Gender:Male  Submitted:2010-01-14, Days after onset: 27
Location:Oregon  Entered:2010-01-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: Minor asthma.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP067AA0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Feeling abnormal
SMQs:, Dementia (broad)
Write-up: After injection was given, student/patient reported feeling "low". An ice pack was applied to the back of the neck. He was given 2 4 oz containers of apple juice. He slowly drank the first container while sitting and talking with the nurse. Afterwards student returned to class less anxious and more relaxed.

VAERS ID:377057 (history)  Vaccinated:2010-01-11
Age:12.0  Onset:2010-01-12, Days after vaccination: 1
Gender:Male  Submitted:2010-01-13, Days after onset: 1
Location:Maryland  Entered:2010-01-15, Days after submission: 2
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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3352AA IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1100Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3056AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1119Y UNRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site induration, Injection site inflammation
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Area of induration measuring 8 x 9 cm over R deltoid. 24 hours after receiving vaccine inflammation started per pt. Pt seen 48 hours after vaccination.

VAERS ID:377112 (history)  Vaccinated:2010-01-07
Age:12.0  Onset:2010-01-07, Days after vaccination: 0
Gender:Female  Submitted:2010-01-16, Days after onset: 9
Location:Kansas  Entered:2010-01-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Skin color pale when she came
Preexisting Conditions: Hypothyroidism; thrombocytopenia; bipolar disorder
Diagnostic Lab Data: None done at time of incident.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR113014AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B047DA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1042Y0SCLA
Administered by: Private     Purchased by: Other
Symptoms: Loss of consciousness, Postictal state
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Approximately 2 minutes after VARIVAX, MENACTRA, and BOOSTRIX were given, pt. slumped over and "passed out". It took approximately 8 minutes for her to awaken and then she appeared postictal, although no seizure activity was noted.

VAERS ID:377130 (history)  Vaccinated:2010-01-14
Age:12.0  Onset:2010-01-15, Days after vaccination: 1
Gender:Female  Submitted:2010-01-18, Days after onset: 3
Location:New Jersey  Entered:2010-01-18
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
HPV4: HPV (GARDASIL)MERCK & CO. INC.1129X2UNAR
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives night of vaccine & continued to increase over 3 d.

VAERS ID:377211 (history)  Vaccinated:2010-01-13
Age:12.0  Onset:2010-01-13, Days after vaccination: 0
Gender:Male  Submitted:2010-01-18, Days after onset: 5
Location:Virginia  Entered:2010-01-18
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: possible allergy to Germ-X ingredients
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP118AA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal discomfort, Scratch
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Approximately 20 minutes after receiving vaccine, patient started with scratching on left arm and stomach was churning for about 30 minutes

VAERS ID:377325 (history)  Vaccinated:2010-01-11
Age:12.0  Onset:2010-01-12, Days after vaccination: 1
Gender:Male  Submitted:2010-01-13, Days after onset: 1
Location:Arizona  Entered:2010-01-19, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Lactose intolerant
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB359A40IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2914AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3098BA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Child developed red area of swelling, itching apprx. 20 mm within 24 hrs of Tdap, Mening. vaccination to LT arm. Parent did not give any medications for relief. Advised to give BENADRYL and ibuprofen p.o. and cool compress every 6 hrs. Bring to M.D. if fever or continued swelling occur.

VAERS ID:377415 (history)  Vaccinated:2010-01-13
Age:12.0  Onset:2010-01-13, Days after vaccination: 0
Gender:Male  Submitted:2010-01-19, Days after onset: 6
Location:Virginia  Entered:2010-01-19
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: scoliosis
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP118AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Hyperhidrosis, Nausea, Tinnitus, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow)
Write-up: Patient felt nausea and stomach churning approximately 10 minutes after receiving vaccine. Shortly after this patient''s left ear began ringing and palms started sweating and hands shaking. Ringing continued for at least 1 hour. Patient was given Benadryl 25mL PO. BP = 110/85, P = 86, T = 97.7

VAERS ID:377421 (history)  Vaccinated:2010-01-13
Age:12.0  Onset:2010-01-13, Days after vaccination: 0
Gender:Female  Submitted:2010-01-19, Days after onset: 6
Location:Virginia  Entered:2010-01-19
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP118AA0IMUN
Administered by: Other     Purchased by: Public
Symptoms: Blood pressure increased, Flushing, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: Fainted in classroom, BP = 160/100, flushed, elevated legs, HR = 111. Stabilized by 12:20 PM.

VAERS ID:377424 (history)  Vaccinated:2010-01-12
Age:12.0  Onset:2010-01-15, Days after vaccination: 3
Gender:Male  Submitted:2010-01-19, Days after onset: 4
Location:California  Entered:2010-01-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abdominal pain
Preexisting Conditions: none noted seen for CHDP (Well Child Visit)
Diagnostic Lab Data: CBC, ESR, Keflex 500mg TID x 10d, Benadryl
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102124P10IMLA
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500721P0IN 
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB762BA1IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB387BA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3053AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF499AA5IMRA
Administered by: Other     Purchased by: Public
Symptoms: Full blood count, Neck pain, Oedema peripheral, Rash papular, Red blood cell sedimentation rate normal
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)
Write-up: Swollen arm. Bump on rt side of neck-painful to the touch, no fever.

VAERS ID:377431 (history)  Vaccinated:2010-01-15
Age:12.0  Onset:2010-01-16, Days after vaccination: 1
Gender:Male  Submitted:2010-01-19, Days after onset: 3
Location:Texas  Entered:2010-01-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergies to bees, wasps, pollen, dust spiders
Diagnostic Lab Data: None Known
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1013293P0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Joint swelling, Rash
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Received injection in left arm and woke up the next morning with swelling and rash in the bend of the right arm and face.

VAERS ID:377535 (history)  Vaccinated:2010-01-14
Age:12.0  Onset:2010-01-14, Days after vaccination: 0
Gender:Male  Submitted:2010-01-14, Days after onset: 0
Location:South Carolina  Entered:2010-01-20, 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:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B047EA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1198Y1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Anaphylactic reaction, Cough, Dyspnoea, Eye pruritus, Eye swelling, Heart rate increased, Nasal congestion, Oxygen saturation decreased, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Anaphylaxis approximately 10-20 minutes after injection. Swelling and itching of eyes, nasal congestion, coughing, wheezing, difficulty breathing. O2 sat decreased 90% HR increased 183. Required oxygen, epinephrine, albuterol via nebulizer, transported to hospital emergency room via ambulance.

VAERS ID:377587 (history)  Vaccinated:2009-12-09
Age:12.0  Onset:2009-12-10, Days after vaccination: 1
Gender:Female  Submitted:2010-01-20, Days after onset: 41
Location:Minnesota  Entered:2010-01-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: At three diagnosed with infection induced reactive airway....no real need for meds since the age of 6
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS 0 LA
Administered by: Unknown     Purchased by: Private
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Chest Pain

VAERS ID:377623 (history)  Vaccinated:2010-01-20
Age:12.0  Onset:2010-01-20, Days after vaccination: 0
Gender:Female  Submitted:2010-01-20, Days after onset: 0
Location:Florida  Entered:2010-01-20
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: allergy to "pollen"
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500731P IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3333AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1199Y1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site urticaria, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: 20-30 minutes after administration, developed 9 cm diameter area of redness/swelling at site of VARIVAX injection with diffuse pruritis and hives - including trunk and extremities.

VAERS ID:377659 (history)  Vaccinated:2010-01-14
Age:12.0  Onset:2010-01-14, Days after vaccination: 0
Gender:Female  Submitted:2010-01-21, Days after onset: 7
Location:New York  Entered:2010-01-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP021AA0IMRA
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500749P IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.1009Y1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: C/o left arm-seen by MD 1/15/10 12PM-?possible reaction to FluMist, GARDASIL or H1N1 rec''d. No additional doses at this time, no intervention necessary now.

VAERS ID:377875 (history)  Vaccinated:2009-11-17
Age:12.0  Onset:2009-11-17, Days after vaccination: 0
Gender:Male  Submitted:2009-11-17, Days after onset: 0
Location:Rhode Island  Entered:2010-01-22, Days after submission: 66
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
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102040P10IMAR
Administered by: Public     Purchased by: Public
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: No c/o of SOB, c/p. Pt. states he vomited aprx. 20 minutes ago in bathroom. VSS 112/70, 84, 22, lung sounds clear.

VAERS ID:378118 (history)  Vaccinated:2010-01-11
Age:12.0  Onset:2010-01-12, Days after vaccination: 1
Gender:Male  Submitted:2010-01-25, Days after onset: 13
Location:Mississippi  Entered:2010-01-25
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
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER62908AA0IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 2 CM RAISED REDDENED AREA

VAERS ID:378251 (history)  Vaccinated:2010-01-14
Age:12.0  Onset:0000-00-00
Gender:Male  Submitted:2010-01-20
Location:California  Entered:2010-01-26, 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:
Current Illness: No documentation, no
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1152X1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Left arm 5cm area of erythema. VIW after arm of VARIVAX.

VAERS ID:378306 (history)  Vaccinated:2010-01-15
Age:12.0  Onset:2010-01-15, Days after vaccination: 0
Gender:Female  Submitted:2010-01-25, Days after onset: 10
Location:Georgia  Entered:2010-01-26, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx - asthma - parent noted no meds taken
Diagnostic Lab Data: Initial V/S at 11:40am. B/P 91/63, HR-65. 2nd set V/S at 11:54am. B/P 110/68 HR - unreliable, weak, faint. SPO2 - 95%
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB167BA2 RA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB376AA1 LA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0216Y1 RA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEUR00422A2 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR I)MERCK & CO. INC.0483Y2 LA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR3012AA1 RA
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LAB027A2 LA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Drooling, Heart rate irregular, Hypoventilation, Loss of consciousness, Malaise, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Noted in Incident Report - patient sitting up in chair @ 11:40am - approx 15 minutes after vaccination. Stated - did not feel well, noted patient was pale, shallow breathing, drooling at mouth slightly... LOC. Patient placed in Trendlenberg position, O2 applied, V/S taken. See below. EMS called. Patient taken to hospital for f/u.

VAERS ID:378308 (history)  Vaccinated:2009-12-16
Age:12.0  Onset:2009-12-17, Days after vaccination: 1
Gender:Male  Submitted:2009-12-18, Days after onset: 1
Location:Idaho  Entered:2010-01-26, Days after submission: 39
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': ID09034
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC3249AA0IMRA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1601X0IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURD0052220IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1759X0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1049Y0SCRA
Administered by: Private     Purchased by: Public
Symptoms: Induration, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Large 4 x 5 cm erythematous and indurated lesion, mildly pruritic, conservative treatment with antihistamines and ice advised.

VAERS ID:378355 (history)  Vaccinated:2009-12-09
Age:12.0  Onset:2009-12-09, Days after vaccination: 0
Gender:Male  Submitted:2009-12-09, Days after onset: 0
Location:Ohio  Entered:2010-01-26, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER102129P1  RA
Administered by: Public     Purchased by: Other
Symptoms: Headache, Hyperhidrosis, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Blurred vision, headache, sweating

VAERS ID:378400 (history)  Vaccinated:2010-01-19
Age:12.0  Onset:2010-01-22, Days after vaccination: 3
Gender:Male  Submitted:2010-01-22, Days after onset: 0
Location:Unknown  Entered:2010-01-26, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No past medical problems
Diagnostic Lab Data: The physician evaluated and treated the site where the vaccine was given.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B030BA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site inflammation, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient recieved TDAP vaccine on January 19, 2010. Mother called January 22, 2010 report severe swelling and inflammation in Right arm, patient was seen the same day as a sick visit.

VAERS ID:378476 (history)  Vaccinated:2009-11-04
Age:12.0  Onset:2009-12-16, Days after vaccination: 42
Gender:Female  Submitted:2010-01-19, Days after onset: 34
Location:Indiana  Entered:2010-01-27, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Cerebral palsy.
Diagnostic Lab Data: Recent MRI brain/spine; normal ABD x-ray; Jan ''10 orthopaedic Doctor observed change.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1008142P0IMLL
Administered by: Private     Purchased by: Private
Symptoms: Abasia, Abdominal X-ray, Abdominal discomfort, Abdominal distension, Aggression, Asthenia, Constipation, Crying, Diarrhoea, Drooling, Dysstasia, Emotional distress, Extraocular muscle paresis, Gait disturbance, Hypotonia, Irritability, Lethargy, Malaise, Moaning, Nuclear magnetic resonance imaging brain abnormal, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Respiratory tract congestion, Sluggishness, Tympanic membrane hyperaemia, Urinary system X-ray, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow)
Write-up: Overall weakness, started drooling, decreased leg hypertonia, decreased abdominal muscle function, extreme constipation with inability to pass stool without daily Fleet enema. Still able to walk, but slower.

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