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Case Details (Sorted by Age)

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VAERS ID:211416 (history)  Vaccinated:2003-10-27
Age:11.0  Onset:2003-10-27, Days after vaccination: 0
Gender:Male  Submitted:2003-10-30, Days after onset: 3
Location:Virginia  Entered:2003-10-31, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0946M1 LA
Administered by: Public     Purchased by: Public
Symptoms: Nausea, Oedema, Pruritus, Rash, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Hives, itching rash all over body, swelling, nauseated. Within 2 hours after receiving shot.

VAERS ID:211817 (history)  Vaccinated:2003-10-20
Age:11.0  Onset:2003-10-20, Days after vaccination: 0
Gender:Male  Submitted:2003-10-21, Days after onset: 1
Location:Missouri  Entered:2003-11-05, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1260AA IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Blister, Rash pustular
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (narrow)
Write-up: Pustules on left shoulder and left leg. Ruptured pustules on left wrist. Developing rash on right shoulder.

VAERS ID:211910 (history)  Vaccinated:2003-09-29
Age:11.0  Onset:2003-10-02, Days after vaccination: 3
Gender:Female  Submitted:2003-09-29, Days after onset: 3
Location:North Carolina  Entered:2003-11-07, Days after submission: 39
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: Chronic UTI
Diagnostic Lab Data:
CDC Split Type: NC03125
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5497A90IMRA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Redness, hot, soreness, hives

VAERS ID:212148 (history)  Vaccinated:2003-11-10
Age:11.0  Onset:2003-11-10, Days after vaccination: 0
Gender:Male  Submitted:2003-11-10, Days after onset: 0
Location:New York  Entered:2003-11-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: BP 100/60. Normal neurologic exam.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0991AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Amnesia, Coma, Dizziness, Fall, Hyperhidrosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad)
Write-up: Patient was standing at desk, then fell over without warning, laid with eyes open and unresponsive for five seconds with no jerking movements or eye-rolling and then came to and sat up immediately and asked what happened. Patient relates no memory of falling over or lying on the ground. Patient comjplained of feeling light-headed and sweaty. He was given some fruit juice and observed for 30 minutes without further complaints. BP 10 minutes later was 100/70 (BP prior to vaccine was 90/60), HR 80. Patient felt better and was sent home from the office.

VAERS ID:212163 (history)  Vaccinated:2003-10-27
Age:11.0  Onset:2003-11-03, Days after vaccination: 7
Gender:Female  Submitted:2003-11-10, Days after onset: 7
Location:Michigan  Entered:2003-11-12, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;Varicella (Varivax);4;0;In Patient
Other Medications: Dayquil; Advil
Current Illness: Headache
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1011AA IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0476N SCRL
Administered by: Private     Purchased by: Private
Symptoms: Cough, Lip ulceration, Nausea, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Patient presented 11/5/03 after being vaccinated for Td and Varivax 10/27/03. Temperature of 101 and rash with onset 11/3/03. Had cold sore last week, nausea and vomiting and cough 2 days prior to 11/05/03 visit. Numerous papules and vesicles in various stages (50-100 present).

VAERS ID:212506 (history)  Vaccinated:2003-10-21
Age:11.0  Onset:2003-11-03, Days after vaccination: 13
Gender:Male  Submitted:2003-11-10, Days after onset: 7
Location:Wisconsin  Entered:2003-11-18, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5376A21IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0390N1SCRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1066M0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Infection, Injection site erythema, Injection site warmth, Pruritus, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Vesicular rash to face, trunk, upper arms and groin; itching. Erythema left arm 2" long, 1.5" wide, hot to touch, itching also. Diagnosed as slight case of varicella by NP.

VAERS ID:212717 (history)  Vaccinated:2003-11-11
Age:11.0  Onset:2003-11-12, Days after vaccination: 1
Gender:Male  Submitted:2003-11-14, Days after onset: 2
Location:Virginia  Entered:2003-11-20, 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: Some abdominal pain and diarrhea
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1001AA5IMRA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site induration, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythema, warmth and slight induration 3x5cm area around injection site beginning 30 hours after injection and began to fade 72 hours after. Fever up to 101.3 degrees.

VAERS ID:212832 (history)  Vaccinated:2003-10-23
Age:11.0  Onset:2003-10-25, Days after vaccination: 2
Gender:Male  Submitted:2003-11-14, Days after onset: 20
Location:Illinois  Entered:2003-11-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Advair, Ventolin
Current Illness: NONE
Preexisting Conditions: Asthma, tree and grass pollen allergy
Diagnostic Lab Data: PFT: FVC 2.88 (114%), FEV, 2.20 (96%) rates 76, FEF 25-75, 1.94/69%).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1128AA2IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0530N0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Cough, Oedema peripheral, Pain, Pyrexia, Serum sickness, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Serum sickness; giant urticaria, fever 104 F, swollen wrist, body aches, cough (history of asthma). Swelling at site of Pneumovax but not flu shot.

VAERS ID:212879 (history)  Vaccinated:2003-11-14
Age:11.0  Onset:2003-11-17, Days after vaccination: 3
Gender:Male  Submitted:2003-11-19, Days after onset: 2
Location:California  Entered:2003-11-24, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES7659790IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS777A20IMRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURW15820IMLA
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUB492AA0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Lymphadenopathy, Malaise
SMQs:
Write-up: 4 vaccines on Friday, 11/11/2003. On Monday morning (11/17/2003) patient''s mother phoned and said that patient was not feeling well on Saturday morning and that he had swollen lymph glands under his left arm and on left side of neck. Patient did not have a fever.

VAERS ID:212997 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2002-09-07
Location:Unknown  Entered:2003-11-25, Days after submission: 444
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: U200200579
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)AVENTIS PASTEUR 2  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling hot, Injection site erythema, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: From telephone contact received at manufacturer on 07/23/2002, it was reported that an 11-year-old female received 3 doses of Imovax IM to the deltoid for post exposure prophylaxis. The pt developed large local reactions at site of injection after each dose. The areas were red, warm, tender to touch, but size not reported. This report, phoned in by pt''s mother, who is a nurse practitioner at a different facility from where the vaccines were administered. No lot number info available, doses were administered at family physician''s office. Mother wasn''t sure if this was reported to VAERS through her health department. A VAERS form was faxed to her requesting she obtain as much info as possible and return to manufacturer.

VAERS ID:213007 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2002-09-07
Location:Tennessee  Entered:2003-11-25, Days after submission: 444
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pt experienced headache after first dose of Imovax, and continues daily, most severe in evenings.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U200200581
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)AVENTIS PASTEUR    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Musculoskeletal stiffness, Pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: From telephone contact received at Aventis Pasteur Inc. on 07/30/2002, it was reported that an 11-year-old male received 2 doses of Imovax in the thigh. Date of vaccination not specified. Pt experienced local soreness and muscle stiffness for approximately one hour after each dose. Also after first dose Imovax, pt experienced headache and continues daily, most severe in evenings.

VAERS ID:213141 (history)  Vaccinated:2003-11-21
Age:11.0  Onset:2003-11-22, Days after vaccination: 1
Gender:Female  Submitted:2003-11-25, Days after onset: 3
Location:Minnesota  Entered:2003-11-26, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5511A91IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0836AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Flushing, Headache, Injection site erythema, Injection site oedema, Nausea, Tongue black hairy, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: The day after vaccination, patient developed nausea and vomiting. Severe headache and flushed face. Left arm around area of immunization was red, swollen and warm to touch. Parents did not take her temperature. The following day, the nausea, vomiting and headache was gone. 3 days after vaccination, patients tongue was coated with a grayish, black substance. By the 4th day arm is less red and swollen and substance on tongue is almost gone.

VAERS ID:213236 (history)  Vaccinated:2003-11-11
Age:11.0  Onset:2003-11-11, Days after vaccination: 0
Gender:Male  Submitted:2003-11-13, Days after onset: 2
Location:New Hampshire  Entered:2003-12-02, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriftyline HCl, Flovent
Current Illness: NONE
Preexisting Conditions: Asthma, migraine headaches
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1145AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Cyanosis, Dizziness, Dyspnoea, Eye movement disorder, Heart rate increased, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Eyes rolled back into head, turned pale with blueness around lip area, lost consciousness, dizziness. Doctor called immediately, still in office. Rapid heartbeat, quickened pulse, chest pain, hard to breathe.

VAERS ID:213384 (history)  Vaccinated:2003-04-16
Age:11.0  Onset:2003-08-15, Days after vaccination: 121
Gender:Female  Submitted:2003-12-02, Days after onset: 109
Location:Minnesota  Entered:2003-12-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Dr. exam, X-ray, and MRI
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5309C93IMRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0822AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Skin atrophy
SMQs:
Write-up: Noted a depression in the left arm when she started volleybal practice in August. No pain unless itis pushed on that area. Depression observable on photos and seems to be increasing.

VAERS ID:213504 (history)  Vaccinated:2003-11-11
Age:11.0  Onset:2003-11-21, Days after vaccination: 10
Gender:Male  Submitted:2003-11-26, Days after onset: 5
Location:Indiana  Entered:2003-12-05, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair, Singulari, Nasonex
Current Illness: NONE
Preexisting Conditions: Asthma; Allergic rhinitis; Allergic to yellow jacket.
Diagnostic Lab Data: FEV, 41% expected; Throat culture; GpG; Beta; Hemolytic strep. CXR (-) in pcp''s office
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1266AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Asthma, Condition aggravated, Headache, Pain, Pharyngolaryngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Body aches, low grade fever, stomach ache, headache, sore throat which began soon after shot. Asthma attack began 11/21/03 (10 days after flu shot). (1st asthma hospitalization for this patient in 6 years.) Failed to clear after 4 days home management and oral steroid. The follow up received on 12/24/03 states URI and pharyngitis were not evident on date of vaccination. Symptoms began within 24 hrs after vaccination. Tx PCN. Later erythromycin and Solu-Medrol. VAccine provider-pcp does not expect a discharge summary will be available-overnight hospitalization.

VAERS ID:213519 (history)  Vaccinated:2003-11-04
Age:11.0  Onset:2003-11-04, Days after vaccination: 0
Gender:Female  Submitted:2003-12-01, Days after onset: 27
Location:Minnesota  Entered:2003-12-05, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1142AA IM 
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Fatigue, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Itching all over for 12 hours. Tired, patient reports feeling funny, tired and tongue felt funny day after shot. No hives or swelling or tongue noted upon exam. No egg allergy. Afebrile.

VAERS ID:213736 (history)  Vaccinated:2002-02-12
Age:11.0  Onset:2002-02-12, Days after vaccination: 0
Gender:Male  Submitted:2003-11-20, Days after onset: 646
Location:Tennessee  Entered:2003-12-09, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type: TN03075
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5261A20IMRA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Whelping rash to hands, arms, chest, back, legs. Itching to face. Rash present before injection. Symptoms occurred within one hour post injection. To ER. Given Benadryl 12.5/5cc tsp qid for 5 days. (History received from Nurse Practitioner and ER record)

VAERS ID:213778 (history)  Vaccinated:2003-11-28
Age:11.0  Onset:2003-12-01, Days after vaccination: 3
Gender:Female  Submitted:2003-12-02, Days after onset: 1
Location:Tennessee  Entered:2003-12-10, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Attention Deficit Disorder
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1080AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Numbness and weakness at left arm.

VAERS ID:213975 (history)  Vaccinated:2003-10-29
Age:11.0  Onset:2003-11-11, Days after vaccination: 13
Gender:Female  Submitted:2003-11-17, Days after onset: 6
Location:Texas  Entered:2003-12-15, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TX03143
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0767M0SCRA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Feeling hot, Injection site oedema, Skin ulcer
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: From elbow to shoulder, warm and swollen area, redness 3 varicella lesions on chest; Diagnosed with cellulitis.

VAERS ID:214122 (history)  Vaccinated:1996-11-18
Age:11.0  Onset:2003-12-08, Days after vaccination: 2576
Gender:Female  Submitted:2003-12-10, Days after onset: 2
Location:North Carolina  Entered:2003-12-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Clinical exam
CDC Split Type:
Vaccination
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Public
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Discrete vesicular lesions. The follow up received on 12/31/03 states not given by our office not received info from previous office.

VAERS ID:214151 (history)  Vaccinated:2003-12-16
Age:11.0  Onset:2003-12-17, Days after vaccination: 1
Gender:Female  Submitted:2003-12-17, Days after onset: 0
Location:New Jersey  Entered:2003-12-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair
Current Illness: NONE
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR41088AA0 LA
Administered by: Private     Purchased by: Private
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Local erythema, color,

VAERS ID:214264 (history)  Vaccinated:2003-10-16
Age:11.0  Onset:2003-10-16, Days after vaccination: 0
Gender:Male  Submitted:2003-10-18, Days after onset: 2
Location:Massachusetts  Entered:2003-12-23, Days after submission: 66
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: Contact dermatitis due to plants
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500032P0IN 
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Heart rate increased, Laryngeal oedema, Oedema, Pruritus, Rash macular, Throat tightness, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Flumist given at 6:46pm appr. 20 mins after receiving vaccine pt had complaints of blotchy redness on back of neck and complaints of throat swelling. Assessed by Dr and 2 tsp of Benadryl given. No difficulty breathing. Assessed every 5 minutes until 7:35. No symptoms at this time. Follow up on 10/13/04 states: "information obtained from the reporter indicated that <20 minutes after FluMist pt had hive-like rash in neck (4-5 reddish spots 2cms in diameter), itching in neck, plus sensation of throat swelling which lasted for approximately 45 minutes. Pulse was 96/min, O2 saturation 99%. Given Benadryl 2 tsp''s (presentation 12.5mgs/5ml) 5 min after symptoms onset. The only history of allergy was dermatitis after poison ivy."

VAERS ID:214274 (history)  Vaccinated:2003-11-03
Age:11.0  Onset:2003-11-04, Days after vaccination: 1
Gender:Male  Submitted:2003-12-16, Days after onset: 42
Location:Texas  Entered:2003-12-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1092AA0 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt had soreness in the injection site day after injection. No swelling, no redness.

VAERS ID:214276 (history)  Vaccinated:2003-10-21
Age:11.0  Onset:2003-10-28, Days after vaccination: 7
Gender:Male  Submitted:2003-11-13, Days after onset: 16
Location:Texas  Entered:2003-12-23, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1092AA0 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0257N0 LA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0527AA0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0335N0 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site mass, Injection site pain, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pt''s left arm was swollen with a large bump at the injection site and hurts to touch. Pt had full range of motion of left arm. Luke warm compresses and Motrin as needed for pain.

VAERS ID:214277 (history)  Vaccinated:2003-10-31
Age:11.0  Onset:2003-11-12, Days after vaccination: 12
Gender:Male  Submitted:2003-12-16, Days after onset: 34
Location:Texas  Entered:2003-12-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1092AA0 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0257N0 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pneumovax 23 was given 10/31/2003 on 11/01-11/02. Pt developed redness and swelling with pan and fever at site of vaccine injection. Symptoms improved with warm compresses.

VAERS ID:214278 (history)  Vaccinated:2003-11-10
Age:11.0  Onset:2003-11-12, Days after vaccination: 2
Gender:Male  Submitted:2003-12-16, Days after onset: 34
Location:Texas  Entered:2003-12-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU1092AA0 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0257N0 RA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Pain
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Right arm and under site into armpit was very sore and red. Luke warm compresses 2-3 times a day and Motrin for pain as prescribed.

VAERS ID:214293 (history)  Vaccinated:2003-10-24
Age:11.0  Onset:2003-10-27, Days after vaccination: 3
Gender:Female  Submitted:2003-11-18, Days after onset: 22
Location:Idaho  Entered:2003-12-23, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: yes, this info was not given to us on 10/24/03;Hep B (unknown mfr);1;5;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Done at clinic
CDC Split Type: ID03064
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5378A2  LA
Administered by: Public     Purchased by: Public
Symptoms: Eye disorder, Malaise, Pyrexia, Yellow skin
SMQs:, Cholestasis and jaundice of hepatic origin (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Corneal disorders (broad), Retinal disorders (broad)
Write-up: Pt came to clinic 10/24/03 for her first Hep B. Mother called 10/28 states pt was ill with fever, abdominal pain, vomiting. Mother called again 10/29 and stated the child was now yellow in her eyes and skin. Fever was better. Mother then said she had a similar reaction 2 years ago at clinic, got 1 Hep B then forgot to tell us. Referred to clinic.

VAERS ID:214712 (history)  Vaccinated:2003-12-15
Age:11.0  Onset:2003-12-18, Days after vaccination: 3
Gender:Male  Submitted:2004-01-07, Days after onset: 20
Location:Maryland  Entered:2004-01-07
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: Medical records state Hx of croup. msv
Diagnostic Lab Data: Croup Lab tests do not document croup, dyspnea, cough. msv
CDC Split Type:
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500033T   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Laryngitis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Patient developed Croup 3 days following Flu Mist vaccine and required an Emergency room visit due to stridor and a course of Prednisone

VAERS ID:215008 (history)  Vaccinated:2002-01-22
Age:11.0  Onset:2002-01-22, Days after vaccination: 0
Gender:Male  Submitted:2004-01-09, Days after onset: 717
Location:Unknown  Entered:2004-01-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD Tuberculin
Current Illness: UNK
Preexisting Conditions: Medical history and concurrent conditions were not specified. The pt did not receive any other vaccinations on 01/22/2002, but he did have the tuberculosis skin test performed.
Diagnostic Lab Data: UNK
CDC Split Type: A0357561A
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS 0IMLL
Administered by: Private     Purchased by: Other
Symptoms: Anorexia, Depressed level of consciousness, Dizziness, Fall, Fatigue, Muscular weakness, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Report 2002001243-1 describes fainting in an 11-year-old male who received hepatitis B vaccine recombinant (Engerix-B). This report was received from the mother of the pt and has not been verified by a physician or other healthcare professional. Medical history and concurrent conditions were not specified. The pt did not receive any other vaccinations on 01/22/2002, but he did have the tuberculosis skin test performed. Reportedly, on 01/22/2002, the pt received his 1st injection of Engerix-B. The mother reported that within 5 minutes of getting in the car, her son "was out cold". She said that it was very difficult to wake him and they had to help him out of the car and into the house. She stated that his condition was "like he was going in and out of consciousness". Reportedly, he had no interest in food, felt dizzy and nauseated, and had "some" muscle weakness. Reportedly, he went to go down the hall to his bedroom and fell down in the hall and went to sleep. Mother said he "was just unable to function". The pt was taken to the ER where, reportedly, the physician said that the pt had "fainted" and sent him home. Mother and pt went to the pediatrician''s office on 01/23/2002 and, reportedly, the physician stated that the pt "seemed fine". Mother reported that on 01/23/2002, her son was throwing up and was very nauseated. She said that he has not had this type of reaction with any other vaccines he has had in the past. As of 01/24/2002, the pt was "still fatigued".

VAERS ID:215140 (history)  Vaccinated:2003-05-19
Age:11.0  Onset:2003-05-21, Days after vaccination: 2
Gender:Female  Submitted:2004-01-09, Days after onset: 233
Location:Virginia  Entered:2004-01-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0419338A
Vaccination
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Lot
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5289C91  
Administered by: Other     Purchased by: Other
Symptoms: Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: This case was reported by a nurse described the occurrence of vomiting in an 11 year old female who received hep B vaccine recombinant (Engerix B) for prophylaxis. On 5/19/03, the pt received her second injection of Engerix B. Two days later, on 5/21/03, the pt experienced nausea, vomiting, and diarrhea. The events resolved on 5/22/03. The reporting nurse considered the events were possibly related to vaccination with Engerix B.

VAERS ID:215750 (history)  Vaccinated:2004-01-22
Age:11.0  Onset:2004-01-22, Days after vaccination: 0
Gender:Male  Submitted:2004-01-28, Days after onset: 6
Location:New York  Entered:2004-01-28
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: ALLERGIC SULFA, CATS....ASTHMA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5374A21IMRA
Administered by: Public     Purchased by: Public
Symptoms: Diarrhoea, Rash
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)
Write-up: MOTHER PHONED ACDOH TO REPORT THAT RASH DEVELOPED THE NIGHT OF THE VACCINE AND HAS PROGRESSED TO ENTIRE FACE (HAS ALSO HAD DIARRHEA OVER THE WEEKEND)STILL HAS RASH

VAERS ID:215740 (history)  Vaccinated:2004-01-14
Age:11.0  Onset:2004-01-15, Days after vaccination: 1
Gender:Female  Submitted:2004-01-16, Days after onset: 1
Location:Michigan  Entered:2004-01-29, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Td Adsorbed, Adult (unknown mfr);;3;17;In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Only to DTP given in 1998.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0467N2 RA
Administered by: Public     Purchased by: Other
Symptoms: Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 01/15/04: Complained to parent of itchiness and rash development all over body. Low grade temperature 100.1. Seen in ER 01/15/04, given Benadryl, Cortisone injections. To start taking Benadryl and Mediol as prescribed by ER MD.

VAERS ID:215766 (history)  Vaccinated:1997-11-10
Age:11.0  Onset:2004-01-25, Days after vaccination: 2267
Gender:Male  Submitted:2004-01-26, Days after onset: 1
Location:Florida  Entered:2004-01-30, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Skin ulcer, Viral infection
SMQs:
Write-up: Viral illness on Friday, Sunday and Monday with new lesions extending at various areas from chest back and face and extremities.

VAERS ID:215960 (history)  Vaccinated:2003-01-07
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2004-01-09
Location:Connecticut  Entered:2004-02-04, Days after submission: 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:
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5393A22IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad)
Write-up: Hep B given around (10:15-10:30 AM) 1/7/03. Came home from school; right leg shaking. Afebrile in PM. Mother called 3:09 PM.

VAERS ID:215968 (history)  Vaccinated:1993-01-01
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2004-01-29
Location:Unknown  Entered:2004-02-04, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Test: Serum measles IgG; Comment: Negative
CDC Split Type: WAES0311USA02732
Vaccination
Manufacturer
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MEA: MEASLES (ATTENUVAX)MERCK & CO. INC. 1SC 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from the father of an 11 year old female who was vaccinated with a dose of measles virus vaccine live (Moraten), subcutaneous administration, 4 days before she turned 1-year-old (lot number not available). On a unspecified date, the patient received another dose of measles virus vaccine live (Moraten), receiving a total number of 2 doses. The father reported that after the second dose of vaccine, his daughter was "still showing up as not protected". Unspecified medical attention was sought. At the time of this report the patient''s outcome was unknown. No further information is available.

VAERS ID:216055 (history)  Vaccinated:2003-10-01
Age:11.0  Onset:2003-10-04, Days after vaccination: 3
Gender:Male  Submitted:2003-10-24, Days after onset: 20
Location:California  Entered:2004-02-05, Days after submission: 104
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza (FluMist);;;8;In Sibling
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: Concurrent Conditions: Overweight
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE0949
Vaccination
Manufacturer
Lot
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Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Private     Purchased by: Private
Symptoms: Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Information regarding Flumist (2003-2004 Formula) (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a consumer regarding an 11-year-old male patient who experienced sneezing and congestion. At 11 years of age, the patient received a dose on 01-Oct-2003. Medical history: The patient''s concurrent illness includes being overweight. Product details: Indication for Flumist (2003-2004 Formula) was immunization. Product was administered on 01-Oct-2003. Dose regimen was 0.5 ml (intranasal). Concomitant therapy: The patient was not receiving concomitant medications. Event details: The patient developed sneezing (sneezing) and congestion (nasal congestion) on 04-Oct-2003. As of 06-Oct-2003, his symptoms persisted. The patient''s brother developed sneezing and congestion following receipt of Flumist on 01-Oct-2003 at 8 years of age (See MCN HQWYE0948). No additional information was available at the date of this report.

VAERS ID:216099 (history)  Vaccinated:2003-12-12
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2004-01-06
Location:California  Entered:2004-02-05, Days after submission: 30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE659816DEC03
Vaccination
Manufacturer
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500034P IN 
Administered by: Other     Purchased by: Other
Symptoms: Medication error
SMQs:
Write-up: A pharmacist reported that an 11 year old female pt inadvertently received a dose of Flumist (influenza virus vaccine, live intranasal (2003-2004 Formula) nasal solution (frozen)) into a single nostril on 12/12/2003. The reporter indicated that the pt does not have any relevant medical history. Indication for Flumist (2003-2004 Formula) was immunization. Product was administered on 12/12/03. Concomitant medications were not reported. Concomitant vaccines were not administered. On 12/12/03, a female pt inadvertently received a dose of Flumist into a single nostril. The reporter indicated that the pt stated the Flumist "tasted sweet" right after administration. No additional information was available at the time of this report.

VAERS ID:216161 (history)  Vaccinated:2003-12-11
Age:11.0  Onset:2003-12-12, Days after vaccination: 1
Gender:Male  Submitted:2003-12-23, Days after onset: 11
Location:Arkansas  Entered:2004-02-05, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: HQWYE687217DEC03
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500018P IN 
Administered by: Private     Purchased by: Other
Symptoms: Cough, Nasal congestion, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: A nurse reported that an 11 year old male patient received a dose of Flumist nasal solution on 12/11/2003. The patient has no significant medical history. Indication for Flumist was immunization. Product was administered on 12/11/03. Dose regimen was 1 dose 1 time per day. There were no concomitant vaccines or medications. On 12/12/03, one day post immunization, the patient developed fever to 102.3 degrees F, nasal congestion and cough. At the date this event was reported, the cough and nasal congestion persisted and the patient''s fever was recorded at 98.5 degrees F. Treatment information was not provided. No additional information was available at the time of this report.

VAERS ID:216166 (history)  Vaccinated:2003-12-15
Age:11.0  Onset:2003-12-16, Days after vaccination: 1
Gender:Female  Submitted:2003-12-19, Days after onset: 3
Location:Louisiana  Entered:2004-02-05, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE692817DEC03
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Private     Purchased by: Private
Symptoms: Nasal congestion, Pharyngolaryngeal pain
SMQs:
Write-up: Information regarding Flumist nasal solution was received from the father of an 11 year old female who experienced stuffy nose and sore throat. At 11 years of age, the child received a dose on 12/15/03. The child had no relevant medical history. Indication for Flumist was immunization. Product was administered on 12/15/03. Dose regimen was 1 dose (IN). The child was not taking concomitant therapy. The child experienced stuffy nose and sore throat on 12/16/03. No additional information was available at the time of this report.

VAERS ID:216169 (history)  Vaccinated:2003-12-12
Age:11.0  Onset:2003-12-13, Days after vaccination: 1
Gender:Female  Submitted:2003-12-18, Days after onset: 5
Location:Virginia  Entered:2004-02-05, Days after submission: 49
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE698317DEC03
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500033P IN 
Administered by: Other     Purchased by: Other
Symptoms: Chills, Pain, Pharyngolaryngeal pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Information regarding Flumist nasal solution was received from a health care professional regarding a 11 year old female patient who experienced fever of 101.9 degrees F, chills, vomiting, body aches, and sore throat. At 11 years of age, the patient received a dose on 12/12/03. Relevant medical history was not provided. Indication for Flumist was immunization. Product was administered on 12/12/03. Dose regimen was 1 dose (IN). Patient was not taking concomitant therapy. The patient experienced fever of 101.9 degrees F, chills, vomiting, body aches, and sore throat on 12/13/03. She was seen by a physician on 12/16/03 for these symptoms. No additional information was available at the date of this report.

VAERS ID:216296 (history)  Vaccinated:2003-12-08
Age:11.0  Onset:2003-12-08, Days after vaccination: 0
Gender:Female  Submitted:2004-01-15, Days after onset: 38
Location:Guam  Entered:2004-02-11, Days after submission: 27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINES765754 IM 
Administered by: Military     Purchased by: Military
Symptoms: Cold sweat, Dizziness, Heart rate increased, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (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: Approximately 1.5 hours after vaccine administration, pt felt nauseated, clammy, racing heart, and dizzy/faint. She was treated by parent-laying her down to rest, cool clothes on face.

VAERS ID:216307 (history)  Vaccinated:2004-01-29
Age:11.0  Onset:2004-01-31, Days after vaccination: 2
Gender:Male  Submitted:2004-02-05, Days after onset: 5
Location:Massachusetts  Entered:2004-02-11, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Fracture right hand.
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
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TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD1055IMLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, Oedema, Pain, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Given Td on 1/29/2004 in left deltoid area. On 1/31/2004 noted by mom to have swollen, red, hot to touch upper left arm. Went to ER, diagnosed with cellulitis put on Kefzol. Area very sore/itchy.

VAERS ID:216326 (history)  Vaccinated:2004-02-03
Age:11.0  Onset:2004-02-04, Days after vaccination: 1
Gender:Male  Submitted:2004-02-04, Days after onset: 0
Location:Michigan  Entered:2004-02-11, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0091AA5IMRA
Administered by: Other     Purchased by: Public
Symptoms: Injection site induration, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: 24 hours after shot, fever with extremely tender indurated right deltoid.

VAERS ID:216623 (history)  Vaccinated:2004-02-06
Age:11.0  Onset:2004-02-07, Days after vaccination: 1
Gender:Male  Submitted:2004-02-13, Days after onset: 6
Location:Unknown  Entered:2004-02-19, 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: NONE
Current Illness: Headache, nausea, induced asthma
Preexisting Conditions: Excessive induced asthma;
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0830AA  RA
Administered by: Private     Purchased by: Other
Symptoms: Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling reaction right deltoid. 2.5x2 inch localized swelling, no erythema, no induration, no limitation of movement right shoulder.

VAERS ID:216735 (history)  Vaccinated:2004-02-16
Age:11.0  Onset:2004-02-16, Days after vaccination: 0
Gender:Female  Submitted:2004-02-19, Days after onset: 3
Location:Minnesota  Entered:2004-02-23, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Lytes, Mg, Poli, EBC, Palse Oximeter, equals all normal.
CDC Split Type:
Vaccination
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HEP: HEP B (FOREIGN)MERCK & CO. INC.0466N0IMLA
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC)MERCK & CO. INC.0812N1SCRA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU1010AA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Patient had a seizure like reaction versus a diptonic reaction after receiving the shot. She recovered within 15 minutes and after 1/2 hour, she completely recovered.

VAERS ID:216765 (history)  Vaccinated:2003-12-09
Age:11.0  Onset:2003-12-09, Days after vaccination: 0
Gender:Male  Submitted:2004-01-07, Days after onset: 29
Location:Tennessee  Entered:2004-02-24, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: TN04001
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5461A20IMRA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Itching and redness to both arms-no hives, eyes also itching. Benadryl 0.8cc (50mg) given IM in right deltoid. Observed 1/5 hours. Uncle contacted.

VAERS ID:217096 (history)  Vaccinated:1996-01-19
Age:11.0  Onset:0000-00-00
Gender:Unknown  Submitted:2004-02-26
Location:Ohio  Entered:2004-03-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0749B IMLA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection, Pruritus, Rash papular, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (broad)
Write-up: Itching rash, developing small papules- vesicles and scabs. Began 2/5 - was seen 2/10 with lesion scabed, some on scalp diagnosis modified chicken pox post vaccine.

VAERS ID:217097 (history)  Vaccinated:1999-07-12
Age:11.0  Onset:2004-02-06, Days after vaccination: 1670
Gender:Male  Submitted:2004-02-26, Days after onset: 20
Location:Ohio  Entered:2004-03-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.029750 LA
Administered by: Private     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:217208 (history)  Vaccinated:1996-02-26
Age:11.0  Onset:2004-02-23, Days after vaccination: 2919
Gender:Male  Submitted:2004-02-26, Days after onset: 3
Location:New York  Entered:2004-03-04, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Pox seen and diagnosed.
CDC Split Type:
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.11124B  LL
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up:

VAERS ID:217362 (history)  Vaccinated:2003-10-20
Age:11.0  Onset:2003-10-24, Days after vaccination: 4
Gender:Female  Submitted:2004-02-24, Days after onset: 123
Location:Connecticut  Entered:2004-03-08, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5386A21IM 
Administered by: Private     Purchased by: Private
Symptoms: Pharyngolaryngeal pain, Pyrexia, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: 10/24 PM: Developed fever to 103 and lasted till 10/25. 10/26, developed a sore throat which resolved by 10/28.

VAERS ID:217466 (history)  Vaccinated:2003-03-03
Age:11.0  Onset:2003-03-04, Days after vaccination: 1
Gender:Female  Submitted:2004-03-05, Days after onset: 367
Location:New York  Entered:2004-03-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Food allergy; allergy to nuts;
Preexisting Conditions: Eczema, reactive airway disease, mild mitral valve prolapse/ regurgitation, and subacute bacterial endocarditis; mitral regurgitation;
Diagnostic Lab Data: NONE
CDC Split Type: WAES0303USA00305
Vaccination
Manufacturer
Lot
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0159M1IMUN
Administered by: Private     Purchased by: Private
Symptoms: Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a licensed practical nurse concerning an 11 year old female with eczema, reactive airway disease, mild mitral valve prolapse/ regurgitation, multiple food allergies: honeydew, Brazil nuts, lentils, chick peas (severe reaction-per mother), and subacute bacterial endocarditis. On 1/21/03 and on 3/3/03 the pt was vaccinated with a first and second dose of hep B vaccine (642923/0159M).There was no concomitant therapy or illness at the time of vaccination. On 3/4/03 the mother contacted the doctor''s office to report that the pt''s fingers had swollen slightly on the right hand and pt complained of pain. There were no markings at the injection site. There was no fever or other systemic symptoms. The physician recommended to try anti-inflammatories and call back in a few days. The physician "does not feel this was related to the hep B vaccine administration," but was reporting on the mother''s request. It was noted that the pt "had no problems" after the first dose of hep B vaccine. Follow-up reported that on 3/5/03 the pt had "history of swelling of arm and shoulder." There were no relevant diagnostic tests or lab data. Additional info has been requested.

VAERS ID:217512 (history)  Vaccinated:2002-04-02
Age:11.0  Onset:2002-04-23, Days after vaccination: 21
Gender:Male  Submitted:2004-03-05, Days after onset: 682
Location:Unknown  Entered:2004-03-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: WAES0308USA02020
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Migraine
SMQs:
Write-up: Information has been received from the mother of an 11 year old male with no medical history and no allergies who on 4/2/02 was vaccinated with a second dose of hepatitis B virus vaccine. There was no concomitant medication. Three weeks later, on approximately 4/23/02, the patient developed acute and chronic migraine headaches. He was given topiramate and ergotamine tartrate which did not help. In July 2002, the patient went to the emergency room and was given dexamethasone, ketorolac tromethamine IV, and promethazine HCl. From August 2002 to April 2003 he was given these drugs IV two to three times per week. On 2/17/03 and on 4/22/03 he was hospitalized. In April 2003 he was switched to nortriptyline HCl. Subsequently, he finally recovered. The mother reported that her son missed 43 days of school and that both his parents lost their jobs because of the time needed for his medical care. No product quality complaint was involved. Acute and chronic migraine headaches were considered to be disabling. Additional information has been requested.

VAERS ID:217625 (history)  Vaccinated:2001-11-05
Age:11.0  Onset:2001-11-05, Days after vaccination: 0
Gender:Male  Submitted:2004-03-09, Days after onset: 855
Location:Virginia  Entered:2004-03-09
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none;
Preexisting Conditions: chronic URI/sinusitis ; positive Epstein Barr virus-mononucleosis indicating convalescent stage of illness; high eosinophil count ;
Diagnostic Lab Data: Please contact the mother for this info. Please contact the school for the type of the vaccine given. Normal head CT
CDC Split Type:
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSENG5224B9   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Difficulty in walking, Disturbance in attention, Dizziness, Dyspnoea, Fatigue, Malaise, Neuritis, Vestibular disorder, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (narrow)
Write-up: My son is diagnosed with chronic fatigue syndrome which started acutely after after he recived HepB vaccine dose. He is profoundly disabled, he can''t attend school or perform any age appropriate activites such as playing, reading, playing sports.Often he can''t walk by himself and at times he even can''t breath without difficulty. He is in a constant state of fatigue, maldie and brain fog. he requires around the clock care since the onset of his illness. Prior to the vaccination he was absolutely healthy, happy and bright little boy. His illness devastated the entire family physically, financially and morally. I am a mother and looking at my son suffer like he is suffering is riping my heart apart.No amount of medical intervention could provide cure or at least some relief. Nurse follow up on 08/05/04 states: "Physician states in his progress note that Hep B was not necessary based on their office records. This would indicate that the Hep B in Box 13 was at least the 4th dose. However, a titer drawn on 2/28/2002, nearly 4 months s/p vaccination, was non-reactive. ADD: weakness; dizziness; vomiting ; vestibular neuronitis ; febrile illness ; pharyngitis-tonsillitis."

VAERS ID:217644 (history)  Vaccinated:1996-08-28
Age:11.0  Onset:2004-03-06, Days after vaccination: 2747
Gender:Female  Submitted:2004-03-08, Days after onset: 2
Location:Maryland  Entered:2004-03-11, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0694E0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Varicella infection. Follow up on 04/21/04: Reporter does not give any more new information.

VAERS ID:217729 (history)  Vaccinated:2003-03-04
Age:11.0  Onset:2003-03-04, Days after vaccination: 0
Gender:Male  Submitted:2004-02-26, Days after onset: 359
Location:California  Entered:2004-03-12, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: The subject''s medical history, concurrent conditions and concurrent medications were not report.
Diagnostic Lab Data: UNK
CDC Split Type: A0399559A
Vaccination
Manufacturer
Lot
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Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS  IM 
Administered by: Other     Purchased by: Other
Symptoms: Headache, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Rash erythematous, Headache, Pyrexia. A nurse reported the occurrence of a rash in an 11-year-old male who was vaccinated with hepatitis A vaccine inactivated (Havrix) for prophylaxis. The subject''s medical history, concurrent conditions, and concurrent medications were not reported. On 04 March 2003, the subject received an injection of Havrix. Later that day, he developed a rash, headache and fever. He was seen by the reporter on 07 March 2003. She noted that the rash was erythematous with demarcated edges and covered an area measuring 5cm by 5cm. The location of the rash was not specified. The subject reported that the rash had gotten bigger over time. The nurse also noted an oral temperature of 99.8 degrees Fahrenheit. The Havrix immunization series was discontinued.

VAERS ID:217779 (history)  Vaccinated:1995-07-27
Age:11.5  Onset:2004-03-01, Days after vaccination: 3140
Gender:Male  Submitted:2004-03-08, Days after onset: 7
Location:Ohio  Entered:2004-03-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE known.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Chicken pox lesions.

VAERS ID:218039 (history)  Vaccinated:2004-03-15
Age:11.0  Onset:2004-03-16, Days after vaccination: 1
Gender:Male  Submitted:2004-03-16, Days after onset: 0
Location:Florida  Entered:2004-03-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0887N1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Injection site pain, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Mother states pt has pain at injection site yesterday. Today 3/16/04 area is red & swollen & warm to touch since 10 AM. Treatment Benadryl Zyrtec.

VAERS ID:218050 (history)  Vaccinated:2003-10-22
Age:11.0  Onset:2003-10-23, Days after vaccination: 1
Gender:Male  Submitted:2003-10-22, Days after onset: 1
Location:Michigan  Entered:2004-03-23, Days after submission: 153
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Steroids 20 m every day for many years off for only 2 weeks.
Current Illness: NONE
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type: MI2004013
Vaccination
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TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0839AA IMLA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Oedema, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Received a phone call from mother stating "my child arm is red, swollen and hot." "He has a welt that''s 8 inches in size." Public health nurse advised parent to follow-up with the Pediatrician as soon as possible. Follow-up phone call was made by Public Health Nurse. Parent states Pediatrician examined the child on 10-23-03 states child had a bad reaction to the TD/adult put child on medication: Augmentin 60 mg twice a day, Benadryl every 6-8 hours and Prednisone 20 mg every day. 2-5-04 per doctor hospital will not administer to again before 10 years lapse, if needs for injury after 5 years lapse must be evaluated by private provider first.

VAERS ID:218246 (history)  Vaccinated:2004-03-02
Age:11.0  Onset:2004-03-02, Days after vaccination: 0
Gender:Male  Submitted:2004-04-12, Days after onset: 40
Location:North Carolina  Entered:2004-03-29, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Developmental delays, Congenital Heart Disease.
Diagnostic Lab Data: UNK
CDC Split Type: NC04022
Vaccination
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.04400 RA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Skin nodule
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Developed 50 mm x 55 mm red indurated area on right upper arm.

VAERS ID:218507 (history)  Vaccinated:2004-03-31
Age:11.0  Onset:2004-04-01, Days after vaccination: 1
Gender:Male  Submitted:2004-04-01, Days after onset: 0
Location:North Carolina  Entered:2004-04-01
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: ceclor-rash
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
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DT: DT ADSORBED (NO BRAND NAME)BSI    
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Public
Symptoms: Drooling, Dysarthria, Facial palsy, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: The day following vaccinations with dT and HepB (#3), he experienced paresthesias that began in hand and ascended arm. Subsequent symptoms included right facial weakness, slurred speech, and drooling. These symptoms gradually resolved. No seizure activity; unremarkable past medical history

VAERS ID:218467 (history)  Vaccinated:2004-03-29
Age:11.0  Onset:2004-03-29, Days after vaccination: 0
Gender:Female  Submitted:2004-04-01, Days after onset: 3
Location:Indiana  Entered:2004-04-02, 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: NONE
Preexisting Conditions: Swelling to mosquito bites. Rash= Ceclor
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0807N1SCRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1017BA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Lymphadenopathy, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Received Td in LD on 3/29/04. Mother of patient called 4/1/04 complained of redness, swelling of left upper arm. Mother also stated swollen lymph node under left arm. Patient complained of rib pain on left side on 3/30/2004.

VAERS ID:218535 (history)  Vaccinated:2004-02-25
Age:11.9  Onset:2004-02-25, Days after vaccination: 0
Gender:Male  Submitted:2004-03-03, Days after onset: 7
Location:Minnesota  Entered:2004-04-05, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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HEP: HEP B (FOREIGN)MERCK & CO. INC.1218N0IMLA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0841AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Unevaluable event
SMQs:
Write-up: Received 2-25-2004 first Hep B in left arm. Gradually resolved over 2 weeks.

VAERS ID:219004 (history)  Vaccinated:2004-04-08
Age:11.0  Onset:2004-04-08, Days after vaccination: 0
Gender:Male  Submitted:2004-04-08, Days after onset: 0
Location:New Jersey  Entered:2004-04-14, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CT-neg, EKG-neg, BMP- normal.
CDC Split Type:
Vaccination
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HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1239N1IMRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1000AA5IMLA
Administered by: Private     Purchased by: Private
Symptoms: Coma, Dizziness, Eye movement disorder, Hyperhidrosis, Musculoskeletal stiffness
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Arthritis (broad)
Write-up: Within 5 minutes of receiving Td booster and Hepatitis B (dose #2) patient became dizzy, collapsed to knees, eyes rolled back per mother and he became stiff and unresponsive. After 1-2 minutes patient became more responsive but was diaphoretic. Stable BT and breathing- transported to ER.

VAERS ID:219187 (history)  Vaccinated:2003-12-12
Age:11.0  Onset:2003-12-14, Days after vaccination: 2
Gender:Male  Submitted:2004-03-17, Days after onset: 94
Location:Wisconsin  Entered:2004-04-19, Days after submission: 32
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Antinuclear antibody (12/30/03): Negative; C-reactive protein (12/16/03, 12/19/03, 12/30/03): 5.0 mg/dL, 6.18 mg/dL, 0.52 mg/dL; Nuclear MRI (12/15/03): MRI of the left lower leg was normal; Red Blood Cell sedimentation rate (12/16/03, 1
CDC Split Type: HQWYE199608JAN04
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC500010P IN 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Laboratory test abnormal, Pyrexia, Red blood cell sedimentation rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad)
Write-up: Follow-up information received from the physician revealed results of an orthopaedic consultation on 12/15/03, including lab and diagnostic test results. Information regarding Flumist (2003-2004 Formula) (influenza virus vaccine, live intranasal solution (frozen) was received from a nurse regarding an 11 year old male pt who experienced a fever of 104 deg F., left ankle pain, elevation of ESR (erythrocyte sedimentation rate), and elevation of CRP (C-Reactive Protein). The pt received a dose on 12/12/03. The pt was reported as "healthy". Indication for Flumist (2003-2004 Formula) was immunization. Product was administered on 12/12/03. Dose regimen was 0.5mL (IN). Concomitant medications were not reported. On 12/14/03, 2 days post-immunization, the pt developed a fever of 104 deg. F. (pyrexia), and anteromedial lower left leg pain proximal to the ankle joint (arthralgia). His fever was controlled with ibuprofen. On 12/15/03, he was seen by an orthopaedic surgeon. Abnormal lab values included an erythrocyte sedimentation rate of 21mm, and a C-reactive protein of 5 mg/dL. Nuclear magnetic resonance imaging (MRI) of the left lower leg was normal. On 12/18/03, the erythrocyte sedimentation rate was 35mm and on 12/19/03, the C-reactive protein was 6.18 mg/dL. On 12/30/03, values of all labs drawn were within NL limits. He was treated "symptomatically". Continued observation and activity as tolerated was recommended. As of 01/07/04, the child''s symptoms had resolved completely.

VAERS ID:219191 (history)  Vaccinated:2003-12-12
Age:11.0  Onset:2003-12-13, Days after vaccination: 1
Gender:Female  Submitted:2003-12-19, Days after onset: 6
Location:New York  Entered:2004-04-19, Days after submission: 121
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: UNK
Diagnostic Lab Data:
CDC Split Type: HQWYE757919DEC03
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Other     Purchased by: Private
Symptoms: Cough, Pharyngolaryngeal pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad)
Write-up: Information regarding Flumist (2002-2004 Formula)(influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from the mother of an 11 year old female who experienced runny nose, congestion, cough and sore throat. At 11 years of age, the pt received a dose on 12/12/03. The child had no relevant medical history. Indication for Flumist (2003-2004 Formula) was immunization. Product was administered on 12/12/03. Dose regimen was 0.5mL (IN). Pt was not taking concomitant therapy. The mother reported that the child only received half of a Flumist dose in one nostril. On 12/13/03, the child experienced runny nose (rhinorrhoea), congestion (nasal congestion), cough (cough) and sore throat (pharyngolaryngeal pain). As of 12/17/03, her symptoms persisted. No additional information was available at the time of this report.

VAERS ID:219202 (history)  Vaccinated:2003-12-18
Age:11.0  Onset:2003-12-19, Days after vaccination: 1
Gender:Male  Submitted:2004-01-02, Days after onset: 14
Location:North Carolina  Entered:2004-04-19, Days after submission: 107
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin; Ritalin;
Current Illness: Cough; Congesetion; Sinusitis;
Preexisting Conditions: ADHD;
Diagnostic Lab Data: UNK
CDC Split Type: HQWYE890723DEC03
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Information regarding Flumist (2003-2004 Formula)(influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (frozen)) was received from a mother regarding her 11 year old son who experienced fever. At 11 years of age, the pt received a dose on 12/18/03. The pt had sinusitis, cough, and congestion when he received the Flumist. The physician began therapy with amoxicillin on 12/18/03, since the pt''s nasal discharge had changed from clear to yellow. The pt''s medical history also included attention deficit/hyperactivity disorder. Indication for Flumist (2003-2004 Formula) was immunization. Product was administered on 12/18/03. Dose regimen was 1 dose (IN). Concomitant therapy included Ritalin (methylphenidate hydrochloride) and amoxicillin. The pt began "spiking" a fever (pyrexia) of 101-103 deg. F., on 12/19/03. The mother stated that Tylenol (acetaminophen) "does not seem to help the fever very much," and ibuprofen helped more, "but you can tell when it wears off." The mother reported that the pt''s cough and congestion were "about the same" as before he received Flumist. No additional information was available at the date of this report.

VAERS ID:219265 (history)  Vaccinated:2003-12-12
Age:11.0  Onset:2003-12-16, Days after vaccination: 4
Gender:Female  Submitted:2004-01-19, Days after onset: 34
Location:North Carolina  Entered:2004-04-19, Days after submission: 90
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Culture 12/16/2003: nasal swab positive for influenza
CDC Split Type: HQWYE994231DEC03
Vaccination
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FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE, INC./WYETH LABORATORIES, INC  IN 
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Influenza. Information regarding Flumist (2003-2004 Formula) (influenza virus vaccine, live intranasal (2003-2004 formula) nasal solution (forzen)) was received from a healthcare professional regarding an 11 year old female patient who received a dose on December 12, 2003 and subsequently developed influenza.

VAERS ID:219308 (history)  Vaccinated:2004-04-06
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2004-04-13
Location:North Carolina  Entered:2004-04-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU1006AA3 RA
Administered by: Private     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: No adverse events. No treatment.

VAERS ID:219342 (history)  Vaccinated:2003-09-24
Age:11.0  Onset:2003-09-24, Days after vaccination: 0
Gender:Female  Submitted:2003-09-26, Days after onset: 2
Location:North Carolina  Entered:2004-04-21, Days after submission: 208
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: NC03113
Vaccination
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Lot
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HEP: HEP B (FOREIGN)MERCK & CO. INC.0047N0IMRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0831AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Feeling hot, Skin nodule, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left arm area hard, flat and size of egg. Warm to touch and tenderness.

VAERS ID:219433 (history)  Vaccinated:2004-03-26
Age:11.0  Onset:2004-03-26, Days after vaccination: 0
Gender:Female  Submitted:2004-04-18, Days after onset: 22
Location:Maryland  Entered:2004-04-23, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1019AA5  
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site induration, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Daughers arm swollen and hard at shot site for 1 week. Redness.

VAERS ID:219472 (history)  Vaccinated:2004-04-15
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2004-04-19
Location:Connecticut  Entered:2004-04-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 05/07/1994;DTP (unknown mfr);4;1;In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:
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DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEUR    
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 6 cm redness, swelling at site of injection

VAERS ID:219584 (history)  Vaccinated:2004-04-05
Age:11.0  Onset:2004-04-20, Days after vaccination: 15
Gender:Male  Submitted:2004-04-25, Days after onset: 5
Location:Illinois  Entered:2004-04-28, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0329N SC 
Administered by: Public     Purchased by: Public
Symptoms: Injection site vesicles, Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Noted pox like blister at injection. One on top of head, one on face and one on chest.

VAERS ID:219829 (history)  Vaccinated:1995-07-05
Age:11.0  Onset:2004-04-27, Days after vaccination: 3219
Gender:Male  Submitted:2004-04-27, Days after onset: 0
Location:Georgia  Entered:2004-05-03, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1033A0SCRA
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow)
Write-up: Child developed varicella rash on 04/24/04.

VAERS ID:219952 (history)  Vaccinated:2004-01-20
Age:11.0  Onset:2004-01-21, Days after vaccination: 1
Gender:Female  Submitted:2004-04-28, Days after onset: 97
Location:Florida  Entered:2004-05-05, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: EKG- normal, Urine- Neg.
CDC Split Type:
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TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0991AA5 LA
Administered by: Private     Purchased by: Private
Symptoms: Agitation, Crying, Erythema, Hypokinesia, Neck pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad)
Write-up: Received Td vaccine, woke up that night crying, temp of 102, shaking- mom gave Motrin-then 10m later c/o neck hurting and not being able to move her legs-taken to ER-mom states given IV fluids, EKG, and labs normal, urine, neg.- follow up visit with pediatrician showed erythematous circular lesion on left deltoid. Otherwise unremarkable.

VAERS ID:220053 (history)  Vaccinated:2004-05-04
Age:11.0  Onset:2004-05-05, Days after vaccination: 1
Gender:Female  Submitted:2004-05-06, Days after onset: 1
Location:Georgia  Entered:2004-05-07, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1343N1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Child received vaccine 05/04/04. Mom noticed redness and swelling AM of 05/05/04 noted increased swelling and warm to touch AM 05/06/04.

VAERS ID:220217 (history)  Vaccinated:1996-03-13
Age:11.0  Onset:2004-04-25, Days after vaccination: 2965
Gender:Female  Submitted:2004-05-05, Days after onset: 10
Location:Pennsylvania  Entered:2004-05-12, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
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VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Headache, Lethargy, Pyrexia, Rash erythematous, Rash maculo-papular, Viral infection
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: 4/25/04. Pt developed abdominal pain. 4/26/04 pt developed fever, t-100.6 and was lethargic with a headache plus a rash on trunk, head and extremities. Pt was seen in our office on 4/27/04 by Dr. with erythematous macules with fluid filled papules on trunk axilla, scalp, ear canal, ankle and webs of fingers- 50-60 lesions. Diagnosed with Varicella by Dr.

VAERS ID:220280 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2004-05-12
Location:Michigan  Entered:2004-05-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fever swelling~Measles + Mumps + Rubella (unknown mfr)~1~3~In Patient|~DTP (unknown mfr)~1~2~In Sibling|~DTP (unknown mfr)~1~1~I
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5760A21 RA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS127A20 LA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURX01481SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0813N SCRA
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1000AA2 LA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURN13480 RA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site induration, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Rt deltoid arm red swollen hard. Mom states redness measured 5 inches and has pictures on digital camera at home. Redness resolved Sunday. Fever started late evening and broke Saturday 104.3- Sunday 99.8. Mom called Dr and gave pt tylenol alleve with Ibuprofen.

VAERS ID:220286 (history)  Vaccinated:2004-05-08
Age:11.0  Onset:2004-05-09, Days after vaccination: 1
Gender:Male  Submitted:2004-05-11, Days after onset: 2
Location:Idaho  Entered:2004-05-13, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU1022AA1 RA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Injection site induration, Injection site warmth, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Induration and dusky erythema with heat and mild pain over right lateral deltoid area. Size 5 cmx 7cm. Onset one day after injection. 99 temp.

VAERS ID:220542 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2004-05-14
Location:Unknown  Entered:2004-05-18, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0304USA00483
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: Information has been received from a registered nurse concerning an 11-year-old female who was vaccinated with a dose of varicella virus vaccine live. The reporter indicated that the child developed a mild case of varicella. The child was treated with calamine (+) camphore (+) camphor (+) pramoxin hydrochloride (AVEENO), diphenhydramine hydrochloride (Benadryl), and acetaminophen (Tylenol) prn. Unspecified medical attention was sought. Additional information is not available at this time. The reporter indicated that 4 other females were vaccinated with a dose of varicella virus vaccine live from different lot numbers and experienced varicella (WAES #0304USA00358, WAES #0304USA00480, WAES #0304USA00481, WAES #0304USA00482). Additional information has been requested.

VAERS ID:220800 (history)  Vaccinated:1996-08-06
Age:11.0  Onset:2003-05-24, Days after vaccination: 2482
Gender:Male  Submitted:2004-05-14, Days after onset: 356
Location:Michigan  Entered:2004-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Concurrent conditions: Drug hypersensitivity.
Diagnostic Lab Data: body height measurement 53 inche. body weight measurement 68 lb.
CDC Split Type: WAES0305USA02987
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.613410/0103D1  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.616997/1656B0  
Administered by: Other     Purchased by: Private
Symptoms: Drug ineffective, Infection, Skin ulcer
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a registered nurse concerning a 11-year-old white male with a cefaclor (CECLOR) allergy and no medical history who on 06-Aug-1996 was vaccinated in the right arm with a first dose of varicella virus vaccine live (lot #616997/1656B). Concomitant vaccination on the same day in the left arm included a second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (lot 3613410/0103D). There was no other concomitant medication. There was no illness at the time of vaccination. The reporter indicated that the patient developed "breakthrough varicella" after being vaccinated in the past. It was noted that the symptoms started a few days before being seen on 27-May-2003 and included "several lesions." The patient was treated with diphenhydramine hydrochloride (Benadryl) and acetaminophen (Tylenol) as needed. It was also indicated that a prescription drug was required. The symptoms had not completely resolved and at the time of the report, the patient had not recovered. Follow-up information from the registered nurse indicated that the patient developed many scattered varicella lesions the trunk. There were no diagnostic tests or laboratory results. It was noted that the patient recovered (also reported as unknown). Follow-up information from the registered nurse indicated that as of 11-Jul-2003 there were no other problems to date related to the varicella experience. No further information is expected. The nurse also reported a similar experience in a female child after vaccination with a dose of varicella virus vaccine live (WAES #0306USA00402). It was noted that the children attended the same school and the reporter notified the school of the children''s status.

VAERS ID:220818 (history)  Vaccinated:2001-02-22
Age:11.0  Onset:2003-05-27, Days after vaccination: 824
Gender:Female  Submitted:2004-05-14, Days after onset: 353
Location:Ohio  Entered:2004-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0306USA00957
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1246K   
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a physician concerning a 11 year white female student on 22FEB2001, was vaccinated in the left arm with a dose of varicella virus vaccine live. There was no illness at the time of vaccination. The physician reported that on 27MAY2003, the patient developed varicella disease. It was unknown if medical attention was sought. Subsequently, the patient recovered. Additional information is not expected.

VAERS ID:220874 (history)  Vaccinated:1996-10-25
Age:11.0  Onset:2003-06-20, Days after vaccination: 2429
Gender:Male  Submitted:2004-05-14, Days after onset: 329
Location:New York  Entered:2004-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Varicella exposure
Diagnostic Lab Data: Serum varicella zoster positive for IgM
CDC Split Type: WAES0307USA00203
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Private     Purchased by: Private
Symptoms: Blister, Drug ineffective, Infection, Laboratory test abnormal, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Information has been received from a registered nurse concerning an 11 year old Caucasian male with no past medical history who on 10/25/95 was vaccinated with a first dose of varicella virus vaccine live (SC), in the left arm. There was no illness at the time of vaccination. On 6/20/03 the patient developed a fever and fluid filled vesicles, about 20 to 30. The patient was diagnosed with chicken pox. The patient sought medical attention. The patient was treated with acyclovir 800 mgm QID for 5 days, acetaminophen and colloidal oatmeal. The symptoms resolved in 5 to 7 days. it was reported that the patient had a positive titer for varicella IgM. It was noted that the patient had been exposed to varicella many times when he was younger but never developed varicella. No further information is expected.

VAERS ID:220875 (history)  Vaccinated:1995-11-09
Age:11.0  Onset:2003-06-25, Days after vaccination: 2785
Gender:Female  Submitted:2004-05-14, Days after onset: 324
Location:New Jersey  Entered:2004-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Mantoux Test
CDC Split Type: WAES0307USA00226
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 0  
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Private     Purchased by: Private
Symptoms: Blister, Drug ineffective, Infection, Rash macular
SMQs:, Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a registered nurse concerning an 11 year old white female with no past medical history who on 11/9/95 was vaccinated with a first dose of varicella virus vaccine live (site unknown). Concomitant therapy that day included a first dose of hepatitis B virus vaccine and a Mantoux Test. On 6/25/03 the patient developed multiple macules, vesicles few scabbed on trunk, arms, legs. The patient had a doctors visit and received symptomatic treatment. There were no other relevant laboratory or diagnostic tests and the patient was not hospitalized. It was reported that the patient recovered. It was also noted that the patient did not experience any adverse events following prior vaccinations. No further information is expected.

VAERS ID:220878 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2003-07-03
Gender:Unknown  Submitted:2004-05-14, Days after onset: 316
Location:Unknown  Entered:2004-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Body temp fever
CDC Split Type: WAES0307USA00461
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection, Pyrexia, Skin ulcer
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: Information has been received from a pharmacist concerning an 11 year old patient who in approximately 1994, when the child was a toddler, was vaccinated with a dose of varicella virus vaccine live. On approximately 7/3/03 the patient developed chicken pox with a fever. The number of lesions and the location of the lesions were not provided. The case was reported as more than a mild case of chicken pox. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested.

VAERS ID:220893 (history)  Vaccinated:1999-02-26
Age:11.0  Onset:2002-06-18, Days after vaccination: 1208
Gender:Female  Submitted:2004-05-14, Days after onset: 696
Location:Ohio  Entered:2004-05-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Gingivitis; Herpes viral infection NOS; Upper respiratory tract infection NOS
Preexisting Conditions: Meningitis viral NOS
Diagnostic Lab Data: UNK
CDC Split Type: WAES0307USA01817
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6285251658H0SC 
Administered by: Private     Purchased by: Other
Symptoms: Drug ineffective, Infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a nursing assistant concerning her 11 year old daughter with no allergies and a history of viral meningitis at the age of 15 months who in 1995 was vaccinated with a dose of varicella virus vaccine live. There was no concomitant medication. In 2002, the pt developed chickenpox. The pt was covered from head to toe with lesions. The pt was seen at the clinic by a physician and treated with acetaminophen (TYLENOL), diphenhydramine hydrochloride (BENADRYL) and oatmeal baths. One and a half weeks later, the chickenpox subsided and the pt recovered. It was noted that prior to this, the pt had been exposed to many children with chickenpox and had no symptoms. A product quality complaint was not involved. Follow up information from a medical office indicated the pt had no pre-existing allergies, birth defects or medical conditions and was vaccinated on 26Feb1999 SC in the right arm with the first dose of varicella virus vaccine live. Illness at the time of vaccination included herpetic gingivitis and an upper respiratory infection. On 18Jun2002 at 15:11, the pt had an episode of varicella. Additional information is not expected.

VAERS ID:221049 (history)  Vaccinated:2003-08-09
Age:11.0  Onset:2003-08-26, Days after vaccination: 17
Gender:Male  Submitted:2004-05-14, Days after onset: 262
Location:Illinois  Entered:2004-05-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0308USA02674
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.6447890329N   
Administered by: Other     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: Information has been received from licensed practical nurse, and a physician concerning an 11 year old male patient with asthma and no allergies who on 09Aug03 was vaccinated with a dose of varicella virus vaccine live. Concomitant medication included fluticasone propionate (-) salmeterol xinafoate (advair) and albuterol (therapy unspecified). On 26Aug2003 (also reported as yesterday) the pt developed chickenpox (also reported as rash). It was noted that he was seen in the office today, 27Aug2003 (also reported as same day) with about 20 poxes (also reported as 3 lesions on the face, 3 on the calf and 5 on the trunk). He was treated with calamine lotion (therapy unspecified), no other treatment was necessary and no fever. There was no product quality complaint involved. It was also noted that the pt had not recovered. Unspecified medical attention was sought. Additional information information has been requested.

VAERS ID:221142 (history)  Vaccinated:1995-10-27
Age:11.0  Onset:2003-09-26, Days after vaccination: 2891
Gender:Male  Submitted:2004-05-14, Days after onset: 231
Location:Florida  Entered:2004-05-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: WAES0309USA03279
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0440B   
Administered by: Other     Purchased by: Other
Symptoms: Drug ineffective, Infection, Rash
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a CMA concerning an 11 year old male with no known allergies who on 10/27/95 was vaccinated with varicella virus vaccine live (Lot # 609295/0440B). There was no concomitant medication. On 09/26/03 the pt presented in the office with chickenpox. It was reported that the pt complained of pain but no itch. The rash appeared on his face and then spread over his body. The number of lesions was not noted. The pt sought unspecified medical attention. There were no lab or diagnostic tests performed. Additional information has been requested.

VAERS ID:221195 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2002-10-13
Gender:Female  Submitted:2004-05-14, Days after onset: 579
Location:Connecticut  Entered:2004-05-20, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES 0310USA01851
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Public     Purchased by: Other
Symptoms: Blister, Drug ineffective, Infection, Pyrexia, Rash papular
SMQs:, Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad)
Write-up: Information has been received from a physician concerning an 11 year old female hispanic student with no allergies, no past medical history and no adverse events following prior vaccinations who in 1998 was vaccinated with a dose of varicella virus vaccine live. There was no illness at the time of vaccination. On 13-Oct-2003, the patient developed chickenpox. The patient had a fever for two days and a rash characterized by papules, vesicles and crusting. Unspecified medical attention was sought, but the patient was not seen by the reporting physician. Laboratory tests were not performed. Subsequently, the patient recovered. A product quality complaint was not involved. Additional information is not expected.

VAERS ID:221238 (history)  Vaccinated:1996-11-25
Age:11.0  Onset:2004-01-24, Days after vaccination: 2616
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:2004-05-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Public
Symptoms: Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Itchy rash. Multiple papules in various stages. Face, back, and trunk.

VAERS ID:221380 (history)  Vaccinated:2004-04-30
Age:11.0  Onset:2004-04-30, Days after vaccination: 0
Gender:Male  Submitted:2004-04-30, Days after onset: 0
Location:Texas  Entered:2004-05-24, Days after submission: 24
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: TX04025
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TETANUS DIPHTHERIA (NO BRAND NAME)AVENTIS PASTEURU0845AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Hypersensitivity, Influenza, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: 11 year old male with allergic reaction with approx 20 inches after TD booster. No shortness of breath, positive hives on torso and upper arms. and 1-2 small hives neck area. looked comfortable no wheezing on PE. CTAB; given 2 tsp orally of Benadryl. No hives with 5-10 inches. Flu in 2 days. Benadryl orally every 6 hours for 48 hours. With flu about 2 all/Im, epipen given.

VAERS ID:221451 (history)  Vaccinated:2003-06-23
Age:11.0  Onset:2003-06-25, Days after vaccination: 2
Gender:Female  Submitted:2004-01-27, Days after onset: 216
Location:New Jersey  Entered:2004-05-24, Days after submission: 117
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: cellulitis;Influenza (unknown mfr);1;10;In Patient
Other Medications: Advair, albuterol, singulair, zyrtec.
Current Illness: NONE
Preexisting Conditions: Asthma, seasonal allergies, allergy to flu vaccine.
Diagnostic Lab Data:
CDC Split Type: 2003 03317
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0831AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Cellulitis, Erythema, Skin nodule, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: From initial information received on 09/Dec/2003 from a health care professional regarding an adverse event occurring in the USA, it was reported that an 11-year old female patient received her first dose of TD ADS adult, lot number U0831AA, administered intra-muscularly in the left deltoid on 23/Jun/2003. Two days later, the patient developed a lump on her arm that was reddened and tender to touch. Warm soaks, Tylenol and Benadryl were advised. The child was taken to the emergency room. Mother called on 26/June/2003 and stated that the child was diagnosed with cellulitis vs allergic reaction. The patient was given Keflex 500 mg three times a day. The patient''s concomitant medications include Advair, Albuterol nebs, Singulair, and Zyrtec. Her pre-existing medical history included asthma, seasonal allergies, and local cellulitis vs allergic reaction after flu vaccine (case #U2002-01023). Reportedly, the patient recovered from these events.

VAERS ID:221472 (history)  Vaccinated:1995-06-05
Age:11.0  Onset:2003-11-14, Days after vaccination: 3084
Gender:Male  Submitted:2004-05-14, Days after onset: 181
Location:Pennsylvania  Entered:2004-05-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: body weight: 85lbs
CDC Split Type: WAES0312USA00300
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0417B0  
Administered by: Private     Purchased by: Private
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from an office staff member on behalf of a physician concerning an 11 year old white male who on 05JUN1995 was vaccinated with a first dose of varicella virus vaccine live. On 14NOV2003 the patient developed clinical varicella. Unspecified medical attention was sought. No diagnostic tests were performed. Subsequently, the patient recovered. No product quality complaint was involved. It was also reported that another patient was vaccinated with a dose of varicella virus vaccine live and developed chicken pox. No further information is expected.

VAERS ID:221519 (history)  Vaccinated:1998-07-13
Age:11.0  Onset:2003-12-05, Days after vaccination: 1971
Gender:Female  Submitted:2004-05-14, Days after onset: 160
Location:Kentucky  Entered:2004-05-24, Days after submission: 10
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: Drug hypersensitivity;
Diagnostic Lab Data: Body height: 49.5; Body temp: no fever; Body weight: 59;
CDC Split Type: WAES0312USA01830
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0163L   
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Private     Purchased by: Private
Symptoms: Dermatitis bullous, Drug ineffective, Infection
SMQs:, Severe cutaneous adverse reactions (narrow), Lack of efficacy/effect (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a CMA concerning an 11 year old "healthy" white female with an allergy to Zithromax who on 07/13/98 was vaccinated in the left arm with a first dose of varicella virus vaccine. Concomitant vaccine therapy included a first dose given in the right arm of MMRII (Lot # 638359/0163L). There were "no routine medications". There was no illness at the time of vaccination. On 12/05/03 the pt developed a moderate to mild case of chickenpox with vesicles/lesions that were widespread. The pt had no fever. The pt was told to watch for other symptoms but none occurred. There were no diagnostic lab tests performed. Unspecified medical attention was sought and no treatment was required. On 12/16/03 the pt recovered. There was no product quality complaint involved. No further information is expected.

VAERS ID:221544 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2004-05-14
Location:Indiana  Entered:2004-05-24, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Varicella (Varivax);;;6;In Sibling;;Varicella (Varivax);;;4;In Sibling
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0401USA00024
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Infection
SMQs:
Write-up: Information has been received from a medical assistant concerning an 11 year old male who was vaccinated with a dose of varicella virus vaccine live. Subsequently the pt experienced chickenpox. It was reported that six of his classmates came down with chickenpox and as a result the pt developed chickenpox. He was covered from head to toe with lesions. He was seen by the physician and prescribed acyclovir (ZOVIRAX) and ibuprofen (ADVIL). There was no product quality complaint involved. The reporter indicated that the pt''s brothers and two other pt''s had similar experiences following exposure to varicella virus vaccine live. Additional information has been requested.

VAERS ID:221569 (history)  Vaccinated:2003-02-19
Age:11.0  Onset:2003-08-07, Days after vaccination: 169
Gender:Female  Submitted:2005-05-16, Days after onset: 648
Location:Minnesota  Entered:2004-05-24, Days after submission: 357
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: ;chickenpox;Varicella (Varivax);0;9;In Sibling;chickenpox;Varicella (Varivax);0;14;In Sibling
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0401USA00639
Vaccination
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Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0566M0SC 
Administered by: Private     Purchased by: Other
Symptoms: Cough, Drug ineffective, Pruritus, Pyrexia, Rash, Rhinorrhoea, Skin ulcer, Viral infection
SMQs:, Anaphylactic reaction (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: This is in follow-up to report(s) previously submitted on 5/14/2004. Information has been received from a health professional concerning an 11 year old female who on 19FEB2003 at 13:00 was vaccinated SC in the deltoid with a first dose of varicella virus vaccine live. The patient''s three siblings were vaccinated the same day. On approximately 30SEP2003 she had full blown chickenpox and was treated with acyclovir. It was reported that two of her siblings (WAES#0311USA01047 and 0401USA005383) also developed chickenpox. The reporter expressed a concern with the lot. Unspecified medical attention was sought. There was no product quality complaint involved. The records of testing prior to release of this lot have been checked by Quality Assurance and found to be satisfactory. The lot complies with the standards of the Center for Biologics Evaluation and Research and was released. Follow-up information indicated that the patient was seen on 08-Jun-2003 and she developed a rash and fever on 07-Jun-2003 (previously reported as approximately 03-Sep-2003), some cough and minimal runny nose were noted. It was noted that all the patient''s vaccinations were up to date and she had no immune disorders. Lesions were classic dew drop appearance and disseminiated throughtout her body with a few in her oral cavity and oral pharynx. No secondary infection was noted. Lesions were in various stages and were vesicular in nature, because of the severity of her rash and her age the patient was started on acyclovir 800 mg QID for 5 days. She was also given hydroxyzine hydrochloride (Atarax) 25mg q 6 hours for itching. Subsequently the patient recovered. The patient received additional vaccinations on 22-Jan-2003 at 13:37 which included a first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live which was given SC in the thigh, a first dose of diphtheria toxoid (+) tetanus toxoid given IM in the thigh, a first dose of poliovirus vaccine inactivated (unspecified) which was given SC in the deltoi

VAERS ID:221596 (history)  Vaccinated:2004-04-19
Age:11.0  Onset:2004-04-19, Days after vaccination: 0
Gender:Male  Submitted:2004-04-22, Days after onset: 3
Location:Texas  Entered:2004-05-25, Days after submission: 33
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: UNK
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM547A22IMLA
Administered by: Public     Purchased by: Public
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Pt immunized with Hep B vaccine #3 in the left deltoid around 5:30pm. Mom returned to clinic at 6.53pm, with a report that child was experiencing numbness in the left fourth and fifth finger as well as the outer/lateral edge of his left hand. All of this presented in the car ride home.

VAERS ID:221598 (history)  Vaccinated:1998-12-07
Age:11.0  Onset:2004-05-20, Days after vaccination: 1991
Gender:Female  Submitted:2004-05-20, Days after onset: 0
Location:Wisconsin  Entered:2004-05-25, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD Shot
Current Illness: Possible exposure to TB
Preexisting Conditions: Overweight, Asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0510H2 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0847H0 LA
Administered by: Public     Purchased by: Other
Symptoms: Rash papular, Rash pustular, Rash vesicular, Skin ulcer
SMQs:, Hypersensitivity (narrow)
Write-up: Had varicella vaccine 12/7/1998. Has varicella infection today 5/20/04 around 50 lesions, papules, pustules and vesicles- 1 scabbed over. Know chickenpox exposure in school 2 weeks prior.

VAERS ID:221724 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:2003-09-10
Gender:Male  Submitted:2004-05-18, Days after onset: 251
Location:Virginia  Entered:2004-05-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: A0426366A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Malaise, Medication error, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: This case was reported by a nurse and described the occurrence of fever in a 11 year old male who received diphtheria and tetanus toxoids and acellular pertussis vaccine absorbed for prophylaxis. On an unspecified date, the patient received an injection of Infanrix, which is not recommended for immunizing individuals 7 years of age or older. On 9/10/03, at an unspecified time post immunization, the patient''s parent telephoned the physician to report that the patient was experiencing fever, malaise, and an injection site reaction characterized by redness, swelling, and induration. The events resolved on an unspecified date prior to 9/17/03.

VAERS ID:221764 (history)  Vaccinated:1996-02-21
Age:11.0  Onset:2004-01-02, Days after vaccination: 2872
Gender:Female  Submitted:2004-05-11, Days after onset: 129
Location:Arkansas  Entered:2004-05-25, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0401USA00832
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1126B0  
Administered by: Private     Purchased by: Private
Symptoms: Rash, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning her 11 year old Asian daughter with no allergies or medical history who on 21FEB1996 was vaccinated in the arm with a 0.5ml first dose of varicella virus vaccine live. There was no illness at the time of vaccination. The reporter indicated that, on an unspecified date, the patient''s body was covered with lesion. No hospitalization was needed. No further information was provided.

VAERS ID:221800 (history)  Vaccinated:1995-08-25
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2004-05-14
Location:California  Entered:2004-05-25, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Bilateral hydronephrosis, Bladder operation
Diagnostic Lab Data: UNK
CDC Split Type: WAES0401USA01807
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0433B0  
Administered by: Private     Purchased by: Unknown
Symptoms: Drug ineffective, Viral infection
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Information has been received from a consumer concerning her 11 year old Caucasian son with no known medical history who on 25AUG1995 was vaccinated in the deltoid with a first 0.5ml dose of varicella virus vaccine live. There was no concomitant medication. There was no illness at the time of vaccination. During the first week of January 2004 the patient developed a full blown case of chickenpox. Unspecified medical attention was sought. There was no treatment required for the adverse event. Subsequently the pt recovered. There was no product quality complaint involved. Follow up information form the physician indicated that the patient was not seen since 05OCT2002. It was reported that the pt has a history of congenital bilateral hydronephrosis and vesicostomy. No further information is expected.

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