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Case Details (Sorted by Age)

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VAERS ID:292049 (history)  Vaccinated:2007-08-02
Age:13.0  Onset:2007-08-02, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 46
Location:Unknown  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: upper extremity X-ray
CDC 'Split Type': WAES0708USA01091
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0244U0IMUN
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Head injury, Limb injury, Syncope, X-ray limb
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a nurse concerning a 13 year old female who on 02-AUG-2007 was vaccinated with Gardasil. Concomitant therapy included meningococcal vaccine (unspecified) and VARIVAX. On 02-AUG-2007 the patient fainted and hit her head and arm. Medical attention was sought. The patient was evaluated with an X-ray of her arm. The patient recovered. No other information was available. The nurse also reported that their office had 4 other patients who had fainted after receiving a dose of Gardasil. No details were available on those patients. Additional information has been requested.

VAERS ID:292063 (history)  Vaccinated:2007-07-30
Age:13.0  Onset:2007-08-02, Days after vaccination: 3
Gender:Female  Submitted:2007-09-17, Days after onset: 46
Location:Unknown  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA01310
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Eye swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Information has been received from a physician concerning a 13 year old female who on 30-JUL-2007 was vaccinated with a first dose of Gardasil. On 02-AUG-2007 the patient experienced swollen eye and welts developed all over her body. Medical attention was sought. The patient recovered from swollen eye and welts developed all over her body. Additional information has requested.

VAERS ID:292078 (history)  Vaccinated:2007-08-08
Age:13.0  Onset:2007-08-08, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 40
Location:Florida  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA01506
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.  UNUN
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Information has been received from a physician concerning a 13 year old female patient who on 08-AUG-2007 was vaccinated IM with a first dose of Gardasil. Concomitant therapy included Vaqta (MSD), Varivax (MSD), MENACTRA, and Tdap. On 08-AUG-2007 the patient experienced "dizziness". Subsequently, the patient recovered from dizziness on 08-AUG-2007. Additional information has been requested.

VAERS ID:292689 (history)  Vaccinated:2007-08-08
Age:13.0  Onset:2007-08-08, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 40
Location:California  Entered:2007-09-20, Days after submission: 3
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: head computed axial, 08/08/07, normal
CDC 'Split Type': WAES0708USA04819
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0171U1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Computerised tomogram normal, Dizziness, Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a physician''s assistant concerning a 13 year old female with no known drug allergies who on 08-AUG-2007 was vaccinated IM in the left deltoid with the second vaccination of Gardasil (Lot # 655620/0171U). The date of the patient''s first vaccination was not reported. It was reported that the patient was not instructed to wait the minimum 15 minutes post vaccination and left the office with her family. As she walked to the car she reported that she felt dizzy. She then fell and hit the occipital area of her head. Paramedics were called and the patient was transported to the ER. A head CT scan was performed which was normal. The event was diagnosed as a syncopal episode. At the time of the report it was unknown if the patient had recovered from the event. Additional information has been requested.

VAERS ID:292796 (history)  Vaccinated:2007-08-02
Age:13.0  Onset:2007-08-02, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 46
Location:Pennsylvania  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA00688
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a physician concerning a 13 year old female who on 02-AUG-2007 was vaccinated with a first dose of Gardasil. On 02-AUG-2007 the patient fainted. Subsequently, the patient recovered from fainted. It was reported that the patient did not seek medical attention. Additional information has been requested.

VAERS ID:292806 (history)  Vaccinated:2007-08-17
Age:13.0  Onset:2007-08-17, Days after vaccination: 0
Gender:Female  Submitted:2008-01-07, Days after onset: 143
Location:Ohio  Entered:2007-09-20, Days after submission: 109
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: Syncope
Diagnostic Lab Data: blood pressure, 08/17/07, 118/6 mmHg;
CDC 'Split Type': WAES0708USA04902
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB186AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0930U0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0834U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a nurse, via a company representative concerning a 13 year old female patient, who in August 2007 (during the week of 13-AUG-2007), was vaccinated with the first dose of Gardasil (lot # not provided), and was also vaccinated with a dose of MENACTRA. About 2 to 3 minutes after the vaccination was administered, the patient "passed out." The nurse indicated she was out for approximately 20 to 30 minutes. She was given a drink and had a cloth on her head, and was feeling better. No medical treatment was required. Additional information has been requested. Follow up information from the nurse stated that there were no further incidents or reactions reported. Additional information is not expected.

VAERS ID:292817 (history)  Vaccinated:2007-08-08
Age:13.0  Onset:2007-08-09, Days after vaccination: 1
Gender:Female  Submitted:2007-09-17, Days after onset: 39
Location:Georga  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA05123
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Private     Purchased by: Private
Symptoms: Rash, Viral rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a health professional concerning her 13 year old daughter with no medical history or allergies who on 08-AUG-2007 at 14:00, was vaccinated with a first dose of Gardasil. On 09-AUG-2007 in the evening, the patient developed a rash. It was described by a dermatologist as viral exanthem. It was reported to have started near both armpits and spread all over her torso and upper legs. The rash seemed to disappear after using 1% hydrocortisone cream which was prescribed by the physician. On 24-AUG-2007, the patient recovered. Additional information is not expected.

VAERS ID:292819 (history)  Vaccinated:2007-06-27
Age:13.0  Onset:2007-06-27, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 82
Location:Pennsylvania  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Near fainting
Preexisting Conditions: Unknown
Diagnostic Lab Data: Blood pressure, 06/27/07, decreased to 98/58
CDC 'Split Type': WAES0708USA05158
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0522U IMUN
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a registered nurse concerning a female who was vaccinated with GARDASIL. Subsequently, reported on 20-AUG-2007 that "in the past few months", the patient fainted. Subsequently, after ten minutes of lying down, the patient recovered from fainting. This is one of several reports received from the same source. Additional information has been requested. This is in follow-up to report(s) previously submitted on 9/17/2007. Information has been received from a physician concerning a 13 year old female patient with a history of almost fainting about once a month, who on 27-JUN-2007, was vaccinated IM into the left arm with a dose of GARDASIL (Lot# 657737/0522U). After getting the vaccine, the patient felt light headed and dizzy. It was reported that it got worse when she sat up or stood up. The patient''s blood pressure decreased to 98/58. The patient left the office after about 50 minutes when she was feeling better. Another physician was consulted before discharging the patient home. On 27-JUN-2007, the patient recovered from lightheaded and dizzy. On an unspecified date, the patient recovered from fainting. Additional information is not expected.

VAERS ID:292986 (history)  Vaccinated:2007-08-27
Age:13.0  Onset:2007-08-27, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 21
Location:California  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA00189
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0515U1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a physician concerning a 13 year old female who was vaccinated with a second dose of Gardasil in her left arm. Subsequently, the patient felt dizzy as she started to walk to the bathroom. She became even more dizzy she decided to sit down on the floor and she fainted. The patient was not injured she didn''t hit her head. The patient was placed in a supine position where cold rags were applied. It was reported that the patient rested for a while. The patient recovered from that event. This is in follow-up to report(s) previously submitted on 9/12/2007. Information has been received from a physician concerning a 13 year old female who was vaccinated with a second dose of GARDASIL in her left arm. Subsequently the patient felt dizzy as she started to walk to the bathroom. She became even more dizzy she decided to sit down on the floor and then fell over. The patient was not injured she didn''t hit her head or loose conciousness. The patient was placed in a supine position for the 25 minutes during Pulse and BP were normal. Cold rags were applied. It was reported that the patient rested for a while and left with her father. The patient admitted to being fasting since 26-Aug-2007, 7:00PM. The patient recovered from that event. No product quality complaint was involved.

VAERS ID:292988 (history)  Vaccinated:2007-08-21
Age:13.0  Onset:2007-08-21, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 27
Location:Unknown  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA00278
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0927U2UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache
SMQs:
Write-up: Information has been received from a registered nurse concerning a 13 year old female who was vaccinated with the third dose of Gardasil (Lot #658222/0927U) on 21-AUG-2007. On approximately 21-AUG-2007, the patient complained of a headache with a short duration after the third dose of Gardasil. This is one of three reports from the same source/siblings. Additional information has been requested.

VAERS ID:293001 (history)  Vaccinated:2007-01-30
Age:13.0  Onset:2007-01-30, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 229
Location:Connecticut  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: vital sign 01/30/07
CDC 'Split Type': WAES0709USA00927
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0961F0UNUN
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a registered medical assistant concerning a 13 year old female with no pertinent medical history, who on 30-JAN-2007 at 3:00 pm, was vaccinated in the left arm with a first dose of Gardasil (lot # 654389/0961F). On 30-JAN-2007 at 3:00 pm, the patient experienced a brief syncopal episode. The patient was monitored in the office for 10 to 15 minutes vital signs were reported as normal. Subsequently, the patient recovered from a brief syncopal episode and patient was left with her mother who is a registered nurse. Additional information is not expected.

VAERS ID:293006 (history)  Vaccinated:2007-08-23
Age:13.0  Onset:2007-08-23, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 25
Location:Unknown  Entered:2007-09-20, Days after submission: 3
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: Unknown
CDC 'Split Type': WAES0709USA01953
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 2UNUN
Administered by: Other     Purchased by: Other
Symptoms: Cold sweat, Dizziness, Feeling cold, Loss of consciousness, Nausea, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on 23-AUG-2007 was vaccinated at 11:15 am with the third dose of Gardasil. Afterwards, the patient experienced dizziness for a couple minutes. She sat down, had a cup of water and walked to the waiting room. About 5 minutes later, she passed out. She was cold, clammy, and pale. When she finally came to, the patient was watched for about 20 minutes. The patient felt nauseated. She received no other vaccines that day. She had eaten breakfast. When she left the office, she still felt nauseous. No further details were provided. This is one of 2 reports from the same source (WAES 0708USA04690). Additional infromation is not expected.

VAERS ID:293022 (history)  Vaccinated:2007-07-27
Age:13.0  Onset:2007-08-03, Days after vaccination: 7
Gender:Female  Submitted:2007-09-17, Days after onset: 45
Location:Texas  Entered:2007-09-20, Days after submission: 3
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: Unknown
Diagnostic Lab Data: total serum lipid test, 08/03/2007, normal
CDC 'Split Type': WAES0708USA02799
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1424F UNUN
Administered by: Other     Purchased by: Other
Symptoms: Lipids normal, Skin hyperpigmentation
SMQs:
Write-up: Information has been received from a physician concerning a 13 year old female who on 27-JUL-2007 was vaccinated with a dose of Gardasil (lot 654885/1424F). There was no concomitant medication. On 03-AUG-2007, the patient returned to the clinic with complaint of hyperpigmentation patch on right wrist. The physician was not sure if the patient''s hyperpigmentation was due to vaccination with Gardasil or other causes. Laboratory evaluations on 03-AUG-2007 revealed normal lipid profile. At the time of this report, the patient had not recovered and was still being treated. Additional information has been requested.

VAERS ID:293032 (history)  Vaccinated:2007-08-14
Age:13.0  Onset:2007-08-14, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 34
Location:Pennsylvania  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA02958
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0524U0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a nurse concerning a 13 year old female who on 14-AUG-2007 was vaccinated with a first dose of Gardasil (658094/0524U). Concomitant vaccination given on the same day included BOOSTRIX and MENACTRA. On 14-AUG-2007 the patient experienced syncope. Unspecified medical attention was sought. On 14-AUg-2007 the patient recovered. Additional information has been requested.

VAERS ID:293194 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-09-17
Location:South Carolina  Entered:2007-09-20, Days after submission: 3
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': WAES0708USA03133
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0523U1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Menorrhagia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Write-up: Information has been received from a certified medical assistant (C.M.A.) concerning a 13 year old female patient who on 06-AUG-2007 was vaccinated with a second dose of Gardasil lot #657868/0523U. The reporter mentioned that patient developed an extended menstrual period after vaccination with the second dose of Gardasil. No further information known at this time. Patient''s mother contacted the doctor''s office for the event. The outcome was unknown. Additional information has been requested.

VAERS ID:293201 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-09-17
Location:Illinois  Entered:2007-09-20, Days after submission: 3
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': WAES0708USA03185
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Information has been received from a nurse concerning a 13 year old female who in approximately June 2007, was vaccinated with Gardasil (0.5 ml). The patient subsequently experienced pain at the injection site following the vaccination. At the time of this report, the injection site pain persisted. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:293687 (history)  Vaccinated:2007-08-20
Age:13.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Female  Submitted:2007-09-17, Days after onset: 28
Location:Oregon  Entered:2007-09-20, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: total heartbeat count, 08/20/07, 48 bpm; total heartbeat count, 08/20/07, 60 bpm; blood pressure, 08/20/07, 100/6 mmHg
CDC 'Split Type': WAES0708USA04303
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.AHAVB182AA1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1060U0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU1821AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0782U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Malaise, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Initial and follow up information has been received from a registered nurse, concerning a 13 year old female patient, with no known medical conditions or allergies, who on 20-AUG-2007 was vaccinated IM in the right deltoid, with a dose, 0.5ml, of Gardasil (lot #658556/1060U), as well as, with the second dose, SC in the left arm, of Varivax (duration and dose not reported) (MSD) (lot #657754/0782U), with the second dose, IM in the left arm, of Vaqta (lot #AHAVB182AA) (manufacturer unspecified) (duration and dose not specified), and with the first dose, IM in the right arm, of MENACTRA (lot #U1821AA). There was no illness at the time of vaccinations. On 20-AUG-2007, following the vaccinations, and while still in the physician''s office, the patient reported not feeling good and was pale, felt faint, dizzy and nauseated. At 4:50pm, her blood pressure (BP) was 100/60 mmHg, and her pulse was 48bpm. The patient had not eaten breakfast and was given crackers and juice and laid flat for 15 minutes. Within 20 minutes, she was feeling better, her BP was "good," and her pulse had increased to 60 bpm (previously reported as 64 bpm). The nurse considered the patient to be recovered and she was discharged to home. Additional information has been requested. Additional information is not expected.

VAERS ID:291081 (history)  Vaccinated:2007-08-30
Age:13.0  Onset:2007-08-30, Days after vaccination: 0
Gender:Female  Submitted:2007-09-21, Days after onset: 22
Location:Michigan  Entered:2007-09-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: PERSISTENT PROTEINURIA
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0680U0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2394BA0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Malaise, Pallor, Peripheral coldness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: AFTER RECEIVING HER IMMUNIZATIONS THE PT FELT SICK, SHE WAS SITTING IN THE EXAM ROOM WITH HER HEAD IN HER HANDS LEANING FORWARD BETWEEN HER KNEES. THE NURSE SAT HER UP AND SHE WAS PALE AND EXTREMITIES COOL. THE NURSE WAS UNABLE TO FEEL A RADIAL PULSE, BUT DID GET AN APICAL PULSE. DR. WAS SUMMONED AND HE WAS ABLE TO FEEL A RADIAL PULSE. THEY BEGAN TO LOWER HER TO THE FLOOR AND SHE LIFTED HER HEAD AND SMILED. HER COLOR WAS PINK, SKIN WARM. SHE WAS ALERT AND ORIENTED. MOM WAS SUMMONED FROM THE WAITING ROOM, AND SHE STATES THAT THE SAME THING HAPPENS TO HER WITH ANY NEEDLE. PT REMAINED IN THE EXAM ROOM FOR 30 MIN. BP WERE TAKEN AND THEY WERE AS FOLLOWS. 90/60 LEFT ARM SITTING- 10 MIN POST SYNCOPE, AND 98/68 LEFT ARM SITTING- 40 MIN POST SYNCOPE.

VAERS ID:291115 (history)  Vaccinated:2007-09-12
Age:13.0  Onset:2007-09-13, Days after vaccination: 1
Gender:Male  Submitted:2007-09-21, Days after onset: 8
Location:Tennessee  Entered:2007-09-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0800U0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2171AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2759AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1011U1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (R) deltoid showed large area of well demarcated edema/erythema. No systemic signs/sx. This would have been site of varicella and Hep A.

VAERS ID:291119 (history)  Vaccinated:2007-09-18
Age:13.0  Onset:2007-09-18, Days after vaccination: 0
Gender:Female  Submitted:2007-09-19, Days after onset: 1
Location:New Hampshire  Entered:2007-09-21, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chewable Fluoride
Current Illness: No
Preexisting Conditions: Wheezing; Chronic Rhinitis - not allergic
Diagnostic Lab Data: No
CDC 'Split Type': NH0736
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB182AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0928U0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Within 1 hour of receiving Hepatitis A vaccine and HPV vaccine, mother reported that patient experiencing nausea, vomiting, and fever.

VAERS ID:291127 (history)  Vaccinated:2007-09-13
Age:13.0  Onset:2007-09-13, Days after vaccination: 0
Gender:Male  Submitted:2007-09-20, Days after onset: 7
Location:Maine  Entered:2007-09-21, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol 0.083%
Current Illness: None
Preexisting Conditions: Asthma - intermittent
Diagnostic Lab Data: Albuterol neb given, Prednisone
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2402AA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: 9/13/07 5:40 PM Patient returned to office a few hours after receiving Menactra. SOB, cough, chest pains. Vaccine was given 11:00 AM. Office visit 5:40 PM. Was given albuterol neb, seemed to improve then given Rx for nebs and prednisone. F/U 9/19/07 Ok, improved.

VAERS ID:291211 (history)  Vaccinated:2007-09-21
Age:13.0  Onset:2007-09-21, Days after vaccination: 0
Gender:Female  Submitted:2007-09-24, Days after onset: 3
Location:Texas  Entered:2007-09-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0017U1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0263U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2342CA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2572AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1121U1SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Asthenia, Nervousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt was given vaccines; was very nervous at the time - walked out clinic and fainted before getting in her car. Pt. brought into clinic very pale, weak. Given alcohol to breathe fresh air fanned on her. Suggested she drink O.J. or a Coke.

VAERS ID:291212 (history)  Vaccinated:2007-09-19
Age:13.0  Onset:2007-09-19, Days after vaccination: 0
Gender:Female  Submitted:2007-09-21, Days after onset: 2
Location:West Virginia  Entered:2007-09-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': WV730
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2405AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2770AA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: Anxiety, Fatigue, Lethargy, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt extremely anxious. Witnessed cousin "faint" from immunization 20 min prior. 30 sec. after Tdap and Menactra given, pt. slumped over in chair and was not responsive. BP - 90/60, P = 80. 60-90 sec. later became responsive. 5 min later BP- 110/70, P - 68, still lethargic several min later even after lying down. Pt to ER by mother. Didn''t attend school next day - still very exhausted.

VAERS ID:291222 (history)  Vaccinated:2007-08-30
Age:13.0  Onset:2007-08-30, Days after vaccination: 0
Gender:Female  Submitted:2007-09-20, Days after onset: 21
Location:Georga  Entered:2007-09-24, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0522U0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0847U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Body temperature increased, Loss of consciousness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Fainted about 40 minutes after vaccine administered. Had not eaten but became nauseated and could not eat. 300 PM Temp 102. Passed out 2-3 times during day. Went to sleep late afternoon, woke up at 9 PM. Temp resolved; no further fainting. Went to school next morning.

VAERS ID:291228 (history)  Vaccinated:2007-09-09
Age:13.0  Onset:2007-09-19, Days after vaccination: 10
Gender:Female  Submitted:2007-09-19, Days after onset: 0
Location:Washington  Entered:2007-09-24, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0171U0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Asthenia, Muscle rigidity, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: About 10 minutes after receiving Gardasil vaccine - while patient sitting in waiting room she drew her Rt arm up to face and became rigid and fainted. She was immediately placed supine on floor. Appeared alert, but weak and pale. B/P 110/62 - O2 Sat 100% - Remained in office for 1 hour then home with mom - B/P back to normal, color pink. Doctor attended to patient.

VAERS ID:291310 (history)  Vaccinated:2007-09-11
Age:13.0  Onset:2007-09-12, Days after vaccination: 1
Gender:Male  Submitted:2007-09-14, Days after onset: 2
Location:New York  Entered:2007-09-25, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N?A
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2395BA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Diffuse swelling of arm that received the vaccine from the deltoid muscle, extending down to the axilla and left side of the upper chest. No weakness or immobility. 3/4cm swollen lymph node in the left axilla.

VAERS ID:291320 (history)  Vaccinated:2007-08-24
Age:13.0  Onset:2007-08-24, Days after vaccination: 0
Gender:Male  Submitted:2007-08-26, Days after onset: 2
Location:Texas  Entered:2007-09-25, Days after submission: 30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pharyngitis (-) RST
Preexisting Conditions:
Diagnostic Lab Data: Vaccine reaction
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2403AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B021CB0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0843U1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pain - redness - swelling

VAERS ID:291411 (history)  Vaccinated:2007-09-14
Age:13.0  Onset:2007-09-14, Days after vaccination: 0
Gender:Female  Submitted:2007-09-18, Days after onset: 4
Location:Kansas  Entered:2007-09-26, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: vital signs-blood sugar
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.024560IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0851U0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Blood glucose, Hyperhidrosis, Hypoaesthesia, Pain in extremity, Pallor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt was sitting up on exam table. Was given immun. x 2. Started c/o arm pain with numbness in (R) arm. Pale with diaphoresis. Pt was layed down with cool compress forehead. Pt was monitored and sent home with mom

VAERS ID:291414 (history)  Vaccinated:2007-09-25
Age:13.0  Onset:2007-09-25, Days after vaccination: 0
Gender:Female  Submitted:2007-09-26, Days after onset: 1
Location:Utah  Entered:2007-09-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta 27 mg
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB149AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2705AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives all over body-Recommended Benadryl.

VAERS ID:291526 (history)  Vaccinated:2007-09-19
Age:13.0  Onset:2007-09-20, Days after vaccination: 1
Gender:Male  Submitted:2007-09-27, Days after onset: 7
Location:North Dakota  Entered:2007-09-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2379BA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B021CB0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1093U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: fever, tired

VAERS ID:295483 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-12-21
Location:Unknown  Entered:2007-09-27, Days after submission: 85
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: Unknown
CDC 'Split Type': WAES0708USA03171
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: Information has been received from a registered nurse concerning a 13 year old female who on an unspecified date was vaccinated with a dose of Zostavax (Oka/Merck) instead of Varivax (Oka/Merck) (MSD). No adverse reactions were reported. Medical attention was not sought. No further information was provided. There was no product quality complaint involved. Additional information has been requested. This is in follow-up to report (s) previously submitted on 9/24/2007. Follow up information was received from the nurse who stated it was a case of the nurse picking up the wrong vaccine and not double checking the label to make sure she had the right vaccine. The nurse reported that the patient is a healthy young lady with no contraindications and fortunately did not experience any untoward effects. Additional information has been requested.

VAERS ID:295992 (history)  Vaccinated:2007-07-03
Age:13.0  Onset:2007-07-03, Days after vaccination: 0
Gender:Female  Submitted:2007-09-24, Days after onset: 83
Location:Illinois  Entered:2007-09-27, Days after submission: 3
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: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0707USA00597
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: Information has been received from a physician concerning a 13 year old patient who on 03-JUL-2007 was vaccinated with a dose of ZOSTAVAX instead of VARIVAX. It was reported that it was not a product confusion but a medical error. No problems reported. Unspecified medical attention was sought. A product quality complaint was not involved. Additional information has been received from the physician who stated that the patient was fine and had no fever and no rash at the injection site. They had the patient on close watch but there were no ill effects. No further information is expected. 03/25/2010 Additional information has been received from the physician who stated that there wer eno adverse effects noted. No further information is expected.

VAERS ID:291613 (history)  Vaccinated:2007-09-17
Age:13.0  Onset:2007-09-18, Days after vaccination: 1
Gender:Female  Submitted:2007-09-24, Days after onset: 6
Location:Unknown  Entered:2007-09-28, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0389U0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1121U1SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Induration, Oedema peripheral, Pharyngolaryngeal pain, Pruritus, Skin warm
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)
Write-up: Started with itchy sensation on 9/18/07 and noted swelling on 9/19/07. Sore throat 1 day swelling left upper outer arm 5" x 3" with an indurated area 2" x 3" with an indurated area 2" x 1". Further redness on the forearm, 4 x 3 1/2". Rise of temp upper arm.

VAERS ID:291620 (history)  Vaccinated:2007-09-26
Age:13.0  Onset:2007-09-27, Days after vaccination: 1
Gender:Female  Submitted:2007-09-28, Days after onset: 1
Location:Virgin Islands  Entered:2007-09-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Nil
Preexisting Conditions: Hgbsc
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0601F0IMRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site pain, 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)
Write-up: Client c/o pain starting at injection site 9/26/07 but get more swollen and painful 9/27/07. Applied with compress x 1. Seen by private MD had fever x 2 days receive treatment of Zinnat 212 500mg and Motrin PRN. Temp normal.

VAERS ID:291657 (history)  Vaccinated:2007-09-21
Age:13.0  Onset:2007-09-22, Days after vaccination: 1
Gender:Female  Submitted:2007-09-28, Days after onset: 6
Location:California  Entered:2007-09-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Allergies to Amoxicillin and Ceclor
Diagnostic Lab Data: Labs on 09/24/2007 CBC: WBC 15.8,RBC 5.21,Plt 456, Nuet 84%, Band 7%, Lymph 7%. Chem: NA 133, Cloride 98, Glucose 117 (on prednisone).
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0171U0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B002AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Band neutrophil count increased, Blood chloride normal, Blood glucose increased, Blood sodium decreased, Laboratory test, Lymphocyte count decreased, Neutrophil count increased, Platelet count increased, Pyrexia, Red blood cell count normal, Urticaria, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow)
Write-up: Patient developed severe large hives over entire body. Also she developed fever of 102. She was treated with Benadryl 50mg for 2 days without resolution of her symptoms. Prednisone 80mg was started on the night of the 2nd day in the ER. Hydroxazine 25mg was given instead of the Benadryl on the 3rd day. The symptoms resolved and treatment was stopped on day 7.

VAERS ID:291669 (history)  Vaccinated:2007-09-18
Age:13.0  Onset:2007-09-20, Days after vaccination: 2
Gender:Male  Submitted:2007-09-24, Days after onset: 4
Location:Massachusetts  Entered:2007-09-28, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergy to Penicillin, Cephalosporins and bee stings
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2393BA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Hypersensitivity, Petechiae
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)
Write-up: Patient woke up with a purple petechial rash on his left lower arm approximately 24 hours after receiving Menactra vaccine in his left upper arm - seen by dermatologist who thought it hypersensitivity reaction.

VAERS ID:291726 (history)  Vaccinated:2007-09-24
Age:13.0  Onset:2007-09-24, Days after vaccination: 0
Gender:Female  Submitted:2007-09-27, Days after onset: 3
Location:California  Entered:2007-10-01, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ergotamine Caffeine
Current Illness: None
Preexisting Conditions: Hx of Migraine Headache
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0243U2IMUN
Administered by: Private     Purchased by: Public
Symptoms: Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Frontal headache with associated nausea x 4 days following vaccine. 7/10 on pain scale Tx: 800 mg Advil

VAERS ID:291749 (history)  Vaccinated:2007-08-20
Age:13.0  Onset:2007-08-20, Days after vaccination: 0
Gender:Female  Submitted:2007-09-24, Days after onset: 35
Location:Colorado  Entered:2007-10-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proventil; Albuterol
Current Illness: N/A
Preexisting Conditions: Fraternal twin with controlled asthma/NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1426F0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Headache, Muscle spasms, Nausea, Syncope, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Immediate reaction to injection: dizzy, lightheaded, syncope, neck spasm lasted a few seconds. Improved quickly, appropriately. Headaches, nausea, dizziness persisted x 15 days. Pt lost 5 lbs.

VAERS ID:291867 (history)  Vaccinated:2007-09-27
Age:13.0  Onset:2007-09-27, Days after vaccination: 0
Gender:Female  Submitted:2007-10-02, Days after onset: 5
Location:Delaware  Entered:2007-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clotrimazole 1% cream BID.
Current Illness: Tinea Versicolor
Preexisting Conditions: None
Diagnostic Lab Data: n/a
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.090600IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2062AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2941AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1184U0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Incorrect route of drug administration, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Patient was initially given varicella vaccine 0.2ml in the left forearm as an intradermal shot. Patient was later given the remaining 0.3ml SC in the left upper arm. There was an immediate localized skin erythema and itching at left forearm.

VAERS ID:291894 (history)  Vaccinated:2007-08-15
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Idaho  Entered:2007-10-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER0800U0IMRA
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.0162U0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Wrong drug administered
SMQs:
Write-up: None

VAERS ID:292155 (history)  Vaccinated:2007-07-19
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2007-10-02
Location:Michigan  Entered:2007-10-04, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1099R IMLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURZ001 SCRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.022PU SCLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2688AA IMRA
Administered by: Public     Purchased by: Public
Symptoms: No adverse reaction, Wrong drug administered
SMQs:
Write-up: Gave MMRV to client instead of MMR and Var. separately. This was out of approved age range. Foster home notified: no adverse effects.

VAERS ID:292179 (history)  Vaccinated:2007-09-27
Age:13.0  Onset:2007-09-27, Days after vaccination: 0
Gender:Female  Submitted:2007-10-04, Days after onset: 7
Location:Texas  Entered:2007-10-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, Claritin, Nasonex
Current Illness: none
Preexisting Conditions: history of shingles, previously diagnosed with asthma
Diagnostic Lab Data: none
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.038400IMLA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt developed fever of 101.0 1 hour after vaccine administration. She began vomiting shortly after and has now been vomiting at least 3 times a day each day since vaccine administration. Her fevers have continued with a maximum temperature of 101.2. Vomiting continues but is not associated with abdominal pain or diarrhea; she also has no nausea but only a sudden intense urge to vomit.

VAERS ID:292280 (history)  Vaccinated:2007-10-05
Age:13.0  Onset:2007-10-05, Days after vaccination: 0
Gender:Female  Submitted:2007-10-05, Days after onset: 0
Location:Pennsylvania  Entered:2007-10-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLONASE, CLARITIN, ADVAIR 100/50
Current Illness: None
Preexisting Conditions: Allergies - asthma
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1065U0 RA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2482AA0 RA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2769AA0  
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Nausea, dizziness after receiving vaccines.

VAERS ID:292292 (history)  Vaccinated:2007-09-28
Age:13.0  Onset:2007-09-28, Days after vaccination: 0
Gender:Female  Submitted:2007-10-01, Days after onset: 3
Location:Indiana  Entered:2007-10-05, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALAVERT
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1175U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site discolouration, Injection site erythema, Injection site induration, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 13 x 18cm red, indurated purple swelling at injection site tender.

VAERS ID:292406 (history)  Vaccinated:2007-09-10
Age:13.0  Onset:2007-10-01, Days after vaccination: 21
Gender:Female  Submitted:2007-10-02, Days after onset: 1
Location:New York  Entered:2007-10-08, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0927U1UNUN
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Dizziness, nausea.

VAERS ID:292409 (history)  Vaccinated:2007-08-06
Age:13.0  Onset:2007-08-07, Days after vaccination: 1
Gender:Female  Submitted:2007-08-09, Days after onset: 2
Location:Idaho  Entered:2007-10-08, Days after submission: 60
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': ID07037
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0524U0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2759AA0IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Chills, Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling and redness at injection site. Treated with antibiotics but really I doubt infection. Child also had low grade fever and chills. Problem rapidly resolved w/o sequela.

VAERS ID:292458 (history)  Vaccinated:1995-06-05
Age:13.0  Onset:2007-10-01, Days after vaccination: 4501
Gender:Female  Submitted:2007-10-02, Days after onset: 1
Location:Pennsylvania  Entered:2007-10-08, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0409B0 RA
Administered by: Unknown     Purchased by: Private
Symptoms: Skin lesion
SMQs:
Write-up: 50 - 249 lesions onset 10/1/07

VAERS ID:292485 (history)  Vaccinated:2007-09-21
Age:13.0  Onset:2007-09-21, Days after vaccination: 0
Gender:Female  Submitted:2007-10-05, Days after onset: 14
Location:North Carolina  Entered:2007-10-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma, Hypothyroidism, sleep apnea, bipolar disorder
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER1060U0 LA
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURERU2329AA0 LA
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURERAC52BB13AA0 RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0854U1 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm swelling at site, pain redness at site within 6-8 degrees of shots ER visit. Return to clinic 9/25/07 Zyrtec and Prednisone.

VAERS ID:292510 (history)  Vaccinated:2007-10-02
Age:13.0  Onset:2007-10-02, Days after vaccination: 0
Gender:Male  Submitted:2007-10-09, Days after onset: 7
Location:Michigan  Entered:2007-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None
Preexisting Conditions: No known medical allergies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2365AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1026U1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site induration, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm swelling at site of varicella/immunization. Complained "painful and hard" raised area 6cm. Benadryl 25mg q 8 hrs prn, cold compress to site.

VAERS ID:292528 (history)  Vaccinated:2007-09-26
Age:13.0  Onset:2007-09-26, Days after vaccination: 0
Gender:Female  Submitted:2007-10-09, Days after onset: 13
Location:North Dakota  Entered:2007-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2379BA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B021CB0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1093U0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: fever of 101 degrees F, left arm, and whole body ache. site to LA (tdap site) reddened

VAERS ID:292530 (history)  Vaccinated:2007-09-26
Age:13.0  Onset:2007-09-26, Days after vaccination: 0
Gender:Female  Submitted:2007-10-09, Days after onset: 13
Location:North Dakota  Entered:2007-10-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2379BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1093U0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)
Write-up: Varicella injection site red, warm, painful, felt woozy. Better by 9-26-07 later afternoon

VAERS ID:292600 (history)  Vaccinated:2007-10-02
Age:13.0  Onset:2007-10-02, Days after vaccination: 0
Gender:Male  Submitted:2007-10-02, Days after onset: 0
Location:Illinois  Entered:2007-10-10, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Vocal Cord Paralysis
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2183AA0UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Pruritus, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Hives over arm, face and swelling/itching. Treated with Benadryl 50mg PO.

VAERS ID:292665 (history)  Vaccinated:2007-10-04
Age:13.0  Onset:2007-10-04, Days after vaccination: 0
Gender:Male  Submitted:2007-10-04, Days after onset: 0
Location:Wyoming  Entered:2007-10-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: seizures~DTaP (no brand name)~4~1~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU1954AC5IMRA
Administered by: Public     Purchased by: Public
Symptoms: Skin warm, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Client immunized w/ Td immunization clinic immediately after injection client had syncopal episode lasting a few seconds client moved to laying position w/feet elevated. O2 mask at 15 per liter. Skin warm to touch ice packs applied to axillary and chest. At which per patient ----$g

VAERS ID:292704 (history)  Vaccinated:2007-08-06
Age:13.0  Onset:2007-08-07, Days after vaccination: 1
Gender:Female  Submitted:2007-08-08, Days after onset: 1
Location:California  Entered:2007-10-11, Days after submission: 64
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': CA070033
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB149AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2731AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Rash over face and body since Aug 07, 2007 afternoon refer to HC and free clinic.

VAERS ID:292711 (history)  Vaccinated:2007-08-23
Age:13.0  Onset:2007-08-24, Days after vaccination: 1
Gender:Female  Submitted:2007-08-24, Days after onset: 0
Location:California  Entered:2007-10-11, Days after submission: 48
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB099CB0IMLA
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURERC2460AA0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.063941SCRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: ~ 20 hours after injection, patient felt pain and itchiness at site of injection. Upon inspection site at 4pm 29 hours, after injection is slightly red, swollen with induration ~ 60mm. Varicella injection site/ 2nd dose. Tx: ice/ Tylenol and Benadryl ?

VAERS ID:292736 (history)  Vaccinated:2007-10-10
Age:13.0  Onset:2007-10-10, Days after vaccination: 0
Gender:Female  Submitted:2007-10-11, Days after onset: 1
Location:California  Entered:2007-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU24589C0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Hypoaesthesia facial
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: C/O numbness left face ~ 3 hours after injection given, no numbness at time of exam, located ~ 12 hours.

VAERS ID:292752 (history)  Vaccinated:2007-10-11
Age:13.0  Onset:2007-10-11, Days after vaccination: 0
Gender:Female  Submitted:2007-10-11, Days after onset: 0
Location:Michigan  Entered:2007-10-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS80062 IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Crying, Dizziness, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Approximately 5 minutes after administration, patient became very flush, dizzy and lightheaded. Also somewhat weepy. Pulse okay. Incident lasted 5 minutes. Patient stayed for observation for 20 minutes and felt fine at release. --Mother did disclose after reaction that child had egg allergy as infant but resolved at 3 years of age and has been eating eggs since.

VAERS ID:292911 (history)  Vaccinated:2007-10-09
Age:13.0  Onset:2007-10-09, Days after vaccination: 0
Gender:Female  Submitted:2007-10-12, Days after onset: 3
Location:Arizona  Entered:2007-10-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol MDI
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB172BA0 LA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1424F0 RA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2338AA0 RA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC528014BA0 LA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0824A1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: On 10/9 patient received Tdap, Hep A, HPV, MCV4, and Varivax after the Varivax patient''s arm swelled slightly and turned red. Ice was applied, swelling went down. Patient was discharged on 10/12 patients mother called arm still swollen and hot to touch patient was sent to ER.

VAERS ID:296715 (history)  Vaccinated:2007-08-27
Age:13.0  Onset:2007-08-31, Days after vaccination: 4
Gender:Female  Submitted:2007-10-08, Days after onset: 38
Location:Florida  Entered:2007-10-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA00878
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Facial palsy, Facial paresis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad)
Write-up: Information has been received from a physician concerning a 13 year old female with no history of drug reactions/allergies who on 25-JUN-2007 was vaccinated with the first dose of GARDASIL 0.5 ml injection. On 27-AUG-2007, the patient was vaccinated with the second dose of GARDASIL 0.5 ml injection. There was no concomitant medication. On approximately 31-AUG-2007, the patient experienced Bell''s palsy. On 31-AUG-2007, the patient went to the emergency room (ER) because she could not close her eye and one side of her face felt heavy. There was no swelling involved. The physician did not specify which eye or which side was involved. The ER physician gave her eye drops to keep her eye moist and a type of ointment. The ER report obtained by the physician stated the patient''s condition as Bell''s palsy. The reporting physician saw the patient on 05-SEP-2007 at the office and she still could not close her eye and felt heaviness on the side of her face. At the time of reporting, the patient''s Bell''s palsy persisted. Additional information has been requested.

VAERS ID:296717 (history)  Vaccinated:2007-07-27
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-08
Location:New York  Entered:2007-10-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0709USA00889
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0802U0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Unevaluable event
SMQs:
Write-up: Information has been received from a registered nurse concerning a 13 year old female with hypersensitivity ("allergies") who on 27-JUL-2007 was vaccinated with a first dose of GARDASIL (lot# 658490/0802U). Concomitant therapy on 27-JUL-2007 included Menactra. Other concomitant therapy included Rhinocort.

VAERS ID:296753 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-08
Location:California  Entered:2007-10-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA00781
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Breast pain
SMQs:, Lipodystrophy (broad)
Write-up: Information has been received from a nurse concerning a 13 year old female who was vaccinated into the left arm with a 0.5 ml second dose of Gardasil. Subsequently, the patient experienced breast pain. Unspecified medical attention was sought. Subsequently, the patient recovered. Additional information has been requested.

VAERS ID:297487 (history)  Vaccinated:2007-08-28
Age:13.0  Onset:2007-08-30, Days after vaccination: 2
Gender:Female  Submitted:2007-10-08, Days after onset: 39
Location:Indiana  Entered:2007-10-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Migraine
Preexisting Conditions:
Diagnostic Lab Data: Unknown; None
CDC 'Split Type': WAES0709USA00218
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1060U IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site erythema, Injection site swelling, Injection site warmth, Migraine, Oedema peripheral
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)
Write-up: Information has been received from a licensed practical nurse concerning a 13 year old female with no known drug allergies and migraines who on 28-AUG-2007 was vaccinated with a dose of GARDASIL, 0.5ml, intramuscularly, in the right arm (Lot#658556/1060U). Concomitant therapy included MENACTRA, ADACEL and VARIVAX (also in the right arm) on that same date. On 30-AUG-2007, the patient''s mother called to report that the child developed a swollen, red area on her right arm. On 31-AUG-2007, the patient''s mother called back to report the child''s arm at the injection site was hot, swollen, and red with the area about 2 inches by 2 inches. It was treated with compresses. The outcome was not reported. Additional information has been requested. This is in follow-up to report(s) previously submitted on 10/8/2007. Follow-up information was received. The patient did not have any illness at the time of vaccination. On 04-SEP-2007 the patient stopped complaining and the mom has not checked the area. The patient recovered on 04-SEP-2007. Additional information is not expected.

VAERS ID:293136 (history)  Vaccinated:2007-04-05
Age:13.0  Onset:2007-04-06, Days after vaccination: 1
Gender:Male  Submitted:2007-10-15, Days after onset: 192
Location:Illinois  Entered:2007-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2069AA0IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC2341AA IMUN
Administered by: Private     Purchased by: Unknown
Symptoms: Eye movement disorder, Headache, Musculoskeletal stiffness, Pyrexia, Vaccination complication
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Arthritis (broad)
Write-up: 24 hrs post Menactra, child woke up with 102 T, severe headache, "stiff", can''t open eyes. Sent to ED. Dx vaccine reaction (Menactra), discharged.

VAERS ID:293149 (history)  Vaccinated:2007-10-08
Age:13.0  Onset:2007-10-09, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:North Carolina  Entered:2007-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSHAVB217BA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2429AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1121U1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Lower quadrant left arm swelling approx size of egg with erythema, warm to touch - warm compresses. Benadryl if worsens.

VAERS ID:293165 (history)  Vaccinated:2007-10-02
Age:13.0  Onset:2007-10-03, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Michigan  Entered:2007-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB211A0UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0802U0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2418AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURG2644AA0UNLA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Pyrexia, Swelling, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Headache, high fever 102.0, blurred vision, swelling.

VAERS ID:298131 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-12
Location:Indiana  Entered:2007-10-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Menstruation irregular
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA01450
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)
Write-up: Initial and follow-up information has been received from a physician and a health professional concerning a 13 year old female who was vaccinated with 0.5 ml dose of Gardasil. Subsequently she received her first period the day after. The patient contacted the physician. At the time of the report the patient''s outcome was unknown. Additional information is not expected.

VAERS ID:298132 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-12
Location:Unknown  Entered:2007-10-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA01460
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Headache
SMQs:
Write-up: Information has been received from a registered nurse concerning a 13 year old female who was vaccinated with a first dose of Gardasil. Subsequently the patient complained of headaches when she came in for the second dose. On an unspecified date the headaches resolved. Additional information has been requested.

VAERS ID:298392 (history)  Vaccinated:2007-08-24
Age:13.0  Onset:2007-08-24, Days after vaccination: 0
Gender:Female  Submitted:2007-10-12, Days after onset: 49
Location:Texas  Entered:2007-10-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Rhinitis allergic; Penicillin allergy
Preexisting Conditions: Reactive airways disease
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA02045
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1060U1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injected limb mobility decreased, Pain in extremity, Tenderness
SMQs:
Write-up: Information has been received from a licensed practical nurse concerning a 13 year old female with allergic rhinitis and AMOXIL and a history of reactive airways disease who on 27-JUN-2007 was vaccinated with the first dose of GARDASIL, the patient was vaccinated with the second dose GARDASIL (lot # 658556/1060U) 0.5 ml IM in the left deltoid. On 24-AUG-2007, the experienced pain and tenderness in her left arm. On 11-SEP-2007, the patient sought medical attention (office visit) and at that time she had decreased range of motion, tenderness and pain of the arm. There was no masses and no redness. At the time of reporting, the patient had not recovered. The patient was scheduled to have a MRI. Additional information has been requested.

VAERS ID:298397 (history)  Vaccinated:2007-09-11
Age:13.0  Onset:2007-09-12, Days after vaccination: 1
Gender:Female  Submitted:2007-10-12, Days after onset: 30
Location:Maine  Entered:2007-10-15, Days after submission: 3
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': WAES0709USA02084
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Information has been received from a nurse concerning a 13 year old female who 11-SEP-2007 was vaccinated with a 0.5 ml dose of GARDASIL. Concomitant vaccination on the same day included a second dose of Varicella virus vaccine live (MSD). On 12-SEP-2007 the mother of the child called the doctor office stating the child had nausea and was vomiting. At the time of the report the patient''s outcome was unknown. Additional information has been requested.

VAERS ID:298557 (history)  Vaccinated:2007-07-26
Age:13.0  Onset:2007-07-26, Days after vaccination: 0
Gender:Female  Submitted:2007-10-12, Days after onset: 78
Location:North Carolina  Entered:2007-10-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma exercise induced
Preexisting Conditions:
Diagnostic Lab Data: blood pressure, 07/26/07, 98/60;
CDC 'Split Type': WAES0709USA02721
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0243U0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a health professional concerning a female who, "a couple of weeks ago," was vaccinated with a dose of Gardasil. It was reported that after vaccination the patient fainted in the parking lot of the physician''s office. The patient''s outcome was unknown. Additional information has been requested. This is in follow-up to report(s) previously submitted on 10/12/2007. Initial and follow-up information has been received from a registered nurse concerning a 13 year old white female with exercise-induced asthma who on 26-JUL-2007, at 9:30, was vaccinated IM in the left arm with a dose of GARDASIL (lot #656372/0243U). It was reported that after vaccination, at 9:45, the patient fainted in the parking lot of the physician''s office. The patient''s blood pressure was noted to be 98/60. The patient was obseved in the physician''s office until asymptomatic. On 26-JUL-2007, the patient was recovered. No additional information is expected.

VAERS ID:298594 (history)  Vaccinated:2007-09-19
Age:13.0  Onset:2007-09-19, Days after vaccination: 0
Gender:Female  Submitted:2007-10-12, Days after onset: 23
Location:Washington  Entered:2007-10-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: blood pressure, 09/19/07, 110/6; pulse oximetry, 09/19/07, 100%
CDC 'Split Type': WAES0709USA03669
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0171U0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Blood pressure, Muscle rigidity, Oxygen saturation normal, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a Registered Nurse concerning a 13 year old female who on 19-SEP-2007 was vaccinated IM in the left arm with the first dose of Gardasil (Lot #655620/0171U). About 10 minutes after she was vaccinated, the patient leaned against her mother, drew the right arm to the face, became rigid and fainted. As the patient was laid to the floor she became alert although weak and pale. Blood pressure was 110/62 and oxygen saturation was 100%. The patient was monitored in the physician''s office for one hour without further adverse symptoms. The patient went to school the following day and is fully recovered. Additional information has been requested.

VAERS ID:298649 (history)  Vaccinated:2007-08-10
Age:13.0  Onset:2007-08-10, Days after vaccination: 0
Gender:Female  Submitted:2007-10-12, Days after onset: 63
Location:New Jersey  Entered:2007-10-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0709USA04357
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0523U0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Blood pressure decreased, Loss of consciousness, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a registered nurse, concerning a 13 year old female student, who on 10-AUG-2007 at 11:30 am, was vaccinated in the left arm with the first dose of Gardasil (lot #657868/0523U). Following the vaccination, the patient "had a vasovagal response to injection;" her blood pressure dropped (value not specified) and she passed out. Treatment included the administration of oxygen; her vital signs were then

VAERS ID:298851 (history)  Vaccinated:2007-08-28
Age:13.0  Onset:2007-09-01, Days after vaccination: 4
Gender:Female  Submitted:2007-10-12, Days after onset: 41
Location:New York  Entered:2007-10-15, Days after submission: 3
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: influenza immunisation
Diagnostic Lab Data: None
CDC 'Split Type': WAES0710USA00231
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1060U0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Headache, Hypoaesthesia facial, Malaise
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Information has been received from a registered nurse concerning a 13 year old female with no drug allergies and with a history of influenza immunisation on 22-SEP-2007 who on 28-AUG-2007 was vaccinated intramuscularly with a first 0.5 mL dose of Gardasil (Lot # 658556/1060U). "A few days after vaccination", the patient developed joint pain, headache, numbness in face and malaise. The patient sought unspecified medical attention. No laboratory diagnostic studies were performed. At the time of this report, the patient had not recovered. No product quality complain was involved. Additional information has been requested.

VAERS ID:293326 (history)  Vaccinated:2007-10-02
Age:13.0  Onset:2007-10-02, Days after vaccination: 0
Gender:Female  Submitted:2007-10-04, Days after onset: 2
Location:Michigan  Entered:2007-10-16, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1061U0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1183U1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Anxiety, Body temperature increased, Eyelid oedema, Hyperventilation, Injection site irritation, Loss of consciousness, Oedema peripheral, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Periorbital and eyelid disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: Given first HPV on 10/2/07 left arm IM. As pt being given 2nd varicella, passed out. Did report some burning at site of HPV. Recurrent syncopal episode later same day and persistent eyelid hand swelling after IV fluids x 48 hours. Low grade temp (99) 48 hours after imm. Anxiety and hyperventilation first 72 hours. Onset of menstrual period 10/3/07.

VAERS ID:293354 (history)  Vaccinated:2007-09-17
Age:13.0  Onset:2007-09-19, Days after vaccination: 2
Gender:Male  Submitted:2007-10-16, Days after onset: 27
Location:Pennsylvania  Entered:2007-10-16
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: Asthma
Diagnostic Lab Data: Culture sent of abscess
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2448AA UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.109211 SCUN
Administered by: Private     Purchased by: Private
Symptoms: Culture, Erythema, Pain, Purulent discharge, Rash vesicular, Subcutaneous abscess
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: at site of Varivax, given on 9/17/07 1-2days later developed redness with blackhead with prudent drainage and pain skin abscess drained and cleansed with antibiotics ointment twice daily. Culture sent and placed on Bactrim DS x 10 days. Culture result

VAERS ID:293438 (history)  Vaccinated:2007-08-28
Age:13.0  Onset:2007-08-28, Days after vaccination: 0
Gender:Female  Submitted:2007-10-04, Days after onset: 37
Location:California  Entered:2007-10-17, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Erythromycin
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.106140IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2370BA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2775AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Pt fainted. Per mom - seizure-like movement for a few seconds. Then became alert and awake. I saw pt immediately after the fainting episode - no post-ictal. No follow-up required.

VAERS ID:293458 (history)  Vaccinated:2007-10-08
Age:13.0  Onset:2007-10-08, Days after vaccination: 0
Gender:Female  Submitted:2007-10-08, Days after onset: 0
Location:Pennsylvania  Entered:2007-10-17, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1063U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2429AR0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient passed out shortly after shots given, given hard candy and rested, then was fine.

VAERS ID:293468 (history)  Vaccinated:2007-10-16
Age:13.0  Onset:2007-10-16, Days after vaccination: 0
Gender:Female  Submitted:2007-10-17, Days after onset: 1
Location:Arizona  Entered:2007-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: mild sore throat no fever
Preexisting Conditions: craniosynostosis treat with surgery @ 11 mos of age
Diagnostic Lab Data: VS 98.8, BP 128/64 HR 75; orthostatic BP''s laying 100/62 sitting 100/60 standing 102/60
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2443A0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0802U0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURO2419AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Arthralgia, Immediate post-injection reaction, Pallor, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad)
Write-up: Immediately following administration of shots got up from exam table and had syncopal episode with collapse for seconds, developed pallor + emesis after. No airway compromise, vital signs normal. Follow-up Information 06-NOV-2007: 14 year old female presents with c/o pain for 3 weeks bilateral knee pain, achiness all the time worse with activity, Advil about one time per day for the last 1 week. Points to lateral aspect of both knees where tendon inserts. Denies: direct trauma, fall. Denies any redness, swelling or other joint pain. Had gardisil vaccine 10/16/07 and family concerned that the joint pain may be related. Also play club soccer with practices 2-3 times per week and games on the weekend. Discussed at length with patient and parents. History and exam c/w tendonitis likely from overuse. Rec advil 400 mg 3 times per day for one week, rest when possible, ice or heat prn. Does not have a break from soccer until the holidays. Also rec doing Jump exercises for adolescent girls they will talk to trainer at school and look on Internet. Could be related to vaccine with small percentage of girls in studies having arthralgias but would expect it to be getting better. Gave Parents phone number for Merck to call and further discuss vaccine with them. Doubt autoimmune with no family history and no other signs or symptoms but if no improvement over the next 1-2 months especially after 1-2 week rest from soccer would consider doing blood work. arthralgia

VAERS ID:293500 (history)  Vaccinated:2007-10-17
Age:13.0  Onset:2007-10-17, Days after vaccination: 0
Gender:Female  Submitted:2007-10-17, Days after onset: 0
Location:Virginia  Entered:2007-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No reported illnesses.
Preexisting Conditions: None listed.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2505AA4IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0797U1IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1061U1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Immediate post-injection reaction, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Received three vaccines. Left Arm - HPV #2 and Right Arm - Fluzone and Hepatitis A. Immediately after receiving vaccines, patient c/o feeling faint, nauseated and weakness in the legs. Patient remained coherrent and blood pressures remained stable. After 15 minutes, patient was released c/o of very mild weakness but reports that it was improving as she stood longer in one place.

VAERS ID:293548 (history)  Vaccinated:2007-09-06
Age:13.0  Onset:2007-09-07, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Pennsylvania  Entered:2007-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1504F0SCUN
Administered by: Public     Purchased by: Public
Symptoms: Cold compress therapy, Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mother reports injection site was itchy, red, and swollen to size of softball x 1 wk. MD advised Benadryl, Tylenol, ice. Mother gave Tylenol and applied "cold compresses" and "itch cream".

VAERS ID:293736 (history)  Vaccinated:2007-10-04
Age:13.0  Onset:2007-10-06, Days after vaccination: 2
Gender:Female  Submitted:2007-10-18, Days after onset: 12
Location:New York  Entered:2007-10-19, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown 11/9/07-records received-CT evidence of intraventricular bleed in frontal horns of lateral vetricles bilaterally with clot extending to foreman no monro bilaterally with evidence of hydrocephalus dilated lateral ventricles bilatera
CDC 'Split Type': WAES0710USA02452
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0187U0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Aneurysm, Arteriovenous malformation, Arteriovenous shunt operation, Computerised tomogram abnormal, Dysphagia, Electroencephalogram normal, Haemorrhage intracranial, Headache, Hydrocephalus, Intraventricular haemorrhage, Nausea, Neck pain, Oesophagram, Subarachnoid haemorrhage, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic cerebrovascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: Information has been received from a physician concerning a 13 year old female with no relevant medical history reported who on 04-OCT-2007 was vaccinated with the first dose Gardasil (lot 656049/0187U). On 06-OCT-2007, the patient was seen at the office complaining of severe headache and vomiting. The patient was transferred to the hospital by ambulance and was admitted. A diagnosis of cranial bleeding due to an aneurysm was made. The patient underwent surgery. At the time of reporting, the patient was recovering. The patient''s aneurysm and intracranial bleeding were considered disabling, immediately life-threatening, and other important medical events. Additional information has been requested. 11/09/07-records received for DOS 10/6/07-seen in ED of transfering facility-Acute 4 hour onset o occipital headache, constant crescendo-decresendo. Nausea vomiting, Headache exacerbated with movement of head, radiating to neck. Awake, alert, oriented X3. 12/06/07-records received from receiving facility for DOS 10/09-10/31/07-DC DX:SAH/IVH secondary to right paravermian/posterior fossa AVM. Procedure:angio cerebral artery-and suboccipital craniectomy, resection of tumor, surgical resection placement of VP shunt. Transferred to rehabilitation facility

VAERS ID:293828 (history)  Vaccinated:2007-10-19
Age:13.0  Onset:2007-10-19, Days after vaccination: 0
Gender:Female  Submitted:2007-10-19, Days after onset: 0
Location:Minnesota  Entered:2007-10-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Amox-rash, seasonal allergies
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2452AA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site rash, Local reaction, Rash macular
SMQs:, Hypersensitivity (narrow)
Write-up: Local reaction-Red Blotch rash around L deltoid injection site immed after 4-5 cm diameter-not itchy. Ice pack applied

VAERS ID:293844 (history)  Vaccinated:2007-10-17
Age:13.0  Onset:2007-10-18, Days after vaccination: 1
Gender:Female  Submitted:2007-10-19, Days after onset: 1
Location:West Virginia  Entered:2007-10-19
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: BACTRIM
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0012U0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: HIVES IN HEAD - BENADRYL

VAERS ID:293878 (history)  Vaccinated:2007-10-04
Age:13.0  Onset:0000-00-00
Gender:Male  Submitted:2007-10-08
Location:South Carolina  Entered:2007-10-19, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB401AA0IMLA
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Public     Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration, Wrong drug administered
SMQs:
Write-up: Invalid vaccine given to patient needed Tdap - given DTaP no symptoms noted.

VAERS ID:293982 (history)  Vaccinated:2007-10-10
Age:13.0  Onset:2007-10-11, Days after vaccination: 1
Gender:Female  Submitted:2007-10-16, Days after onset: 5
Location:Michigan  Entered:2007-10-22, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Redness, Pain, Pimples~HPV (Gardasil)~1~13~In Patient
Other Medications:
Current Illness: None Known
Preexisting Conditions: Allergies to Kiwi and olives
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.106240UNLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site papule
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Client reports redness, pain and raised pimples around injection site (Left deltoid) Started within 24 hours of infection and are still occurring on 10/16/07

VAERS ID:294260 (history)  Vaccinated:2007-10-22
Age:13.0  Onset:2007-10-24, Days after vaccination: 2
Gender:Female  Submitted:2007-10-24, Days after onset: 0
Location:Ohio  Entered:2007-10-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMRA
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Chest discomfort, Chest pain, Headache, Heart rate increased, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Patient received the MCV4 Meningococcal and T-Dap vaccine at approximately 2:30 pm on October 22, 2007. She awoke the next day with a rapid heartbeat, chest pain/tightness, sore throat and headache. She was seen at her primary care physicians office on October 23, 2007. He indicated that she possibly is having an adverse reaction to her vaccines. He prescribed her Zithromax and is re-checking her heart rate in one week. If it is still elevated, he will order an EKG.

VAERS ID:294453 (history)  Vaccinated:2007-09-20
Age:13.0  Onset:2007-09-24, Days after vaccination: 4
Gender:Female  Submitted:2007-10-25, Days after onset: 31
Location:Indiana  Entered:2007-10-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: MRI Brain, CBC, Electrolyte 10/26/07-records received-MRI brain-single left frontal subcortical white matter abnormality, nonspecific in nature. CBC WNL
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.106062UNRA
Administered by: Private     Purchased by: Private
Symptoms: Balance disorder, Coordination abnormal, Dizziness, Dyspnoea, Electrocardiogram, Headache, Laboratory test, Nuclear magnetic resonance imaging brain, Pallor, Presyncope, Vertigo
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Gardasil vaccine #3 on 9-2007; On morning of 9-24-07 woke up dizzy, pale, unbalance, headache, change coordination-Referred to Neurologist-eval 9-26-07 Had Exam, MRI Brain, Labs, EKG-Follow up visit with PCP on 10-25-07. 10/26/07-records received for DOS 9/26/07-neurology consultation. Impression vertigo and near syncope. May represent a begign post infectious type phenomenon. Little odd in that they occur episodically rather than with movement. Three episodes of veritgo and near syncope have occurred in last 6 weeks. No positional type veritgo. Occasional headache after episodes. Some shortness of breath with episodes.

VAERS ID:294489 (history)  Vaccinated:2007-10-19
Age:13.0  Onset:2007-10-21, Days after vaccination: 2
Gender:Female  Submitted:2007-10-22, Days after onset: 1
Location:Minnesota  Entered:2007-10-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Improving cough/cold past 2 weeks
Preexisting Conditions: NKDA patient on Zoloft, Celexa taper, and Ritalin LA (on meds for several months)
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2502AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Fatigue, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: 10/21 Onset of generalized pruritic rash 36-40 hours after receiving Fluzone vaccine, + fatigue, mild abdominal pain, No fever, chills, myalgias, headache. Rx with OTC Claritin and Benadryl. 10/22 patient saw her primary PCP - diagnosed with hives by PCP - Rx with Zyrtec QD and Benadryl PRN HS Cod tepid both PRN no signs of anaphylaxis.

VAERS ID:294608 (history)  Vaccinated:2007-09-26
Age:13.0  Onset:2007-09-26, Days after vaccination: 0
Gender:Male  Submitted:2007-09-27, Days after onset: 1
Location:Indiana  Entered:2007-10-27, Days after submission: 30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Reglan; Prevacid; Librex
Current Illness:
Preexisting Conditions: Irritable Bowel Syndrome .... extensive testing (bowels)
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B018CA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Patient received Tdap vaccine at approximately 11:50am without complications. Mother called office at 1:30pm stating child had rash on bilateral ankles/feet and in groin area. C/O itching. No difficulty with breathing. Rec take Benadryl and contact primary care MD for f/u ---$g next day patient pc to patient ---$g "did not go to PCP, rash gone"

VAERS ID:294756 (history)  Vaccinated:2007-10-22
Age:13.0  Onset:2007-10-23, Days after vaccination: 1
Gender:Female  Submitted:2007-10-29, Days after onset: 6
Location:California  Entered:2007-10-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Xopenex and Flovent 44-neither currently.
Current Illness: None
Preexisting Conditions: Asthma, Previous hx of Pneumovax x''s 2
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2440AA0UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0929U1UNLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0889F0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Discomfort, Injection site erythema, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Per mother-red, egg size mark on arm (Lt deltoid area) starting the morning after her injections. Body ache and low grade fever (100-104) Mom started Benadry and Ibuprofen and ice to local area. Redness increased to nearly cover upper arm. See in ER 4 days after injection 2-4 hr sudden increased in redness. Started on Acithromycin and TMP/Sulfa-Today c/o abd discomfort and nausea. Still has body aches, redness decreasing in size.

VAERS ID:294786 (history)  Vaccinated:2007-10-18
Age:13.0  Onset:2007-10-22, Days after vaccination: 4
Gender:Male  Submitted:0000-00-00
Location:North Carolina  Entered:2007-10-29
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: Cancer - unknown type
Diagnostic Lab Data:
CDC 'Split Type': NC07110
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0038U0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient presented to clinic with doctor''s prescription to receive PCV-23 vaccine. Mom informed nurse that patient had multiple medical problems including an one day diagnosis. Mom states that patient''s blood count are "fine." PCV-23 administered left deltoid IM. On Oct 22 School nurse calls nurse to state that mom concerned that site is red, no itching. She (school nurse) says that she will tell mom that redness is a mild side effect. No severe reactions were reported at this time. On Oct 24 mom calls to state patient went to ER and received IV antibiotics and sent home on PO meds for infection.

VAERS ID:295090 (history)  Vaccinated:2007-07-13
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-26
Location:Connecticut  Entered:2007-10-31, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0181U0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR42377BA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Medication error
SMQs:
Write-up: Heard doctor say give Menactra and Gardasil vaccines. I did not check well child visit sheet to double check doctor''s documentation of same.

VAERS ID:295091 (history)  Vaccinated:2007-07-13
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-10-26
Location:Connecticut  Entered:2007-10-31, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0181U0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR42377BA0IMUN
Administered by: Private     Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Medication error
SMQs:
Write-up: Heard doctor say give Menactra & Gardasil vaccines. I did not check well child visit sheet to double check doctor''s documentation of same

VAERS ID:295154 (history)  Vaccinated:2007-10-22
Age:13.0  Onset:2007-10-23, Days after vaccination: 1
Gender:Female  Submitted:2007-10-23, Days after onset: 0
Location:Missouri  Entered:2007-10-31, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB207BA1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1184U1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Mother reports tennis ball size area of redness on L arm at site of immunization.

VAERS ID:295242 (history)  Vaccinated:2007-10-17
Age:13.0  Onset:2007-10-28, Days after vaccination: 11
Gender:Female  Submitted:2007-10-30, Days after onset: 2
Location:New Mexico  Entered:2007-11-01, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None 12/11/07-records received-Clinical HX raises possibility of mononucleosis.
Diagnostic Lab Data: CBC, Chem 16, ESR 12/11/07-records received-Labs: lymph % 51, alk phos 180, ESR 2.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0960F1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2342CA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Blood alkaline phosphatase increased, Encephalitis, Facial palsy, Full blood count, Hypoaesthesia, Hypoaesthesia facial, Hypoaesthesia oral, Laboratory test, Lymphocyte percentage increased, Red blood cell sedimentation rate
SMQs:, Liver related investigations, signs and symptoms (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious meningitis (broad)
Write-up: Numbness starting in feet, now hands and mouth. No muscle weakness 12/11/07-records received for DOS 10/30/07 C/O numbness to hands and feet began last week 10/17/07. Numbness in hands and lower arms as well as lips and face. 11/12/07-seen by neurologist, DX Postinfection cerebelitis, improving. Right Bell''s palsy, improving. Current clinical events are not related to vaccination with Gardasil.

VAERS ID:295265 (history)  Vaccinated:1996-06-27
Age:13.0  Onset:2007-10-04, Days after vaccination: 4116
Gender:Male  Submitted:2007-10-16, Days after onset: 12
Location:Georga  Entered:2007-11-01, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: info unavailable
Preexisting Conditions: None
Diagnostic Lab Data: clinical diagnosis
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0393130UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Varicella
SMQs:
Write-up: Chickenpox diagnosed after vaccine given

VAERS ID:295333 (history)  Vaccinated:2007-10-30
Age:13.0  Onset:2007-11-01, Days after vaccination: 2
Gender:Female  Submitted:2007-11-02, Days after onset: 1
Location:Michigan  Entered:2007-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500491P0IN 
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2538AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2862AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Blister, Erythema, Skin lesion, Tenderness
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Pt. awoke 11/01/2007 approximately 0700 to discover 1cm bulla-appearing lesion on L upper arm which had a small rim of erythema surrounding it. Entire area of upper arm tender to touch.

VAERS ID:295515 (history)  Vaccinated:2007-10-23
Age:13.0  Onset:2007-10-24, Days after vaccination: 1
Gender:Female  Submitted:2007-11-05, Days after onset: 12
Location:Texas  Entered:2007-11-05
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: NKDA, healthy child
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1343U1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Body temperature increased, Injection site erythema, Injection site swelling
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Child received varicella on 10/23 and returned to North clinic on 10/25 C/O redness and swelling at L arm site. Normal temp recorded. Pt was given rocephin im for cellulitis. Patient returned next day to PCP, had temp of 99 oral, 90% difference in redness, started on keflex oral antibiotic for 10 days.

VAERS ID:295589 (history)  Vaccinated:2007-08-01
Age:13.0  Onset:2007-08-03, Days after vaccination: 2
Gender:Female  Submitted:2007-10-22, Days after onset: 80
Location:Louisiana  Entered:2007-11-05, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': LA071001
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0960F0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2058AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2491AA5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0791R1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: 10/16/2007-Came to clinic with aunt to receive HPV & flu vaccine but when questioned if had any complications from last vaccines she stated she broke out in bumps after a couple of days that itched. Denied any drainage from the bumps and stated they were on her face, trunk & extremities. Patient was a poor historian and her aunt was unaware of the reaction. Obtained her mother''s phone numbers and will attempt to get more history from her. Rescheduled appointment for immunization appointment day. 10/22/2007=Unable to get in touch with mother for more history after attempting for 1 week. Called our medical director, and reported what history we had and he stated he was convinced it was the varicella immunization that caused the reaction and it was o.k. for her to receive her HPV.

VAERS ID:296109 (history)  Vaccinated:2007-11-06
Age:13.0  Onset:2007-11-07, Days after vaccination: 1
Gender:Male  Submitted:2007-11-08, Days after onset: 1
Location:Texas  Entered:2007-11-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: shock-like~DTP (no brand name)~3~1~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 5  
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1  
Administered by: Private     Purchased by: Private
Symptoms: Nausea, Pyrexia, Rash, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Nausea, vomiting (began ~10 hrs after immunization), duration 48 hrs; Rash/hives (began ~28 hrs after immunization), duration 4 hrs (gave Benedryl); Fever 103 degrees (began ~10 hrs after immunization), duration 48-72 hrs.

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