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Case Details (Sorted by Age)

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VAERS ID:455535 (history)  Vaccinated:2012-03-01
Age:11.0  Onset:2012-05-01, Days after vaccination: 61
Gender:Female  Submitted:2012-05-08, Days after onset: 7
Location:Texas  Entered:2012-05-14, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Dermatographism
Preexisting Conditions: Dermatographism
Diagnostic Lab Data: Sent a referral to see neurology
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0963AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4032AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3921AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1247AA1SCLA
Administered by: Private     Purchased by: Other
Symptoms: Convulsion, Pain in extremity, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: On 5-1-2012 parents stated patient had seizure went to the Emergency Room this was 2nd seizure. 1st seizure may have happen few weeks earlier. Since day immunizations given 3-1-2012 (L) arm has hurt - now feel she has altered sensations in her (L) arm.

VAERS ID:455579 (history)  Vaccinated:2012-05-09
Age:11.0  Onset:2012-05-11, Days after vaccination: 2
Gender:Male  Submitted:2012-05-15, Days after onset: 4
Location:Michigan  Entered:2012-05-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None stated or documented by Mother
Preexisting Conditions: None stated or documented by Mother
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB539CA1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA2IMRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Gardasil #3 given on 5/9/12 in right deltoid. Mother called 5/11/12 stating patients right deltoid was red, swollen, painful and hot to touch. Client states CC was pruritus. Mother gave Ibuprofen, ice pack and Benadryl cream. Advised to seek medical attention if worsens.

VAERS ID:455599 (history)  Vaccinated:2012-04-30
Age:11.0  Onset:2012-05-02, Days after vaccination: 2
Gender:Female  Submitted:2012-05-02, Days after onset: 0
Location:California  Entered:2012-05-15, Days after submission: 13
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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3517BA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Blister, Oedema peripheral, Pyrexia, Vomiting
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Report of fever, with vomiting, swollen arm with a blister. No report of fever on 5/3/12. Instructed to see provider. Pt. seen Dr.

VAERS ID:455766 (history)  Vaccinated:2012-05-17
Age:11.0  Onset:2012-05-17, Days after vaccination: 0
Gender:Female  Submitted:2012-05-17, Days after onset: 0
Location:Michigan  Entered:2012-05-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None that I was aware of.
Preexisting Conditions: NKDA, None
Diagnostic Lab Data: Provider said patient could have meningococcal titer drawn in future to test antibody.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4249AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4325AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1061AA2IMLA
Administered by: Public     Purchased by: Other
Symptoms: Underdose
SMQs:
Write-up: Patient didn''t have reaction to immunization. However a Menactra was being administered via route of IM by a 25g 1in needle in patient''s deltoid muscle of her right arm. Upon first poke patient pulled her arm away from me and only a 1/2 dose of Menactra was administed, in which some of it could have came out with blood from patient''s arm. Needle was held away from patient and everyone else in room after this occurred. Once patient calmed down, the L.P.N. I was helping administer these imm''s with, came over and held the patient''s arm for me as I poked patient for a second time (in the same arm, just below first needle entry) to administer the rest of the Menactra dose that was left. Patient was told to keep arm relaxed but still tensed up arm and was able to free her arm from the L.P.N. holding it and pull away again from needle. There was only a slight bit of Menactra (less than 1/2 ml) that was not administered upon second poke. Patient''s mother was in room during all of this and was made aware that patient might need another Menactra in future if provider/state felt necessary after this incident.

VAERS ID:455779 (history)  Vaccinated:2012-05-15
Age:11.0  Onset:2012-05-16, Days after vaccination: 1
Gender:Male  Submitted:2012-05-17, Days after onset: 1
Location:Missouri  Entered:2012-05-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA110710IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt had MENVEO vaccine given in right deltoid on 5/15/12. Seen on 5/17/12 with 12 cm x 14 cm red warm swollen area about injection site. No discharge. Area slightly itchy per patient.

VAERS ID:455870 (history)  Vaccinated:2012-05-14
Age:11.0  Onset:2012-05-16, Days after vaccination: 2
Gender:Male  Submitted:2012-05-18, Days after onset: 2
Location:California  Entered:2012-05-21, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma; allergic rhinitis
Preexisting Conditions: No known allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4021AA0IDLA
Administered by: Other     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Vaccination complication
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient seen on 05/16/12 by Dr. and was diagnosed with Adverse effect of vaccine-Left arm with large red area, swelling, warmth; no pain, no fever.

VAERS ID:455882 (history)  Vaccinated:2012-04-27
Age:11.0  Onset:2012-05-15, Days after vaccination: 18
Gender:Female  Submitted:0000-00-00
Location:Wisconsin  Entered:2012-05-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B067BA5UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0606AA1UNRA
Administered by: Other     Purchased by: Public
Symptoms: Pruritus, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Developed lesions on trunk, arms, then remainder of body. ($g100). C/o itching, denies fever or other illness. No drainage.

VAERS ID:455912 (history)  Vaccinated:2012-05-11
Age:11.0  Onset:2012-05-11, Days after vaccination: 0
Gender:Female  Submitted:2012-05-15, Days after onset: 4
Location:Kansas  Entered:2012-05-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Peanuts; ROCEPHIN; soy; amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3843AA0IMUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B070BA0IMUN
Administered by: Public     Purchased by: Public
Symptoms: Pallor, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)
Write-up: 955 AM - After vaccines administered, client left room to sit down in lobby. Then proceeded to bathroom & threw up. Appeared pale. Put clean damp washcloth on forehead. Administered O2 at 1 L/via face mask at 10:00 am after VS were addressed, B/P 82/60, wheezes heard to upper lobes (B) upon auscultation. 1015 am - T 97.8, HR - 92, B/P - 90/60, Respirations - 24. Lungs CTA (B). A/O x 3. Upon dismissal gait normal. Client voices no dizzy, nausea, difficulty breathing.

VAERS ID:455922 (history)  Vaccinated:2012-05-18
Age:11.0  Onset:2012-05-19, Days after vaccination: 1
Gender:Female  Submitted:2012-05-21, Days after onset: 2
Location:Maine  Entered:2012-05-21
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: Anemia
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1539Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4080AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1207AA0SCRA
Administered by: Unknown     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hives, area on posterior right arm 6 x 12cm. appt, at clinic on 05/21/12, continue with otc Benadryl.

VAERS ID:455961 (history)  Vaccinated:2012-04-16
Age:11.0  Onset:2012-04-16, Days after vaccination: 0
Gender:Male  Submitted:2012-04-18, Days after onset: 2
Location:Unknown  Entered:2012-05-21, Days after submission: 33
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: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4009AA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Erythema, Hypersensitivity, Injection site erythema, Injection site swelling, Skin induration, Skin warm, Tenderness, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Patient was administered vaccine on 4/16/12. The following day the patient''s mother called & reported some redness & swelling at injection site. Patient returned to our office on 4/18/12 & exam revealed a large indurated, erythematous, homogenous & tender area on (R) deltoid, 4 x 4.5 circumference & warm to touch. No rashy pustules, ulceration or discharge. Suspect allergic reaction to Tdap vaccine component - localized.

VAERS ID:455970 (history)  Vaccinated:2012-05-18
Age:11.0  Onset:2012-05-19, Days after vaccination: 1
Gender:Female  Submitted:2012-05-21, Days after onset: 2
Location:Arkansas  Entered:2012-05-21
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: Overweight
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4053AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3927AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 2 cm x 2 cm area of redness & elevated temp (local). RUA (ADACEL site IM).

VAERS ID:456039 (history)  Vaccinated:2012-05-15
Age:11.0  Onset:2012-05-15, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:Pennsylvania  Entered:2012-05-23
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: Allergic rhinitis; Poor appetite
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURH4030AA0IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURU4106BA0IMUN
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Pallor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: A few minutes after GARDASIL patient felt faint became pale & shaky - gave cake & layed patient down - vitals remained good - episode pasted in about 10 minutes.

VAERS ID:456089 (history)  Vaccinated:2012-05-21
Age:11.0  Onset:2012-05-22, Days after vaccination: 1
Gender:Male  Submitted:2012-05-23, Days after onset: 1
Location:California  Entered:2012-05-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1359AA0IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1375AA2SCLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4072BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red and Swollen upper left arm with pain.

VAERS ID:456090 (history)  Vaccinated:2012-05-19
Age:11.0  Onset:2012-05-19, Days after vaccination: 0
Gender:Male  Submitted:2012-05-23, Days after onset: 4
Location:Maryland  Entered:2012-05-23
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: allergic to penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR 0IM 
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 5IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1IM 
Administered by: Private     Purchased by: Private
Symptoms: Headache, Migraine, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient fainted. When he became responsive his head hurt and it took him an extended period of time to be able to get up and leave office. Vital signs were good. He developed a migraine necessitating treatment at emergency room.

VAERS ID:456100 (history)  Vaccinated:2012-05-17
Age:11.0  Onset:2012-05-22, Days after vaccination: 5
Gender:Male  Submitted:2012-05-23, Days after onset: 1
Location:Maryland  Entered:2012-05-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA0IMRA
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)
Write-up: Swelling of right arm x 5 days.

VAERS ID:456107 (history)  Vaccinated:2012-05-21
Age:11.0  Onset:2012-05-21, Days after vaccination: 0
Gender:Male  Submitted:2012-05-23, Days after onset: 2
Location:Massachusetts  Entered:2012-05-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0100AE0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4096AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1792AA1SCLA
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)
Write-up: Local redness & swelling only at injection site - not pruritic.

VAERS ID:456182 (history)  Vaccinated:2012-05-22
Age:11.0  Onset:2012-05-23, Days after vaccination: 1
Gender:Male  Submitted:2012-05-24, Days after onset: 1
Location:New York  Entered:2012-05-24
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: Cellulitis left upper arm
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM100320IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3486AA0IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Injection site 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)
Write-up: Tdap and MENVEO vaccines were administered IM on left deltoid muscle on 5/22/12. Child developed adverse reaction on 5/23/12. Symptoms included pain, swelling, erythema of left deltoid muscle.

VAERS ID:456177 (history)  Vaccinated:2012-05-16
Age:11.0  Onset:2012-05-18, Days after vaccination: 2
Gender:Female  Submitted:2012-05-18, Days after onset: 0
Location:Washington  Entered:2012-05-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB522BA1UNRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0477AA1UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1381AA1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Redness & swelling the size of a baseball.

VAERS ID:456212 (history)  Vaccinated:2012-05-16
Age:11.0  Onset:2012-05-17, Days after vaccination: 1
Gender:Male  Submitted:2012-05-21, Days after onset: 4
Location:Colorado  Entered:2012-05-25, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Right arm 2 vaccines administered. Right upper arm with area of light erythema. No increased warmth but slightly indurated.

VAERS ID:456225 (history)  Vaccinated:2012-05-23
Age:11.0  Onset:2012-05-24, Days after vaccination: 1
Gender:Female  Submitted:2012-05-25, Days after onset: 1
Location:Texas  Entered:2012-05-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1489AA0IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Cellulitis, Erythema, Injected limb mobility decreased, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt in office around 3:30pm. Right arm developed a baseball size area that was red, swollen, and painful. Decreased range of motion in right arm. No fever. Pt given Motrin, Benadryl, and Augmentin for cellulitis.

VAERS ID:456240 (history)  Vaccinated:2012-05-23
Age:11.0  Onset:2012-05-24, Days after vaccination: 1
Gender:Male  Submitted:2012-05-25, Days after onset: 1
Location:Texas  Entered:2012-05-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: None
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1489AA1IMLL
Administered by: Private     Purchased by: Private
Symptoms: Gait disturbance, Oedema peripheral, Pain in extremity, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Came to doctors office at 1540. Left leg swollen, warm to touch, and painful. Child limping. Motrin administered. Dr. rec Benadryl at home.

VAERS ID:456295 (history)  Vaccinated:2012-05-17
Age:11.0  Onset:2012-05-18, Days after vaccination: 1
Gender:Male  Submitted:2012-05-25, Days after onset: 7
Location:California  Entered:2012-05-25
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: Hx of Asthma
Diagnostic Lab Data: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0466AA1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Itching and redness (L) arm - at site of injection, no SOB - no chest pain.

VAERS ID:456309 (history)  Vaccinated:2012-05-21
Age:11.0  Onset:2012-05-22, Days after vaccination: 1
Gender:Female  Submitted:2012-05-23, Days after onset: 1
Location:Pennsylvania  Entered:2012-05-29, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1317AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM110650IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B076BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Activities of daily living impaired, Erythema, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Left arm swollen, red, warm to touch. Mother gave MOTRIN po to child. Given 5/22/12 pm - Went to school 5/23/12 but sent home by school nurse.

VAERS ID:456321 (history)  Vaccinated:2012-05-25
Age:11.0  Onset:2012-05-26, Days after vaccination: 1
Gender:Male  Submitted:2012-05-29, Days after onset: 3
Location:D.C.  Entered:2012-05-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4021AE0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Induration, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Red, swollen, hard, warm to touch.

VAERS ID:456352 (history)  Vaccinated:2012-05-24
Age:11.0  Onset:2012-05-25, Days after vaccination: 1
Gender:Male  Submitted:2012-05-29, Days after onset: 4
Location:Florida  Entered:2012-05-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3779AA IM 
TDAP: TDAP (ADACEL)SANOFI PASTEURU3486CA IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1148AA SC 
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Vaccination site induration, Vaccination site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Quarter size red, warm induration at vaccine site.

VAERS ID:456455 (history)  Vaccinated:2012-05-29
Age:11.0  Onset:2012-05-30, Days after vaccination: 1
Gender:Female  Submitted:2012-05-30, Days after onset: 0
Location:Pennsylvania  Entered:2012-05-30
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 known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B076AA0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM11062 UNRA
Administered by: Private     Purchased by: Other
Symptoms: Convulsion, Staring, Vision blurred
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Episode of short seizure 1-2 min, staring, no focus, does not remember episode better after 15 min.

VAERS ID:456479 (history)  Vaccinated:2012-05-23
Age:11.0  Onset:2012-05-25, Days after vaccination: 2
Gender:Male  Submitted:2012-05-30, Days after onset: 5
Location:Wisconsin  Entered:2012-05-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4021AD IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS  IMLA
Administered by: Public     Purchased by: Public
Symptoms: Discomfort, Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right deltoid red, hard and swollen per school Nurse. Area approx. 4"X2". Meningitis Vaccine given in that location. Instructed to ice area and take Tylenol for discomfort.

VAERS ID:456486 (history)  Vaccinated:2012-05-21
Age:11.0  Onset:2012-05-22, Days after vaccination: 1
Gender:Male  Submitted:2012-05-23, Days after onset: 1
Location:Pennsylvania  Entered:2012-05-30, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4051AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Pallor, Skin tightness, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: 2 days s/p vaccine admin. (L) upper arm with erythema & edema. No hives or diffuse rash. Tautness to skin positive blanching cap refil 2 sec. Warm.

VAERS ID:456548 (history)  Vaccinated:2012-05-30
Age:11.0  Onset:2012-05-30, Days after vaccination: 0
Gender:Female  Submitted:2012-05-31, Days after onset: 1
Location:New York  Entered:2012-05-31
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, NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1229AA2IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Injection site pruritus, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Child developed injection site itching and pain with facial swelling the evening after recieving the HPV/Gardasil vaccine, dose 2. No wheezing, shortness of breath or tongue swelling. No history of food, drug or environmental allergies. Mother administered Tylenol and Benadryl and was seen in the office 5/31/12.

VAERS ID:456576 (history)  Vaccinated:2012-05-21
Age:11.0  Onset:2012-05-22, Days after vaccination: 1
Gender:Female  Submitted:2012-05-23, Days after onset: 1
Location:Maine  Entered:2012-05-31, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4020AA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis
SMQs:
Write-up: Localized cellulitis vs imm reaction pt put on Cephalexin.

VAERS ID:456582 (history)  Vaccinated:2012-05-30
Age:11.0  Onset:2012-05-30, Days after vaccination: 0
Gender:Female  Submitted:2012-05-31, Days after onset: 1
Location:New York  Entered:2012-05-31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1261AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling abnormal, Headache, Injection site erythema, Injection site induration, Nausea, Visual impairment, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: PATIENT DEVELOPED NAUSEA AND VOMITING, HA AND VISUAL CHANGES. REPORTED "I FELT LIKE I WAS DYING". SITE WITH 4X6 CM RED HARD AREA.

VAERS ID:456601 (history)  Vaccinated:2012-05-29
Age:11.0  Onset:2012-05-29, Days after vaccination: 0
Gender:Male  Submitted:2012-06-01, Days after onset: 3
Location:Maryland  Entered:2012-06-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA101340IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B073BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Mild, large local reaction to Tdap in upper left, lateral deltoid area is warm to touch with 3.5 cm of induration - No redness, streaking or fever present. Symptoms started on 5/29/12 with gradual improvement. Advised to administer ice 15 min on/15 min off and ibuprofen q 6 hrs prn.

VAERS ID:456619 (history)  Vaccinated:2012-04-30
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2012-05-25
Location:South Carolina  Entered:2012-06-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: My ASO nl Lymes; Nl LFTs. No decreased complement (C3 or C4)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICS  UNUN
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Borrelia test negative, Complement factor C3, Complement factor C4, Complement factor normal, Haematuria, Liver function test normal, Red blood cell sedimentation rate increased, Streptococcus test negative
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Arthritis (broad), Tubulointerstitial diseases (broad)
Write-up: Painful lower extremity joints - knees lumbar, bilat 14 days after MENVEO. No joint inflammation, AF, no rash. On labs, microscopic hematuria. EJR = = 36. Labs nl/ Sx resolved 5-7 d.

VAERS ID:456625 (history)  Vaccinated:2012-05-02
Age:11.0  Onset:2012-05-04, Days after vaccination: 2
Gender:Female  Submitted:2012-05-25, Days after onset: 21
Location:Maryland  Entered:2012-06-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1495A2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: GARDASIL vaccine, 3rd dose, administered 5/2/12. Child seen on 5/4/12 9 cm x 10 cm area of (L) upper arm red and hard warm to touch but without cellulitis or lymph involvement.

VAERS ID:456650 (history)  Vaccinated:2012-06-01
Age:11.0  Onset:2012-06-01, Days after vaccination: 0
Gender:Male  Submitted:2012-06-01, Days after onset: 0
Location:Massachusetts  Entered:2012-06-01
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: Allergies - Bee sting
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3904AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Red and elevated area on left deltoid. Increased warmth at site of MENACTRA injection.

VAERS ID:456653 (history)  Vaccinated:2012-05-30
Age:11.0  Onset:2012-05-30, Days after vaccination: 0
Gender:Female  Submitted:2012-06-01, Days after onset: 2
Location:Pennsylvania  Entered:2012-06-01
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: Unspecified Neurological Disorder; Conductive Hearing Loss
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0215AE0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0131AE0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4257AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4023AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right upper arm edema, redness; firm to touch.

VAERS ID:456672 (history)  Vaccinated:2012-05-31
Age:11.0  Onset:2012-05-31, Days after vaccination: 0
Gender:Female  Submitted:2012-06-01, Days after onset: 1
Location:New Mexico  Entered:2012-06-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1291AA0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSU4072BA0UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B074AA0UNRA
Administered by: Other     Purchased by: Other
Symptoms: Eye swelling, Lip swelling, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Per patient''s mother: Approximately 1 hour after vaccines patient broke out with hives, itching and swelling to left eye and lips. Vaccines administered were Tdap and MENACTRA to right deltoid, and GARDASIL #1 to left deltoid.

VAERS ID:456690 (history)  Vaccinated:2012-05-31
Age:11.0  Onset:2012-05-31, Days after vaccination: 0
Gender:Male  Submitted:2012-06-03, Days after onset: 3
Location:California  Entered:2012-06-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data: unknown
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B066AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Asthenia, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Arthritis (broad)
Write-up: Patient reported weakness approximately 25 minutes after receiving vaccine. Assisted to supine position with lower extremities elevated. Approximately 10 minutes later complained of all four extremities and joints aching. BP 80s to 90s/50s with HR 70s. No wheezing or shortness of breath. Respirations unlabored. Oxygen administered along with IM epinephrine and IM Benadryl. Symptoms resolved over approximately 10-15 minutes. Patient evaluated by paramedics and taken to Emergency Department by parent. Discharged by Emergency Department to home same day.

VAERS ID:456691 (history)  Vaccinated:2012-05-31
Age:11.0  Onset:2012-05-31, Days after vaccination: 0
Gender:Female  Submitted:2012-06-03, Days after onset: 3
Location:California  Entered:2012-06-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Diagnostic Lab Data: unknown; thought to be no
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B066AA IMLA
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Headache
SMQs:
Write-up: Approximately 40 minutes after receiving vaccine patient complained of worsening headache that had occurred after receiving vaccine and feeling like something bad was going to happen inside of her. Denied pain or shortness of breath. No swelling, pain or redness at vaccine site. Assisted supine position with legs elevated. BP 118/64 HR 76 initially then to 108/66 with HR 64. Resp unlabored at 18/min. Symptoms did not resolve with rest and observation. Student treated with supplemental oxygen with no resolution of symptoms, and then with IM epinephrine. Student transported to emergency room via paramedics. Evaluated and discharged home same day.

VAERS ID:456692 (history)  Vaccinated:2012-06-01
Age:11.0  Onset:2012-06-01, Days after vaccination: 0
Gender:Male  Submitted:2012-06-03, Days after onset: 2
Location:New York  Entered:2012-06-03
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR  IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Became nauseous, lost consciousness.

VAERS ID:456737 (history)  Vaccinated:2012-05-22
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2012-05-25
Location:Ohio  Entered:2012-06-04, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKD/NKDA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3461CA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEUR43497CA5IMLA
Administered by: Public     Purchased by: Public
Symptoms: No adverse event, Wrong drug administered
SMQs:
Write-up: The pt. was given Tdap and should have gotten a BOOSTRIX. No adverse reactions.

VAERS ID:456769 (history)  Vaccinated:2012-06-04
Age:11.0  Onset:2012-06-04, Days after vaccination: 0
Gender:Female  Submitted:2012-06-04, Days after onset: 0
Location:Georgia  Entered:2012-06-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: allergic to amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4239AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B079BA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1792AA1SCLA
Administered by: Military     Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: After administering 2nd vaccine Menactra, pt stated I feel like I''m going to faint. Pt became pale and then had a jerk reaction about 1 second.

VAERS ID:456819 (history)  Vaccinated:2012-06-05
Age:11.0  Onset:2012-06-05, Days after vaccination: 0
Gender:Male  Submitted:2012-06-05, Days after onset: 0
Location:Kentucky  Entered:2012-06-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB541DA1UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4099AA0UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B074BA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Cold sweat, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt began to feel faint & turned pale and clammy. Pt ask to lie on exam table. He was given a cool wash cloth for his head & ice pack for site of injection. No irregular breathing or heart rate. (this was after MCV4)

VAERS ID:456857 (history)  Vaccinated:2007-12-05
Age:11.0  Onset:2008-07-01, Days after vaccination: 209
Gender:Female  Submitted:2012-06-01, Days after onset: 1431
Location:Oregon  Entered:2012-06-06, Days after submission: 5
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 54 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Gene mutation Polg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500576P0IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.1063U0SYRAR
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain upper, Back pain, Blindness, Convulsion, Gene mutation identification test
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: GARDASIL vaccine giving 12/5/07 and second injection 3/5/08. Chronic stomach pain noted for several months. Dr seen 10/24/08 for stomach pain. 3rd GARDASIL shot giving 11/12/08. Chronic stomach pain continues medical involvement continues for stomach pain. Patient seen 5/09 for severe back pain. Stomach pain continues until April 6, 2010 when patient stricken with seizures, hospitalization, blindness.

VAERS ID:456903 (history)  Vaccinated:2012-05-21
Age:11.0  Onset:2012-06-01, Days after vaccination: 11
Gender:Female  Submitted:2012-06-06, Days after onset: 5
Location:Missouri  Entered:2012-06-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: sore and tender, started to cough about an hour after shot, at 4:00 am Friday morning woke up with high temp and big red spot on back of right upper back of arm
Preexisting Conditions: n/a
Diagnostic Lab Data: severe allergic reaction to vaccine and still has cellulitis and red rash
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 1SCRA
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER 1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Erythema, Hypersensitivity, Inflammation, Nodule, Pain, Rash erythematous, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hypersensitivity (narrow)
Write-up: Severe red knot showed up and got bigger as the day progress, so bad with pain and inflammation ended up going to ER on Saturday, doctor said she had a severe allergic reation to vaccine.

VAERS ID:456907 (history)  Vaccinated:2012-05-30
Age:11.0  Onset:2012-05-30, Days after vaccination: 0
Gender:Male  Submitted:2012-06-06, Days after onset: 7
Location:Indiana  Entered:2012-06-06
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: ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1537AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Became ill w/vomiting almost immediately after receiving vaccine. Pt was put in an exam room to lie down, BP taken (ok). Advised to remain at office for observation (which is routine after this vaccine, for 15 minutes) and wait for a second BP. Pt left before being released by the Medical Assistant. Follow up phone call a few hours later revealed that the patient continued to vomit for a few hours after leaving the office. Home to rest and push fluids, Mom was advised to call the next day if still any symptoms.

VAERS ID:456921 (history)  Vaccinated:2012-06-01
Age:11.0  Onset:2012-06-02, Days after vaccination: 1
Gender:Male  Submitted:2012-06-06, Days after onset: 4
Location:California  Entered:2012-06-06
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: Unknown.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B066AA1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site vesicles, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Mother stated, child got blister at site where he got vaccine. Later had hives on body. She took him to ER. and was given Rx of steroids and BENADRYL. Is a little better today. But still has hives. Appt sch to see Dr 6/7/12 at 1 pm.

VAERS ID:456988 (history)  Vaccinated:2012-06-07
Age:11.0  Onset:2012-06-07, Days after vaccination: 0
Gender:Female  Submitted:2012-06-07, Days after onset: 0
Location:Pennsylvania  Entered:2012-06-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1495AA2IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: NAUSEA AND LIGHTHEADEDNESS RESOLVED IN 20 MINUTES VS BP90/50, HR64, RR20 RESTED AND H2O GIVEN.

VAERS ID:456999 (history)  Vaccinated:2012-06-05
Age:11.0  Onset:2012-06-06, Days after vaccination: 1
Gender:Male  Submitted:2012-06-07, Days after onset: 1
Location:California  Entered:2012-06-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0101AE1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4052AD0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local large (7 in x 5.5 in) local erythema, warmth, tense swelling of arm where injections given. Systemic headache.

VAERS ID:457010 (history)  Vaccinated:2012-06-05
Age:11.0  Onset:2012-06-06, Days after vaccination: 1
Gender:Male  Submitted:2012-06-07, Days after onset: 1
Location:Kansas  Entered:2012-06-07
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4255AA0IMUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B079CA0IMLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Injection site erythema, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Redness, sore, mild fever; redness in left arm (upper) deltoid, due to Tdap.

VAERS ID:457118 (history)  Vaccinated:2012-06-06
Age:11.0  Onset:2012-06-07, Days after vaccination: 1
Gender:Male  Submitted:2012-06-11, Days after onset: 4
Location:North Carolina  Entered:2012-06-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Fever, H/A, S/A, pain in feet, dizzy, pt. slept 16 hours symptoms reported verbally by mother over phone 6-7-12 recommended office visit to be seen by doctor pt. refused care, follow-up call 6-8-12 pt. still refused care mom to monitor symptoms. Follow up call 6-11-12 pt. better.

VAERS ID:457139 (history)  Vaccinated:2012-06-01
Age:11.0  Onset:2012-06-03, Days after vaccination: 2
Gender:Female  Submitted:2012-06-04, Days after onset: 1
Location:Pennsylvania  Entered:2012-06-11, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM110650IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC526074AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Vaccination site erythema, Vaccination site induration
SMQs:
Write-up: Large area of erythema & induration both vaccine sites ((R) & (L) arms) from vaccine site to $g 1/2 distance to elbow. No difficulty with respiration or ill feeling.

VAERS ID:457199 (history)  Vaccinated:2012-06-07
Age:11.0  Onset:2012-06-07, Days after vaccination: 0
Gender:Male  Submitted:2012-06-08, Days after onset: 1
Location:North Carolina  Entered:2012-06-11, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AA0IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC3947BA5IMUN
Administered by: Private     Purchased by: Private
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Approximately 2 hrs after immunization, pt began with itching of his neck.

VAERS ID:457207 (history)  Vaccinated:2012-05-29
Age:11.0  Onset:2012-05-29, Days after vaccination: 0
Gender:Female  Submitted:2012-05-29, Days after onset: 0
Location:South Carolina  Entered:2012-06-11, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: OMNICEF; BACTRIM; PCN; Corn; Rice; Tomatoes; Eggs
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1359AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4020AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3561CA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Mother called 225 pm. States child has rash. Called and left message (urgent for mom to bring child to office at 228/pm. ? Allergy to vaccine. Called mom 330/pm. Stated child broke out in hives. Mother gave BENADRYL. VIS sheets were given prior to vaccine for reading. Asked mother if allergic to yeast. Mom said yes. Mom to continue BENADRYL over next 24 hours. See sooner if worsens per nurse in am if needed 5/30/12.

VAERS ID:457212 (history)  Vaccinated:2012-05-29
Age:11.0  Onset:2012-05-29, Days after vaccination: 0
Gender:Female  Submitted:2012-06-05, Days after onset: 7
Location:California  Entered:2012-06-11, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Peanut Allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1359AA1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Dry mouth, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad)
Write-up: 510 pm dizzy after vaccine was given, arm felt like its asleep, dry mouth water was given BP taken at 5:30 much improved.

VAERS ID:457218 (history)  Vaccinated:2012-06-04
Age:11.0  Onset:2012-06-05, Days after vaccination: 1
Gender:Male  Submitted:2012-06-07, Days after onset: 2
Location:North Dakota  Entered:2012-06-11, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data: Not applicable
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AB0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4136AA IMLA
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)
Write-up: Pt given Tdap 6-4-12 & mom called 6-7-12 with c/o upper (L) arm very red & swelling & now redness spreading downward. Pt came in to have arm looked at by Dr..

VAERS ID:457243 (history)  Vaccinated:2012-06-01
Age:11.0  Onset:2012-06-10, Days after vaccination: 9
Gender:Female  Submitted:2012-06-12, Days after onset: 2
Location:Pennsylvania  Entered:2012-06-12
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: Chronic ITP
Diagnostic Lab Data: CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B077BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Contusion, Full blood count, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)
Write-up: Diffuse Petechiae- feet, hands, arms, chest, and upper back. Several light bruises on extremities.

VAERS ID:457249 (history)  Vaccinated:2012-05-18
Age:11.0  Onset:2012-05-19, Days after vaccination: 1
Gender:Male  Submitted:2012-06-12, Days after onset: 24
Location:Washington  Entered:2012-06-12
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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEUR 0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS 0IMRA
Administered by: Unknown     Purchased by: Private
Symptoms: Incorrect drug dosage form administered, No adverse event
SMQs:
Write-up: No symptoms developed. We realized that patient was vaccinated incorrectly. Vaccine was diluted with Sterile diluent instead of enclosed diluent.

VAERS ID:457310 (history)  Vaccinated:2012-06-12
Age:11.0  Onset:2012-06-12, Days after vaccination: 0
Gender:Female  Submitted:2012-06-12, Days after onset: 0
Location:Ohio  Entered:2012-06-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV2: HPV (CERVARIX)GLAXOSMITHKLINE BIOLOGICALSAHPVA113AA2UNLA
Administered by: Private     Purchased by: Public
Symptoms: Altered state of consciousness, Dizziness, Fall
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Triaged pt. (took vitals) then administered CERVARIX to (L) arm. Pt. was sitting at the time of shot. Pt. indicated her fear of needles so I instructed her to look away and stay seated. Once given I proceeded to fill out physical form. Pt. got dizzy and fell over about a minute after given. Vitals were taken and pt. was released once vitals were normal and Dr. released. Pt. did not fully pass out. Got dizzy and fell down.

VAERS ID:457376 (history)  Vaccinated:2012-02-20
Age:11.0  Onset:2012-02-21, Days after vaccination: 1
Gender:Female  Submitted:2012-06-13, Days after onset: 112
Location:Washington  Entered:2012-06-13
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: Allergic rhinitis, asthma
Diagnostic Lab Data: As in Box 7
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.M0840AA1UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Angioedema, Aspartate aminotransferase increased, Bilirubin urine, Blood urine present, Culture throat positive, Eye swelling, Eyelid oedema, Periorbital oedema, Post streptococcal glomerulonephritis, Protein urine present, Rash, Rash erythematous, Rash maculo-papular, Streptococcus test positive
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Systemic lupus erythematosus (broad), Oropharyngeal allergic conditions (narrow), Periorbital and eyelid disorders (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Proteinuria (narrow), Tubulointerstitial diseases (broad)
Write-up: Puffy eyes developed overnight the night after vaccine administered. Benadryl no help. Continued to wake with puffy eyes for a few mornings. 2/27/12 seen by MD for a fine erythematous maculopapular rash which developed on extremities and trunk. Rash faded but thereafter would recur with exertion. Eye swelling became more prominent even into the evening. Seen by MD again 3/2/12 for periorbital edema. Urine dip was neg except for trace blood. Suspected post-streptococcal glomerulonephritis. Throat culture was positive for group A strep and patient was treated with Amoxicillin starting on 3/4/12. Other bloodwork was negative at the time except for AST 62 and ALT 77. Eye swelling persisited and was referred to allergist. Her angioedema was thought to be post-viral. A urine dip showed trace blood, trace protein and 2+ bilirubin. Treated with 9 day steroid taper, after which angioedema never recurred. On 3/7/12, AST 216, ALT 260. By 3/16/12, AST 24, ALT 66. No further blood in urine. As of 5/8/12, rash continues to recurr with exercise, though less frequently now.

VAERS ID:457379 (history)  Vaccinated:2012-06-08
Age:11.0  Onset:2012-06-09, Days after vaccination: 1
Gender:Male  Submitted:2012-06-13, Days after onset: 4
Location:North Carolina  Entered:2012-06-13
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: Allergies and Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3999AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B072FA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.10037 SCRA
Administered by: Unknown     Purchased by: Public
Symptoms: Erythema, Local reaction, Oedema, Pain, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: Redness, warm to touch, edema, soreness dx with localized reaction. Treatment Ibuprofen 600 mg TID x 7 days, ice pack.

VAERS ID:457390 (history)  Vaccinated:2012-06-11
Age:11.0  Onset:2012-06-12, Days after vaccination: 1
Gender:Male  Submitted:2012-06-12, Days after onset: 0
Location:Texas  Entered:2012-06-13, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting; Rash to body; (L) ear ache
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4075BA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA0UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness around area in the (R) arm deltoid.

VAERS ID:457396 (history)  Vaccinated:2012-06-13
Age:11.0  Onset:2012-06-13, Days after vaccination: 0
Gender:Male  Submitted:2012-06-13, Days after onset: 0
Location:New Jersey  Entered:2012-06-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AB0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4009AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dyskinesia, Hyperhidrosis, Loss of consciousness, Musculoskeletal stiffness, Pallor, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad)
Write-up: After receiving vaccines - mom & patient left office. Per mom, when in car patient passed out/became stiff and questionable movements of arms & legs. Also incontinent of urine. Walked back in office with mom. Pale & diaphoretic. B/P 88/54, P 100. Laid down. Tolerated sips PEDIALYTE. After 20 mins B/P 98/56, P 88. Alert & oriented throughout. Requesting to go to ER for eval.

VAERS ID:457438 (history)  Vaccinated:2012-06-11
Age:11.0  Onset:2012-06-13, Days after vaccination: 2
Gender:Male  Submitted:2012-06-14, Days after onset: 1
Location:Colorado  Entered:2012-06-14
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: Exam only
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1441AA1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA101320IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B075BA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swollen red left arm. Concern for cellulitis.

VAERS ID:457460 (history)  Vaccinated:2012-06-11
Age:11.0  Onset:2012-06-12, Days after vaccination: 1
Gender:Male  Submitted:2012-06-12, Days after onset: 0
Location:California  Entered:2012-06-14, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0690AA UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURV4022AA UNLA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURC3921AA UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Injection site pain, Muscle tightness
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Red, spot, tightness in muscle, pain on site of injection.

VAERS ID:457461 (history)  Vaccinated:2012-06-12
Age:11.0  Onset:2012-06-13, Days after vaccination: 1
Gender:Male  Submitted:2012-06-14, Days after onset: 1
Location:Virginia  Entered:2012-06-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA101320UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B080AA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Inflammation, Oedema peripheral, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 24 hours after receiving MENVEO vaccine, left arm began to turn red and inflamed. 48 hours, even after BENADRYL and cool compress, area was larger, hot to touch, red and swollen.

VAERS ID:457492 (history)  Vaccinated:2012-05-31
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2012-06-01
Location:Washington  Entered:2012-06-15, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH9172423IMLA
Administered by: Private     Purchased by: Public
Symptoms: Drug administered to patient of inappropriate age
SMQs:
Write-up: None.

VAERS ID:457554 (history)  Vaccinated:2012-06-15
Age:11.0  Onset:2012-06-15, Days after vaccination: 0
Gender:Male  Submitted:2012-06-15, Days after onset: 0
Location:Michigan  Entered:2012-06-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4025AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B070BA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient became faint, and fainted in waiting room.

VAERS ID:457622 (history)  Vaccinated:2012-06-14
Age:11.0  Onset:2012-06-15, Days after vaccination: 1
Gender:Female  Submitted:2012-06-18, Days after onset: 3
Location:Missouri  Entered:2012-06-18
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: Hx febrile seizure
Diagnostic Lab Data: Exam only
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B149CA3IMLL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB5911AA0IMRL
HIBV: HIB (PEDVAXHIB)MERCK & CO. INC.1823AA2IMRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (Lt) upper thigh with edema, induration & warmth day following routine imm. Afebrile. Seen in office x 2 days after imm. given. TX PRN with TYLENOL or MOTRIN; gave BENADRYL.

VAERS ID:457626 (history)  Vaccinated:2012-06-15
Age:11.0  Onset:2012-06-16, Days after vaccination: 1
Gender:Male  Submitted:2012-06-18, Days after onset: 2
Location:Pennsylvania  Entered:2012-06-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM11032 IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Erythema, Local swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Child reported to mom, area was itchy, red, and swollen. Mom gave Benadryl Medication, and applied ice to area. Symptoms lasted for 2 days.

VAERS ID:457725 (history)  Vaccinated:2012-06-11
Age:11.0  Onset:2012-06-14, Days after vaccination: 3
Gender:Male  Submitted:2012-06-14, Days after onset: 0
Location:Ohio  Entered:2012-06-19, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1647AA1IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B067BA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Contusion, Induration, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen, bruised, hard area on (L) arm.

VAERS ID:457753 (history)  Vaccinated:2012-06-18
Age:11.0  Onset:2012-06-19, Days after vaccination: 1
Gender:Female  Submitted:2012-06-20, Days after onset: 1
Location:Kentucky  Entered:2012-06-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AA IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4325AB IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0315AE1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: - (L) arm site is red with induration (3 in width x 4 in ht). - Painful to touch. - Warm to touch. - Tx with ibuprofen for pain, BENADRYL et ice (cool) compress.

VAERS ID:457807 (history)  Vaccinated:2010-12-13
Age:11.0  Onset:2012-06-17, Days after vaccination: 552
Gender:Female  Submitted:2012-06-20, Days after onset: 3
Location:Wyoming  Entered:2012-06-20
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:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3476AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0896Z1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Herpes zoster
SMQs:
Write-up: Patient diagnosed with shingles at dr''s office 6-20-12 started on VALTREX. No previous dx of chickenpox. Did receive two doses of Varicella vaccine, one at 12 mo of age and one at 11 years.

VAERS ID:457853 (history)  Vaccinated:2012-06-13
Age:11.0  Onset:2012-06-14, Days after vaccination: 1
Gender:Male  Submitted:2012-06-15, Days after onset: 1
Location:Pennsylvania  Entered:2012-06-21, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: BACTRIM; CECLOR
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB515AA0UNLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1745AA0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4256AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4009CA5UNLA
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)
Write-up: Swelling, redness, tenderness & itching on (R) deltoid.

VAERS ID:457858 (history)  Vaccinated:2012-06-13
Age:11.0  Onset:2012-06-13, Days after vaccination: 0
Gender:Male  Submitted:2012-06-21, Days after onset: 8
Location:North Carolina  Entered:2012-06-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: well
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM10130 IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B070BA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0080AE1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site urticaria, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: LESS THAN FIVE MINUTES AFTER VARIVAX WAS ADMINISTERED BEGAN TO ITCH; LOCALIZED HIVE AT SITE. NO RESP SX OBSERVED FOR FIFTEEN MORE MIN. AND GIVEN BY MOUTH ANTIHISTAMINE.

VAERS ID:457885 (history)  Vaccinated:2012-06-19
Age:11.0  Onset:2012-06-20, Days after vaccination: 1
Gender:Female  Submitted:2012-06-21, Days after onset: 1
Location:Idaho  Entered:2012-06-22, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sore throat; cough
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: ID12012
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1288AA1IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4098AB0IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1878AA1SCUN
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Redness, tenderness, hot to touch.

VAERS ID:457927 (history)  Vaccinated:2012-06-14
Age:11.0  Onset:2012-06-19, Days after vaccination: 5
Gender:Male  Submitted:2012-06-22, Days after onset: 3
Location:Louisiana  Entered:2012-06-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1696AA IMLA
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURU4021AE IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B075BA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Injection site urticaria, Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: HIVES ON HIS LEGS, ABDOMEN, AND ON RT DELTOID WHERE VACCINE WAS ADMINISTERED. HAS REDNESS & SWELLING ON RT ARM.

VAERS ID:457934 (history)  Vaccinated:2012-06-19
Age:11.0  Onset:2012-06-21, Days after vaccination: 2
Gender:Male  Submitted:2012-06-22, Days after onset: 1
Location:California  Entered:2012-06-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sinusitis
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4081AA0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Feeling hot, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Per mom warmth and swelling. 2 days after MENACTRA vaccination. Denies fever. Today decreased swelling and erythema.

VAERS ID:457962 (history)  Vaccinated:2012-06-20
Age:11.0  Onset:2012-06-21, Days after vaccination: 1
Gender:Female  Submitted:2012-06-22, Days after onset: 1
Location:Oklahoma  Entered:2012-06-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB550BA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM101330IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B074CA0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Abdominal pain upper, Back pain, Body temperature increased, Chills, Nausea, Pain in extremity, Urinary tract infection
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Patient woke up at 3:00 am on 6/21/12 complaining of (Rt) arm pain, back pain, stomach pain, nausea, chills. Temp at 100.5 F. Reported by father at 1:15 - 6/21/12. Denied swelling, redness or rash at injection site. Advise to see private physician, seen at 3:30 pm at dr''s office with redness, swelling at (Rt) arm, shoulder. Lab indicated UTI. Tx with ATB, PHENERGAN. Pt doing better as of 6-22-12 at 10:00 am.

VAERS ID:458031 (history)  Vaccinated:2012-06-22
Age:11.0  Onset:2012-06-23, Days after vaccination: 1
Gender:Male  Submitted:2012-06-25, Days after onset: 2
Location:California  Entered:2012-06-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1495AA0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM10134A0UNRA
Administered by: Private     Purchased by: Other
Symptoms: Blister, Erythema, Swelling
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Swelling, redness with large blisters.

VAERS ID:458111 (history)  Vaccinated:2012-06-13
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Kentucky  Entered:2012-06-26
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: Penicillin allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0271AE0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4136AA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Dyspnoea, Injection site erythema, Injection site pain, Injection site swelling, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Within hours of vaccine he developed pain at site, swelling at site, erythema at site and chest pain. Dyspnea. His symptoms worsened 24 hours post vaccination required antibiotics and steroids. L arm swelling.

VAERS ID:458120 (history)  Vaccinated:2012-06-10
Age:11.0  Onset:2012-06-20, Days after vaccination: 10
Gender:Female  Submitted:2012-06-20, Days after onset: 0
Location:Pennsylvania  Entered:2012-06-26, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0629AE1SYRLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Hit her (L) arm on a wall the day after vaccine. Now c/o pain, with upward movement. Red/warm 4" around injection site.

VAERS ID:458167 (history)  Vaccinated:2012-06-18
Age:11.0  Onset:2012-06-18, Days after vaccination: 0
Gender:Male  Submitted:2012-06-21, Days after onset: 3
Location:Arizona  Entered:2012-06-26, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Bipolar Disorder
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1524AA0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM101330UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling (L) deltoid. 6/18/12 at night.

VAERS ID:458248 (history)  Vaccinated:2012-06-20
Age:11.0  Onset:2012-06-21, Days after vaccination: 1
Gender:Male  Submitted:2012-06-27, Days after onset: 6
Location:Mississippi  Entered:2012-06-27
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: na
CDC Split Type: MS12006
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1697AA0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1696AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3957DA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1061AA1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site erythema, Injection site swelling
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: States woke up next am with small red patch to right arm. Then woke up this am (06/22/2012) with red ring around patch. Square red swollen are approximately 1 inch x 1 inch with red ring approximately 3 inch x 3 inch noted to right deltoid. To be seen by PMD today (06/22/2012).

VAERS ID:458256 (history)  Vaccinated:2012-06-26
Age:11.0  Onset:2012-06-26, Days after vaccination: 0
Gender:Male  Submitted:2012-06-27, Days after onset: 1
Location:New York  Entered:2012-06-27
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: Sickle cell disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4100AA0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1490Z0IMLA
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)
Write-up: L deltoid swelling and erythema.

VAERS ID:458262 (history)  Vaccinated:2012-06-27
Age:11.0  Onset:2012-06-27, Days after vaccination: 0
Gender:Female  Submitted:2012-06-27, Days after onset: 0
Location:Arizona  Entered:2012-06-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4043AD IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B072EA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Broke out with hive starting on chest and spread all over body.

VAERS ID:458374 (history)  Vaccinated:2012-02-20
Age:11.0  Onset:2012-02-20, Days after vaccination: 0
Gender:Male  Submitted:2012-06-28, Days after onset: 128
Location:Texas  Entered:2012-06-28
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: TX120016PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH506AA  RA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1141AA  LA
Administered by: Private     Purchased by: Public
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: As per mom patient started with shortness of breath in the evening of day vaccines administer.

VAERS ID:458397 (history)  Vaccinated:2010-06-02
Age:11.0  Onset:2012-06-05, Days after vaccination: 734
Gender:Female  Submitted:2012-06-18, Days after onset: 13
Location:Colorado  Entered:2012-06-28, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Ovarian torsion
SMQs:
Write-up: Ovarian torsion after receiving HPV.

VAERS ID:458441 (history)  Vaccinated:2012-06-27
Age:11.0  Onset:2012-06-28, Days after vaccination: 1
Gender:Male  Submitted:2012-06-29, Days after onset: 1
Location:Ohio  Entered:2012-06-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Anxiety; Depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4329AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Dysarthria, Hypoaesthesia, Paraesthesia, VIIth nerve paralysis
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Write-up: Received ADACEL and MENACTRA on Wednesday 6/27/12. Thursday afternoon c/o numbness & tingling ie Lt hand, arm & face. Left side of face droopy. Woke this AM 6/29 c/o Rt side numbness & tingling. Speech slurred as with dental work. No fever, visual change, intermittent & presenting symptoms as of 11:30.

VAERS ID:458490 (history)  Vaccinated:2012-04-16
Age:11.0  Onset:2012-04-17, Days after vaccination: 1
Gender:Female  Submitted:2012-06-29, Days after onset: 73
Location:Texas  Entered:2012-06-29
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: Dyslexia, seasonal allergies, speech disorder
Diagnostic Lab Data: None
CDC Split Type: TX120026PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM10133 IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site pain, Local swelling
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Child with localized swelling, tenderness at site of injection.

VAERS ID:458504 (history)  Vaccinated:2012-06-29
Age:11.0  Onset:2012-06-29, Days after vaccination: 0
Gender:Male  Submitted:2012-06-29, Days after onset: 0
Location:Hawaii  Entered:2012-06-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illnesses at the time of vaccine administration.
Preexisting Conditions: Shellfish allergy.
Diagnostic Lab Data: Patient was taken to the ER by paramedics. Patient was stable upon leaving the clinic.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUH453AB IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4021AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B080AA IMRA
Administered by: Military     Purchased by: Military
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotension, Nausea, Pallor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Light headedness, nausea, pallor, dyspnea, bradycardia, and hypotension.

VAERS ID:458610 (history)  Vaccinated:2012-06-18
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2012-06-22
Location:Washington  Entered:2012-07-03, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4074BA SCRA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Local swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Localized swelling - small. Redness - small.

VAERS ID:458614 (history)  Vaccinated:2012-07-03
Age:11.0  Onset:2012-07-03, Days after vaccination: 0
Gender:Female  Submitted:2012-07-03, Days after onset: 0
Location:California  Entered:2012-07-03
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: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1745AA0IMLL
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURUH066AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3922AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 9:30 7/3/12 Patient was told to lay down after HPV. Patient was sitting down and fainted. Within minutes patient was alert. Dr was called. B/P WNL.

VAERS ID:458631 (history)  Vaccinated:2012-05-22
Age:11.0  Onset:2012-05-22, Days after vaccination: 0
Gender:Female  Submitted:2012-07-03, Days after onset: 42
Location:Texas  Entered:2012-07-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: TX120034PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1495AA IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSX10133 IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3941AA IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Vaccination site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness, swelling at site of vaccination.

VAERS ID:458676 (history)  Vaccinated:2011-04-06
Age:11.0  Onset:2011-04-08, Days after vaccination: 2
Gender:Female  Submitted:2012-07-03, Days after onset: 452
Location:Virginia  Entered:2012-07-05, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1207USA00088
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR 0UNUN
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Dyspnoea, Hypersensitivity, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)
Write-up: Information has been received from a licensed practical nurse concerning a 11 year old female patient with no pertinent medical history and no drug allergies who on 06-APR-2011 was vaccinated with the first dose of GARDASIL (lot number, dose and site not reported). On the same date the patient also received the first dose of MENACTRA and Tdap (manufacturer unspecified). On 08-APR-2011, the patient experienced a systemic reaction with full body swelling and some difficulty breathing. The patient was taken to the emergency room of an unknown hospital and received steroids as treatment. Subsequently on an unspecified date, the patient recovered from systemic reaction, full body swelling and some difficulty breathing. Systemic reaction, full body swelling and some difficulty breathing was considered as other important medical event by the reporter. Additional information has been requested.

VAERS ID:458741 (history)  Vaccinated:2012-06-25
Age:11.0  Onset:2012-06-26, Days after vaccination: 1
Gender:Male  Submitted:2012-06-27, Days after onset: 1
Location:New York  Entered:2012-07-05, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Type II; Meatal stenosis; Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSA110710IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Area around injection site red, swollen, hot and hard. Patient complaining of itching.

VAERS ID:458770 (history)  Vaccinated:2012-07-06
Age:11.0  Onset:2012-07-06, Days after vaccination: 0
Gender:Female  Submitted:2012-07-06, Days after onset: 0
Location:West Virginia  Entered:2012-07-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)SANOFI PASTEURC4136BA IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3906AB IMLA
Administered by: Private     Purchased by: Other
Symptoms: Dizziness, Gaze palsy, Loss of consciousness, Pallor, Skin discolouration, Tongue disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Face got very pale, eyes rolled back and she began tongue rolling and passed out for approximately 10 seconds. Skin around mouth turned green and she remained pale for approx 10 min. She was light-headed for approx 30 min and came home (20 min drive) and went to sleep for about an hour.

VAERS ID:458773 (history)  Vaccinated:2011-12-21
Age:11.0  Onset:2011-12-21, Days after vaccination: 0
Gender:Male  Submitted:2012-07-06, Days after onset: 197
Location:West Virginia  Entered:2012-07-06
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: lazy eye
Diagnostic Lab Data: EEG - negative for seizure activity EKG - showed slightly prolonged QT interval, went to follow up with cardiologist and advised his cardiac status was WNL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4246AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4008AA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Electrocardiogram abnormal, Electroencephalogram normal, Immediate post-injection reaction, Loss of consciousness, Seizure like phenomena
SMQs:, Torsade de pointes/QT prolongation (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: Immediately after MCV injection, patient passed out and had seizure-like posturing for approximately 5 minutes. He was able to sit up but immediately passed out again. After 25 minutes, he was not able to return to "normal" and an ambulance was called.

VAERS ID:458782 (history)  Vaccinated:2012-07-05
Age:11.0  Onset:2012-07-05, Days after vaccination: 0
Gender:Male  Submitted:2012-07-06, Days after onset: 1
Location:North Carolina  Entered:2012-07-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO)NOVARTIS VACCINES AND DIAGNOSTICSM110500IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt''s left deltoid got swollen, red, and firm and hot to touch; got worse overnight. Pt given Benadryl in office for this.

VAERS ID:458784 (history)  Vaccinated:2012-07-03
Age:11.0  Onset:2012-07-03, Days after vaccination: 0
Gender:Male  Submitted:2012-07-06, Days after onset: 3
Location:Virginia  Entered:2012-07-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0754AE IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4258AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BO77BA IMLA
Administered by: Military     Purchased by: Military
Symptoms: Asthenia, Dizziness, Throat tightness, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Weakness, dizziness, pressure on throat, blurred vision.

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