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Case Details (Sorted by Age)

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VAERS ID: 423106 (history)  
Age: 4.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2011-03-06
Submitted: 2011-05-12
   Days after onset:66
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Antibody test, Blister, Herpes zoster, Pyrexia, Varicella post vaccine, Varicella virus test positive
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: Bone marrow transplant; haemochromatosis; histiocytosis
Diagnostic Lab Data: body temp, 03/09/11, 102 F; VZV strain, 03/08/11, final result vaccine strain; serum varicella zoster, .04
CDC Split Type: WAES1103USA02441

Write-up: Information has been received from a physician concerning a 4 year old male patient with a history of bone marrow transplant from brother for Hemochromatosis (histiocytosis) in 2008 and no history of chickenpox who on an unspecified date was vaccinated with VARIVAX (Merck) (site of vaccination unknown). On 06-MAR-2011 the patient experienced herpes zoster (dermatome L2, 3, 4) from right thigh to generalized. There were about 50 vesicles lesions that distributed at right thigh, face and chest. The physician also added that she was unsure if the patient was vaccinated for chicken pox and the patient titer was .04; the brother was vaccinated and had a titer of 2.7 and 2.26 prior to treatment. The patient was enrolled in the Varicella Zoster Virus Identification Program to identify if VZV is present and if it is present, to identify if it is associated with the wild-type (WT) VZV strain or with the Merck vaccine strain. A skin lesion sample was collected on 08-MAR-2011. The final result was vaccine strain. On 09-MAR-2011, the patient had a fever of 102.0 F degrees. The patient was hospitalized briefly for antiviral therapy. The patient was treated with acyclovir. At the time of reporting, the patient was recovering. Additional information has been requested.


VAERS ID: 423115 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-05-11
Onset:2011-05-11
   Days after vaccination:0
Submitted: 2011-05-18
   Days after onset:7
Entered: 2011-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3813AA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0742Z / 1 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E88942 / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1188Z / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Local swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: SWELLING AND REDNESS ON THE SIDE OF THE SHOT, SWELLING AND REDNESS ON BOTH UNCLES, BENADRYL 50MG IM WERE GIVEN TO THE PT. IN OUR OFF.


VAERS ID: 423117 (history)  
Age: 4.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2011-05-02
Onset:2011-05-05
   Days after vaccination:3
Submitted: 2011-05-18
   Days after onset:13
Entered: 2011-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1484Z / 1 LL / SC

Administered by: Unknown       Purchased by: Private
Symptoms: C-reactive protein normal, Mental status changes, Streptococcus test, Streptococcus test negative, Toxicologic test normal
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

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: none
Current Illness: vocal tics diagnosed that day
Preexisting Conditions: vocal tics
Diagnostic Lab Data: CRP WNL, Strep titers and rapid strep WNL, toxicity screen urine WNL
CDC Split Type:

Write-up: significant acute mental status change, possible psychotic episode, required emergency room visit and short-stay observation


VAERS ID: 423122 (history)  
Age: 4.0  
Gender: Male  
Location: Washington  
Vaccinated:2011-05-17
Onset:2011-05-17
   Days after vaccination:0
Submitted: 2011-05-17
   Days after onset:0
Entered: 2011-05-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1008Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1492Z / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ROBITUSSIN this am.
Current Illness: Cold sx
Preexisting Conditions: Nuts, eggs (eats in baked goods)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o itchy throat. Then developed hives all over. EPI-PEN Jr was administered.


VAERS ID: 423124 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-05-16
Onset:2011-05-17
   Days after vaccination:1
Submitted: 2011-05-18
   Days after onset:1
Entered: 2011-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC1413126AA / 4 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0123 / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0742Z / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915572 / 0 RL / UN

Administered by: Other       Purchased by: Public
Symptoms: Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: H/O swelling on 5/17/11 & itching - on Rt thigh. No pain. Itching (+).


VAERS ID: 423126 (history)  
Age: 4.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2011-05-16
Onset:2011-05-17
   Days after vaccination:1
Submitted: 2011-05-18
   Days after onset:1
Entered: 2011-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1396Z / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915252 / 4 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: 4 x 6 inch redness, swelling, (L) anterior thigh within 48 hours of vaccination.


VAERS ID: 423141 (history)  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2007-11-12
Onset:2010-03-09
   Days after vaccination:848
Submitted: 2011-05-12
   Days after onset:428
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1177U / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES1004USA02207

Write-up: Information has been received from a physician concerning a 6 year old male patient who on 15-OCT-2004 and 12-NOV-2007 was vaccinated with the first dose (lot# 648032/1157N) and second dose (lot# 658408/1177U) of VARIVAX (Merck). On 09-MAR-2010 the patient was diagnosed with the chickenpox and was given ZOVIRAX (manufacturer unspecified). The patient sought unspecified medical attention. No laboratory diagnostic studies were performed. The patient recovered from chickenpox on an unspecified date. Additional information has been requested.


VAERS ID: 423143 (history)  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2010-03-03
Onset:0000-00-00
Submitted: 2011-05-12
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1203Y / 0 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1004USA02235

Write-up: Information has been received from a physician concerning a 4 year old female patient who on 03-MAR-2010 was vaccinated with the first dose of VARIVAX (Merck) (Lot # 665587/1203Y). The physician reported that the patient received all 4 years old vaccines. On an unspecified date, the patient experienced chickenpox and the patient was given BENADRYL and CALADRYL. At the time of this report, the patient''s outcome was unspecified. Additional information has been requested.


VAERS ID: 423171 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2008-07-30
Onset:2010-03-05
   Days after vaccination:583
Submitted: 2011-05-12
   Days after onset:432
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Cough, Malaise, Oropharyngeal pain, Skin lesion, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES1005USA00860

Write-up: Information has been received from a physician concerning a 6 year old female who on 24-SEP-2007 was subcutaneously vaccinated with the first dose of VARIVAX (Merck). On 30-JUL-2008, the patient was subcutaneously vaccinated with the second dose of VARIVAX (Merck). On 05-MAR-2010 the patient was feeling sick with sore throat and minute cough. On 07-MAY-2010, the patient came in and had about 10 lesions and the physician diagnosed the patient with chickenpox. There were no lab diagnostic studies performed. At the time of the report, the patient had not recovered. Additional information has been requested.


VAERS ID: 423209 (history)  
Age: 4.0  
Gender: Male  
Location: Florida  
Vaccinated:2009-05-15
Onset:2010-02-16
   Days after vaccination:277
Submitted: 2011-05-12
   Days after onset:449
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Scar, Varicella post vaccine
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Adenoidectomy
Diagnostic Lab Data: None
CDC Split Type: WAES1004USA00635

Write-up: Information has been received from a physician concerning a 5 year old male patient with a history of adenoidectomy who was vaccinated with a dose of VARIVAX (Merck) on 10-JUN-2005 and 15-MAY-2009. On 16-FEB-2010 the patient developed a moderate case of chickenpox. It was reported that the patient had a few scars from the chickenpox. The patient sought medical attention by an office visit. On an unknown date the patient recovered from chickenpox. The outcome of scars from the chickenpox was unknown. Follow up information has been received from a physician who indicated that the child with no illness at the time of vaccination, no pre-existing allergies, no birth defects and no medical conditions had not been vaccinated in her office. On 16-FEB-2010 the patient came to her office with rash that was typical of chickenpox. On an unknown date the patient recovered from chickenpox. No laboratory or diagnostic studies were performed. Additional information is not expected.


VAERS ID: 423220 (history)  
Age: 4.0  
Gender: Female  
Location: Unknown  
Vaccinated:2003-06-24
Onset:2003-06-24
   Days after vaccination:0
Submitted: 2011-05-09
   Days after onset:2876
Entered: 2011-05-18
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 59289 / 4 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Oedema peripheral, Pruritus, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: There were no concomitant medications and no relevant medical history. The subject had not experienced adverse events following previous or subsequent vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0867958A

Write-up: This case was reported by a healthcare professional (the subject''s mother) and described the occurrence of swelling arm in a 4-year-old female subject who was vaccinated with INFANRIX (SmithKline Beecham). On 24 June 2003 the subject received 5th dose of INFANRIX (.5 ml, unknown route, left arm). On 24 June 2003, less than one day after vaccination with INFANRIX, the subject experienced swelling arm and hive. The circumference of her arm increased with swelling, and she could not help but scratch the itch. The healthcare professional reported that it took 2-3 weeks for swelling of her arm to resolve. On 7 July 2003, the events were resolved. The healthcare professional considered the events were probably related to vaccination with INFANRIX. The subject had not had any reactions to any vaccinations before or since.


VAERS ID: 423225 (history)  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2008-08-29
Onset:2010-05-10
   Days after vaccination:619
Submitted: 2011-05-12
   Days after onset:367
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 UN / SC

Administered by: Private       Purchased by: Public
Symptoms: Pruritus, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: None
Diagnostic Lab Data: None
CDC Split Type: WAES1005USA02698

Write-up: Information has been received from a nurse concerning a 5 year old patient with no pertinent medical history and no drug reactions/allergies who on 16-AUG-2005 and on 29-AUG-2008 was vaccinated with the first and the second doses of VARIVAX (Merck) (lot number and expiration date not provided). The second dose was received at another office. There was no concomitant medication. On 19-MAY-2010 the patient came into the office with 5 to 10 varicella like bumps on the buttocks area and also an another region of the body it was itchy. The nurse reported that the patient was diagnosed as varicella. No laboratory tests were performed. At the time of the report, the patient was recovering. In follow-up, the nurse indicated that on 16-AUG-2005 the female patient received the first dose of VARIVAX (Merck) (lot number 660331/0485X) into the left arm/left thigh. On 29-AUG-2008 the patient received the second dose of VARIVAX (Merck) (lot number not reported) subcutaneously. On 10-MAY-2010 the patient was seen in the office and was diagnosed with chickenpox with 10 papules peri area and no fever. On 18-MAY-2010 the patient''s mother stated that "all spots gone per phone". On 18-MAY-2010 the patient recovered from chickenpox. Additional information is not expected.


VAERS ID: 423281 (history)  
Age: 4.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-12
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Herpes zoster
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1006USA01798

Write-up: Information has been received from a physician who mentioned that a local pediatrician (name unspecified) had a now around 4 year old patient who on an unspecified date was vaccinated with the first dose of VARIVAX (Merck). Subsequently the patient developed herpes zoster. At the time of reporting, the outcome was unknown. The pediatrician wanted to know if this patient should get a second dose. The patient sought unspecified medical attention. Additional information is not expected.


VAERS ID: 423306 (history)  
Age: 4.0  
Gender: Female  
Location: Unknown  
Vaccinated:2010-06-07
Onset:2010-06-07
   Days after vaccination:0
Submitted: 2011-05-12
   Days after onset:339
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1080Y / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Unknown
Diagnostic Lab Data: Body temp, 06/07?/10, 101
CDC Split Type: WAES1007USA03086

Write-up: Information has been received from a registered nurse concerning a 4 year old female patient who on 07-JUN-2010 was vaccinated with a dose of VARIVAX (Merck) (lot number 665392/1080Y) (it was unknown if it was the first or second dose). Concomitant therapy included MMR II and KINRIX. The nurse reported that between 07-JUN-2010 and 08-JUN-2010 the patient had a fever of 101 and vomited four times in one day after receiving VARIVAX (Merck). At the time of the report the patient''s outcome was unknown. The patient sought unspecified medical attention. Additional information has been requested.


VAERS ID: 423313 (history)  
Age: 4.0  
Gender: Male  
Location: Maine  
Vaccinated:0000-00-00
Onset:2007-02-01
Submitted: 2011-05-12
   Days after onset:1560
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Herpes zoster, Laboratory test abnormal, Pain in extremity, Pyrexia, Varicella virus test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Diagnostic laboratory, 07?, sent in the vesicle and it was confirmed as Merck strain; Body temp, 07?, 102
CDC Split Type: WAES1102USA01048

Write-up: Information has been received from a physician concerning a 4.5 year old male with no history of chicken pox who in approximately 2003, reported as "at 13 months of age", was vaccinated with a dose of VARIVAX (Merck) and was healthy with no medical condition. "4 years ago", in February 2007 when the patient was 4.5 years old, he experienced 102 fever with left arm pain of unknown etiology and subsequently developed shingles on the left side of his body from neck to left wrist. The physician sent in the vesicle to CDC and it was confirmed as Merck strain. The patient sought unspecified medical attention. At the time of the report, the patient''s outcome was unknown. Additional information has been requested.


VAERS ID: 423410 (history)  
Age: 4.0  
Gender: Unknown  
Location: Delaware  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-12
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Nervous system disorder
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1007USA00887

Write-up: Information has been received from a physician concerning a 4 to 6 year old patient who on an unspecified date was vaccinated with a dose of VARIVAX (Merck) (lot# not reported) and a dose of MMR II (lot# not reported). Subsequently the patient experienced "neurological effects" after receiving VARIVAX (Merck) and MMR II on the same day. At the time of this report, the patient had recovered from neurological effects. This is one of several reports from the same source. Additional information has been requested.


VAERS ID: 423465 (history)  
Age: 4.0  
Gender: Male  
Location: Florida  
Vaccinated:2010-07-02
Onset:2011-03-06
   Days after vaccination:247
Submitted: 2011-05-12
   Days after onset:66
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1290Y / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1604Y / 1 RA / UN

Administered by: Private       Purchased by: Public
Symptoms: Papule, Rash, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Asthma; Rhinitis allergic
Preexisting Conditions: Respiratory syncytial virus infection
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1102USA03359

Write-up: Information has been received from a physician concerning a patient who on an unspecified date was vaccinated with a first 0.5 ml dose of VARIVAX (Merck) (therapy route and lot # not provided). The reporter stated that the patient came into her office" today", on 24-FEB-2011 who had developed chicken pox, even though the patient had been given VARIVAX (Merck) in the past. At the time of reporting, the patient''s status was not provided. The patient sought unspecified medical attention. This is one of several reports received from the same source. Follow up information has been received from a medical assistant concerning the 4 year old male with asthma and rhinitis allergic and a history of respiratory syncytial virus infection and pneumonia who on 04-JAN-2008 was vaccinated with the first dose of VARIVAX (Merck) (lot# 658937/1560U) subcutaneously in the left thigh. On 02-JUL-2010 the patient was vaccinated with the second dose of VARIVAX (Merck) (lot # 665900/1604Y) in the right deltoid. On 04-JAN-2008, the patient was also received the third dose of (DAPTACEL) (Sanofi) (lot # C2800AA) in the left thigh, and the fourth dose of PREVNAR (lot # B47300H) in the right thigh, which was given elsewhere. Secondary suspect therapy included the second dose of MMR II (lot# 665803/1290Y) in the left deltoid on 02-JUL-2010. On 06-MAR-2011, the patient developed rash, no fever and multiple papules in different stages, over upper, lower extremities, lower abdomen and face and was diagnosed with varicella. The patient sought medical attention via doctor visit. OTC BENADRYL was given for treatment. At the time of reporting, the status of the patient was unknown. Additional information has been requested.


VAERS ID: 423487 (history)  
Age: 4.0  
Gender: Female  
Location: Florida  
Vaccinated:2010-06-01
Onset:2011-03-04
   Days after vaccination:276
Submitted: 2011-05-12
   Days after onset:68
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1589Y / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VENTOLIN; ZYRTEC; FLOVENT
Current Illness: Asthma
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1103USA01289

Write-up: Information has been received from a physician concerning a 4 year old female with asthma who in June 2010, was vaccinated with the second dose of VARIVAX (Merck) (lot number 665885/1589Y). Concomitant therapy included FLOVENT, VENTOLIN and ZYRTEC. The patient went to the physician''s office on 04-MAR-2011 with chickenpox. At the time of reporting, the patient was recovering from chickenpox. Additional information has been requested.


VAERS ID: 423488 (history)  
Age: 4.0  
Gender: Male  
Location: Florida  
Vaccinated:2010-07-10
Onset:2011-03-08
   Days after vaccination:241
Submitted: 2011-05-12
   Days after onset:64
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1604Y / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; QVAR; BENADRYL
Current Illness: Asthma
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1103USA01291

Write-up: Information has been received from a physician concerning a 4 year old male with asthma who on 10-JUL-2010 was vaccinated with the second dose of VARIVAX (Merck) (lot number 665900/1604Y). Concomitant therapy included BENADRYL, albuterol and QVAR. On 08-MAR-2011 the patient experienced chickenpox; and he sought medical attention via doctor''s office visit. At the time of report, patient present status was recovering. Additional information has been requested.


VAERS ID: 423492 (history)  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2007-09-04
Onset:2011-03-05
   Days after vaccination:1278
Submitted: 2011-05-12
   Days after onset:67
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Skin lesion, Varicella post vaccine
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES1103USA01376

Write-up: Information has been received from a licensed practical nurse concerning an 8 year old male with no drug allergies and no medical histories who on 20-NOV-2003 was vaccinated with the first dose of VARIVAX (Merck) (therapy route and lot # not provided). On 04-SEP-2007 he was vaccinated with the second dose of VARIVAX (Merck) (therapy route and lot # not provided). There was no concomitant medication. On 07-MAR-2011 the patient presented to the licensed practical nurse''s practice with multiple lesions characteristic of chicken pox. The patient''s mother stated that the lesions began to appear two days prior to the office visit, on 05-MAR-2011. The patient, who was otherwise "healthy", was started on KEFLEX 500 mg to prevent secondary infection and was being referred to an infectious disease specialist. No lab diagnostics studies were performed. At the time of reporting, the patient''s status was recovering. Additional information has been requested.


VAERS ID: 423510 (history)  
Age: 4.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-06-07
Onset:2010-06-08
   Days after vaccination:1
Submitted: 2011-05-12
   Days after onset:338
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / IJ

Administered by: Other       Purchased by: Other
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1008USA01912

Write-up: Information has been received from a registered nurse at the physician''s office concerning a 4 year old female who on 07-JUN-2010 was vaccinated with VARIVAX (Merck), injection. On 08-JUN-2010 ("the next day"), the patient returned to the office with a fever of 101.5 degrees (taken orally), she was also vomiting however did not have any pain or diarrhea. At the time of the report, the outcome was unknown. Therapy with VARIVAX (Merck) was not reintroduced. Additional information has been requested.


VAERS ID: 423620 (history)  
Age: 4.0  
Gender: Female  
Location: Unknown  
Vaccinated:2010-02-03
Onset:2010-08-21
   Days after vaccination:199
Submitted: 2011-05-12
   Days after onset:264
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1009USA00048

Write-up: Information has been received from a school nurse (registered nurse) concerning a 5 year old female who on 03-FEB-2010 was vaccinated with VARIVAX (Merck) (lot# not reported). On 21-AUG-2010 (10 days ago) the patient developed chickenpox. The nurse stated initially the child''s physician was not certain if it was chickenpox but the mom getting shingles prompted him to say the child had chickenpox. Medical attention was sought by office visit. At the time of the report the patient had not recovered. It was reported the the pregnant mother of the child diagnosed with a mild case of shingles after the child developed chickenpox. Follow up information has been received from the registered nurse indicated that there was no "exposure to VARIVAX". Again there was no adverse reaction to the VARIVAX (Merck), none were given. Follow up information has been received from the registered nurse concerning the 4 year old (previously reported as 5 year old) female patient who on 03-FEB-2010 was vaccinated with a dose of VARIVAX (Merck) (lot number unavailable). In August 2010 the patient developed chickenpox. On an unspecified date the patient recovered. This is one of several reports received from the same source. Additional information is not expected.


VAERS ID: 423643 (history)  
Age: 4.0  
Gender: Female  
Location: Washington  
Vaccinated:2010-02-24
Onset:2010-08-27
   Days after vaccination:184
Submitted: 2011-05-12
   Days after onset:258
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1153Y / 1 LL / SC

Administered by: Other       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1009USA03058

Write-up: Information has been received from a physician concerning a 4 year old female student patient with no know pre-existing allergies, birth defects or medical conditions who on 05-OCT-2006 was vaccinated with the first dose of VARIVAX (Merck) (Lot # and route no reported) and on 24-FEB-2010 was vaccinated SQ into the left thigh with the second dose of VARIVAX (Merck) (lot # 665209/1153Y). Concomitant therapy included the second dose of MMR (lot # 663521/1759X) SC into the left thigh, hepatitis A vaccine (lot # 665114/0739Y) IM into the right vastus and DAPTACEL (lot # C3142A) IM into the left vastus. The physician reported that on 27-AUG-2010 the patient was diagnosed with chickenpox beside she had both doses of VARIVAX (Merck). On 07-SEP-2010 the patient had recovered from chickenpox. It was unknown if the patient sought medical attention. Additional information has been requested.


VAERS ID: 423654 (history)  
Age: 4.0  
Gender: Male  
Location: Georgia  
Vaccinated:2008-08-14
Onset:2010-09-10
   Days after vaccination:757
Submitted: 2011-05-12
   Days after onset:244
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349U / 1 RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Rash pustular, Scab, Skin lesion, Varicella post vaccine
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1009USA04232

Write-up: Information has been received from a physician concerning an approximately 4 year old male patient (now 6 years old) who in approximately August 2005, at the age of 15 months old, was vaccinated with the first dose of VARIVAX (Merck) (lot number 651043/0215R). In approximately May 2008, at the age of 4 year old, the patient was vaccinated with the second dose of VARIVAX (Merck) (lot number 658935/1349U). After receiving VARIVAX (Merck), the patient presented with pustules on his arms, legs, and trunk. Patient was seen by the physician for this symptom on 13-SEP-2010 and at this time the pustules had started to crust over. At the time of report the patient''s status was unknown. Follow-up information has been received from the physician concerning the patient, a 4 year old male child (now 6 years old, last year height around 46 inches). The physician reported that the patient was "well child" when "given at 4 and half years" with the second dose of VARIVAX (Merck) (lot number 658935/1349U), subcutaneously in the right thigh on 14-AUG-2008 (previously reported as approximately May 2008). On 10-SEP-2010 the patient was seen in ER with pustules on his arms, legs, and trunk. Diagnosis was chicken pox. No lab test was performed. The patient was put on CEFZIL. On 13-SEP-2010, the patient was seen in office. Physician confirmed diagnosis. There were many crusted lesions on arms and thighs. No new ones and no signs of infection. The patient was still on CEFZIL. He was out of school for 7 days. The patient recovered from the event within 2 weeks. No further information is available.


VAERS ID: 423658 (history)  
Age: 4.0  
Gender: Male  
Location: Georgia  
Vaccinated:2008-05-22
Onset:2010-09-20
   Days after vaccination:851
Submitted: 2011-05-12
   Days after onset:234
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349U / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Malaise, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1009USA04234

Write-up: Information has been received from a physician concerning a 6 year old male who "at 15 months old" (in approximately August 2005), was vaccinated with the first dose of VARIVAX (Merck) (LOT# 647960/0070R) and the second dose (LOT# 658935/1349U) "at age 4" (in approximately May 2008). On approximately 20-SEP-2010 the patient experienced scattered rash on his trunk and extremities. The physician stated that the patient developed a scattered rash on his trunk and extremities after receiving VARIVAX (Merck). On 20-SEP-2010, patient was seen by the physician for the symptom. No specific dates were provided for administration of the doses. No further AE information provided. Follow up information was received from a nurse who reported that the 6 year old male student on 22-MAY-2008 was vaccinated subcutaneously into the right thigh with a second dose of VARIVAX (Merck) (LOT# 658935/1349U). There was no illness at the time of the vaccination. On 20-SEP-2010 the school nurse called the patient''s guardian to come to get the patient at school. The patient was broke out in a rash and not feeling well at 14:15. The patient was brought straight to the physician''s office. No relevant laboratory data was reported. The patient didn''t go to school for 1 week. On an unspecified date, the patient recovered. No further information is available.


VAERS ID: 423673 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2010-02-01
Onset:2010-08-01
   Days after vaccination:181
Submitted: 2011-05-12
   Days after onset:284
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Skin lesion, Varicella post vaccine
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1010USA00001

Write-up: Information has been received from a physician concerning an approximately 4 year old female patient with a history of previous immunization with a dose of PROQUAD (Merck upgrade process) (some time in 2006) at the age of one who in February 2010, was vaccinated with a 0.5 mL dose of VARIVAX (Merck) (lot # not reported). About six months after received VARIVAX (Merck), in approximately August 2010, the patient developed chickenpox. The patient was treated with VALTREX. At the time of the report, the physician reported that the patient still had some visible lesions but she was recovering. The patient sought unspecified medical attention. Additional information has been requested. This is one of two reports received from the same source.


VAERS ID: 423694 (history)  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2010-03-24
Onset:2010-09-22
   Days after vaccination:182
Submitted: 2011-05-12
   Days after onset:232
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 1252X / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1205Y / - LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Blister, Herpes zoster, Rash, Rash erythematous
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Drug hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES1010USA01127

Write-up: Information has been received from a registered nurse concerning a 5 year old male patient with drug reactions or allergies to OMNICEF, amoxicillin and BACTRIM and no pertinent medical history who on 24-MAR-2010 was vaccinated subcutaneously into the left deltoid with a dose of VARIVAX (Merck) (Lot # 665644/1205Y, expiration date: 21-AUG-2011). There was no concomitant medication. The nurse reported that on 22-SEP-2010, the patient developed a rash, "shingles" on his forehead. Child was seen by physician and he prescribed him acyclovir and fluids. Rash resolved on an unknown date. Follow up information has been received from a physician concerning the male patient with no illness at time of vaccination. It was reported that on 24-MAR-2010 at 13:23, the patient also received a second dose of MMR II (Lot# 662560/1252X) in the left upper deltoid. On 22-SEP-2010, the patient experienced rash-red erythematous area 3 to 4 cm with broken open vesicles. At the time of the report, the patient had recovered. The patient sought medical attention by a doctor visit. No further information is available.


VAERS ID: 423715 (history)  
Age: 4.0  
Gender: Male  
Location: Alaska  
Vaccinated:2010-10-22
Onset:2010-10-24
   Days after vaccination:2
Submitted: 2011-05-12
   Days after onset:200
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0550Z / - LG / SC

Administered by: Other       Purchased by: Other
Symptoms: Injection site erythema, Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES1010USA03222

Write-up: Information has been received from a physician concerning a 4 year old male patient, with no pertinent medical history and no drug reactions or allergies, who on 22-OCT-2010 was vaccinated with a dose of VARIVAX (Merck), (lot # 666917/0550Z, expire date not reported), 0.5 ml, subcutaneously. Concomitant therapy included PREVNAR. On 24-OCT-2010 the patient developed an injection site reaction. The patient received the VARIVAX on his thigh and it became red and swollen. The red and swollen area was about 37 cm in diameter. It was not tender. There were no laboratory diagnostics performed. The patient sought unspecified medical attention. At the time of the report, the patient had not recovered. Additional information has been requested.


VAERS ID: 423787 (history)  
Age: 4.0  
Gender: Unknown  
Location: Washington  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-05-12
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Injection site vesicles
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1012USA02887

Write-up: Information has been received from a physician concerning a 4 year old patient, who on an unspecified date was vaccinated with a dose of VARIVAX (Merck) (dose, route and Lot # not reported). The physician reported that the patient developed a small, local bubbling at the injection site after administration of VARIVAX (Merck). At the time of the report, the outcome of the patient was unknown. It was unspecified if the patient sought medical attention. Additional information has been requested.


VAERS ID: 423210 (history)  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-05-17
Onset:2011-05-18
   Days after vaccination:1
Submitted: 2011-05-19
   Days after onset:1
Entered: 2011-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0789Z / 1 LL / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH E89952 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1608Z / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5*5 PINK, SLIGHTLY SWOLLEN, NONTENDER AND WARM-CLEARING. GIVE MOTRIN PRN; WALKING WELL


VAERS ID: 423234 (history)  
Age: 4.0  
Gender: Male  
Location: Idaho  
Vaccinated:2011-05-06
Onset:2011-05-07
   Days after vaccination:1
Submitted: 2011-05-09
   Days after onset:2
Entered: 2011-05-19
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B099BA / 4 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0674 / 3 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915703 / 4 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1324Z / 1 RL / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site oedema, Injection site pruritus, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: ID11009

Write-up: Local erythema/edema Lt ant thigh (+) mild induration (+) itchy.


VAERS ID: 423301 (history)  
Age: 4.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-03-17
Onset:2011-03-18
   Days after vaccination:1
Submitted: 2011-05-12
   Days after onset:55
Entered: 2011-05-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / 0 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH180AA / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0662Z / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site vesicles
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Seen by family physician. Arm resolved in 7 days.
CDC Split Type: PA11493

Write-up: Mother phoned Dept of Health on 5/11/11 to report that patient had a red sore (L) upper arm. The redness continued to the (L) scapula. Also she developed a blister at injection site. Saw family doctor who advised her to avoid this vaccine in the future.


VAERS ID: 423305 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-05-11
Onset:2011-05-12
   Days after vaccination:1
Submitted: 2011-05-19
   Days after onset:7
Entered: 2011-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 4 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: Redness and swelling to L Deltoid noticed by mother next day after vaccination ice applied to arm


VAERS ID: 423456 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-05-06
Onset:2011-05-06
   Days after vaccination:0
Submitted: 2011-05-13
   Days after onset:7
Entered: 2011-05-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3782AA / 1 LA / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / 2 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1024Z / 1 RA / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915703 / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1138Z / 1 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Blood test, Convulsion, Gaze palsy, Heart rate decreased, Musculoskeletal stiffness, Pallor, Presyncope
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD skin test
Current Illness: None
Preexisting Conditions: HX: Supraventricular tachycardia - DX: (2008)
Diagnostic Lab Data: Seizure vs. pre-syncope
CDC Split Type:

Write-up: After vaccines were given, Pt. turned pale & stiffened arms & legs & eyes rolled up after last vaccine was given. Lasted few seconds. Had lower heart rate, but responded to stimulation. Pt. send out for blood test and chest X-ray.


VAERS ID: 423558 (history)  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-05-17
Onset:2011-05-19
   Days after vaccination:2
Submitted: 2011-05-20
   Days after onset:1
Entered: 2011-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1484Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1703Z / 1 LL / SC

Administered by: Unknown       Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: Left thigh swollen, with redness and warm to touch, and hard.


VAERS ID: 423579 (history)  
Age: 4.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-05-13
Onset:2011-05-14
   Days after vaccination:1
Submitted: 2011-05-16
   Days after onset:2
Entered: 2011-05-20
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3497BA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 942440 / 3 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0743Z / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915376 / - RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0439Z / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling at lt anterior & anteromedial aspect of thigh which increased in size in 24 hrs. No tenderness, no d/c, no h/o fever, SOB or cough. Tx: pt was seen at hospital ER & started on SEPTRA and KEFLEX on 5/5/11. 5/20/11 completely resolved.


VAERS ID: 423586 (history)  
Age: 4.0  
Gender: Female  
Location: Arkansas  
Vaccinated:2011-05-18
Onset:2011-05-20
   Days after vaccination:2
Submitted: 2011-05-20
   Days after onset:0
Entered: 2011-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / - LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB477CA / - RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0919Z / - LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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:

Write-up: 3 cc red area on left deltoid.


VAERS ID: 423591 (history)  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2011-05-09
Onset:0000-00-00
Submitted: 2011-05-19
Entered: 2011-05-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 4 UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 9988700 / 1 UN / SC
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3958AA / 0 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 16057 / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)

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:

Write-up: Vaccine error, the patient was given a Tdap instead of the Dtap that was due & ordered. CDC states because it is 5th dose it counts and no other action is needed.


VAERS ID: 423747 (history)  
Age: 4.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2011-05-02
Onset:2011-05-03
   Days after vaccination:1
Submitted: 2011-05-23
   Days after onset:20
Entered: 2011-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / 0 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0666Z / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E94497 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0783Z / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site haematoma, Injection site oedema, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC
Current Illness: None
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right thigh with injection site (PCV13) surrounded by 1 cm bruise with additional 2 in. area of erythema/warmth/edema. No tenderness.


VAERS ID: 423752 (history)  
Age: 4.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2011-05-19
Onset:2011-05-22
   Days after vaccination:3
Submitted: 2011-05-22
   Days after onset:0
Entered: 2011-05-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1008Z / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915375 / - RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1141Z / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Culture wound, Injection site pustule, Vaccination site cellulitis
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Asthma meds
Current Illness: None
Preexisting Conditions: Penicillin and Cephalosporin allergy; Asthma
Diagnostic Lab Data: Wound culture sent.
CDC Split Type:

Write-up: Cellulitis developed around vaccine site. Positive fluid filled pustules at margin of cellulitis. Culture sent.


VAERS ID: 423755 (history)  
Age: 4.0  
Gender: Male  
Location: Unknown  
Vaccinated:2011-03-11
Onset:2011-05-15
   Days after vaccination:65
Submitted: 2011-05-23
   Days after onset:8
Entered: 2011-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B091AA / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0304 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1116Y / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1158Y / 0 RL / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Injection site vesicles, Skin lesion, Varicella post vaccine
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt came down with Rt leg & thigh vesicular lesions first thought to be impetigo, then diagnosed as varicella by 2 dermatologist.


VAERS ID: 423762 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-05-16
Onset:2011-05-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2011-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 4 RA / IJ
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 3 RA / IJ
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1394Z / 1 LA / IJ
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1475Z / 1 LA / IJ

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling, erythema, induration noted 24 hrs after injection. KEFLEX 500mg BID, TAC ointment 0.1%.


VAERS ID: 423902 (history)  
Age: 4.0  
Gender: Male  
Location: Washington  
Vaccinated:2011-05-17
Onset:2011-05-18
   Days after vaccination:1
Submitted: 2011-05-23
   Days after onset:5
Entered: 2011-05-24
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3514AA / 4 RA / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB807AA / 3 LA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D10861 / 3 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0958Z / 1 RA / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 3 LA / UN

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Injection site erythema, Injection site pruritus, Injection site swelling, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Mild vitiligo
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Red, itchy, swollen (L) arm from deltoid to mid forearm (crossing elbow joint). Resolved after 2 days.


VAERS ID: 423907 (history)  
Age: 4.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2011-05-23
Onset:2011-05-24
   Days after vaccination:1
Submitted: 2011-05-25
   Days after onset:1
Entered: 2011-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1428Y / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Localized redness and swelling around injection site where varicella vaccine was given.


VAERS ID: 423926 (history)  
Age: 4.0  
Gender: Female  
Location: Delaware  
Vaccinated:2011-05-09
Onset:2011-05-19
   Days after vaccination:10
Submitted: 2011-05-20
   Days after onset:1
Entered: 2011-05-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB469AA / - LA / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915373 / - RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Ear pain, Herpes zoster oticus, Pain, Rash pruritic, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL
Current Illness: None
Preexisting Conditions: Recurrent otitis media with BMT placed
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5/19/11 PM pt developed itchy painful rash around (L) ear & spreading up to (L) forehead & into scalp, associated with ear pain. No fever, no otitis media. I thought it looked like early varicella (Ramsay Hunt Syndrome) & sent pt to dermatology who concurred. Pt started on acyclovir & prednisolone.


VAERS ID: 423973 (history)  
Age: 4.0  
Gender: Male  
Location: Virginia  
Vaccinated:2011-05-23
Onset:0000-00-00
Submitted: 2011-05-25
Entered: 2011-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / - RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 01892 / 1 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site pruritus, Vaccination site induration, Vaccination site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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:

Write-up: Pt had rash/hard red area 3-4 cm at location of vaccine, some itching. Advised ice/bandage.


VAERS ID: 423986 (history)  
Age: 4.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-05-20
Onset:2011-05-21
   Days after vaccination:1
Submitted: 2011-05-25
   Days after onset:4
Entered: 2011-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / - RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G0168 / - LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Abdominal pain, Fall, Head injury, Hyperhidrosis, Hypotonia, Staring, Streptococcus test negative, Tremor, Unresponsive to stimuli, Urine analysis normal, X-ray abnormal
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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: Urinalysis normal; rapid strep test normal; AXR - focal retention
CDC Split Type:

Write-up: Patient was sitting on the floor, complained of abdominal pain and then fell over and hit her head. Parent picked her up and noted her to be floppy and non-responsive. Patient was slightly shaky and sweaty, her eyes were open but glassy eyed. EMS was called. Vitals were normal. Patient did not speak for minutes until EMS arrived. Transported to the ED. Took a few hours to return completely to normal. Syncope vs seizure.


VAERS ID: 424001 (history)  
Age: 4.0  
Gender: Female  
Location: Oregon  
Vaccinated:2011-05-17
Onset:2011-05-19
   Days after vaccination:2
Submitted: 2011-05-25
   Days after onset:6
Entered: 2011-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B101AA / 4 LA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 3 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1394Z / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Swollen, red, warm to touch, and painful for the patient.


VAERS ID: 424009 (history)  
Age: 4.0  
Gender: Male  
Location: Ohio  
Vaccinated:2011-05-23
Onset:2011-05-24
   Days after vaccination:1
Submitted: 2011-05-25
   Days after onset:1
Entered: 2011-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915522 / 0 LL / IJ

Administered by: Private       Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Seen in office KEFLEX given for cellulitis 5/25/11
CDC Split Type:

Write-up: Upper (L) leg erythemic warm area to touch 16 cm x 9 cm from injection site. No fevers, c/o pain, tenderness, no streaking.


VAERS ID: 424064 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-05-17
Onset:0000-00-00
Submitted: 2011-05-26
Entered: 2011-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 4 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0791Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1313Z / 1 LL / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Injection site cellulitis, Injection site erythema, Injection site inflammation
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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: Cellulitis at injection site
CDC Split Type:

Write-up: Red inflamed 4 cm area on left leg. Pt given KEFLEX and BENADRYL on follow on 5/20/11 pt improving.


VAERS ID: 424104 (history)  
Age: 4.0  
Gender: Male  
Location: Michigan  
Vaccinated:2011-05-25
Onset:2011-05-26
   Days after vaccination:1
Submitted: 2011-05-26
   Days after onset:0
Entered: 2011-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown       Purchased by: Other
Symptoms: Decreased appetite, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: VOMITING AT 2 AM, FEVER (102 DEGREES), LOSS OF APPETITE CONTINUED THROUGHOUT ENTIRE DAY.


VAERS ID: 424114 (history)  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2011-05-23
Onset:2011-05-23
   Days after vaccination:0
Submitted: 2011-05-27
   Days after onset:4
Entered: 2011-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1393Z / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1605Z / 0 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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 known.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling, and extreme redness spreading out from injection site on Left anterio lateral thigh. Warm to the touch. Redness approx 6-8 inches across.


VAERS ID: 424167 (history)  
Age: 4.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2011-05-20
Onset:2011-05-20
   Days after vaccination:0
Submitted: 2011-05-20
   Days after onset:0
Entered: 2011-05-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1486Y / 2 LA / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915703 / - RA / UN

Administered by: Private       Purchased by: Public
Symptoms: Dizziness, Fall
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received PEDVAXHIB to left deltoid and PREVNAR 13 to right deltoid. About 2 minutes after vaccines given, patient felt dizzy and fell.


VAERS ID: 424168 (history)  
Age: 4.0  
Gender: Female  
Location: Illinois  
Vaccinated:2011-05-21
Onset:2011-05-22
   Days after vaccination:1
Submitted: 2011-05-23
   Days after onset:1
Entered: 2011-05-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915375 / 0 RL / IJ

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site haematoma, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: Around injection site red, swollen, hot to touch. Starting to bruise, tender to touch, 6 cm around of redness.


VAERS ID: 424174 (history)  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-05-23
Onset:2011-05-23
   Days after vaccination:0
Submitted: 2011-05-23
   Days after onset:0
Entered: 2011-05-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / - LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1250Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1562Z / 1 LL / SC

Administered by: Other       Purchased by: Public
Symptoms: Dyspnoea, Eyelid oedema, Respiration abnormal, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EPIPEN; BENADRYL; Albuterol neb; Prednisone
Current Illness: None; Asthma and AR were under control
Preexisting Conditions: Asthma; Allergic Rhinitis
Diagnostic Lab Data: O2 sat was 98% on RA after EPIPEN
CDC Split Type:

Write-up: Puffiness of both eyelids bilaterally, hives on cheeks and ear pinna, start with difficulty breathing, mom heard wheezing. Decreased air exchange before EPIPEN & albuterol, all symptoms went away after tx. N.B. local reaction around MMR, VARIVAX.


VAERS ID: 424185 (history)  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2011-05-18
Onset:0000-00-00
Submitted: 2011-05-20
Entered: 2011-05-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER D06741 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 0674Z / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E57642 / - RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1004Z / 1 RL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Swelling/erythema & temp in leg.~Pertussis (no brand name)~UN~0.00~Patient
Other Medications:
Current Illness: Congestion
Preexisting Conditions: Asthma; GERD; developmental coordination disorder; pertussis allergy; tegaderm allergy; tape allergy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling & redness increasing at site of (R) thigh injection of PREVNAR 13. Non confluent erythema about 5.5-6 cm in diameter - warm to touch.


VAERS ID: 424250 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-05-03
Onset:2011-05-04
   Days after vaccination:1
Submitted: 2011-05-13
   Days after onset:9
Entered: 2011-05-27
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577AA / 4 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 4 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1008Z / 1 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915703 / 4 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1320Z / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site rash, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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:

Write-up: Right deltoid swelling < 24 hours s/p immunization warm, painful, with red bump.


VAERS ID: 424244 (history)  
Age: 4.0  
Gender: Male  
Location: Oregon  
Vaccinated:2011-05-17
Onset:2011-05-27
   Days after vaccination:10
Submitted: 2011-05-28
   Days after onset:1
Entered: 2011-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B126AA / 2 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1058Z / 0 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Molluscum contagiosum
Preexisting Conditions: Hx of varicella disease
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/fever & red spots on torso. No other symptoms per mom.


VAERS ID: 424231 (history)  
Age: 4.0  
Gender: Male  
Location: Iowa  
Vaccinated:2011-05-25
Onset:2011-05-26
   Days after vaccination:1
Submitted: 2011-05-29
   Days after onset:3
Entered: 2011-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RL / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / -

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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: Environmental allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and itching around injection site. Benadryl given PO.


VAERS ID: 424276 (history)  
Age: 4.0  
Gender: Male  
Location: Tennessee  
Vaccinated:2011-05-10
Onset:2011-05-12
   Days after vaccination:2
Submitted: 2011-05-12
   Days after onset:0
Entered: 2011-05-31
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / - UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site cellulitis, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: Cellulitis Rt upper lg. Red, hot, swollen thigh. Placed on ABX.


VAERS ID: 424278 (history)  
Age: 4.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2011-05-24
Onset:2011-05-25
   Days after vaccination:1
Submitted: 2011-05-31
   Days after onset:6
Entered: 2011-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178DA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0742Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1491Z / 1 LL / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Injection site rash, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Had Varicella and MMR SQ Vaccination on left thigh. Area with raised rash, no open vesicles. Had mild. fever. Treated with ibuprofen and Tylenol. Had one dose of Benadryl at night.


VAERS ID: 424298 (history)  
Age: 4.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2011-02-03
Onset:2011-02-04
   Days after vaccination:1
Submitted: 2011-05-26
   Days after onset:110
Entered: 2011-05-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Condition aggravated, Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject has a history of febrile seizures. Inactive since 2008
Diagnostic Lab Data:
CDC Split Type: 201103075

Write-up: Initial report received on 25 May 2011 from an investigator participating in a trial. A four-year-old male subject (initials not collected) with a medical history of febrile seizures (inactive since 2008) experienced a febrile seizure due to high fever one day after receiving a first dose of either INFLUENZA VIRUS VACC QUAD A & B or INFLUENZA VIRUS VACC NO PRESERV. TRIVAL A&B SV-U ALT-B or FLUZONE No Preservative 2010-2011 (route and site of administration not reported) on 03 February 2011. Lot number was not reported. The subject''s mother noted a mild episode of fever with febrile seizure that lasted only a "couple of minutes". Treatment included MOTRIN 200 mg x 1. After the one treatment the fever and seizure subsided without reoccurrence. The subject had a subsequent second dose of trial product on 03 March 2011. The seriousness was reported as Other: Important medical event specify event of special interest. The subject was not discontinued from the trial. The outcome was reported as recovered. According to the investigator the event of febrile seizure (due to high fever) was related to the trial product but was not related to the trial procedures. Documents held by sender: none.


VAERS ID: 424307 (history)  
Age: 4.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2011-05-24
Onset:2011-05-26
   Days after vaccination:2
Submitted: 2011-05-26
   Days after onset:0
Entered: 2011-05-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 4 LA / IJ
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0123 / 3 RA / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: (L) upper arm red, swollen at site of injection.


VAERS ID: 424315 (history)  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-05-17
Onset:2011-05-18
   Days after vaccination:1
Submitted: 2011-05-20
   Days after onset:2
Entered: 2011-05-31
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 4 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0330 / 3 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1393Z / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1278Z / 1 RL / UN

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Edema & erythema along entire right thigh. This is the side where varicella & IPV were given.


VAERS ID: 424316 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-05-17
Onset:2011-05-18
   Days after vaccination:1
Submitted: 2011-05-20
   Days after onset:2
Entered: 2011-05-31
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3841AA / 0 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1694Z / 1 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Induration, Local reaction, Pain, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: Reaction to insect bite 2wks prior
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: One day after PENTACEL vaccine, patient started with local reaction to vaccine = redness, swelling, small amount of pain/itching, redness measured 10 cm x 18 1/2 cm, induration measured 71/2 cm x 14 cm. Mom advised on symptom treatment.


VAERS ID: 424360 (history)  
Age: 4.0  
Gender: Male  
Location: Alaska  
Vaccinated:2011-05-23
Onset:2011-05-23
   Days after vaccination:0
Submitted: 2011-05-27
   Days after onset:4
Entered: 2011-05-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B099BA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0674 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0667Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1475Z / 1 LL / SC

Administered by: Private       Purchased by: Other
Symptoms: Cough, Dyspnoea, Epistaxis, Periorbital oedema, Pruritus, Sneezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Possible HgB E trait; eczema
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 4 vaccines in bilateral thighs. He left the clinic with father, but returned within 5-10 minutes with epistaxis, pruritus of trunk, sneezing, coughing, breathing problems, periorbital edema, wheezing. BENADRYL given by mouth, then epinephrine via SQ injection. Observed about 60 min with recovery. Prescribed ZANTAC, BENADRYL and ORAPRED. Follow up visit on 5/26, complete recovery.


VAERS ID: 424361 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-05-16
Onset:0000-00-00
Submitted: 2011-05-27
Entered: 2011-05-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B136AA / 3 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0945Y / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1563Z / 1 LA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Local swelling, Pain, Skin warm
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: Pt came in for PPD reading. Mom stated she had just noticed redness on (L) arm where shots were given. No fever, 3/10 pain, measurements of 90x90, slightly warm, pt''s mom was advised to put cold pack in area to help with swelling, and take TYLENOL if any pain.


VAERS ID: 424393 (history)  
Age: 4.0  
Gender: Female  
Location: Mississippi  
Vaccinated:2011-05-24
Onset:2011-05-24
   Days after vaccination:0
Submitted: 2011-06-01
   Days after onset:8
Entered: 2011-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR E0123 / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508Z / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1473Z / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Local reaction, Nodule, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type: MS11011

Write-up: On 5/24 @ 8:30 pm swelling with knot; skin warm to touch. Next morning second knot appeared. "Looked like 2 mosquito bites" per mother. Mom took patient to MD (on 5/26/11; MD stated "no infection. Localized reaction". No treatment. Also no redness noted.


VAERS ID: 424402 (history)  
Age: 4.0  
Gender: Male  
Location: Virginia  
Vaccinated:2008-06-01
Onset:2008-06-01
   Days after vaccination:0
Submitted: 2011-05-26
   Days after onset:1089
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Peanut allergy
Preexisting Conditions: Eczema
Diagnostic Lab Data: Temperature measurement, 06/??/08, 104.5 F
CDC Split Type: WAES1103USA02827

Write-up: Information has been received from a consumer concerning her "4 1/2 year old" son with peanut allergy and medical history of eczema who in June 2008, was vaccinated with a first dose of MMR II (Dose, route and Lot # not reported). There was no concomitant medication. The consumer stated that on approximately June 2008, "8-10 days after receiving MMR II". Her son developed a fever of 104.5 F and had 2 seizures. TYLENOL and IV fluids were given as a treatment for the events. The patient went to emergency room and was released within 4-5 hours. On an unspecified date the patient recovered. Upon internal review seizures was considered to be an other important medical event. No further information is available.


VAERS ID: 424433 (history)  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2011-05-18
Onset:2011-05-19
   Days after vaccination:1
Submitted: 2011-06-01
   Days after onset:13
Entered: 2011-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3470CA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0743Z / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling and erythema at left entire arm 5/19/11.


VAERS ID: 424449 (history)  
Age: 4.0  
Gender: Male  
Location: Illinois  
Vaccinated:2011-05-19
Onset:0000-00-00
Submitted: 2011-05-21
Entered: 2011-06-01
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1068 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0742Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1517Z / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: Amoxicillin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling and tenderness at Rt quadriceps with some swelling of the knees.


VAERS ID: 424453 (history)  
Age: 4.0  
Gender: Male  
Location: Virginia  
Vaccinated:2011-05-23
Onset:2011-05-23
   Days after vaccination:0
Submitted: 2011-06-01
   Days after onset:9
Entered: 2011-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B178CB / 0 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB446A / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0575Z / 0 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Rash generalised, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Parent called to our facility less than 1 hour after leaving the office. Patient complained of scratchy throat. 20 min afterwards the patient was found to have a generalized rash - (hives) erythematous wheals. Tx BENADRYL.


VAERS ID: 424455 (history)  
Age: 4.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2011-05-24
Onset:2011-05-26
   Days after vaccination:2
Submitted: 2011-05-31
   Days after onset:5
Entered: 2011-06-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577AA / 0 RA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1366Z / 0 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Injection site swelling, Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Rt upper arm all swollen to below the elbow red & hot.


VAERS ID: 424459 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-01-03
Onset:2011-01-05
   Days after vaccination:2
Submitted: 2011-05-26
   Days after onset:140
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / - UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1709Y / - UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: None
Diagnostic Lab Data: None
CDC Split Type: WAES1101USA01155

Write-up: Information has been received from a physician concerning a 4 year old male with no pertinent medical history or drug reactions/allergies who on 03-JAN-2011 was vaccinated subcutaneously with a dose of MMR II (lot # 666512/1709Y, expiration date unknown). Concomitant therapy included FLUZONE and PENTACEL. On 05-JAN-2011 the patient returned to the office with a 4 inch by 4 inch rash on his left thigh, the child was given BENADRYL and was told to use ice on the area. The condition was resolving at the time of reporting. No laboratory diagnostics study was performed. Additional information has been requested.


VAERS ID: 424499 (history)  
Age: 4.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-10-19
Onset:0000-00-00
Submitted: 2011-05-26
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0588Z / - RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0779Z / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MOTRIN
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES1011USA00686

Write-up: Information has been received from a physician concerning a 4 year old female patient with no pre-existing conditions who on 19-OCT-2010 was vaccinated with MMR II (lot number 664455/0588Z). Concomitant therapy included VARIVAX (lot number 667759/0779Z), KINRIX and MOTRIN. On an unspecified date the patient experienced erythema and induration at the injection site. The MMR II injection was given in the right upper thigh. The reporter stated that there was no adverse event related to the other vaccination products. On an unknown date the patient recovered from erythema and induration at the injection site. No lab diagnostics studies were performed. The patient sought unspecified medical attention. No further information is available.


VAERS ID: 424616 (history)  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2010-06-25
Onset:2010-07-05
   Days after vaccination:10
Submitted: 2011-05-26
   Days after onset:325
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Injection site rash, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Pervasive developmental disorder; Developmental delay
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1008USA00185

Write-up: Information has been received from a registered nurse concerning a 4 year old male patient with pervasive developmental disorder (PDD) and mild developmental delay who at the age of 15 months was vaccinated with the first dose of MMR II and on 25-JUN-2010, was vaccinated with the second dose of the vaccine. The nurse reported that on 05-JUL-2010, the patient developed a generalized rash on his body that lasted 3 days. On 29-JUL-2010, the rash reappeared on the patient''s legs. The nurse stated that the patient was evaluated at an unspecified emergency room for the rash. The outcome of the patient was not reported. No further information is available.


VAERS ID: 424625 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2010-08-17
Onset:2010-08-27
   Days after vaccination:10
Submitted: 2011-05-26
   Days after onset:272
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - RA / UN

Administered by: Other       Purchased by: Other
Symptoms: C-reactive protein normal, Full blood count normal, Joint swelling, Pain, Red blood cell count normal, Skin discolouration, Tenderness
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Serum C-reactive, normal; Complete blood cell, normal; Erythrocyte, normal
CDC Split Type: WAES1008USA04159

Write-up: Information has been received from a physician and father of the patient concerning a 4 year old female who on 17-AUG-2010 was vaccinated with a dose of MMR II in the right deltoid. There was no concomitant medication. 10 days later on 27-AUG-2010 the patient developed swelling and discoloration in both ankles. Little tenderness/pain was noted. The patient was brought to the emergency room where labs (serum C-reactive protein test, complete blood cell count, erythrocyte sedimentation rate) were analyzed and all were negative. This presentation persisted. Additional information has been requested.


VAERS ID: 424632 (history)  
Age: 4.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-09-07
Onset:2010-09-07
   Days after vaccination:0
Submitted: 2011-05-26
   Days after onset:261
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Crying, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES1009USA00974

Write-up: Information has been received from a physician concerning a 4 year old female patient with no pertinent medical history and no known drug allergies who on 07-SEP-2010 was vaccinated intramuscularly with a dose of MMR II. There was no concomitant medication. Later that evening, the patient was crying because of pain at site of injection. On 08-SEP-2010, the patient recovered from pain at site of injection. No lab diagnostics studies were performed. Patient sought unspecified medical attention. Additional information has been requested.


VAERS ID: 424658 (history)  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2010-08-25
Onset:2010-08-25
   Days after vaccination:0
Submitted: 2011-05-26
   Days after onset:274
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0256Z / 1 AR / UN

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Body temp, 08/25/10, 104 F
CDC Split Type: WAES1008USA03659

Write-up: Information has been received from a physician and assistant concerning a 4 year old male patient with no pertinent medical history and no allergies who on 25-AUG-2010 was vaccinated with the second dose of MMR II (lot# 667006/0256Z). There was no concomitant medication. On 25-AUG-2010, within 4 hours of vaccination with his 2nd dose of MMR II, the patient developed a fever of 104F. Unspecified medical attention was sought via phone call. The patient''s fever persisted. Follow up information has been received from the physician concerning the 4 year old male patient who on 25-AUG-2010 was vaccinated with the second dose of MMR II (lot# 667006/0256Z) into his arm. There was no illness at time of vaccination. On 25-AUG-2010, in the afternoon, approximately 2 to 4 hours after injection with his 2nd dose of MMR II, the patient developed a fever of 104F. At the time of this report, the patient had recovered. The physician advised that the patient in this case had a cousin who lived upstairs from him. The cousin had coxsackie. The cousin did not receive MMR II. The physician mentioned it because the patient had been playing with the cousin, but nothing developed from his exposure to his cousin. The patient was fine. Additional information is not expected.


VAERS ID: 424670 (history)  
Age: 4.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2010-03-18
Onset:2010-03-18
   Days after vaccination:0
Submitted: 2011-05-26
   Days after onset:434
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B13BAA / 4 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0617Y / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0970Y / 1 RA / UN

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Erythema; Swelling
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1005USA01682

Write-up: Information has been received which reported that a 4 year old male patient with none pre-existing allergies, birth defects or medical conditions and red arm and swelling at the time of vaccination, who on 18-MAR-2010 at 8:00 a.m. was vaccinated with a second dose of MMR II in the left deltoid (route unspecified and lot number: 664606/0617Y), a second dose of VARIVAX (Merck) in the right deltoid (route unspecified and lot number: 664614/0970Y) and a fifth dose of KINRIX, on the same day, at 08:00 in the left deltoid (route unspecified and lot number:AC20B13BAA). On 18-MAR-2010 at 08:00, the health professional reported that the patient''s left arm was red and swollen. The patient visited the emergency room and was given with antibiotics. At the time of the report, the outcome of the patient was recovered on 31-MAR-2010. Additional information has been requested.


VAERS ID: 424743 (history)  
Age: 4.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2010-03-31
Onset:2010-03-31
   Days after vaccination:0
Submitted: 2011-05-26
   Days after onset:421
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20BI36AA / 4 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB311BA / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0617Y / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0970Y / 1 RA / UN

Administered by: Private       Purchased by: Other
Symptoms: Cellulitis, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: WAES1004USA03200

Write-up: Information has been received from a healthcare worker concerning a 4 year old female with no pertinent medical history and no drug allergies, who was vaccinated with a second dose of MMR II (0.5ml, lot # 664606/0617Y) on 31-MAR-2010. Suspected therapy included a dose of VARIVAX. Concomitant therapy included DTaP, hepatitis A virus vaccine (unspecified) and poliovirus vaccine. On 31-MAR-2010 the patient developed cellulitis. The patient was taken to emergency room and given antibiotics and recovered that day. There were no labs or diagnostic tests performed. Follow up information has been received from a healthcare worker concerning a 4 year old female with no pre-existing drug allergies, who was vaccinated with a second dose of MMR II (lot # 664606/0617Y) on 31-MAR-2010 at 3:30 p.m. in the left deltoid. Suspect therapy included a second dose of VARIVAX (lot # 664614/0970Y) on 31-MAR-2010 at 3:30 p.m. in the right deltoid. Other concomitant therapies included a fifth dose of KINRIX (SKB, lot # ac20bi36aa) on 31-MAR-2010 at 3:30 p.m. in the left deltoid, and a dose of HAVRIX (SKB, lot # ahavb311ba). On 31-MAR-2010 at 3:30 p.m. the patient''s left arm was red and swollen. The patient went to emergency room on 02-APR-2010 with cellulitis. The patient was given antibiotics and recovered on 05-APR-2010. No further information is available.


VAERS ID: 424745 (history)  
Age: 4.0  
Gender: Male  
Location: Utah  
Vaccinated:2010-04-05
Onset:2010-04-06
   Days after vaccination:1
Submitted: 2011-05-26
   Days after onset:415
Entered: 2011-06-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1288Y / 1 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1004USA03482

Write-up: Information has been received from an office manager concerning a 4 year old male patient who on 05-APR-2010, was vaccinated with a dose of MMR II (Lot # 665801-1288Y) in his leg (right or left leg was unspecified). It was reported that "2 days after MMR II was given", on 07-APR-2010, the patient''s leg was "triplet in size". At the time of the report the patient was recovering. The patient sought medical attention by an office visit to the physician. This is one of several reports received from the same source. A standard lot check investigation has been finalized. All in-process quality checks for the lot number in question were satisfactory. In addition, an expanded lot check investigation was performed. The testing performed on the batch prior to release met all release specifications. The lot met the requirements of the Center for Biologics Evaluation and Research and was released. Follow up information has been received from an office manager who indicated that the patient was a male who on 05-APR-2010, was vaccinated with the second dose of MMR II into his left leg at 11:30. On 06-APR-2010, the day after the shot was given, (previously reported as 07-APR-2010) at 09:00 the patient''s upper thigh was swollen, his leg got very hot and red. The patient was given prednisolone to reduce the reaction. The patient recovered on 08-APR-2010. No further information is available.


VAERS ID: 424530 (history)  
Age: 4.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-05-25
Onset:2011-05-28
   Days after vaccination:3
Submitted: 2011-05-31
   Days after onset:3
Entered: 2011-06-02
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3282CA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0413 / 3 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0544Z / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Culture positive, Injection site erythema, Injection site reaction, Injection site swelling, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PULMICORT; Amoxicillin; SINGULAIR; Albuterol
Current Illness: Strep throat
Preexisting Conditions: Asthma
Diagnostic Lab Data: (+) Strep culture 5/21/11
CDC Split Type:

Write-up: Vaccines given on 5/25/11 - mom noticed swelling and redness in (R) thigh on 5/28/11 and then red rash "spots" on face then arms, legs & feet on 5/29/11.


VAERS ID: 424579 (history)  
Age: 4.0  
Gender: Female  
Location: Georgia  
Vaccinated:2011-06-01
Onset:2011-06-02
   Days after vaccination:1
Submitted: 2011-06-02
   Days after onset:0
Entered: 2011-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 4 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 3 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1608Z / 1 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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:

Write-up: Child collapsed, dizzy, syncope.


VAERS ID: 424597 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2011-05-26
Onset:2011-05-26
   Days after vaccination:0
Submitted: 2011-06-02
   Days after onset:7
Entered: 2011-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: swollen and red sight~DT+IPV+Hib+HepB (no brand name)~1~0.17~Patient
Other Medications:
Current Illness: none
Preexisting Conditions: has had reactions to his first set of immunizations around 2 months of age, was not immunized since
Diagnostic Lab Data:
CDC Split Type:

Write-up: itchy rash on sight of injection for 1 week, swollen, red, painful, 8cm*10 cm


VAERS ID: 424608 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2011-04-19
Onset:2011-04-21
   Days after vaccination:2
Submitted: 2011-06-02
   Days after onset:42
Entered: 2011-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B126BA / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB441BA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / 3 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0646Z / 1 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1138Z / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: Lt thigh red swollen 9" x 6" (DTA area) was given BENADRYL (12.5 mg) 1-6 hrs - 6oz on 4/22/11 2:30pm.


VAERS ID: 424690 (history)  
Age: 4.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2011-06-02
Onset:2011-06-03
   Days after vaccination:1
Submitted: 2011-06-03
   Days after onset:0
Entered: 2011-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH - / - - / -

Administered by: Unknown       Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: FOOD ALLERGIES: EGG, ALMOND, CITRUS, DAIRY, WHEAT, GLUTEN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling around site of vaccination, tenderness and redness at site.


VAERS ID: 424706 (history)  
Age: 4.0  
Gender: Male  
Location: Colorado  
Vaccinated:2011-05-23
Onset:2011-05-24
   Days after vaccination:1
Submitted: 2011-05-26
   Days after onset:2
Entered: 2011-06-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3474AA / 1 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0123 / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0961Z / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1179Z / 1 LA / SC

Administered by: Public       Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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:

Write-up: 10.5 x 10.5cm immunization site reaction. Child had 12-72 hours ago developed erythema, heat, swelling and pain on palpation to left deltoid region. The erythema regressed yesterday. Plan to treat with BENADRYL and PO KEFLEX. Follow up 48 hrs or sooner if worsening.


VAERS ID: 424713 (history)  
Age: 4.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2011-05-24
Onset:2011-05-24
   Days after vaccination:0
Submitted: 2011-05-26
   Days after onset:2
Entered: 2011-06-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / - LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1009Z / 1 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1562Z / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Flushing, Lip swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLARITIN; NASONEX
Current Illness: None
Preexisting Conditions: Egg, Milk, Inhalant allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lip swelling - sl. facial swelling & flushing - no respiratory difficulty (known allergy to egg, milk, Inhalants).


VAERS ID: 424757 (history)  
Age: 4.0  
Gender: Female  
Location: Washington  
Vaccinated:2011-05-23
Onset:2011-05-24
   Days after vaccination:1
Submitted: 2011-05-25
   Days after onset:1
Entered: 2011-06-03
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 4 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0204 / 3 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1024Z / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 7-21-08~Varicella (no brand name)~1~1.30~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: Reaction to Varicella at 15 m appt
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt was given two injections in right thigh. First DTaP #5 no previous reaction & MMR first dose. Pt had 6 mm size circle that was red and hot to touch. Pt mother also noted fever of 101.0.


VAERS ID: 424791 (history)  
Age: 4.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2011-05-26
Onset:2011-05-30
   Days after vaccination:4
Submitted: 2011-06-02
   Days after onset:3
Entered: 2011-06-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3618AA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR E0950 / 3 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1438Z / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Ecchymosis, Full blood count normal, Gingival bleeding, Idiopathic thrombocytopenic purpura, Intensive care, Petechiae, Platelet count decreased, Rectal haemorrhage, Red blood cell count normal, White blood cell count normal
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Gingival disorders (narrow), Ischaemic colitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? Yes
Previous Vaccinations: Rash & fever 1 wk after vaccine~Measles + Mumps + Rubella (no brand name)~1~2.00~Patient
Other Medications: PRN MIRALAX; ALLEGRA; VERAMYST; FLINSTONE Vitamins; PRN PULMICORT; XOPENOX; Melatonin
Current Illness: None
Preexisting Conditions: IgA Deficiency; Allergic Rhinitis; Reactive Airway Disease
Diagnostic Lab Data: CBC attached, WBC, RBC all normal. Plt count < 1000. Dx of ITP per Hematology.
CDC Split Type:

Write-up: Within 5 days of receiving vaccines listed below child developed petechial rash, gingival, rectal bleeding multiple ecchymoses. Platelet count less than 1,000 on adm. to Intensive Care Unit at Hospital.


VAERS ID: 424779 (history)  
Age: 4.0  
Gender: Male  
Location: Colorado  
Vaccinated:2011-06-02
Onset:2011-06-03
   Days after vaccination:1
Submitted: 2011-06-04
   Days after onset:1
Entered: 2011-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH EE23419 / 0 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Induration, Injection site erythema, Injection site warmth, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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:
CDC Split Type:

Write-up: Large redness and warmth in area over 4 cm medial to injection site. Some induration and tenderness.


VAERS ID: 424858 (history)  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-04-05
Onset:2011-04-08
   Days after vaccination:3
Submitted: 2011-06-06
   Days after onset:59
Entered: 2011-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577BA / - LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / - LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 09612 / - RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 14692 / - RL / -

Administered by: Unknown       Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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 LISTED
Diagnostic Lab Data:
CDC Split Type: TX20110012

Write-up: LT LEG RED/SWOLLEN WARM TO TOUCH 6 CM X 8 CM INDURATION/ERYTHEMA


VAERS ID: 424861 (history)  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-04-06
Onset:2011-04-08
   Days after vaccination:2
Submitted: 2011-06-06
   Days after onset:59
Entered: 2011-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577BA / - RL / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 15102 / - RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / - LL / -

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site abscess, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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 LISTED
Diagnostic Lab Data:
CDC Split Type: TX20110013

Write-up: LT LEG RED/SWOLLEN WARM TO TOUCH 6.5 CM X 6 CM INDURATION/ERYTHEMA


VAERS ID: 424863 (history)  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2011-04-07
Onset:2011-04-08
   Days after vaccination:1
Submitted: 2011-06-06
   Days after onset:59
Entered: 2011-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3577BA / - LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D1086 / - LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 09612 / - RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 10382 / - RL / -

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)

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 LISTED
Diagnostic Lab Data:
CDC Split Type: TX20110015

Write-up: RED/SWELLING OF LT LEG


VAERS ID: 424878 (history)  
Age: 4.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-06-03
Onset:0000-00-00
Submitted: 2011-06-06
Entered: 2011-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B139AA / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0666Z / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E63662 / 0 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1499Z / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 6/5/11 mom stated leg (right) was red & swollen around vaccine site. At office visit 6/6/11 child was given BENADRYL & TYLENOL.


VAERS ID: 424907 (history)  
Age: 4.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2011-06-01
Onset:2011-06-03
   Days after vaccination:2
Submitted: 2011-06-07
   Days after onset:4
Entered: 2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0601Z / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E84461 / 0 RL / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Diarrhoea, Irritability, Pain, Pyrexia, Rash erythematous, Rash generalised, Similar reaction on previous exposure to drug, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Measles + Mumps + Rubella (no brand name)~UN~1.00~Patient|~Pneumo (Prevnar)~UN~1.00~Patient|~Varicella (no brand name)~UN~1.00~
Other Medications:
Current Illness: None
Preexisting Conditions: Had same at 12 mo vaccines that never stopped; possible mastocytosis?
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received MMR and PREVNAR 13 at 4pm 6/1/11. Pt. was grumpy and fussy 6/2 and 6/3 - late afternoon 6/3/11 developed clusters of white bumps surrounded by red area then progressed to full body rash. Improved with BENADRYL, CLARITIN and SINGULAIR - very painful so also MOTRIN. Resolved 6/4/11 but pt. awoke with fever of 101 degrees, vomiting and diarrhea x 24 hours.


VAERS ID: 424909 (history)  
Age: 4.0  
Gender: Female  
Location: Georgia  
Vaccinated:2011-06-01
Onset:2011-06-03
   Days after vaccination:2
Submitted: 2011-06-07
   Days after onset:4
Entered: 2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB509AA / 1 LL / IJ
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 915347 / 4 RL / IJ

Administered by: Private       Purchased by: Private
Symptoms: Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Nurse visit
Preexisting Conditions: Only seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child had PREVNAR (Rt) thigh 6/1/11; came in 6/3/11, at injection site edema and increase temp. to skin per Dr.


VAERS ID: 424913 (history)  
Age: 4.0  
Gender: Female  
Location: Maine  
Vaccinated:2011-06-06
Onset:2011-06-07
   Days after vaccination:1
Submitted: 2011-06-07
   Days after onset:0
Entered: 2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3718AA / 2 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: Atrial septal defect
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red at site & swollen.


VAERS ID: 424927 (history)  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2011-06-01
Onset:2011-06-01
   Days after vaccination:0
Submitted: 2011-06-06
   Days after onset:5
Entered: 2011-06-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B158AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1481Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1474Z / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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:

Write-up: Fever 101 degrees, vomiting.


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