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Case Details (Sorted by Age)

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VAERS ID:520651 (history)  Vaccinated:2014-01-06
Age:11.0  Onset:2014-01-06, Days after vaccination: 0
Gender:Female  Submitted:2014-01-24, Days after onset: 18
Location:Arizona  Entered:2014-01-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: FLONASE; MIRALAX
Current Illness: None
Preexisting Conditions: Bee sting allergy; NKDA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0097881IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Haematoma, Local swelling, Muscle injury, Nerve compression, Pain in extremity, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt c/o pain after vaccination, swelling, redness, tingling and radiating pain traveling down arm to hand. Pt saw neurology - R/O''d nerve involvement. DX: by provider as prob muscle tear vs. hematoma with nerve pressure.

VAERS ID:520708 (history)  Vaccinated:2014-01-22
Age:11.0  Onset:2014-01-22, Days after vaccination: 0
Gender:Female  Submitted:2014-01-24, Days after onset: 2
Location:Colorado  Entered:2014-01-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: Allergies to sulfates, paraben, latex
Diagnostic Lab Data: School nurse indicated that several kids suffered same symptoms (most of them, on the next day also)...
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNUN
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNRA
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain upper, Erythema, Headache, Pain, Pyrexia, Skin discolouration, Upper extremity mass
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: HUGE swollen lump on arm, about the size of a large baseball (width), purple, RED, FEVERISH!!!, achy, sore, painful to touch. Also caused headache, tummy ache, possible diarrhea, and had to leave school early the day after.

VAERS ID:520815 (history)  Vaccinated:2013-11-25
Age:11.0  Onset:2013-11-25, Days after vaccination: 0
Gender:Female  Submitted:2014-01-27, Days after onset: 63
Location:North Carolina  Entered:2014-01-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone propionate
Current Illness: Leg pain; ringing in head
Preexisting Conditions: No known drug allergies; Allergic Rhinitis NOS
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0112720UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4658AA0UNUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSZRY590UNLA
Administered by: Private     Purchased by: Private
Symptoms: Immediate post-injection reaction, Pain in extremity, Tinnitus
SMQs:, Hearing impairment (narrow), Hypersensitivity (narrow)
Write-up: Pt complained of leg pain and ringing in her head. Started immediately after vaccines and lasted 1 week. Symptoms have completely resolved.

VAERS ID:520903 (history)  Vaccinated:2014-01-24
Age:11.0  Onset:2014-01-25, Days after vaccination: 1
Gender:Male  Submitted:2014-01-25, Days after onset: 0
Location:Nevada  Entered:2014-01-27, 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: Asthma
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J013324 IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM13012 IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B088AA IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Local swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, itchiness, and swelling of the left arm. Necessitating ER visit 1 day after Tdap, MENACTRA, and HPV vaccination.

VAERS ID:521040 (history)  Vaccinated:2014-01-28
Age:11.0  Onset:2014-01-28, Days after vaccination: 0
Gender:Male  Submitted:2014-01-28, Days after onset: 0
Location:Ohio  Entered:2014-01-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fainting~Hep B (Recombivax HB)~2~11.00~Patient|Fainting and Vomiting~Hep B (Recombivax HB)~1~10.92~Patient|Fainting and Vomiting
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0041611SCRA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient was reclined when vaccine given and remained that way for 15 minutes post vaccination without complaints of dizziness. Upon walking out of the clinic, he became pale and dizzy. Patient sat on the floor, was laid flat with feet elevated and cold compress applied to back of neck for relief. Remained in that position for 10 minutes after which patient felt fully recovered. Sat up, stood up, and ambulated out of office without further problems.

VAERS ID:521055 (history)  Vaccinated:2014-01-21
Age:11.0  Onset:2014-01-23, Days after vaccination: 2
Gender:Male  Submitted:2014-01-28, Days after onset: 5
Location:California  Entered:2014-01-28
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Bed rest, Dizziness, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Headaches, fever, vomiting, dizzy. Treated mostly with bed rest, limited ibuprofen for headache.

VAERS ID:521180 (history)  Vaccinated:2008-02-22
Age:11.0  Onset:2008-11-19, Days after vaccination: 271
Gender:Female  Submitted:2014-01-09, Days after onset: 1877
Location:Unknown  Entered:2014-01-29, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Admitted to hospital on diagnosis of Type 1 diabetes, Hospital work up and treatment for stomach pain has included a cholecystectomy for an atonic gallbladder, now s/p colonoscopy and EGD with negative biopsies
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1522U0IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Biopsy site unspecified normal, Cholecystectomy, Colonoscopy normal, Gallbladder non-functioning, Oesophagogastroduodenoscopy normal, Type 1 diabetes mellitus, Vomiting, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Gallbladder related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Developed type 1 diabetes after first HPV and severe stomach pain with recurrent vomiting and weight loss x $g1 year after second.

VAERS ID:521237 (history)  Vaccinated:2014-01-28
Age:11.0  Onset:2014-01-28, Days after vaccination: 0
Gender:Male  Submitted:2014-01-29, Days after onset: 1
Location:Massachusetts  Entered:2014-01-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURA121009HX121000UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4247AA UNLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Induration, Pain, Pain in extremity, Skin warm
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: 24 hours post immunization patient presented with an 8.5 cm x 11 cm indurated area of erythema and warmth. Mild pain wiht moving (R) arm.

VAERS ID:521264 (history)  Vaccinated:2014-01-20
Age:11.0  Onset:2014-01-23, Days after vaccination: 3
Gender:Male  Submitted:2014-01-30, Days after onset: 7
Location:Mississippi  Entered:2014-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURN2K270IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt. had a 3 inch erythematous area to (R) upper arm with 0.5 inch hematoma in the center.

VAERS ID:521287 (history)  Vaccinated:2014-01-16
Age:11.0  Onset:2014-01-16, Days after vaccination: 0
Gender:Male  Submitted:2014-01-24, Days after onset: 8
Location:Maryland  Entered:2014-01-30, 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: Allergies: OMNICEF, POLYTRIM, RONDEC
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0112720IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA120030IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4612AA IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site rash, Injection site swelling, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Mother stated that the patient had rash on his left arm where the patient received his 11 year shot. Rash was from his upper arm to his left elbow. Localized rash according to mother. Mother applied ice to the site for the swelling and administer BENADRYL. Mother stated that the patient rash clear up by 1-20-14.

VAERS ID:521333 (history)  Vaccinated:2014-01-27
Age:11.0  Onset:2014-01-29, Days after vaccination: 2
Gender:Male  Submitted:2014-01-30, Days after onset: 1
Location:Florida  Entered:2014-01-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM130510SYRRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Local swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness, swelling, some tenderness (R) upper arm (size 12 x 12cm). No relation to injection site.

VAERS ID:521394 (history)  Vaccinated:2013-12-01
Age:11.0  Onset:2013-12-01, Days after vaccination: 0
Gender:Unknown  Submitted:2014-01-31, Days after onset: 61
Location:South Carolina  Entered:2014-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1401USA013391
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Feeling abnormal
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: This spontaneous report as received from a nurse refers to a 11 year old patient of unknown gender who on approximately on December 2013 (within the last month or two), was vaccinated with the first dose of GARDASIL dose 1 (Dose, route and lot number was not provided). The reporter informed that the patient experienced that they "felt funny" and then had a seizure, after receiving the "eleven year old shots" which included the first dose of GARDASIL, "within the last month or two." The patient was sent to the Hospital, as per the office protocol. The patient did not required intervention to prevent serious criteria. At the time of the report the patient was well. The outcome of had a seizure, after receiving their first dose of GARDASIL and felt funny was unknown. Upon internal review, the event of seizure was considered as medically significant. The relationship between adverse events and GARDASIL was unknown. This is one of two reports from the same source. Additional information has been requested.

VAERS ID:521413 (history)  Vaccinated:2013-12-01
Age:11.0  Onset:2013-12-01, Days after vaccination: 0
Gender:Male  Submitted:2014-01-31, Days after onset: 61
Location:South Carolina  Entered:2014-01-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1401USA014092
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Convulsion, Feeling abnormal, Urinary incontinence
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: This spontaneous report as received from a nurse refers to a 11 year old patient who in approximately December 2013 (within the last month or two), was vaccinated with the first dose of GARDASIL dose 1 (dose, route and lot number was not provided). The reporter informed that the patient experienced that they "felt funny" and then had a seizure, after receiving the "eleven year old shots" which included the first dose of GARDASIL, "within the last month or two." The patient urinated upon himself, during the seizure. The patient was sent to the hospital, as per the office protocol. The patient did not require intervention to prevent serious criteria. At the time of the report the patient was well. No further information was provided. The outcome of had a seizure, after receiving their first dose of GARDASIL, urinated upon himself, during the seizure and "felt funny" was unknown. Upon internal review, the event of seizure was considered as medically significant. The relationship between adverse events and GARDASIL was unknown. This is one of two reports from the same source. Additional information has been requested.

VAERS ID:521437 (history)  Vaccinated:2014-01-22
Age:11.0  Onset:2014-01-23, Days after vaccination: 1
Gender:Male  Submitted:2014-01-28, Days after onset: 5
Location:Texas  Entered:2014-01-31, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4648AA IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4612AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site scab, Injection site swelling, Injection site warmth, Nodule, Pain, Tenderness, Ultrasound scan abnormal
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient presents for ER follow-up. He was seen in clinic on 1/22 for his WCC and received Tdap and MENACTRA. He developed swelling and itching at the site 24 hours later. No fever. Was seen at medical center on 1/24 for pain and swelling. He was diagnosed with cellulitis and placed on Clindamycin and BENADRYL q8 hours. The swelling and pain is much improved. Per notes from medical center he presented to the ER 3 days after receiving vaccinations. Exam was notable for "large area of erythema, warmth, induration and tenderness to palpation to left upper arm over deltoid. Small scab to center from injection. No fluctuance. No drainage. Small nodule palpable to anterior aspect of axilla. Tender to touch." Ultrasound was performed with impression: Cellulitis without abscess.

VAERS ID:521452 (history)  Vaccinated:2014-01-29
Age:11.0  Onset:2014-01-30, Days after vaccination: 1
Gender:Male  Submitted:2014-01-30, Days after onset: 0
Location:California  Entered:2014-01-31, 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: None
Current Illness: None
Preexisting Conditions: None known
Diagnostic Lab Data: Patient was evaluated by the Dr. If sx return to call back.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU4689AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Pain in extremity, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient received the Tdap vaccine on 1-29-14. He never developed a fever or any other sx. He slept fine. The next morning 1/30 he awoke with a sore arm 10 min later he felt dizzy, vomited, then fainted. He was fine the rest of the day.

VAERS ID:521455 (history)  Vaccinated:2014-01-29
Age:11.0  Onset:2014-01-29, Days after vaccination: 0
Gender:Male  Submitted:2014-01-29, Days after onset: 0
Location:Arizona  Entered:2014-01-31, 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: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4446AC4IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site reaction, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Site reaction, redness, warmth pain.

VAERS ID:521547 (history)  Vaccinated:2014-01-30
Age:11.0  Onset:2014-01-30, Days after vaccination: 0
Gender:Female  Submitted:2014-01-31, Days after onset: 1
Location:Texas  Entered:2014-01-31
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH949AA0UNRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Feeling hot, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling with redness and feeling hot to area.

VAERS ID:521635 (history)  Vaccinated:2014-01-22
Age:11.0  Onset:2014-01-23, Days after vaccination: 1
Gender:Male  Submitted:2014-01-23, Days after onset: 0
Location:Arizona  Entered:2014-02-03, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0084230UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AB0UNLA
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: None stated.

VAERS ID:521700 (history)  Vaccinated:2014-01-31
Age:11.0  Onset:2014-02-01, Days after vaccination: 1
Gender:Male  Submitted:2014-02-03, Days after onset: 2
Location:Maryland  Entered:2014-02-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOCALIN XR
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0122120UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM121320UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4395AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site discharge, Injection site erythema, Injection site reaction, Injection site swelling, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local reaction at injection site, minor swelling, warm to touch, pink in color. Located on left deltoid area. Per patient it doesn''t hurt any longer, only discomfort when touching. Pt given ibuprofen.

VAERS ID:521798 (history)  Vaccinated:2014-01-27
Age:11.0  Onset:2014-01-27, Days after vaccination: 0
Gender:Female  Submitted:2014-02-04, Days after onset: 8
Location:Virginia  Entered:2014-02-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications being taken by patient. GERD well controlled with diet. No other Rx or otc meds given that day before the vaccinations.
Current Illness: No illness at all. This was a well child visit.
Preexisting Conditions: GERD
Diagnostic Lab Data: Abdominal ultrasound; urinlaysis - negative; glucose 117; Bun 15; SCr .7; Ca 10.1; Na 140; K 4.6; Cl 105; Co2 26
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.J0129630IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4431BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Carbon dioxide normal, Nausea, Ultrasound abdomen abnormal, Urine analysis normal, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: About 2 hours after receiving Tdap and Hep A vaccines (4:30 pm) my daughter started to feel nauseous. Two hours later she started having bad abdominal pain and vomiting. She vomited about 6 times and her abdominal pain had gotten worse before I took her to the ER at about 9:15 pm. She was given 1 dose of iv ondansetron, iv morphine, 30 cc of po Maalox and 1 liter of Normal Saline. An abominal ultrasound ruled out acute appendicitis and ovarian torsion while some debris was seen in the bladder. She had a urinalysis done that was negative. She never had a fever and that was documented at the ER and doctor''s office earlier in the day. She experienced relief about 20 minutes after the iv morphine dose. After ruling out other causes the ER assumed this was the beginning of a virus and sent us home with an RX for 4 doses of ondansetron (4mg po q6hr prn nausea) and warned us that she would probably could also have explosive diarrhea. The next day she was able to eat the diet recommended by the hospital and she did not have any virus symptoms. She did have some abdominal pain later in the week only after drinking milk. That seems to have subsided. She has recovered from the event. Considering the temporal relationship of the event and vaccine administration, and other causes ruled out, it''s difficult to rule out an association between the vaccine administration and this event.

VAERS ID:521802 (history)  Vaccinated:2013-02-08
Age:11.0  Onset:2013-02-11, Days after vaccination: 3
Gender:Male  Submitted:2014-02-04, Days after onset: 358
Location:North Carolina  Entered:2014-02-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0162381UNUN
Administered by: Unknown     Purchased by: Private
Symptoms: Butterfly rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Hypersensitivity (narrow)
Write-up: Bright red rash on cheeks (mallar rash) for 2 weeks. No other issues.

VAERS ID:522036 (history)  Vaccinated:2014-02-03
Age:11.0  Onset:2014-02-03, Days after vaccination: 0
Gender:Female  Submitted:2014-02-06, Days after onset: 3
Location:Florida  Entered:2014-02-06
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; Pt did pull arm away as nurse was giving vaccine
Preexisting Conditions: None known
Diagnostic Lab Data: Unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0132772IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Local swelling, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt pulled arm away from nurse as vaccine was being given. Mother reports arm red, swollen and sore, no fever.

VAERS ID:522056 (history)  Vaccinated:2014-02-04
Age:11.0  Onset:2014-02-04, Days after vaccination: 0
Gender:Male  Submitted:2014-02-06, Days after onset: 2
Location:Colorado  Entered:2014-02-07, 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: No
Preexisting Conditions: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH910AA1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4648AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS33AG55IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Limb discomfort, Local reaction, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: MOC stated child c/o LA discomfort since the night of vaccination. She states that upper LA has two areas (one golf ball size, the other tennis ball size) that are red and warm to the touch. She states that this local reaction has progressively become more pronounced. Vaccines may have been given in opposite arms to what is noted below per MOC comment.

VAERS ID:522155 (history)  Vaccinated:2014-02-07
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2014-02-07
Location:Pennsylvania  Entered:2014-02-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Expired drug administered, No adverse event
SMQs:
Write-up: Expired ADACEL was given to patient. No reaction. CDC was contacted - they said to re-administer. Parent wants to wait. Expired 1-18-2014.

VAERS ID:522156 (history)  Vaccinated:2014-02-07
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2014-02-07
Location:Pennsylvania  Entered:2014-02-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA UNLA
Administered by: Private     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:
Write-up: Expired ADACEL was given to patient. No reaction. CDC was contacted - they said to re-administer. Patient wants to wait. Expired 1-18-2014.

VAERS ID:522176 (history)  Vaccinated:2014-02-04
Age:11.0  Onset:2014-02-05, Days after vaccination: 1
Gender:Female  Submitted:2014-02-07, Days after onset: 2
Location:Arizona  Entered:2014-02-07
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4446AC1IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: SWELLING OF INJECTION SITE WITH PRURITUS. SEEN THE NEXT DAY, RECOMMENDED COLD COMPRESS AND BENARYL 25 MG Q 6-8 HOURS PRN SCRATCHING.

VAERS ID:522180 (history)  Vaccinated:2011-02-16
Age:11.0  Onset:2011-03-01, Days after vaccination: 13
Gender:Female  Submitted:2014-02-07, Days after onset: 1074
Location:Alabama  Entered:2014-02-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: After 3 years of tests, no diagnosis. All tests come back negative. Patient is so ill and fatigued that she is no longer able to attend school.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1437Z2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Activities of daily living impaired, Alopecia, Arthralgia, Chest pain, Dyspnoea, Fatigue, Feeling abnormal, Laboratory test normal, Malaise, Memory impairment, Pain, Pain in extremity, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad)
Write-up: Joint pain, leg and body pain, auto-immune symptoms, losing hair, extreme fatigue, difficulty breathing, lung pain, chest pain, shaking, memory problems (brain fog), etc.

VAERS ID:522211 (history)  Vaccinated:2014-02-05
Age:11.0  Onset:2014-02-06, Days after vaccination: 1
Gender:Female  Submitted:2014-02-07, Days after onset: 1
Location:California  Entered:2014-02-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH906AE2UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA121300UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4170AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: (L) deltoid redness, pain.

VAERS ID:522213 (history)  Vaccinated:2014-02-06
Age:11.0  Onset:2014-02-07, Days after vaccination: 1
Gender:Male  Submitted:2014-02-07, Days after onset: 0
Location:Texas  Entered:2014-02-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURX12014 IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4612AA IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Cellulitis, Vaccination complication
SMQs:
Write-up: Cellulitis, complication of immunization.

VAERS ID:522225 (history)  Vaccinated:2014-01-08
Age:11.0  Onset:2014-01-08, Days after vaccination: 0
Gender:Male  Submitted:2014-01-08, Days after onset: 0
Location:Texas  Entered:2014-02-08, 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: None
Current Illness: None reported
Preexisting Conditions: None reported
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLULAVAL)GLAXOSMITHKLINE BIOLOGICALST3959 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Dizzy, fainted (approximately 1 sec) per mom after left the store.

VAERS ID:522238 (history)  Vaccinated:2013-09-16
Age:11.0  Onset:2013-09-16, Days after vaccination: 0
Gender:Male  Submitted:2014-02-10, Days after onset: 147
Location:Unknown  Entered:2014-02-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA002349
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0026412IMUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:
Write-up: This spontaneous report as received from a healthcare worker refers to an 11 year old male patient. On 14-MAY-2013 the patient was vaccinated intramuscularly with first 0.5 ml dose of GARDASIL (injection site and lot# not provided). On 15-JUL-2013 and 16-SEP-2013, the patient was vaccinated with second and third dose of GARDASIL respectively (injection site and lot# not provided). Third dose given early and no adverse effects were reported. Additional information has been requested.

VAERS ID:522279 (history)  Vaccinated:2014-02-02
Age:11.0  Onset:2014-02-03, Days after vaccination: 1
Gender:Male  Submitted:2014-02-10, Days after onset: 7
Location:New York  Entered:2014-02-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Guanfacine ER 2 mg, sertraline 25 mg, diphenhydramine 25 mg, amphetamine/dextroamphetamine XR
Current Illness: Psychiatric illness only
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH897AB IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 4" diameter red circle, warm to touch at injection site.

VAERS ID:522288 (history)  Vaccinated:2014-01-29
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-01-31
Location:New York  Entered:2014-02-10, 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: Well child visit
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH921AA IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS99P591IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0068500IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSAX130120IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abscess, Cellulitis, Injection site erythema, Injection site oedema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (L) upper arm, red, itchy, edematous. Dx ICD - 682.9 cellulitis and abscess. Rx KEFLEX 500mg bid x 10 days.

VAERS ID:522367 (history)  Vaccinated:2008-06-19
Age:11.0  Onset:2008-06-20, Days after vaccination: 1
Gender:Male  Submitted:2014-02-10, Days after onset: 2061
Location:Unknown  Entered:2014-02-11, 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: No other medciations
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA000323
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1030U SCUN
Administered by: Other     Purchased by: Other
Symptoms: Hypersomnia, Injection site erythema, Injection site reaction, Injection site swelling, Loss of consciousness, Malaise, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: This spontaneous report as received from a consumer refers to her son, a 11 year old male patient. Patient had no pertinent medical history and no drug reactions/allergies. On 19-JUN-2008 the patient was vaccinated with a dose of VARIVAX (Merck) (lot # 658422/1030U, Exp date: 27-JUN-2009) (dose and route unspecified). No concomitant medication reported. On 20-JUN-2008, less than 24 hours later the patient started throwing up and became ill while at a soccer game. The consumer reported that her son left the soccer game and when her son got home he "passed out" and fell asleep. The consumer reported that her son slept for the next 24 hours. The consumer reported that when her son was sleeping she noticed that there was an injection site reaction at the site of the VARIVAX (Merck) vaccination that was described as a red, raised oval about 4 inches by 4 inches at the site of the VARIVAX (Merck) vaccination. The consumer reported that when her son woke up he felt better and within 4 or 5 days the injection site reaction resolved and her son was recovered (date unspecified). No treatment was given for the events and no lab diagnostics studies performed. Additional information is not expected.

VAERS ID:522457 (history)  Vaccinated:2013-09-04
Age:11.0  Onset:2013-10-27, Days after vaccination: 53
Gender:Female  Submitted:2014-02-12, Days after onset: 108
Location:Unknown  Entered:2014-02-12
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA004484
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0200020IMRA
Administered by: Other     Purchased by: Other
Symptoms: Disability, Fatigue, Headache, Infectious mononucleosis
SMQs:
Write-up: This spontaneous report as received from a pharmacist via company representative refers to a 12 year old female patient (also reported as the pharmacist''s daughter). The patient did not have any pertinent medical history. On an unknown date in October 2013, the patient was vaccinated with a first dose of GARDASIL (route, dose, lot number and expiry date were not reported). On an unknown date in 2013, a couple of weeks later, after administration of GARDASIL the patient developed mononucleosis (disability) with a chronic headache (disability) and fatigue (disability). The pharmacist did not administer GARDASIL again and therapy with GARDASIL was discontinued. The outcome of the events mononucleosis, chronic headache and fatigue were unknown. The events mononucleosis, chronic headache and fatigue led to disability. Additional information has been requested.

VAERS ID:522510 (history)  Vaccinated:2014-02-10
Age:11.0  Onset:2014-02-12, Days after vaccination: 2
Gender:Male  Submitted:2014-02-12, Days after onset: 0
Location:South Carolina  Entered:2014-02-12
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site nodule, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Heat, pain, swelling, knot at injection site.

VAERS ID:522560 (history)  Vaccinated:2014-02-11
Age:11.0  Onset:2014-02-11, Days after vaccination: 0
Gender:Male  Submitted:2014-02-13, Days after onset: 2
Location:Iowa  Entered:2014-02-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA006162
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0231AA2IMLL
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:
Write-up: This spontaneous report as received from license practical nurse refers to a patient of unknown age and gender. On 11-FEB-2014 the patient was vaccinated with expired dose of RECOMBIVAX HB with lot # 0231AA and expiry date 14-OCT-2013 (dose unit and route unknown). No adverse event was reported. The outcome of received a dose of expired RECOMBIVAX HB and no adverse event was unknown. No further information was provided. Additional information has been requested.

VAERS ID:522861 (history)  Vaccinated:2014-02-13
Age:11.0  Onset:2014-02-14, Days after vaccination: 1
Gender:Female  Submitted:2014-02-17, Days after onset: 3
Location:Kentucky  Entered:2014-02-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Headache
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.J0129631IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0153091IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM13047 IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J006693 SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: 7 INCHES X 4 INCHES WARM AND SIGNIFICANT ERYTHEMA.

VAERS ID:522897 (history)  Vaccinated:2014-02-17
Age:11.0  Onset:2014-02-17, Days after vaccination: 0
Gender:Male  Submitted:2014-02-17, Days after onset: 0
Location:Arizona  Entered:2014-02-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0097880IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM130130IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS9FS270IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient was in lobby waiting 15 minutes after imm. given when approx. 3 mins after imm was given he felt lightheaded and fainted. Was brought to back to be monitored. Waited 15 mins in room, and was okay to leave.

VAERS ID:522954 (history)  Vaccinated:2013-12-04
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2014-02-18
Location:Unknown  Entered:2014-02-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA006145
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (AFLURIA)CSL LIMITED  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0062360UNLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This spontaneous report was received from a physician via company representative refers to a 11 year old male patient. On an unknown date, the patient was vaccinated with AFLURIA (dose, route and frequency was not reported) and first shot of GARDASIL (route and frequency was not reported) at the same time. On an unknown date, after receiving both the vaccines at the same time, the patient experienced swelling at the injection site. It was also reported that the patient had not yet received the second and third dose of GARDASIL. The outcome of the event swelling at the injection site was unknown. The reporter did not provide the causality between the event and the suspect drug. Additional information has been requested.

VAERS ID:523040 (history)  Vaccinated:2014-01-30
Age:11.0  Onset:2014-02-03, Days after vaccination: 4
Gender:Male  Submitted:2014-02-18, Days after onset: 15
Location:Pennsylvania  Entered:2014-02-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: KEPPRA
Current Illness: Headache; Myalgias; Decreased appetite for one month
Preexisting Conditions:
Diagnostic Lab Data: MRI; CSF studies; Oligomonoclonal bands in serum - collected at hospital
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4648AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abnormal behaviour, CSF oligoclonal band, CSF test, Computerised tomogram head, Confusional state, Lethargy, Mental status changes, Nuclear magnetic resonance imaging brain, Somnolence, Speech disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad)
Write-up: 1/30/14 - Received vaccine. 1/31/14 - Started KEPPRA because of history of seizure. First time seizure occurred was in week preceding vaccine, head CT was normal, patient was scheduled for brain MRI on 2/3/14. 2/4/14 Mom brought child into office - stating he had been behaving abnormally since night of 2/3/14 and deteriorating till time of visit. He was lethargic, falling asleep constantly, his speech was abnormal, no fever at the time, and was assessed as having altered mental status and transferred to hospital ER.

VAERS ID:523075 (history)  Vaccinated:2014-02-13
Age:11.0  Onset:2014-02-13, Days after vaccination: 0
Gender:Female  Submitted:2014-02-13, Days after onset: 0
Location:Arizona  Entered:2014-02-19, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0084231SYRLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AB1SYRRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS4G9951SYRRA
Administered by: Private     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: Fainted after shot. Monitor in office for 20 minutes.

VAERS ID:523161 (history)  Vaccinated:2014-02-18
Age:11.0  Onset:2014-02-19, Days after vaccination: 1
Gender:Male  Submitted:2014-02-20, Days after onset: 1
Location:North Carolina  Entered:2014-02-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Strawberry allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4561AA1IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4332BA1IMRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Local swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Arm swollen, red, warm.

VAERS ID:523178 (history)  Vaccinated:2014-02-19
Age:11.0  Onset:2014-02-19, Days after vaccination: 0
Gender:Female  Submitted:2014-02-20, Days after onset: 1
Location:Indiana  Entered:2014-02-20
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DPP: DIPHTHERIA TOXOID + PERTUSSIS + IPV (NO BRAND NAME)UNKNOWN MANUFACTURER  IMAR
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  IMAR
Administered by: Public     Purchased by: Other
Symptoms: Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Fever, vomiting, headache over last 5 hours. Treatment so far is Advil and fluids. Dr visit later today.

VAERS ID:523180 (history)  Vaccinated:2014-02-03
Age:11.0  Onset:2014-02-05, Days after vaccination: 2
Gender:Female  Submitted:2014-02-20, Days after onset: 15
Location:Virginia  Entered:2014-02-20
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: H/o vaccine reaction to DTAP at a younger age
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.J0113850IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4430AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J0113861SCRA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site cellulitis, Injection site erythema, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Rash, redness and swelling at injection site. Diagnosed as cellulitis. Treated with antibiotics x 7 days.

VAERS ID:523198 (history)  Vaccinated:2014-02-08
Age:11.0  Onset:2014-02-11, Days after vaccination: 3
Gender:Female  Submitted:2014-02-20, Days after onset: 9
Location:Texas  Entered:2014-02-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type: TX140006PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4618AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Edema and erythema right arm (MCV4) vaccine site 50x50. Tender to touch. Injection site feels warm.

VAERS ID:523352 (history)  Vaccinated:2014-02-17
Age:11.0  Onset:2014-02-17, Days after vaccination: 0
Gender:Male  Submitted:2014-02-21, Days after onset: 4
Location:Colorado  Entered:2014-02-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0132772IMRA
Administered by: Unknown     Purchased by: Other
Symptoms: Chest discomfort, Decreased appetite, Dizziness, Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: After being in hot tub, developed chest tightness, dizziness, fatigue, and decreased appetite. Shortly after developed fever (103). Developed nausea and emesis (x10) around 3:00 AM on 02/18/2014. Treated with Advil and small sips of fluids at home. Came to urgent care at 9:52 AM on 02/18/2014 and was feeling well.

VAERS ID:523447 (history)  Vaccinated:2014-02-17
Age:11.0  Onset:2014-02-18, Days after vaccination: 1
Gender:Male  Submitted:2014-02-24, Days after onset: 6
Location:Virginia  Entered:2014-02-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4593AB0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4688BA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Abdominal discomfort, Abdominal pain, Chills, Diarrhoea, Lethargy, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow)
Write-up: Severe abdominal cramping/discomfort followed by diarrhea, vomiting, chills, lethargy, muscle aches, fever of 102.5 with Tylenol.

VAERS ID:523460 (history)  Vaccinated:2014-02-14
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-02-24
Location:California  Entered:2014-02-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA009564
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J013324 SYRUN
Administered by: Other     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:
Write-up: This spontaneous report as received from a registered nurse refers to an unknown number of patients of unknown ages and genders. Nurse mentioned an unknown number of patients might have received GARDASIL injection (lot #, expiry date, dose and route unknown) that was improperly stored. No adverse symptoms reported. Additional information has been requested.

VAERS ID:523483 (history)  Vaccinated:2014-02-13
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-02-14
Location:Florida  Entered:2014-02-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Localized swelling of arm
Preexisting Conditions: None known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.J0050812IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J006850 IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4626AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4365AA IMRA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, Local swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling and redness / cellulitis right arm.

VAERS ID:523524 (history)  Vaccinated:2014-02-20
Age:11.0  Onset:2014-02-20, Days after vaccination: 0
Gender:Unknown  Submitted:2014-02-24, Days after onset: 4
Location:Unknown  Entered:2014-02-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA010823
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  SCUN
Administered by: Other     Purchased by: Other
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: This spontaneous report as received from a nurse refers to 11 year old patient (gender unspecified). On 20-FEB-2014, nurse inadvertently administered ZOSTAVAX, subcutaneous (dose unspecified) to an 11 year old patient for vaccination. It was reported this would have been dose two of the patient''s VARIVAX (Merck). Concomitant therapy was unspecified. No adverse effects reported. No product quality complaint was involved. No further information was provided. Additional information has been requested.

VAERS ID:523631 (history)  Vaccinated:2013-11-02
Age:11.0  Onset:2013-11-02, Days after vaccination: 0
Gender:Male  Submitted:2013-11-04, Days after onset: 2
Location:Illinois  Entered:2014-02-24, Days after submission: 112
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE81266
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Exposure via direct contact, Underdose
SMQs:
Write-up: A report has been received from a Health Professional concerning an 11 year old, Male subject, who had been receiving FLUMIST, (intranasal). FLUMIST started on an unknown date. It was reported that patient received half of a dose of FLUMIST in one nostril and other half squired into his face and maybe in his eye which started on 02-Nov-2013. The outcome of the event of received half of a dose of FLUMIST in one nostril and other half squirted into his face and maybe eye is unknown. The report was considered to be non-serious.

VAERS ID:523644 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2013-10-22
Gender:Male  Submitted:2013-10-22, Days after onset: 0
Location:New Hampshire  Entered:2014-02-24, Days after submission: 125
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE77977
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BK2062 IN 
Administered by: Other     Purchased by: Other
Symptoms: Exposure via direct contact
SMQs:
Write-up: A report has been received from a Health Professional concerning an 11 year old, Male subject, who had been receiving Nasal FLUMIST QUADRIVALENT. FLUMIST QUADRIVALENT started on an unknown date. The patient was administered into eye on 22-Oct-2013. The outcome of the event of ADMINISTRATION INTO EYE is unknown. The report was considered to be non-serious.

VAERS ID:523710 (history)  Vaccinated:2013-12-03
Age:11.0  Onset:2013-12-03, Days after vaccination: 0
Gender:Female  Submitted:2013-12-04, Days after onset: 1
Location:Montana  Entered:2014-02-24, Days after submission: 82
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE88710
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH2026 IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: A report has been received from a Health Professional concerning an 11 year old, female subject, who had been receiving Nasal FLUMIST QUADRIVALENT. FLUMIST started on 03-Dec-2013. The patient was inadvertently given an expired dose of FLUMIST which started on 03-Dec-2013. The outcome of the event of inadvertently gave an expired dose of FLUMIST is unknown. The report was considered to be non-serious.

VAERS ID:523711 (history)  Vaccinated:2013-09-16
Age:11.0  Onset:2013-10-07, Days after vaccination: 21
Gender:Male  Submitted:2013-10-09, Days after onset: 2
Location:Texas  Entered:2014-02-24, Days after submission: 138
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE74731
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH2124 IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM12120 IMUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSACS2B099CA IMUN
Administered by: Other     Purchased by: Other
Symptoms: Ear infection, Ear pain, VIIth nerve paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: A report had been received from a Health Professional concerning an 11 years old, male patient. The relevant history and concomitant drugs of the patient were not reported. The patient had received nasal FLUMIST QUADRIVALENT of batch number BH2124 on 16-Sep-2013. The patient also received Tdap and MCV4 vaccines on that day. The nurse reported that the patient had right ear pain on 01-Oct-2013. The patient was diagnosed with right ear infection on 01-Oct-2013. The patient was started on CIPRODEX drops - four drops to right ear two times a day. The patient started to experience a symptom of Bell''s palsy (right sided facial drooping) on 07-Oct-2013. Patient was seen in office on 08-Oct-2013. Doctor started him on ZITHROMAX 250 mg-two tablet, the first day, then one tablet for four days, Prednisone 20 mg tablet two tablet for seven days, one and half tablet for two days, then one tablet for two days then half tablet for two days and then one fourth tablet for two days. At the time of reporting, the event of patient''s right sided droop had not improved. The outcome of the event of right ear infection was unknown. The reporter considered the events of right ear infection and right sided facial droop to be non-serious. Summary of follow-up information received by AstraZeneca/MedImmune on 09-Oct-2013 from health professional: Event verbatim and coding for event of right sided facial droop/Bell''s palsy was updated. Reporter''s type patient was added. Reporter''s and patient''s details were updated. Concomitant drugs were added. Narrative was amended. Corrected report 20-Oct-2013: Manufacturer for suspect vaccine was added.

VAERS ID:523747 (history)  Vaccinated:2013-11-29
Age:11.0  Onset:2013-11-29, Days after vaccination: 0
Gender:Female  Submitted:2013-12-06, Days after onset: 7
Location:Wisconsin  Entered:2014-02-24, Days after submission: 80
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE90325
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH2029 IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: A report has been received from a Health Professional concerning an 11 year old, female subject, who had been receiving FLUMIST (Intranasal). FLUMIST (Intranasal) started on 29-Nov-2013. Reporter reported that they administered expired FLUMIST/one of my staff members accidentally administered expired FLUMIST which started on 29-Nov-2013. The outcome of the event of administered expired FLUMIST/one of my staff members accidentally administered expired FLUMIST is unknown. The report was considered to be non-serious.

VAERS ID:523884 (history)  Vaccinated:2013-11-11
Age:11.0  Onset:2013-11-11, Days after vaccination: 0
Gender:Male  Submitted:2013-11-25, Days after onset: 14
Location:Unknown  Entered:2014-02-24, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE86911
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Underdose
SMQs:
Write-up: A report has been received from a Pharmacist concerning a 11 year old, male subject, who had been receiving FLUMIST. FLUMIST started on 11-Nov-2013. It was reported that the consumer was administered only a half dose of FLUMIST in one nostril which started on 11-Nov-2013. The outcome of the event of administration of only a half dose of FLUMIST in one nostril is unknown. The report was considered to be non-serious.

VAERS ID:523889 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2013-11-11
Gender:Female  Submitted:2013-11-25, Days after onset: 14
Location:Unknown  Entered:2014-02-24, Days after submission: 91
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE87093
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Underdose
SMQs:
Write-up: A report has been received from a Pharmacist concerning an 11 year old, female subject, who had been receiving FLUMIST. FLUMIST started on an unknown date. Pharmacist reported that the patient received only a half dose FLUMIST in one nostril which started on 11-Nov-2013 at one of the mobile clinics. The outcome of the event of administration of only a half dose of FLUMIST in one nostril is unknown. The report was considered to be non-serious.

VAERS ID:523914 (history)  Vaccinated:2013-11-27
Age:11.0  Onset:2013-11-27, Days after vaccination: 0
Gender:Male  Submitted:2013-12-03, Days after onset: 6
Location:Pennsylvania  Entered:2014-02-25, Days after submission: 84
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE88428
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH2027 IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: A report has been received from a Pharmacist concerning an 11 year old, male subject, who had been receiving Nasal FLUMIST QUADRIVALENT. FLUMIST QUADRIVALENT started on 27-Nov-2013. The pharmacist reported that inadvertently administered expired FLUMIST QUADRIVALENT to a patient on 27-Nov-2013. The outcome of the event of administration of expired FLUMIST is unknown. The report was considered to be non-serious. Summary of significant follow-up information received by AstraZeneca/MedImmune on 03-Dec-2013 from a Pharmacist: Product lot number ane expiry date added with updation of start date for FLUMIST. Event start date updated. Patient details updated. Reporter details updated.

VAERS ID:523917 (history)  Vaccinated:2013-12-02
Age:11.0  Onset:2013-12-02, Days after vaccination: 0
Gender:Male  Submitted:2013-12-03, Days after onset: 1
Location:Unknown  Entered:2014-02-25, Days after submission: 84
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE88410
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH2173 IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered, No adverse event
SMQs:
Write-up: A report has been received from a Health Professional concerning an 11 year old, Male subject, who had been receiving FLUMIST quadrivalent (intranasal). FLUMIST quadrivalent (intranasal) started on 02-Dec-2013. The medical assistant reported that six patients received FLUMIST quadrivalent that expired on 25-Nov-2013 on 02-Dec-2013. Not reporting any symptoms. The outcome of the event of administration of expired product is unknown. The report was considered to be non-serious by reporter.

VAERS ID:523919 (history)  Vaccinated:2013-12-02
Age:11.0  Onset:2013-12-02, Days after vaccination: 0
Gender:Female  Submitted:2013-12-03, Days after onset: 1
Location:Unknown  Entered:2014-02-25, Days after submission: 84
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 2013SE88526
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BH2173 IN 
Administered by: Other     Purchased by: Other
Symptoms: Expired drug administered
SMQs:
Write-up: A report has been received from a Health Professional concerning an 11 year old, Female subject, who had been receiving FLUMIST quadrivalent (intranasal). FLUMIST quadrivalent (intranasal) started on an unknown date. The health professional reported that patient received expired FLUMIST quad on 02-Dec-2013. The outcome of the event of administration of expired product is unknown. The report was considered to be non-serious.

VAERS ID:524049 (history)  Vaccinated:2014-02-24
Age:11.0  Onset:2014-02-25, Days after vaccination: 1
Gender:Male  Submitted:2014-02-26, Days after onset: 1
Location:Rhode Island  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: School problems, learning disorder, math
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4445AB0IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling of arm where vaccine administered. No systemic symptoms. Pain to touch.

VAERS ID:524084 (history)  Vaccinated:2014-02-24
Age:11.0  Onset:2014-02-24, Days after vaccination: 0
Gender:Female  Submitted:2014-02-24, Days after onset: 0
Location:California  Entered:2014-02-26, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0122120UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM130120UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site reaction
SMQs:
Write-up: Injection site reaction. S/P vaccination ice to area, Motrin as needed.

VAERS ID:524092 (history)  Vaccinated:2014-02-18
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-02-26
Location:California  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J013324 UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Three (3) HPV, lot # (J013324) had been exposed to the out of range temperature and need to be returned. These three vaccines were mistakenly and in administered to three (3) patients. Whoever the staff person was who administered 3 doses of the HPV that should not have been used, clicked on the new lot number (J012212) instead of the old lot # (J013324). We have been unable to identify the three patients who received the vaccines exposed to the out of range temp. I have been indentify the 12 patients who administered HPV vaccine between the dates of 2/12 - 12/18/14 under lot number (J012212).

VAERS ID:524093 (history)  Vaccinated:2014-02-18
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2014-02-26
Location:California  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J013324 UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Three (3) HPV, lot # (J013324) had been exposed to the out of range temperature and needed to be returned to clinic. These three vaccines were mistakenly and in administered to three (3) patients. Whoever the staff person was who administered 3 doses of the HPV that should not been used, clicked on the new lot number (J012212) instead of the old lot # (J013324). We have been unable to identify the three patients who received the vaccines exposed to the out of range temp. I have been identify the 12 patients who administered HPV vaccine between the dates of 2/12 - 12/18/14 under lot number (J012212).

VAERS ID:524094 (history)  Vaccinated:2014-02-18
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2014-02-26
Location:California  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Three (3) HPV, lot # (J013324) had been exposed to the out of range temperature and needed to be returned. These three vaccines were mistakenly and in administered to three (3) patients. Whoever the staff person was who administered 3 doses of the HPV that should not been used, clicked on the new lot number (J012212) instead of the old lot # (J013324). We have been unable to identify the three patients who received the vaccines exposed to the out of range temp. I have been identify the 12 patients who administered HPV vaccine between the dates of 2/12 - 2/18/14 under lot number (J012212).

VAERS ID:524097 (history)  Vaccinated:2014-02-14
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2014-02-26
Location:California  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Three (3) HPV, lot # (J013324) had been exposed to the out of range temperature and needed to be returned. These three vaccines were mistakenly and in administered to three (3) patients. Whoever the staff person was who administered 3 doses of the HPV that should not been used, clicked on the new lot number (J012212) instead of the old lot # (J013324). We have been unable to identify the three patients who received the vaccines exposed to the out of range temp. I have been identify the 12 patients who administered HPV vaccine between the dates of 2/12 - 2/18/14 under lot number (J012212).

VAERS ID:524099 (history)  Vaccinated:2014-02-13
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-02-26
Location:California  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J013324 UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Three (3) HPV, lot # (J013324) had been exposed to the out of range temperature and needed to be returned to VFC. These three vaccines were mistakenly and in administered to three (3) patients. Whoever the staff person was who administered 3 doses of the HPV that should not been used, clicked on the new lot number (J012212) instead of the old lot # (J013324). We have been unable to identify the three patients who received the vaccines exposed to the out of range temp. I have been identify the 12 patients who administered HPV vaccine between the dates of 2/12 - 2/18/14 under lot number (J012212).

VAERS ID:524100 (history)  Vaccinated:2014-02-13
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-02-26
Location:California  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Three (3) HPV, lot # (J013324) had been exposed to the out of range temperature and needed to be returned to VFC. These three vaccines were mistakenly and in administered to three (3) patients. Whoever the staff person was who administered 3 doses of the HPV that should not been used, clicked on the new lot number (J012212) instead of the old lot # (J013324). We have been unable to identify the three patients who received the vaccines exposed to the out of range temp. I have been identify the 12 patients who administered HPV vaccine between the dates of 2/12 - 2/18/14 under lot number (J012212).

VAERS ID:524101 (history)  Vaccinated:2014-02-12
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-02-26
Location:California  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Three (3) HPV, lot # (J013324) had been exposed to the out of range temperature and needed to be returned to VFC. These three vaccines were mistakenly and in administered to three (3) patients. Whoever the staff person was who administered 3 doses of the HPV that should not been used, clicked on the new lot number (J012212) instead of the old lot # (J013324). We have been unable to identify the three patients who received the vaccines exposed to the out of range temp. I have been identify the 12 patients who administered HPV vaccine between the dates of 2/12 - 2/18/14 under lot number (J012212).

VAERS ID:524102 (history)  Vaccinated:2014-02-24
Age:11.0  Onset:2014-02-25, Days after vaccination: 1
Gender:Female  Submitted:2014-02-26, Days after onset: 1
Location:California  Entered:2014-02-26
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
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM130120UNRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site reaction
SMQs:
Write-up: Injection site reaction. S/P vaccination, ice to area, Motrin as needed.

VAERS ID:524107 (history)  Vaccinated:2014-02-10
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-02-26
Location:California  Entered:2014-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J013324 UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Incorrect storage of drug
SMQs:
Write-up: Patient received vaccines exposed to the out of range temperature.

VAERS ID:524118 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Unknown  Submitted:2014-02-27
Location:Unknown  Entered:2014-02-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA007622
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.J006732 SCRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)
Write-up: This spontaneous report was received from a medical assistant refers to a 11 year old child of unknown gender. Medical history was reported as none. No known drug allergy was reported. On an unknown date the patient was vaccinated with VARIVAX (Merck) lot # J006732; expiry: 30-MAY-2015, dose: 0.5 ml (millilitres), subcutaneous in the right arm. Concomitant therapy was reported was none. On an unknown date the patient developed a rash at the injection site after administration of VARIVAX (Merck). The patients were evaluated in the office. No medical treatment was prescribed. The patient sought medical attention and had an office visit. The outcome of rash at the injection site was unknown. Causality assessment for the event was not provided. This case is linked to: 1402USA013049 (same reporter link). Additional information has been requested.

VAERS ID:524205 (history)  Vaccinated:2014-02-27
Age:11.0  Onset:2014-02-27, Days after vaccination: 0
Gender:Male  Submitted:2014-02-27, Days after onset: 0
Location:Kansas  Entered:2014-02-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH949AB1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0084230IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM130120IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness, Hyporesponsive to stimuli
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: About 5-8 minutes after vaccine given became lightheaded, less verbally responsive. Placed in supine position, eyes closed not verbally responsive for 1-2 minutes. Gradually felt better, verbally responsive all sx resolved within 15 minutes.

VAERS ID:524260 (history)  Vaccinated:2014-02-24
Age:11.0  Onset:2014-02-24, Days after vaccination: 0
Gender:Male  Submitted:2014-02-28, Days after onset: 4
Location:Kentucky  Entered:2014-02-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: some swelling~Tdap (no brand name)~UN~11.00~Patient
Other Medications: Singulair
Current Illness: Several allergies, asthma. Takes Singulair daily. Takes albuterol inhaler and neb treatments and Benadryl as needed
Preexisting Conditions: Asthma. Allergies to All nuts, sunflower seeds, Pineapples, Pulmacort, Ibuprofen
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA121040IMLA
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea, Erythema, Nausea, Swelling face, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: Swelling/Redness to face; hives 10:00AM treated with Benadryl. Later- went to ER d/t no improvement and now N/V/D received steroid injections and Zofran per mom.

VAERS ID:524314 (history)  Vaccinated:2014-02-26
Age:11.0  Onset:2014-02-28, Days after vaccination: 2
Gender:Female  Submitted:2014-02-28, Days after onset: 0
Location:California  Entered:2014-02-28
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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0122120IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM130140IMRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness/swelling on R deltoid.

VAERS ID:524348 (history)  Vaccinated:2014-02-26
Age:11.0  Onset:2014-02-27, Days after vaccination: 1
Gender:Male  Submitted:2014-02-28, Days after onset: 1
Location:Florida  Entered:2014-02-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.BN21950IN 
HEPA: HEP A (VAQTA)MERCK & CO. INC.J0050101IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0209010IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4593AB0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4700BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site inflammation, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness and severe inflammation to (L) deltoid arm muscle also c/o pain.

VAERS ID:524396 (history)  Vaccinated:2014-02-26
Age:11.0  Onset:2014-02-27, Days after vaccination: 1
Gender:Male  Submitted:2014-03-03, Days after onset: 4
Location:Texas  Entered:2014-03-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: Allergy - Penicillins
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J009788 IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4658BB IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4506BA IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Child received Tdap, MENACTRA and GARDASIL on 2/26/14. Mom noticed redness and swelling on 2/27/14 after playing baseball, some warmness to the touch also.

VAERS ID:524412 (history)  Vaccinated:2011-02-26
Age:11.0  Onset:2011-03-20, Days after vaccination: 22
Gender:Female  Submitted:2014-03-03, Days after onset: 1079
Location:Indiana  Entered:2014-03-03
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO ILLNESS AT TIME OF INJECTION... BUT THIS WAS FOR THE HPV INJECTION 2ND SHOT 2/26/2011 3RD SHOT 6/23/2011... AFTER HAVING 2ND SHOT ON 2/26/2011, MY DAUGHTER STARTED HAVING SEIZURES ON 3/20/2011, EXPERIENCES HEADACHES, FATIGUE, BEHAVIOR CHANGES, DIZZINESS, MUSCLE PAINS, AND BLURRED VISION AT TIMES
Preexisting Conditions: ADHD
Diagnostic Lab Data: PT. HAS SINCE HAD A FEW ABNORMAL EEG''S
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1317Y1IM 
Administered by: Unknown     Purchased by: Private
Symptoms: Abnormal behaviour, Convulsion, Dizziness, Electroencephalogram abnormal, Fatigue, Headache, Myalgia, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: MY DAUGHTER STARTED HAVING SEIZURES ON 3/20/2011, EXPERIENCES HEADACHES, FATIGUE, BEHAVIOR CHANGES, DIZZINESS, AND BLURRED VISION AT TIMES.

VAERS ID:524433 (history)  Vaccinated:2014-02-19
Age:11.0  Onset:2014-02-19, Days after vaccination: 0
Gender:Male  Submitted:2014-03-03, Days after onset: 12
Location:Oregon  Entered:2014-03-03
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
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 2IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Fever of 102 that lasted for 18 hours and extreme soreness at injection site that lasted for 2-3 days.

VAERS ID:524450 (history)  Vaccinated:2014-02-11
Age:11.0  Onset:2014-02-12, Days after vaccination: 1
Gender:Female  Submitted:2014-03-03, Days after onset: 19
Location:Missouri  Entered:2014-03-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: See above note
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA130500IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS253B40IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Lymphadenopathy, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt.''s mom reported to Dr. on 02/27/14 during a sib O.V. that pt. ''developed approximately baseball size'' area of redness to RA after rec''ng vaccines in office on 02/11/14. Pt. was not brought to office; also reports pt. with 99 degree F temp at same time. No tx. Also reports pt. had ''swollen'' glands, but not enough to bring her in for, and dev. URI sx 1-2 days after that.

VAERS ID:524480 (history)  Vaccinated:2014-02-26
Age:11.0  Onset:2014-02-27, Days after vaccination: 1
Gender:Female  Submitted:2014-03-04, Days after onset: 5
Location:Michigan  Entered:2014-03-04
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: ALLERGIES
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0068501IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash erythematous, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: CHILD NOTICED SMALL RED BUMPS EARLIER BY 10P MOM STATES CHILD COVERED IN HIVES. MOM CONTACTED PCP AND WAS TOLD TO GIVE CHILD HER ALLERGY MEDICINE, BY MORNING HIVES WERE GONE.

VAERS ID:524676 (history)  Vaccinated:2014-03-04
Age:11.0  Onset:2014-03-05, Days after vaccination: 1
Gender:Male  Submitted:2014-03-05, Days after onset: 0
Location:Texas  Entered:2014-03-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data: None.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALSA259X1UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4657AA0UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSP572X0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site inflammation
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness with induration 5 x 6 cm and inflammation. On (R) deltoid region.

VAERS ID:524744 (history)  Vaccinated:2014-03-03
Age:11.0  Onset:2014-03-04, Days after vaccination: 1
Gender:Male  Submitted:2014-03-05, Days after onset: 1
Location:Arizona  Entered:2014-03-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALST4MS9 IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0133241IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AC0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU461788 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient with swelling, redness and tenderness to entire left deltoid area.

VAERS ID:524755 (history)  Vaccinated:2014-03-03
Age:11.0  Onset:2014-03-03, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Alabama  Entered:2014-03-05
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: Hx of eczema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4610BA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4431BA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Local swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt arms swollen w/redness and warm to touch. Treated w/PO OTC Benadryl, Tylenol and Motrin.

VAERS ID:525273 (history)  Vaccinated:2014-03-06
Age:11.0  Onset:2014-03-06, Days after vaccination: 0
Gender:Female  Submitted:2014-03-07, Days after onset: 1
Location:Oregon  Entered:2014-03-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None at the time of immunizations, but started on Keflex after leaving Clinic.
Current Illness: Patient was being seen by FNP for a laceration on her left foot. Treated with Keflex.
Preexisting Conditions: None
Diagnostic Lab Data: To watch and observe and call/RTC for any further concerns or s/s of infection/reaction.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0209010IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4561AA0IMRA
Administered by: Other     Purchased by: Other
Symptoms: Erythema, Local swelling, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: At 11:00am started w/arm itching, then after one hour it began to hurt and swell. The redness 10cmX8cm started this morning around 8am(03/07/2014).

VAERS ID:525309 (history)  Vaccinated:2014-03-04
Age:11.0  Onset:2014-03-06, Days after vaccination: 2
Gender:Male  Submitted:2014-03-07, Days after onset: 1
Location:Alabama  Entered:2014-03-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Swollen arm~Tdap (Boostrix)~1~10.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions: Obesity; Obstructive sleep apnea
Diagnostic Lab Data: Referred to allergist
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM12092 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site discharge, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 3/6/14 (L) upper arm swollen and draining clear fluid. Given BENADRYL and Rx for prednisone.

VAERS ID:525380 (history)  Vaccinated:2014-03-06
Age:11.0  Onset:2014-03-06, Days after vaccination: 0
Gender:Female  Submitted:2014-03-10, Days after onset: 3
Location:Indiana  Entered:2014-03-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4608A10IMRA
Administered by: Private     Purchased by: Private
Symptoms: Abnormal behaviour, Confusional state, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad)
Write-up: High fever (102 F) starting 3/6/14 evening into 3/7/14. Still febrile today (3/10/14). Behavioral changes beginning 3/6/14; confusion 3/7/14. Cervical adenopathy.

VAERS ID:525436 (history)  Vaccinated:2014-02-27
Age:11.0  Onset:2014-02-28, Days after vaccination: 1
Gender:Female  Submitted:2014-03-11, Days after onset: 10
Location:Unknown  Entered:2014-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions: Sulfa, Drug hypersensitivity; amoxicillin, Drug hypersensitivity
Diagnostic Lab Data: Blood pressure, result not specified not provided; Urine analysis, result not specified not provided
CDC Split Type: WAES1403USA001849
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0213460IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR04593AB IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS  IMLA
Administered by: Other     Purchased by: Other
Symptoms: Headache, Loss of consciousness, Nausea, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: This spontaneous report was received from a Nurse refers to a 11 year old female patient. On 27-FEB-2014 the patient was vaccinated with GARDASIL lot # H021346 (Expiry: 01-OCT-2015), 0.5 ml, intramuscular. On 28-FEB-2014, 2 days after onset of therapy the patient experienced everything went black and then she developed headache and nausea. The patient sought medical attention and visited the office. The patient was prescribed with TYLENOL and MOTRIN. On an unknown date, the patient had blood pressure checked and urine analysis completed but results were not specified. The nurse stated that prescription was rest fluid, check urine output closely. On an unknown date, the patient was feeling fine. The reporter did not provide the causality between the event and the suspect drug. Additional information has been requested.

VAERS ID:525478 (history)  Vaccinated:2014-02-21
Age:11.0  Onset:2014-02-26, Days after vaccination: 5
Gender:Male  Submitted:2014-03-11, Days after onset: 12
Location:Arizona  Entered:2014-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLEGRA
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AC0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4313AA0UNRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site mass, Injection site urticaria, Rash papular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Lump on (R) upper arm with purpura and some raised wheals.

VAERS ID:525507 (history)  Vaccinated:2014-03-06
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2014-03-11
Location:Pennsylvania  Entered:2014-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; POLY VI FLOR
Current Illness: None
Preexisting Conditions: Asthma; Overweight
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0122120UNRL
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4445AB0UNLL
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS534H40UNLA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)
Write-up: Immuniz. given at 2:33 PM 3/6/13. Pt felt faint on her way out of the office but did not appear to lose consciousness - fell to floor. No injury. Was asked to wait 15 min after admin but Mom had declined due to other commitments.

VAERS ID:525537 (history)  Vaccinated:2014-03-10
Age:11.0  Onset:2014-03-11, Days after vaccination: 1
Gender:Female  Submitted:2014-03-11, Days after onset: 0
Location:Colorado  Entered:2014-03-11
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSP57ZX0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient had localized redness & swelling to injection site, reported no pain, no itching, no fever, no additional symptoms. Patient came into school nurse office & stated had not noticed but someone in class pointed out redness.

VAERS ID:525623 (history)  Vaccinated:2014-01-15
Age:11.0  Onset:2014-01-15, Days after vaccination: 0
Gender:Female  Submitted:2014-03-12, Days after onset: 55
Location:Iowa  Entered:2014-03-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: Family did not inform Physician until 2 mo. after. They just went to PT.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.J0113851IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0122122IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4658BB0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSN435Z0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site joint pain, Synovitis
SMQs:, Arthritis (narrow)
Write-up: Pain Right elbow diagnosed as Transient Synovitis by PT.

VAERS ID:525698 (history)  Vaccinated:2014-03-10
Age:11.0  Onset:2014-03-11, Days after vaccination: 1
Gender:Female  Submitted:2014-03-13, Days after onset: 2
Location:Ohio  Entered:2014-03-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PCN Allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS7973G0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM120240IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site discolouration, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Injection site swollen, warm to touch, red/purple in color.

VAERS ID:525720 (history)  Vaccinated:2014-02-27
Age:11.0  Onset:2014-02-27, Days after vaccination: 0
Gender:Male  Submitted:2014-03-13, Days after onset: 13
Location:New Mexico  Entered:2014-03-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratidine 10 mg PRN. Prevacid 15 mg twice daily.
Current Illness: None
Preexisting Conditions: Eczema
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4556AC0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS7GH570IMRA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Dizziness postural, Musculoskeletal stiffness
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Arthritis (broad)
Write-up: Post-Medication Assessment performed by LPN at 4:13 PM. Adverse Reaction - After shot, pt stood up and needed to sit back down because he felt like he was going to faint, he then had a "stiffening event" but did not pass out. Monitored by Dr. and released after monitoring.

VAERS ID:525732 (history)  Vaccinated:2014-03-09
Age:11.0  Onset:2014-03-10, Days after vaccination: 1
Gender:Male  Submitted:2014-03-13, Days after onset: 3
Location:Utah  Entered:2014-03-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Fever 103.8~Measles + Mumps + Rubella (no brand name)~~1.25~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS 0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local reaction redness, swelling, heat at injection site of 11cm. Patients left arm circumference is 3cm larger than the right arm and the patient is right handed. 12% increase from sIte swelling.

VAERS ID:525792 (history)  Vaccinated:2014-03-10
Age:11.0  Onset:2014-03-12, Days after vaccination: 2
Gender:Male  Submitted:2014-03-13, Days after onset: 1
Location:California  Entered:2014-03-14, 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: None
Current Illness: No
Preexisting Conditions: H/O concussion Jan 2014 (mild)
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0133240IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4657AA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Dehydration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Syncope at school on 3/12/14 no aura, no orthostatic symptoms revived by pain response. Paramedics came. Evaluated at ER. Thought secondary to dehydration.

VAERS ID:525814 (history)  Vaccinated:2014-02-20
Age:11.0  Onset:2014-02-22, Days after vaccination: 2
Gender:Male  Submitted:2014-03-14, Days after onset: 19
Location:New York  Entered:2014-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Well 11 year old P.E.
Preexisting Conditions: Allergy: Bee stings
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA130120IMLA
Administered by: Unknown     Purchased by: Public
Symptoms: Joint range of motion decreased, Vaccination site erythema, Vaccination site induration, Vaccination site pain
SMQs:, Arthritis (broad)
Write-up: FIRM, ERYTHEMATOUS, PAINFUL AREA SURROUNDING VACCINE SITE EXTENDING DOWN TO ELBOW. UNABLE TO MOVE UPPER ARM. STARTED ON AUGMENTIN 875MG BID RESOLVED 2 DAYS LATER.

VAERS ID:525826 (history)  Vaccinated:2014-03-14
Age:11.0  Onset:2014-03-14, Days after vaccination: 0
Gender:Female  Submitted:2014-03-14, Days after onset: 0
Location:California  Entered:2014-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: Blood pressure 90/60, 98/60
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.J0133240IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4658AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4247AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Vasovagal reaction/syncopal episode.

VAERS ID:525870 (history)  Vaccinated:2014-03-05
Age:11.0  Onset:2014-03-05, Days after vaccination: 0
Gender:Male  Submitted:2014-03-05, Days after onset: 0
Location:Puerto Rico  Entered:2014-03-14, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA; No medical condition
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.H0209010IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4656AA0IMUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSN4L770IMUN
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Dizziness, Hyperhidrosis, Nausea, Pallor, Peripheral coldness, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After administering the vaccines, the patient presented abdominal pain, nausea, dizziness and vomit. He was pale, sweaty and cool to touch. B/P 80/50 P-62.

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