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Case Details (Sorted by Age)

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VAERS ID: 493809 (history)  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2013-06-04
Onset:2013-06-04
   Days after vaccination:0
Submitted: 2013-06-05
   Days after onset:1
Entered: 2013-06-10
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4345AA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1027 / 3 LA / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H020852 / 0 RA / IM

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

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

Write-up: Hives on bilat. arms, (L) cheek chest - CLARITIN given 15 min.


VAERS ID: 493815 (history)  
Age: 4.0  
Gender: Male  
Location: Florida  
Vaccinated:2013-03-22
Onset:2013-06-01
   Days after vaccination:71
Submitted: 2013-06-04
   Days after onset:3
Entered: 2013-06-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BC / 4 UN / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015641 / 1 UN / UN

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

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

Write-up: Bumps all over.


VAERS ID: 493832 (history)  
Age: 4.0  
Gender: Male  
Location: Michigan  
Vaccinated:2013-06-07
Onset:2013-06-08
   Days after vaccination:1
Submitted: 2013-06-10
   Days after onset:2
Entered: 2013-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4275AA / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. J001011 / 0 LL / SC

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

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

Write-up: Pt received PENTACEL in (R) ant lat thigh. The next morning injection site was warm, raised and red 11 cm x 11 cm. Sharpie line drawn on perimeter. Resolved this morning.


VAERS ID: 493855 (history)  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2013-06-07
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2013-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BC / 4 LG / SC
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB692CA / 0 LG / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H020850 / 1 LG / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H015136 / 1 LG / SC

Administered by: Private       Purchased by: Public
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Pt. given MMRV and varicella. There was nothing to recover from.


VAERS ID: 493965 (history)  
Age: 4.0  
Gender: Male  
Location: Unknown  
Vaccinated:2013-06-04
Onset:2013-06-04
   Days after vaccination:0
Submitted: 2013-06-07
   Days after onset:3
Entered: 2013-06-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Public       Purchased by: Public
Symptoms: Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (broad)

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

Write-up: Bluish spot on upper left arm.


VAERS ID: 493984 (history)  
Age: 4.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2013-06-04
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4345AA / 4 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1605 / 3 RA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J001054 / 1 LA / UN

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

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

Write-up: Right deltoid area with redness, swelling and warmth to touch.


VAERS ID: 494007 (history)  
Age: 4.0  
Gender: Female  
Location: Oregon  
Vaccinated:2013-06-03
Onset:2013-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B184AA / - RA / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: OR201317

Write-up: Soft tissue swelling at injection site, without redness: Hives to trunk (macular rash).


VAERS ID: 494008 (history)  
Age: 4.0  
Gender: Female  
Location: Oregon  
Vaccinated:2013-06-06
Onset:0000-00-00
Submitted: 2013-06-07
Entered: 2013-06-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H10659 / 0 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: OR201318

Write-up: Hep A - Only vaccine she has ever had. Had yesterday prophylactic from Berry mix she had eaten with family. Today came into clinic with brother because he couldn''t come yesterday. Hives under (L) arm in armpit and half way down chest. # 8 hives. Mom doesn''t know of any other changes other than the vaccine.


VAERS ID: 494021 (history)  
Age: 4.0  
Gender: Male  
Location: Virginia  
Vaccinated:2013-05-13
Onset:2013-05-13
   Days after vaccination:0
Submitted: 2013-06-12
   Days after onset:30
Entered: 2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4383BA / 1 RL / SYR
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 975075 / 0 RL / SYR

Administered by: Unknown       Purchased by: Other
Symptoms: Eye swelling, Lip swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergies to peanuts, beef, lamb, eggs.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen eyes and lips. Welts all over torso, arms, and legs. ER visit was required.


VAERS ID: 494031 (history)  
Age: 4.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2013-01-01
Onset:2013-01-01
   Days after vaccination:0
Submitted: 2013-06-12
   Days after onset:161
Entered: 2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 448757 / 0 RA / SYR

Administered by: Public       Purchased by: Public
Symptoms: Abdominal pain upper, Decreased appetite, Fatigue, Headache, Pyrexia, Urticaria
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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Vaccine reaction~Hib (no brand name)~1~0.33~Patient
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Allergic to HIB vaccination. Healthy prior to Hep A vaccine.
Diagnostic Lab Data: Going to Pediatrician on June 13, 2013 for examination.
CDC Split Type:

Write-up: Fatigue after vaccine. Headache for at least 4 days after vaccine. Fatigue 3 days after vaccine. Cluster of hives on hip region day after vaccine. Low grade fever and loss of appetite. Complained of stomach hurting.


VAERS ID: 494077 (history)  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2013-06-11
Onset:2013-06-12
   Days after vaccination:1
Submitted: 2013-06-13
   Days after onset:1
Entered: 2013-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20621BBA / - LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010136 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018794 / 1 RL / SC

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

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

Write-up: Day after immunizations pateint complained of leg pain, has a large red bump. Saw provider today, looks like a hive, pt has a fever since last night, 101?.


VAERS ID: 494094 (history)  
Age: 4.0  
Gender: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2013-06-13
Entered: 2013-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B153AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1028 / 3 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H015824 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H019681 / 1 RL / SC

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

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

Write-up: Site where DTaP given has large area of redness around injection site. Area is the size of an orange. Area hot to touch. Pt. has no pain or fever.


VAERS ID: 494106 (history)  
Age: 4.0  
Gender: Female  
Location: Kansas  
Vaccinated:2013-06-06
Onset:0000-00-00
Submitted: 2013-06-07
Entered: 2013-06-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B225BA / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB527EA / 2 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H017027 / 0 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H020252 / 0 RL / UN

Administered by: Military       Purchased by: Unknown
Symptoms: Drug administration error
SMQs:, Medication errors (narrow)

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

Write-up: Misadministration of Hep A vaccine. It was meant to be given to her sister and nurse gave it to patient on accident.


VAERS ID: 494174 (history)  
Age: 4.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2013-06-11
Onset:2013-06-12
   Days after vaccination:1
Submitted: 2013-06-13
   Days after onset:1
Entered: 2013-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BC / 0 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H019440 / 0 RL / SC

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

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

Write-up: 16.5 cm x 11.75 cm Rx (L) thigh site KINRIX decreased pain today but larger today.


VAERS ID: 494132 (history)  
Age: 4.0  
Gender: Female  
Location: Ohio  
Vaccinated:2013-05-23
Onset:2013-05-30
   Days after vaccination:7
Submitted: 2013-06-03
   Days after onset:4
Entered: 2013-06-14
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B204AA / - - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015623 / - - / -

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: METROHEALTHESP201258642

Write-up: Nonspecif skin erupt NEC on 2013-05-30, clinician comment: maybe vaccination related rash.


VAERS ID: 494178 (history)  
Age: 4.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2013-05-23
Onset:2013-05-29
   Days after vaccination:6
Submitted: 2013-06-04
   Days after onset:6
Entered: 2013-06-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B177BA / 4 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1605 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H014646 / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018796 / 1 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Confusional state, Convulsion, Depressed level of consciousness, Electroencephalogram abnormal, Nuclear magnetic resonance imaging brain normal, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CLARITIN
Current Illness: None
Preexisting Conditions: Febrile seizure; Autism spectrum
Diagnostic Lab Data: Abnormal EEG; Normal head MRI; See attached labs; MRI; EEG report
CDC Split Type:

Write-up: The morning after vaccination she became febrile and had decreased level of alertness and confusion. She may have had an unwitnessed seizure. Over the course of that day she had 2 more seizures when she was not febrile. She was started on TRILEPTAL. No seizures since starting TRILEPTAL.


VAERS ID: 494295 (history)  
Age: 4.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2013-06-10
Onset:2013-06-11
   Days after vaccination:1
Submitted: 2013-06-14
   Days after onset:3
Entered: 2013-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B254AA / - LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017245 / 1 LL / SC

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

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

Write-up: Injection site erythema and tenderness local on anterior left thigh. No fever.


VAERS ID: 494298 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-06-12
Onset:2013-06-13
   Days after vaccination:1
Submitted: 2013-06-14
   Days after onset:1
Entered: 2013-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4310BA / 4 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1452 / 3 LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H021362 / - RL / UN

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

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

Write-up: Erythema and swelling (L) lateral thigh DPT injection site.


VAERS ID: 494335 (history)  
Age: 4.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2013-06-04
Onset:2013-06-08
   Days after vaccination:4
Submitted: 2013-06-11
   Days after onset:3
Entered: 2013-06-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4363AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1027 / 3 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015641 / - LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site rash, Injection site scab, Injection site vesicles
SMQs:, Hypersensitivity (narrow)

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

Write-up: Received PROQUAD 6/4/13. Called office 6/8/13. Patient c/o blister rash around injection site. Some have scabbed. Dr discussed with mom. Told not unusual watch.


VAERS ID: 494359 (history)  
Age: 4.0  
Gender: Male  
Location: Colorado  
Vaccinated:2013-06-11
Onset:2013-06-11
   Days after vaccination:0
Submitted: 2013-06-17
   Days after onset:6
Entered: 2013-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B204AA / 0 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536BA / 1 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H020136 / 0 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F65734 / 0 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cold sweat, Cyanosis, Hypotonia, Somnolence, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Upon leaving clinic, patient bacame sleepy, cold/clammy, blue lips, vomited 3-4 times, and eventually became limp and unresponsive.


VAERS ID: 494424 (history)  
Age: 4.0  
Gender: Male  
Location: Arkansas  
Vaccinated:2013-05-28
Onset:2013-05-29
   Days after vaccination:1
Submitted: 2013-06-17
   Days after onset:19
Entered: 2013-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B208AA / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H020856 / 0 RL / SC

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

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

Write-up: Local reaction to KINRIX 5cm x 3cm macule, (L) thigh erythematous, no fluctuance, and TTP noted day after adminisration. Seen by MD in office on 5/30/13. Reassurance, TYLENOL PRN.


VAERS ID: 494428 (history)  
Age: 4.0  
Gender: Female  
Location: Ohio  
Vaccinated:2013-06-06
Onset:2013-06-10
   Days after vaccination:4
Submitted: 2013-06-11
   Days after onset:1
Entered: 2013-06-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B16AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H012569 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018781 / 1 RL / IM

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

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

Write-up: 5 days after immunizations developed papular erythematous rash, itchy, on arms, trunk, and 6/1 - worst on inner thighs.


VAERS ID: 494454 (history)  
Age: 4.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2013-06-14
Onset:2013-06-14
   Days after vaccination:0
Submitted: 2013-06-18
   Days after onset:4
Entered: 2013-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B225BA / 0 LA / IM

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

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

Write-up: 6/17/13 mom called reporting 6 hrs after patient received a KINRIX on 6/14/13 she broke out in red blotches all over her body. She was itchy. Blotches on neck, face, legs, stomach, arms. Mom states the arm where KINRIX given was red and itchy, warm to touch. Mom gave 3 doses of BENADRYL in a 24 hrs period and blotchiness resolved. Arm redness and warmth resolved by 6/17/13.


VAERS ID: 494509 (history)  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2013-06-10
Onset:2013-06-13
   Days after vaccination:3
Submitted: 2013-06-13
   Days after onset:0
Entered: 2013-06-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4363AA / 4 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1027 / 3 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H016132 / 1 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018524 / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Feeling hot, Induration, Rash generalised, Rash papular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Erythema and induration 3-4cm in diameter also papulovesicular rash all over body each 1-2mm, induration felt warm.


VAERS ID: 494563 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-06-06
Onset:2013-06-06
   Days after vaccination:0
Submitted: 2013-06-18
   Days after onset:12
Entered: 2013-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4345AA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1027 / 0 LA / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J000140 / 0 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dysphemia
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Father reported "stammering"
Preexisting Conditions: Wears glasses
Diagnostic Lab Data: To have audiology and speech evaluations.
CDC Split Type:

Write-up: Parent reports patient stuttering after adminisration of vaccines, feels strongly it is because of MMR and wants "report filed".


VAERS ID: 494564 (history)  
Age: 4.0  
Gender: Female  
Location: Georgia  
Vaccinated:2013-06-17
Onset:2013-06-18
   Days after vaccination:1
Submitted: 2013-06-18
   Days after onset:0
Entered: 2013-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221AB / - LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015638 / 0 RA / SC

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

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

Write-up: Pt was given KINRIX and PROQUAD for 4yr checkup. Redness - localized swelling, warm to touch - some drainage from where PROQUAD was given (RA).


VAERS ID: 494565 (history)  
Age: 4.0  
Gender: Male  
Location: Arizona  
Vaccinated:2013-05-28
Onset:2013-05-29
   Days after vaccination:1
Submitted: 2013-06-18
   Days after onset:20
Entered: 2013-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC208193DA / 2 RA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB692AA / 0 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015782 / 1 LA / SC

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

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

Write-up: 5-29-13 - Day - Fever 101.0. That night Mom noticed (R) arm was swollen and red, with red lines coming away from injection site. No c/o''s pain. 5-30-12 Instructed to go to ED. No fever. Symptoms same. Mom states that ED stated "It was something with his immune something...possibly an infection. Placed on 2 antibiotics: BACTRIM and Cephalexin. 6-4-13 Follow up. Mom states "He is way better". States he has finished his antibiotics".


VAERS ID: 494579 (history)  
Age: 4.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2013-06-10
Onset:2013-06-12
   Days after vaccination:2
Submitted: 2013-06-13
   Days after onset:1
Entered: 2013-06-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B207AA / 4 RL / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: H/O allergy to egg white
Diagnostic Lab Data: Local recation; Meaasly cellulitis Rt thigh
CDC Split Type:

Write-up: Vaccine on 06/10/13. Patient seen in office 06/13/13 with swelling at Rt thigh 5 1/2" x 3". No regional lymphadenopathy. H/O allergy to egg white.


VAERS ID: 494581 (history)  
Age: 4.0  
Gender: Female  
Location: Kansas  
Vaccinated:2013-06-17
Onset:2013-06-18
   Days after vaccination:1
Submitted: 2013-06-19
   Days after onset:1
Entered: 2013-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B166AB / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H16041 / 4 RL / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H019440 / 0 LL / SC

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

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

Write-up: Mother reports child woke up with leg red and painful, thought was normal but didn''t go away so came to clinic today to get checked. Assessment was 3x2 inch area with induration and smaller pea size (3-4) add''l indurations on lt thigh. Redness noted but not complete solid red. Not hot to touch, no blistering. Denies itching. Adv to use cold packs, ibuprofen, and Benadryl OTC x2 days. If no improvement or worsens to seek medical care with PCP.


VAERS ID: 494613 (history)  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2013-01-14
Onset:2013-01-15
   Days after vaccination:1
Submitted: 2013-06-19
   Days after onset:154
Entered: 2013-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B155AA / 1 RL / IM

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

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

Write-up: Firm mass at leg. No erythema. Treatment - BACTROBAN ointment applied to site until clear.


VAERS ID: 494616 (history)  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2013-05-02
Onset:2013-05-03
   Days after vaccination:1
Submitted: 2013-06-19
   Days after onset:47
Entered: 2013-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B155AA / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Skin reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Itchy at site, red, swollen at shot site, warm came to office 5/18/13. Treatment: cephalexin x 3 days. Localized reaction calmed down and resolved.


VAERS ID: 494647 (history)  
Age: 4.0  
Gender: Female  
Location: Ohio  
Vaccinated:2013-06-19
Onset:2013-06-19
   Days after vaccination:0
Submitted: 2013-06-20
   Days after onset:1
Entered: 2013-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C478AA / 4 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H01895 / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H019761 / 1 RA / SC

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

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

Write-up: (R) deltoid with 6 x 5 cm red, hot area at injection site.


VAERS ID: 494684 (history)  
Age: 4.0  
Gender: Female  
Location: Illinois  
Vaccinated:2013-06-14
Onset:2013-06-15
   Days after vaccination:1
Submitted: 2013-06-18
   Days after onset:3
Entered: 2013-06-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221AB / - LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H015825 / - RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H020254 / - LL / SC

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

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

Write-up: Red, raised, warm circular area approx 7 cm in diameter. Rx: clindamycin x 10 days


VAERS ID: 494692 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-06-18
Onset:2013-06-20
   Days after vaccination:2
Submitted: 2013-06-20
   Days after onset:0
Entered: 2013-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4335A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H014646 / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018791 / 0 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Pallor, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: IPV given to left deltoid. 9 cm x 9 cm warm erythematous area. Blanchable. Diphenhydramine, ibuprofen and cephalexin prescribed.


VAERS ID: 494711 (history)  
Age: 4.0  
Gender: Female  
Location: Missouri  
Vaccinated:2013-06-19
Onset:2013-06-20
   Days after vaccination:1
Submitted: 2013-06-20
   Days after onset:0
Entered: 2013-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B204AA / 0 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015786 / 0 RA / SC

Administered by: Public       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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 102, nausea, 1 episode of vomiting.


VAERS ID: 494713 (history)  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2013-06-18
Onset:2013-06-19
   Days after vaccination:1
Submitted: 2013-06-20
   Days after onset:1
Entered: 2013-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B213BA / 0 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H020852 / 0 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Urticaria, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hives covering upper torso, reaction to MMRV or KINRIX.


VAERS ID: 494722 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2013-06-12
Onset:2013-06-13
   Days after vaccination:1
Submitted: 2013-06-18
   Days after onset:5
Entered: 2013-06-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B166BA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0078AE / 0 RA / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Crying, Erythema, Feeling hot, Rash
SMQs:, Anaphylactic reaction (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoride
Current Illness: None
Preexisting Conditions: Amoxicillin - hives
Diagnostic Lab Data: 6/18/13 - much better.
CDC Split Type:

Write-up: 6/13 - arm very hot and red, pt crying all day. 6/14 - work up, still hot and red with rash almost to elbow (approx 4"). Doesn''t think she had fever. Appt offered - "too far to come" may go to UC mom says its from the DTaP IZ.


VAERS ID: 494717 (history)  
Age: 4.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2013-06-18
Onset:2013-06-19
   Days after vaccination:1
Submitted: 2013-06-21
   Days after onset:2
Entered: 2013-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4378AA / 4 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1605 / 3 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H019440 / 1 LA / SC

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

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

Write-up: 10cm x 8cm area of erythema (R) upper arm.


VAERS ID: 494808 (history)  
Age: 4.0  
Gender: Female  
Location: Nevada  
Vaccinated:2013-06-18
Onset:2013-06-18
   Days after vaccination:0
Submitted: 2013-06-20
   Days after onset:2
Entered: 2013-06-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B225BA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site pruritus, Injection site reaction, Injection site warmth, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Later in evening 6/18/13 - Red rash increased up (RT) side (thigh), warm to touch, itching at site. Mildly pink erythematous on day ie exam 6/20/13.


VAERS ID: 494814 (history)  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2013-06-18
Onset:2013-06-19
   Days after vaccination:1
Submitted: 2013-06-21
   Days after onset:2
Entered: 2013-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4383BA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1028 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0496AE / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H019681 / 1 RA / SC

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

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

Write-up: (L)O arm - swelling (+), mild itch (+), (-) for pain.


VAERS ID: 494821 (history)  
Age: 4.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2013-06-17
Onset:2013-06-18
   Days after vaccination:1
Submitted: 2013-06-21
   Days after onset:3
Entered: 2013-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4378AA / 4 LA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1058 / 3 LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H019440 / - RA / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site vesicles, Vaccination site induration, Vaccination site swelling
SMQs:

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

Write-up: 8 x 9 cm swelling with induration at vaccine site no drainage. (+) cluster of vesicles in center of site. (R) lateral upper arm.


VAERS ID: 494837 (history)  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2013-05-15
Onset:2013-05-15
   Days after vaccination:0
Submitted: 2013-06-21
   Days after onset:37
Entered: 2013-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B204AA / 4 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015624 / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Death, Pulmonary aplasia
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Died? Yes
   Date died: 2013-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ventolin 90 mcg QID, glycopyrrolate 0.5mg QID, montelukast 4mg qHS, nitrofurantoin 25mg qHS, Flovent 11mcg BID
Current Illness: Multiple congenital abnormalities-see below
Preexisting Conditions: Chronic Respiratory Disease, Tracheal Anomoly, Sleep Apnea, Hydronephrosis, Polydactyly, esophogeal abnormalities, uretal obstruction
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown-patient died at home on 5/15/13. Time of death not indicated on death certificate. Manner of death indicated as natural and pulmonary aplasia listed as cause of death.


VAERS ID: 494847 (history)  
Age: 4.0  
Gender: Female  
Location: West Virginia  
Vaccinated:2013-06-20
Onset:2013-06-20
   Days after vaccination:0
Submitted: 2013-06-21
   Days after onset:1
Entered: 2013-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC0B235AA / 4 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J001051 / 1 RL / IM

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

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

Write-up: Complained of a headache, loss of appetite. Fever of 101 progressed to 102 within an hour.


VAERS ID: 494879 (history)  
Age: 4.0  
Gender: Male  
Location: Illinois  
Vaccinated:2013-06-17
Onset:2013-06-17
   Days after vaccination:0
Submitted: 2013-06-21
   Days after onset:4
Entered: 2013-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B196CA / 4 LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015634 / 1 RA / UN

Administered by: Private       Purchased by: Public
Symptoms: Immediate post-injection reaction, Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Erythema and induration about 3 cm at site of MMRV. Immediate reaction after vaccination, still present 4 days.


VAERS ID: 494849 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-06-20
Onset:2013-06-21
   Days after vaccination:1
Submitted: 2013-06-21
   Days after onset:0
Entered: 2013-06-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 LA / -

Administered by: Unknown       Purchased by: Private
Symptoms: Extensive swelling of vaccinated limb, Feeling hot, Injection site rash, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: A rash that resembled a sunburn covered the entire upper arm that was injected with the 5th dose of DTap vaccine. This was the only vaccine administered. The arm has extensive swelling that is more than double the normal size. There is pain, heat, and itchiness.


VAERS ID: 494853 (history)  
Age: 4.0  
Gender: Male  
Location: Unknown  
Vaccinated:2013-06-20
Onset:2013-06-22
   Days after vaccination:2
Submitted: 2013-06-22
   Days after onset:0
Entered: 2013-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / - - / -

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

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

Write-up: Swelling, erythema and some pain to arm where vaccines were administered. Started on Keflex for cellulitis and early abscess.


VAERS ID: 494866 (history)  
Age: 4.0  
Gender: Female  
Location: Washington  
Vaccinated:2013-06-20
Onset:2013-06-21
   Days after vaccination:1
Submitted: 2013-06-24
   Days after onset:3
Entered: 2013-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 90700 CPT(R) / - RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 90713 CPT(R) / - LA / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 90710 CPT(R) / - RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Asthenia, Injection site erythema, Injection site swelling, Injection site warmth, Skin tightness, Sluggishness
SMQs:, Guillain-Barre syndrome (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)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None. By the time we got the car it was already red and puffy.
Preexisting Conditions:
Diagnostic Lab Data: Going in tomorrow for a blood test.
CDC Split Type:

Write-up: Red swollen puffy very hot area around the injection. Patient is very sluggish and low energy. Skin feels tight and hot over the injection sight.


VAERS ID: 494908 (history)  
Age: 4.0  
Gender: Male  
Location: Arkansas  
Vaccinated:2013-06-19
Onset:2013-06-20
   Days after vaccination:1
Submitted: 2013-06-24
   Days after onset:4
Entered: 2013-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS 935RF / - LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H017885 / 0 LA / SC

Administered by: Unknown       Purchased by: Private
Symptoms: Benign intracranial hypertension, CSF pressure increased, Cerebrospinal fluid drainage, Lumbar puncture, Nuclear magnetic resonance imaging normal, Optic nerve disorder, Strabismus
SMQs:, Optic nerve disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: MRI/MRIV- no tumors or masses; LP- 34.5 mm Hg opening pressure.
CDC Split Type:

Write-up: My son began to have crossed eyes for no apparent reason. No vomiting, no headaches, no gait issues. The eyes would cross and uncross. We saw the pediatrician where the vaccines were done and they advised us to see ophthalmologist if "it kept reoccurring in a few weeks". I did not feel like this was right as my son''s eyes were continued to be crossed. I made an appt at the ophthalmologist the next day (Friday 6/21). During exam he noticed increased pressure on the optic nerve. He advised us to go to hospital. At hospital, after MRI & MRIV the determined it necessary to do an LP where they determined opening pressure was 34.5mm Hg. They drained off the excess spinal fluid. His eyes were better after that. Diagnosis was pseudotumor cerebri. We were given Diamox to be taken twice a day for a month with reg followups with the ophthalmologist.


VAERS ID: 494912 (history)  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2013-06-05
Onset:2013-06-09
   Days after vaccination:4
Submitted: 2013-06-24
   Days after onset:15
Entered: 2013-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B235 / 0 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H014648 / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018788 / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Injection site cellulitis, Injection site discolouration, Injection site erythema, Injection site pruritus, Injection site reaction, Purpura
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Seen in ER 6-10-13 and treated with KEFLEX for cellulitis at immunization site; redness started day before. Today 6-21-13 seen with red-purplish spot at site. Not raised; 4cm circular purpuric lesion (L) thigh; not acutely infected, no warmth, no erythema, no induration.


VAERS ID: 494925 (history)  
Age: 4.0  
Gender: Male  
Location: Alabama  
Vaccinated:2013-06-17
Onset:2013-06-17
   Days after vaccination:0
Submitted: 2013-06-20
   Days after onset:3
Entered: 2013-06-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4363AA / 3 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1028 / 3 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. J002502 / 1 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016738 / 1 LL / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No meds taken as of 6-20-2013
Current Illness: None
Preexisting Conditions: Cerumen impaction; Port wine nevus
Diagnostic Lab Data:
CDC Split Type:

Write-up: Local rash, redness, swelling x 4 days since administration to (L) leg where DTaP and Varicella given.


VAERS ID: 494979 (history)  
Age: 4.0  
Gender: Female  
Location: Georgia  
Vaccinated:2013-06-20
Onset:2013-06-22
   Days after vaccination:2
Submitted: 2013-06-24
   Days after onset:2
Entered: 2013-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B254BA / 3 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J0001052 / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G94059 / 3 LL / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: PT DENIED
Preexisting Conditions: DENIED
Diagnostic Lab Data: Clinic visit with pediatrician. No testing indicated.
CDC Split Type:

Write-up: Pain/redness/warmth/swelling to the injection site, approx 6cm in diameter.


VAERS ID: 494981 (history)  
Age: 4.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2013-06-21
Onset:2013-06-23
   Days after vaccination:2
Submitted: 2013-06-24
   Days after onset:1
Entered: 2013-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B204AA / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H020140 / 0 LL / SC

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

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

Write-up: Per mom noticed redness at site of vaccine.


VAERS ID: 495055 (history)  
Age: 4.0  
Gender: Female  
Location: Alaska  
Vaccinated:2013-06-18
Onset:2013-06-18
   Days after vaccination:0
Submitted: 2013-06-20
   Days after onset:2
Entered: 2013-06-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B204AA / - LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0411AE / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018448 / 1 LA / UN

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

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

Write-up: Immunized 6/18/2013 presented to clinic 6/20/2013 with rash and swollen/red arms. (L) arm 25 cm (R) arm 22.5 cm. Raised red welts on arms, trunk, legs. Warm to touch, itchy.


VAERS ID: 495064 (history)  
Age: 4.0  
Gender: Female  
Location: Michigan  
Vaccinated:2013-06-11
Onset:0000-00-00
Submitted: 2013-06-25
Entered: 2013-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1305 / - LA / SC
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B102BA / - LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: No S and S.


VAERS ID: 495182 (history)  
Age: 4.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2013-05-29
Onset:2013-05-29
   Days after vaccination:0
Submitted: 2013-06-26
   Days after onset:28
Entered: 2013-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4310BA / 4 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1452 / 3 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H013040 / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017597 / 1 LA / SC

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

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

Write-up: Significant arm swelling and erythema.


VAERS ID: 495226 (history)  
Age: 4.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2013-06-25
Onset:2013-06-25
   Days after vaccination:0
Submitted: 2013-06-26
   Days after onset:1
Entered: 2013-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4345AA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. J002502 / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H020251 / 1 RA / SC

Administered by: Unknown       Purchased by: Private
Symptoms: Loss of consciousness, Rash, Urticaria
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pt broke out in rash/hives and then passed out.


VAERS ID: 495251 (history)  
Age: 4.0  
Gender: Female  
Location: Texas  
Vaccinated:2013-06-24
Onset:2013-06-25
   Days after vaccination:1
Submitted: 2013-06-26
   Days after onset:1
Entered: 2013-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B208AA / 0 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H019490 / 0 RL / UN

Administered by: Public       Purchased by: Public
Symptoms: Body temperature increased, Eye swelling, Ocular hyperaemia, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Doctor visit; unknown rash; Rx: prednisone/loratadine
CDC Split Type:

Write-up: Both eyes red and swollen; rash on face and neck; 100.9 temp.


VAERS ID: 495259 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-06-20
Onset:2013-06-21
   Days after vaccination:1
Submitted: 2013-06-25
   Days after onset:4
Entered: 2013-06-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B166BA / - LA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1452 / - RA / UN

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

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

Write-up: (L) arm/swollen, red, itchy. Med: KEFLEX.


VAERS ID: 495280 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-06-25
Onset:2013-06-26
   Days after vaccination:1
Submitted: 2013-06-27
   Days after onset:1
Entered: 2013-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4310BA / 4 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1452 / 3 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H021362 / - RL / UN

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

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

Write-up: Swelling and redness (L) thigh secondary to DPT reaction. Rx prednisone 18 m daily x 5 days. Cephalexin 250 m bid x 10d. Avoid pertussis vaccine in future.


VAERS ID: 495311 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-06-21
Onset:2013-06-24
   Days after vaccination:3
Submitted: 2013-06-27
   Days after onset:3
Entered: 2013-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? 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:

Write-up: Broke out in red bumps all over body. Progressively worsened and itch. They are still present from head to toe. Dr. didn''t request to see patient, just treating with 2.5% hydrocortisone ointment.


VAERS ID: 495594 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-06-10
Onset:2013-06-10
   Days after vaccination:0
Submitted: 2013-06-28
   Days after onset:18
Entered: 2013-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018790 / 2 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Irritability, Local swelling, Skin warm
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1306USA008688

Write-up: This spontaneous report as received from a registered nurse refers to a 4 year old male patient with no illness at the time of vaccination and no pre-existing conditions or allergies. On 10-JUN-2013 the patient was vaccinated with a third dose of VARIVAX (Merck), (subcutaneous injection in the right arm, lot number: H018790, exp. date 15-OCT-2014). On 10-JUN-2013, the patient experienced 6.5 x 7.5 cm area of swelling, hot and red arm and the patient was fussy. At the time of report, the patient''s outcome was unknown. The relatedness between the patient''s events and the patient was fussy and VARIVAX (Merck) was not reported. Additional information has been requested.


VAERS ID: 495646 (history)  
Age: 4.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2002-08-13
Onset:2013-06-21
   Days after vaccination:3965
Submitted: 2013-06-28
   Days after onset:7
Entered: 2013-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Blood immunoglobulin G, Hepatitis B surface antibody, Mumps antibody test
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions: Lemierre syndrome
Diagnostic Lab Data: 06/21/2013, Blood immunoglobin G, 0.59.
CDC Split Type: WAES1306USA013199

Write-up: This spontaneous report was received from a registered nurse regarding a 15 year old male patient with history of Lemierre disease and no drug reactions or allergies. The patient was vaccinated with M-M-R II (lot number and expiration date not reported) (dose and route were not reported) on 09-NOV-1998 and on 13-AUG-2002. No other suspect therapies were reported, there was no concomitant medication. On 21-JUN-2013 the patient was found to have a Mumps IgG of 0.59 (no reference units and ranges reported). The patient was required to have testing of titers for a camp physical. Outcome for Mumps IgG of 0.59 was unknown at the time of the report. No treatment was given for the above mentioned event. On 21-06-2013 an "m-MR varicell and Hepp B surface antibody" tests were performed (results not reported). It was reported that the patient sought medical attention (reported as "physical for camp"). The reporting nurse did not assess the relatedness between Mumps IgG of 0.59 and M-M-R II. Additional information has been requested.


VAERS ID: 495479 (history)  
Age: 4.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2013-06-27
Onset:2013-06-28
   Days after vaccination:1
Submitted: 2013-06-29
   Days after onset:1
Entered: 2013-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 LA / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 LA / UN

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

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

Write-up: Shot administered in upper left arm. Reaction includes redness and extreme swelling of arm from 1" above injection to elbow (about 5" below injection), and wrapping around to back/underside of arm. The entire area is red, swollen, hot, and hard to the touch. Patient is complaining of itchiness in entire area.


VAERS ID: 495489 (history)  
Age: 4.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2013-06-26
Onset:2013-06-29
   Days after vaccination:3
Submitted: 2013-06-30
   Days after onset:1
Entered: 2013-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 LA / SYR

Administered by: Private       Purchased by: Other
Symptoms: Erythema multiforme, Pyrexia, Rash pruritic, Streptococcus test negative
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Common cold symptoms 2 1/2 weeks prior, but no on-going symptoms at the time of the vaccine
Preexisting Conditions: No
Diagnostic Lab Data: Rapid strep was negative on 06/30/2013
CDC Split Type:

Write-up: Within 12 hours of vaccine spikes fever of 103. Within 72 hours of vaccine broke out in diffuse pruritic rash. Saw Pediatrician on 06/30/2013 and diagnosed with Erythema Multiforme.


VAERS ID: 495547 (history)  
Age: 4.0  
Gender: Male  
Location: Georgia  
Vaccinated:2013-06-28
Onset:2013-06-30
   Days after vaccination:2
Submitted: 2013-07-01
   Days after onset:1
Entered: 2013-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B211BC / - LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J000138 / - LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site bruising, Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Kinrix given in left thigh on Friday, June 28, 2013. Site is now red, swollen, measuring 10.5cm. Proquad given in left upper arm subcutaneously. Site is now red/bruised and 2cm. Patient has also been running a fever of 102.0. Patient started on Septra.


VAERS ID: 495569 (history)  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2013-06-06
Onset:0000-00-00
Submitted: 2013-06-07
Entered: 2013-07-01
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB493AA / 0 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: M.A. gave an adult dose of Hep A instead of a pediatric dose.


VAERS ID: 495575 (history)  
Age: 4.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2013-06-28
Onset:2013-06-29
   Days after vaccination:1
Submitted: 2013-06-29
   Days after onset:0
Entered: 2013-07-01
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B204AA / 0 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J001012 / 1 RA / SC

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

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

Write-up: Minor swelling rt. deltoid. Mild tenderness, using arm normally.


VAERS ID: 495582 (history)  
Age: 4.0  
Gender: Male  
Location: Arizona  
Vaccinated:2013-04-29
Onset:0000-00-00
Submitted: 2013-06-24
Entered: 2013-07-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BC / - LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015782 / - RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017706 / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: None


VAERS ID: 495584 (history)  
Age: 4.0  
Gender: Female  
Location: Arizona  
Vaccinated:2013-04-29
Onset:0000-00-00
Submitted: 2013-06-24
Entered: 2013-07-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BC / - LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015782 / - RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017706 / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: No adverse events.


VAERS ID: 495764 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2013-06-28
Onset:2013-07-01
   Days after vaccination:3
Submitted: 2013-07-02
   Days after onset:1
Entered: 2013-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B225BA / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J000142 / 0 RL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was not taking any medications at the time vaccines were administered.
Current Illness: None present
Preexisting Conditions: Asthma, Obesity
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: Localized swelling and redness to administration site (left anterior thigh).


VAERS ID: 495777 (history)  
Age: 4.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2013-04-02
Onset:2013-04-02
   Days after vaccination:0
Submitted: 2013-07-02
   Days after onset:91
Entered: 2013-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private       Purchased by: Other
Symptoms: Aggression, Condition aggravated, Nervous system disorder, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hostility/aggression (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Evolving neurological issues, sensory issues that became 10 times worse within days of the vaccine after an hour long tantrum following the vaccine
Preexisting Conditions:
Diagnostic Lab Data: Currently in Occupational Therapy and upcoming neurological appointment.
CDC Split Type:

Write-up: Hour long tantrum from time of vaccine until long after arriving home, neurological issues including sensory issues and evolving sensory and possible Sensory Processing Disorder or ADHD became increasingly worse within days of vaccine.


VAERS ID: 495785 (history)  
Age: 4.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2013-06-25
Onset:2013-06-27
   Days after vaccination:2
Submitted: 2013-06-28
   Days after onset:1
Entered: 2013-07-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221AB / - LL / IM

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

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

Write-up: (L) thigh rash. Mild and faint erythematous macular area w/faint borders located on anterior thigh from proximal to midline. No pain or edema. Onset x 3 days. Monitor sxs (conservative mngmt).


VAERS ID: 495913 (history)  
Age: 4.0  
Gender: Female  
Location: California  
Vaccinated:2013-06-26
Onset:2013-06-27
   Days after vaccination:1
Submitted: 2013-07-03
   Days after onset:6
Entered: 2013-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4345AA / 4 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / 3 RL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H021358 / 0 LL / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: KEPPRA; Trileptal - started 3 wks ago
Current Illness:
Preexisting Conditions: CP - Hydrocephalus, sz.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after vaccines only had fever and red and worse 2 days later and very warm. Seen in ER and Dx with cellulitis marked on leg 90 x 102 mm size now resolved and tx with Abx - (R) anterior thigh. Given DTaP, IPV.


VAERS ID: 495891 (history)  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2013-07-01
Onset:2013-07-02
   Days after vaccination:1
Submitted: 2013-07-04
   Days after onset:2
Entered: 2013-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Public       Purchased by: Public
Symptoms: Gait disturbance, Mobility decreased, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide 10mg/ml 10mg twice daily
Current Illness: Showed rash over entire body. Doctor said she still wanted to administer shots since he was not sick or showing any sings of fever or infection.
Preexisting Conditions: Has 4 heart defects. Large VSD close to aorta. Has ASD of no concern according to Pediatric Cardiologist. Has 2 smaller VSD below larger VSD but are located on a muscle part of the heat. The 3 VSD allow blood to flow from left to right, the Larger VSD being the only one of main concern due to its location near aortic valve. This larger VSD has a flap of tissue that helps keep the amount of blood crossing over from being too much. This is my explanation based on what I understand from the cardiologist.
Diagnostic Lab Data: Has not been checked by doctor. Will be going in July 5th, 2013 due to clinic being closed on July 4th. As per Dr. at the practice (based on what I could describe over phone) she does not believe he needs to be taken in to the ER being that there is no complain of severe pain, no apparent swelling or redness. If such were to occur I need to take to ER. Otherwise they will see him on the 5th.
CDC Split Type:

Write-up: Patient showed signs of limping with his right leg. Appears to not be able to bend the leg at the knee. No significant pain seems to be present. No swelling, no redness or bruises. Shots were administered on both arms. Two on left arm and 1 on right arm. I was only able to see the "limping" after he woke up late the following day after the shots. He also slept more then usual. Did not show signs of fever or the such. As per doctor, I applied cold compresses on the knee area and muscle ointment to see if any improvement would occur with in the following 24 hrs. A day and a half after seeing the effects there is little improvement, still limping, no bending of knee when walking. He is able to fold/bend knee when sitting down and does not complain of pain.


VAERS ID: 495893 (history)  
Age: 4.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2013-06-28
Onset:2013-06-28
   Days after vaccination:0
Submitted: 2013-07-04
   Days after onset:6
Entered: 2013-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC2013204AA / - RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009781 / - UN / UN
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER H07132 / - UN / UN

Administered by: Public       Purchased by: Public
Symptoms: Gingivitis
SMQs:, Oropharyngeal infections (narrow), Gingival disorders (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen; Amoxicillin; Diphenhydramine
Current Illness: Bleeding Gums; "Allergic" conjunctivitis (likely viral); Afebrile, Pharyngitis (strep rapid and culture neg) and cough (had ibuprofen at home for pain and vaccine anticipation 12:00pm
Preexisting Conditions: Severe Dental decay, Bottle" teeth, has silver Caps; Allergies, environmental, Cat dander (anaphylaxis)
Diagnostic Lab Data: Pending
CDC Split Type:

Write-up: Pt has bacterial gingivitis, had pharyngitis (unknown etiology, negative strep-rapid and culture, cough (known RSV only in 5 months age, no known resp since. Given amoxicillin, IM Kinrix (Tdap+IPV), Varicella, and MMR.


VAERS ID: 496086 (history)  
Age: 4.0  
Gender: Male  
Location: Delaware  
Vaccinated:2006-03-08
Onset:2006-03-08
   Days after vaccination:0
Submitted: 2013-07-04
   Days after onset:2674
Entered: 2013-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0773P / - UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Flushing, Lacrimation increased, Sneezing, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Prophylaxis, Drug hypersensitivity, Food allergy, Allergy to chemicals
Preexisting Conditions: Kawasaki''s disease; neomycin, Drug hypersensitivity
Diagnostic Lab Data:
CDC Split Type: WAES1307USA002246

Write-up: This spontaneous report was received from a other health professional refers to a 4 year old male patient with unspecified preservative allergy, jello allergy, and neomycin allergy. The patient''s medical history included Kawasaki''s disease. On 08-MAR-2006, the patient was vaccinated with a dose of M-M-R II (lot# 649509/0773P), 0.5 ml, subcutaneously. Concomitant therapies included IPOL (Manufactured by PMC per the caller) and INFANRIX (Manufactured by GlaxoSmithKline). On 08-MAR-2006, the patient became flushed, developed sneezing and watery eyes after receiving M-M-R II. No treatment was given and the symptoms resolved within an hour of the onset of symptoms on 08-MAR-2006. On 20-MAR-2006, the patient was vaccinated with VARIVAX (Merck) and experienced wheezing and hives (see related case 1307USA002101). Laboratory diagnostic tests performed was none. Patient sought medical attention as adverse events occurred in the doctor''s office. The outcome of became flushed, sneezing and watery eyes was reported as recovered. This is 1 of 2 reports regarding the same patient. Additional information is not expected.


VAERS ID: 495899 (history)  
Age: 4.0  
Gender: Female  
Location: Iowa  
Vaccinated:2013-06-07
Onset:2013-06-08
   Days after vaccination:1
Submitted: 2013-06-24
   Days after onset:16
Entered: 2013-07-05
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0138AE / 1 LA / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SINGULAIR 4 mg
Current Illness: None
Preexisting Conditions: Extrinsic asthma since 5/24/12; Allergic rhinitis
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Mom called stating patient woke up the morning after varicella vaccine with a red 3 inch circle, swelling and pain at injection site. They applied ice and stared BENADRYL. Redness and swelling still present 72 hours later, but improving. No fevers.


VAERS ID: 495902 (history)  
Age: 4.0  
Gender: Male  
Location: Arizona  
Vaccinated:2013-06-21
Onset:2013-06-24
   Days after vaccination:3
Submitted: 2013-06-24
   Days after onset:0
Entered: 2013-07-05
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS 015782 / 0 UN / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. AC20B204AA / 0 LA / UN

Administered by: Public       Purchased by: Public
Symptoms: Swelling, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: (R) shoulder swelling. Adverse reaction to KINRIX.


VAERS ID: 495904 (history)  
Age: 4.0  
Gender: Male  
Location: Delaware  
Vaccinated:2013-06-24
Onset:2013-06-24
   Days after vaccination:0
Submitted: 2013-06-27
   Days after onset:3
Entered: 2013-07-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BC / 0 LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H020856 / 0 RA / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Scabies
Preexisting Conditions: Autism; Seizure d/o; Tuberous sclerosis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling left arm on day of vaccine.


VAERS ID: 496064 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-07-02
Onset:2013-07-03
   Days after vaccination:1
Submitted: 2013-07-05
   Days after onset:2
Entered: 2013-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4346AA / 4 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1027 / 3 LA / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J00142 / 0 RL / SC

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? 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:

Write-up: Has swelling and redness (R) thigh - MMR-Varicella site. Rx - Prednisone 18mg daily x 5 days. Cephalexin 200mg bid x 10 days.


VAERS ID: 496183 (history)  
Age: 4.0  
Gender: Female  
Location: Florida  
Vaccinated:2013-06-27
Onset:2013-06-28
   Days after vaccination:1
Submitted: 2013-07-02
   Days after onset:4
Entered: 2013-07-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B2211AB / - UN / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J002307 / 0 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H019521 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Incorrect dose administered, Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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:

Write-up: Patient was given an accidental extra dose of VARIVAX on 6/27/13. It was discovered that she was given a PROQUAD and separate VZV when vaccine counts did not add up. Grandmother and CDC were called and she was advised to watch for increased reaction. She was seen on 6/28/13 for redness at injection site 2cm diameter. She was told to start KEFLEX (250/5) 4.5 ml PO TID x 10 days if persists after cool compress. She was to follow up 7/2/13 but canceled stating pt was better.


VAERS ID: 496258 (history)  
Age: 4.0  
Gender: Female  
Location: North Dakota  
Vaccinated:2013-05-13
Onset:2013-05-14
   Days after vaccination:1
Submitted: 2013-07-09
   Days after onset:56
Entered: 2013-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357AA / - LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0288AE / 1 LA / IM

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

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

Write-up: Left upper arm reddened and swollen the next morning when this client woke up for the day. Mom monitored arm throughout the day. Mom monitored arm over the next couple days before she called me and reported the reaction. Advised mom to take her to her provider. Mom called me on 5/20/2013 and stated patient was seen by the doctor on 5/17/2013. Doctor had no concerns other than it was a normal reaction to vaccinations per moms phone statement.


VAERS ID: 496284 (history)  
Age: 4.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2013-04-30
Onset:2013-05-03
   Days after vaccination:3
Submitted: 2013-07-09
   Days after onset:67
Entered: 2013-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B204AA / - LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Injection site mass, Local reaction, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: CT201302

Write-up: 4/30 received vaccine in office - pt tolerated well. Mom called office 5/3 reddened area only - ? ethyl chloride used but to office for eval. determined normal local reaction. Mom already hesitant about vaccines - reassured. 5/9 pt to office for acute URI - no mention of vaccine reaction by mom. 5/25 Mom still concerned about local reaction - into office for MD eval. Mom reassured no sign of dangerous reaction w/ lump at site.


VAERS ID: 496327 (history)  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2013-07-08
Onset:2013-07-08
   Days after vaccination:0
Submitted: 2013-07-09
   Days after onset:1
Entered: 2013-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B221BG / 0 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H015826 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H019447 / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Body temperature increased, Convulsion, Laboratory test
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: KEPPRA; PREVACID; fish oil; albuterol
Current Illness: None
Preexisting Conditions: Latex, rash; Elavated transaminase/LDH; S/P Repair of Tetralogy of Fallot; S/P Ventriculoperitoneal shunt; Portal hypertension syndrome; Splenomegaly; Portal vein obstruction; Alternating exotropia; Unspecified chronic suppurative otitis media; Anemia; Ascites; Abdominal distension; Hematemesis; Unspecified conductive hearing loss; Speech delay; Localization-related epilepsy; Redundant prepuce and phimosis; melena; Tetralogy of Fallot; Homograft cardiac valve stenosis; Pulmonary artery stenosis; Hydrocephalus; Elevated liver enzymes; Developmental delay; Hx MRSA infection; Unspecified asthma; Chronic lung disease; Liver disease; TOF (tetralogy of fallot); Seizure disorder; SNHL (sensorineural hearing loss); Splenomegaly; Anterior subcapsula
Diagnostic Lab Data: Lab work at ER
CDC Split Type:

Write-up: Patient had seizure and temp 99F the night after vaccines administered. Patient taken from home to ER by paramedics.


VAERS ID: 496333 (history)  
Age: 4.0  
Gender: Male  
Location: New York  
Vaccinated:2013-06-30
Onset:2013-07-02
   Days after vaccination:2
Submitted: 2013-07-10
   Days after onset:8
Entered: 2013-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4452AA / 4 LL / SYR
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H017027 / 1 RL / SYR

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

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

Write-up: The patient did not have a fever. The area of injection, left leg, was swollen and tender. Treatment given was a cold compress.


VAERS ID: 496433 (history)  
Age: 4.0  
Gender: Male  
Location: Missouri  
Vaccinated:2013-07-08
Onset:2013-07-09
   Days after vaccination:1
Submitted: 2013-07-11
   Days after onset:2
Entered: 2013-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS 935RF / - RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J001053 / 0 LA / SC

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

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

Write-up: (+) erythema with slight firmness at injection site to (Rt) upper arm began day after imm. Seen 7/11/13 at PCP - 6cm x 9cm area redness; small induration no warmth afebrile - mod. localized imm. reaction. Tx -I.P. children''s BENADRYL and ibuprofen.


VAERS ID: 496435 (history)  
Age: 4.0  
Gender: Female  
Location: Louisiana  
Vaccinated:2013-07-10
Onset:2013-07-10
   Days after vaccination:0
Submitted: 2013-07-11
   Days after onset:1
Entered: 2013-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B254AA / - LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J000134 / 0 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Cough
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZYRTEC; NASONEX
Current Illness: None
Preexisting Conditions: Allergies, peanuts, milk, eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccines given. Starting coughing constantly approx 5-10 min. later. O2 sat 100% RA. BENADRYL 18mg po, ORAPRED 40mg po, Epi 1:1000 0.2 ml 1 SQ, Albuterol 2.5mg neb given.


VAERS ID: 496466 (history)  
Age: 4.0  
Gender: Female  
Location: Virginia  
Vaccinated:2013-06-06
Onset:2013-06-26
   Days after vaccination:20
Submitted: 2013-07-01
   Days after onset:5
Entered: 2013-07-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4365AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1028 / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H014650 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018781 / 1 LL / SC

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

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

Write-up: Rash post vaccination, dx of varicella, refer to OV notes attached.


VAERS ID: 496504 (history)  
Age: 4.0  
Gender: Female  
Location: Virginia  
Vaccinated:2013-07-09
Onset:2013-07-10
   Days after vaccination:1
Submitted: 2013-07-11
   Days after onset:1
Entered: 2013-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B25AA / - RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J001012 / - LL / SC

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

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

Write-up: Bilat RVL & LVL areas where injections administered, red, warm to touch and swollen.


VAERS ID: 496528 (history)  
Age: 4.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2012-01-01
Onset:2012-01-01
   Days after vaccination:0
Submitted: 2013-07-11
   Days after onset:556
Entered: 2013-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Pruritus, Rash generalised, Speech disorder
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Talking stopped~Vaccine not specified (no brand name)~UN~1.00~Patient|Fainted~Vaccine not specified (no brand name)~UN~8.00~Sibl
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient could not speak for many hours after flu shot. Next day complained he was itchy and could not control himself. Speech returned. Body had a rash. ADHD? Still struggles and has issues!


VAERS ID: 496646 (history)  
Age: 4.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2013-07-10
Onset:2013-07-11
   Days after vaccination:1
Submitted: 2013-07-12
   Days after onset:1
Entered: 2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B22BC / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H014988 / 1 RA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G04773 / 4 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H020600 / 1 LA / SC

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

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

Write-up: 5cm. round red area R arm itchy induration. 15 X 10 cm. area with red, warm induration which includes a 4X4 cm. area of vesicles at the injection site.


VAERS ID: 496744 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-07-10
Onset:2013-07-12
   Days after vaccination:2
Submitted: 2013-07-12
   Days after onset:0
Entered: 2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0078AE / - RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018790 / - LA / UN

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

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

Write-up: Mom did not see it till now child c/o pain yesterday on left upper arm. No itching no fever. Using arm normally. 25 cm x 30 cm erythema and induration noted left lower upper arm.


VAERS ID: 496720 (history)  
Age: 4.0  
Gender: Male  
Location: Puerto Rico  
Vaccinated:2013-07-15
Onset:0000-00-00
Submitted: 2013-07-15
Entered: 2013-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G69332 / 0 LL / UN

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

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

Write-up: Presented rash in the area of the chest and back.


VAERS ID: 496828 (history)  
Age: 4.0  
Gender: Male  
Location: Ohio  
Vaccinated:2013-06-10
Onset:2013-06-22
   Days after vaccination:12
Submitted: 2013-07-16
   Days after onset:24
Entered: 2013-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B235AA / - - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. J000197 / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Cellulitis
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: METROHEALTHESP201258773

Write-up: Cellulitis of leg on 2013-06-22, clinician comment: Cellulitis was really on inner thigh under buttock and not at the site of vaccination.


VAERS ID: 496838 (history)  
Age: 4.0  
Gender: Female  
Location: Utah  
Vaccinated:2013-05-17
Onset:2013-05-17
   Days after vaccination:0
Submitted: 2013-06-10
   Days after onset:24
Entered: 2013-07-16
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B177 / 1 RL / IM

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

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

Write-up: Redness, swelling and pain surrounding the injection site and extending four inches outward along with the arm, duration of 3 days.


VAERS ID: 496879 (history)  
Age: 4.0  
Gender: Male  
Location: California  
Vaccinated:2013-07-08
Onset:2013-07-08
   Days after vaccination:0
Submitted: 2013-07-12
   Days after onset:4
Entered: 2013-07-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4363AA / 4 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR J1028 / 3 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009782 / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H020247 / 1 LA / SC

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

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

Write-up: (R) arm baseball size swelling, pain, erythema - after MMR and DTAP placed, resolving when seen 7/12/13.


VAERS ID: 496898 (history)  
Age: 4.0  
Gender: Male  
Location: Texas  
Vaccinated:2013-07-15
Onset:2013-07-16
   Days after vaccination:1
Submitted: 2013-07-16
   Days after onset:0
Entered: 2013-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LA / IM

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

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

Write-up: Swelling, heat coming from injection site, painful welt.


VAERS ID: 496933 (history)  
Age: 4.0  
Gender: Female  
Location: New York  
Vaccinated:2013-07-02
Onset:2013-07-02
   Days after vaccination:0
Submitted: 2013-07-15
   Days after onset:13
Entered: 2013-07-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4383CA / 4 RA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / 3 UN / IM

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

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

Write-up: Started with redness and swelling of right arm and which progressed almost to a size of golf ball. Very painful and itchy but no fever. Mom gave MOTRIN and applied ice.


VAERS ID: 496959 (history)  
Age: 4.0  
Gender: Male  
Location: Illinois  
Vaccinated:2013-07-15
Onset:2013-07-16
   Days after vaccination:1
Submitted: 2013-07-17
   Days after onset:1
Entered: 2013-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B254AA / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Injection site rash, Rash generalised, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On 7/15 Received KINRIX in L arm - On 7/16 on awakening at 7 AM mom noted raised rash at site of injection and also chest/arms/legs/back/buttocks. Seen in office at 9:30 AM - Dx urticaria/ no S/S SOB/no wheezing.


VAERS ID: 496962 (history)  
Age: 4.0  
Gender: Female  
Location: Florida  
Vaccinated:2013-06-20
Onset:2013-07-16
   Days after vaccination:26
Submitted: 2013-07-17
   Days after onset:1
Entered: 2013-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS 935RF / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H014989 / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. J001177 / 1 LL / UN

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

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

Write-up: Pt received MMR vaccine on 6/20/13. On 7/16, pt. came to office with (L) jaw gland lymph node swelling, tender, mild fever (per parent), and overlying erythema. Pt. able to talk, open mouth. Pt. given PRELONE 15/5 - 5 mL BID x 5d. Told to use ice, MOTRIN, eat soft foods PRN.


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