MedAlerts Home
  Read the MedAlerts Blog Subscribe to the MedAlerts Blog 

Found 505988 cases in entire database

Case Details (Sorted by Age)

This is page 2479 out of 5060

Result pages: prev   2380 2381 2382 2383 2384 2385 2386 2387 2388 2389 2390 2391 2392 2393 2394 2395 2396 2397 2398 2399 2400 2401 2402 2403 2404 2405 2406 2407 2408 2409 2410 2411 2412 2413 2414 2415 2416 2417 2418 2419 2420 2421 2422 2423 2424 2425 2426 2427 2428 2429 2430 2431 2432 2433 2434 2435 2436 2437 2438 2439 2440 2441 2442 2443 2444 2445 2446 2447 2448 2449 2450 2451 2452 2453 2454 2455 2456 2457 2458 2459 2460 2461 2462 2463 2464 2465 2466 2467 2468 2469 2470 2471 2472 2473 2474 2475 2476 2477 2478 2479 2480 2481 2482 2483 2484 2485 2486 2487 2488 2489 2490 2491 2492 2493 2494 2495 2496 2497 2498 2499 2500 2501 2502 2503 2504 2505 2506 2507 2508 2509 2510 2511 2512 2513 2514 2515 2516 2517 2518 2519 2520 2521 2522 2523 2524 2525 2526 2527 2528 2529 2530 2531 2532 2533 2534 2535 2536 2537 2538 2539 2540 2541 2542 2543 2544 2545 2546 2547 2548 2549 2550 2551 2552 2553 2554 2555 2556 2557 2558 2559 2560 2561 2562 2563 2564 2565 2566 2567 2568 2569 2570 2571 2572 2573 2574 2575 2576 2577 2578   next


VAERS ID:379731 (history)  Vaccinated:2010-02-03
Age:11.0  Onset:2010-02-04, Days after vaccination: 1
Gender:Male  Submitted:2010-02-05, Days after onset: 1
Location:Minnesota  Entered:2010-02-08, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3158AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1086Y1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 2/3/10 ADACEL and VARIVAX administered. 2/4/10 Red and hardness to arm distal to ADACEL administration site. On 2/6/10 - 4 to 6cm size redness and warmth distal to administration site. Site no problem. 2/4/10 2cm redness and itchy around varicella administration site continued 2/5/10. Treatment: BENADRYL 2/5/10.

VAERS ID:379791 (history)  Vaccinated:2010-02-09
Age:11.0  Onset:2010-02-09, Days after vaccination: 0
Gender:Female  Submitted:2010-02-09, Days after onset: 0
Location:Georgia  Entered:2010-02-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1099Y0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1161Y1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Body temperature increased, Dizziness, Flushing, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad)
Write-up: Feeling dizzy, nausea, vomiting, flushing BP 100/60 pulse 114 Temp 97.9 resp. 18 monitored and sent home.

VAERS ID:379831 (history)  Vaccinated:2010-02-02
Age:11.0  Onset:2010-02-05, Days after vaccination: 3
Gender:Female  Submitted:2010-02-09, Days after onset: 4
Location:Nebraska  Entered:2010-02-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN3: INFLUENZA (SEASONAL) (FLUMIST)MEDIMMUNE VACCINES, INC.500735P1IN 
HEPA: HEP A (VAQTA)MERCK & CO. INC.095041UNRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B037AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site discolouration, 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: L arm 2 x 2 cm pale, pink, purple @ site swelling painful

VAERS ID:379988 (history)  Vaccinated:2010-02-05
Age:11.0  Onset:2010-02-07, Days after vaccination: 2
Gender:Female  Submitted:2010-02-09, Days after onset: 2
Location:Missouri  Entered:2010-02-10, Days after submission: 1
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: Insulin resistant
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB365CA1IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1378Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU30B0AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B093DA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1202Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Induration, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: (R) tricep area with 6.5 x 4 cm erythema and mild swelling - (L) tricep area with 13 x 9 outer erythema/swelling and central 4.5 x 3cm red/indurated area, tx with KEFLEX.

VAERS ID:380011 (history)  Vaccinated:2010-02-08
Age:11.0  Onset:2010-02-08, Days after vaccination: 0
Gender:Female  Submitted:2010-02-10, Days after onset: 2
Location:Oregon  Entered:2010-02-10
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
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB311BA1UNRA
Administered by: Private     Purchased by: Private
Symptoms: Dyspnoea, Injected limb mobility decreased, Injection site pain, Injection site swelling, Insomnia, No reaction on previous exposure to drug
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: See attached.

VAERS ID:380072 (history)  Vaccinated:0000-00-00
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2010-02-10
Location:New Hampshire  Entered:2010-02-11, 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:
Preexisting Conditions:
Diagnostic Lab Data: IgG varicella = 300; Is this a vaccine failure?
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Blood immunoglobulin G increased, Herpes zoster, Varicella post vaccine
SMQs:, Hypersensitivity (broad)
Write-up: Pt had 2 doses of VARIVAX. 2wks after mother developed Shingles. She developed apparent post vaccination varicella. Titre at time of outbreak = 300.

VAERS ID:380174 (history)  Vaccinated:2010-01-18
Age:11.0  Onset:2010-01-21, Days after vaccination: 3
Gender:Female  Submitted:2010-02-10, Days after onset: 20
Location:Virginia  Entered:2010-02-12, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical history included macrohydrocephaly, and "GI issue"; no known allergies.
Diagnostic Lab Data: CT scan and blood work: normal
CDC Split Type: 201001001
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3069AA0IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURC32570IMUN
Administered by: Private     Purchased by: Private
Symptoms: Blood test normal, Computerised tomogram normal, Diarrhoea, Headache, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Initial case received on 05 February 2010 from a health care professional, who was also the patient''s mother. An 11-year-old female patient received a first intramuscular injection of ADACEL (sanofi pasteur ltd lot number C3257, sanofi pasteur inc lot number U3042AA) and a first intramuscular injection of MENACTRA (lot number U3069AA) on 18 January 2010. The patient had a history of macrohydrocephaly and "GI issue", and was taking ZANTAC and MIRALAX concomitantly. On 21 January 2010, three days post vaccination, the patient developed severe diarrhea which lasted for 6 days. On 26 January 2010 she developed severe headaches which were still ongoing. She also complained of leg weakness, which lasted approximately 48 hours. A CT scan and blood work were performed, and results were reported as normal. The patient was seen by her physician; at the time of the report, the headaches had not yet resolved.

VAERS ID:380501 (history)  Vaccinated:2010-01-25
Age:11.0  Onset:2010-01-25, Days after vaccination: 0
Gender:Female  Submitted:2010-01-27, Days after onset: 2
Location:Virginia  Entered:2010-02-12, Days after submission: 16
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: No known allergies. No medical history reported. No illness was reported at the time of vaccination.
Diagnostic Lab Data:
CDC Split Type: 201000693
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR03334AA UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling cold, Immediate post-injection reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow)
Write-up: Initial case received 25 January 2010 from a healthcare professional. An 11 year old female patient received a right arm injection of MENACTRA (lot number 03334AA) on 25 January 2010 and experienced immediately a cold sensation down the arm and tingling of fingers. The patient had no reported illness at the time of the vaccination. She had no known allergies and no medical history was reported. Her concomitant medication included Singulair and Veramyst for unspecified indications. It was unknown if the patient recovered from the adverse events. Documents held by sender: none

VAERS ID:380392 (history)  Vaccinated:2010-01-28
Age:11.0  Onset:2010-01-29, Days after vaccination: 1
Gender:Male  Submitted:2010-02-03, Days after onset: 5
Location:California  Entered:2010-02-15, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic Rhinitis
Preexisting Conditions: Allergic Rhinitis, Asthmatic
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102142P10IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3044AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF544AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: 99.4 fever erythematous rash on left arm and face. Tx given Benadryl 25mg TID.

VAERS ID:380430 (history)  Vaccinated:2010-02-10
Age:11.0  Onset:2010-02-11, Days after vaccination: 1
Gender:Male  Submitted:2010-02-15, Days after onset: 4
Location:Texas  Entered:2010-02-15
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: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3274BA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3044AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B037AA0IMRA
Administered by: Unknown     Purchased by: Public
Symptoms: Injection site erythema, Injection site inflammation, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 3 inch by 4 in red inflamed tender right deltoid, no fever. Apply cool compresses, take Motrin for pain and Benadryl for redness and inflammation.

VAERS ID:380495 (history)  Vaccinated:2010-02-10
Age:11.0  Onset:2010-02-11, Days after vaccination: 1
Gender:Male  Submitted:2010-02-16, Days after onset: 5
Location:Alabama  Entered:2010-02-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None acute
Preexisting Conditions: asthma; obesity; Asperger''s disorder; Eosinophilic esophagitis
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3394AA3IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS1397Y0IMLL
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3056AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1121Y1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 10 x 10 cm lg red warm local rxn to varicella booster R arm.

VAERS ID:380514 (history)  Vaccinated:2010-02-15
Age:11.0  Onset:2010-02-15, Days after vaccination: 0
Gender:Female  Submitted:2010-02-16, Days after onset: 1
Location:Michigan  Entered:2010-02-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP016AA1IMLA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3378AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0847Y1SCRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site pruritus, Injection site reaction, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Localized reaction to site 8 x 10 cm erythema, slightly raised, warm to touch and slightly itching.

VAERS ID:380516 (history)  Vaccinated:2010-01-22
Age:11.0  Onset:2010-01-24, Days after vaccination: 2
Gender:Female  Submitted:2010-02-16, Days after onset: 23
Location:Texas  Entered:2010-02-16
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no, none
Preexisting Conditions: allergic to molds and mint, otherwise healthy
Diagnostic Lab Data: none performed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP053AA IJLA
Administered by: Other     Purchased by: Other
Symptoms: Asthma, Bronchitis, Cough, Decreased activity, Facial pain, Fatigue, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Write-up: Had a sore arm on that weekend then on that Sunday night had a deep croupy cough went to the pediatric center and saw doctor was diagnosed with bronchitis was prescribed antibiotics and given cough medication then cough turned asthmatic and was started on albuterol breathing treatments and steroids. its been over 21days and 3 doctor visits and she is still ill she cannot participate in PE at school and is getting PRN breathing treatments there also. She is now complaining of pain on her legs arms and face and is mainly fatigue and tired .

VAERS ID:380518 (history)  Vaccinated:2010-02-16
Age:11.0  Onset:2010-02-16, Days after vaccination: 0
Gender:Female  Submitted:2010-02-16, Days after onset: 0
Location:California  Entered:2010-02-16
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2827CA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2865AA IMRA
Administered by: Public     Purchased by: Other
Symptoms: Fall, Head injury, Immediate post-injection reaction, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)
Write-up: Pt fainted after 1minute of receiving menactra and Tdap and hit the wall with her head, fell to the floor and started to shake for about 3seconds and woke up and alert immediatly. Mom grabed her and Pt soon recovered with no residual symptoms.

VAERS ID:380767 (history)  Vaccinated:2010-02-16
Age:11.0  Onset:2010-02-17, Days after vaccination: 1
Gender:Male  Submitted:2010-02-18, Days after onset: 1
Location:Montana  Entered:2010-02-18
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: Med allergies; Xanax; Augmentin; Cefzil; Omnicef
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1538Y UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3060AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1165Y SCLA
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: Local reaction with 4 inches x 6 inches of warm and indurated skin left triceps at site of VARIVAX.

VAERS ID:380776 (history)  Vaccinated:2010-02-15
Age:11.0  Onset:2010-02-16, Days after vaccination: 1
Gender:Female  Submitted:2010-02-19, Days after onset: 3
Location:Wisconsin  Entered:2010-02-19
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: Penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP056AA0IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3350AA1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3080AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF544AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1169Y1SCLA
Administered by: Public     Purchased by: Other
Symptoms: Fatigue, Injection site erythema, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Noticed a dime size red area around injection site. She felt tingling in her fingers as well. On 2/17/10- tingling gone but area now about twice the size (50 cent piece size). She is tired and aches all over. 2/18/2010- tired still but arm feels better, no further swelling noted per mom.

VAERS ID:380788 (history)  Vaccinated:2010-02-02
Age:11.0  Onset:2010-02-04, Days after vaccination: 2
Gender:Male  Submitted:2010-02-05, Days after onset: 1
Location:Washington  Entered:2010-02-19, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Head trauma; victim of bullying
Preexisting Conditions: Peanut and daily allergy
Diagnostic Lab Data: None known
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3020AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BC37AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1153Y1SCLA
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: Extreme swelling deltoid to elbow all vaccines 1 arm.

VAERS ID:380817 (history)  Vaccinated:2010-02-16
Age:11.0  Onset:2010-02-19, Days after vaccination: 3
Gender:Male  Submitted:2010-02-19, Days after onset: 0
Location:Alabama  Entered:2010-02-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: dysuria, candidiasis
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3238AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3027AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3098AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1113Y1UNRA
Administered by: Unknown     Purchased by: Public
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Noted redness of skin. Swelling of skin is noted. Pain of left upper arm at site of injections. Gradual increase in pain, warmth, and swelling. No fever.

VAERS ID:380835 (history)  Vaccinated:2010-01-21
Age:11.0  Onset:2010-01-22, Days after vaccination: 1
Gender:Female  Submitted:2010-02-19, Days after onset: 28
Location:California  Entered:2010-02-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Joint swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)
Write-up: 1/22 swelling on one wrist the size of a half golfball. ice 1/23, 1/27 & several more times: broke out in hives (never had hives before). tried Benadryl but it didn''t help. used ice to numb it.

VAERS ID:380906 (history)  Vaccinated:2010-02-15
Age:11.0  Onset:2010-02-15, Days after vaccination: 0
Gender:Female  Submitted:2010-02-16, Days after onset: 1
Location:Florida  Entered:2010-02-22, 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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSUF486AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1300Y1UNRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Computerised tomogram normal, Dizziness, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Pt. felt dizzy, collapsed at parking lot, hit concrete, few seconds LOC. Approximately 20-25 min after shots. Called 911-$gimmobilized-$gER-$gCT nl.

VAERS ID:380908 (history)  Vaccinated:2010-02-10
Age:11.0  Onset:2010-02-11, Days after vaccination: 1
Gender:Female  Submitted:2010-02-12, Days after onset: 1
Location:Unknown  Entered:2010-02-22, 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:
Current Illness: none per mop
Preexisting Conditions: none per mop; bee sting allergy (2002)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP051AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3047AA0IMRA
Administered by: Military     Purchased by: Military
Symptoms: Abdominal pain upper, Erythema, Headache, Injection site pruritus, Lethargy
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)
Write-up: Sx erythema (R) shoulder, lethargic, epigastric pain, frontal headache, itchy at. Txt TYLENOL OTC x2 (11 Feb 10) Benadryl x1 (11 Feb 10) cold pack x 20 min x 5 -6). 9.0 DMM X 13.5 mm.

VAERS ID:380999 (history)  Vaccinated:2010-02-16
Age:11.0  Onset:2010-02-17, Days after vaccination: 1
Gender:Male  Submitted:2010-02-22, Days after onset: 5
Location:Wisconsin  Entered:2010-02-22
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
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52BD30AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1151Y1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pruritus, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 2-17-10 awhile at school arm became red, swollen, and warm to touch. Other students were bumping into arm. Went home early (at school for 1 1/2 hrs). No elevated temperature, mother stats it looked like "bullseye". He complained of it itching. Ice applied. Stayed home from school on 2/18. 2-22-10 -Mother states his arm is better and back to school.

VAERS ID:381043 (history)  Vaccinated:2009-12-18
Age:11.0  Onset:2009-12-21, Days after vaccination: 3
Gender:Male  Submitted:2010-02-23, Days after onset: 64
Location:New Hampshire  Entered:2010-02-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient was treated on 12/16/09 for pneumonia
Preexisting Conditions: none
Diagnostic Lab Data: Patient had several blood tests and consults to rule out other conditions.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Public
Symptoms: Blood test, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Patient experienced severe right upper arm pain.

VAERS ID:381138 (history)  Vaccinated:2008-05-02
Age:11.0  Onset:2008-05-04, Days after vaccination: 2
Gender:Male  Submitted:2010-02-23, Days after onset: 660
Location:Tennessee  Entered:2010-02-23
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: allergin to penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMAR
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 0IMAR
Administered by: Private     Purchased by: Private
Symptoms: Chills, Headache, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)
Write-up: fever of 102 degrees F, shivering and chills, body aches, headache, malaise; symptoms lasted approximately 12 hours

VAERS ID:381210 (history)  Vaccinated:2010-02-19
Age:11.0  Onset:2010-02-21, Days after vaccination: 2
Gender:Male  Submitted:2010-02-23, Days after onset: 2
Location:Arizona  Entered:2010-02-24, 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: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3060NA0IJLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU2936BA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Oedema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pt''s mother reported to me that pt developed swelling in his (L) axilla (vaccines were both given in his (L) upper arm with swelling extending to the (L) pectoralis area. I saw patient on 2/23/2010 and found same tender edema of his (L) pectoral area was tender.

VAERS ID:381213 (history)  Vaccinated:2010-01-12
Age:11.0  Onset:2010-01-13, Days after vaccination: 1
Gender:Male  Submitted:2010-02-24, Days after onset: 42
Location:Pennsylvania  Entered:2010-02-24
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: oral allergy syndrome- allergies to various fresh fruits and vegetables
Diagnostic Lab Data: eeg, ekg, mri, all normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER  IJ 
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Electrocardiogram normal, Electroencephalogram normal, Fatigue, Headache, Nuclear magnetic resonance imaging normal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Dizziness, fainting 2 times, once in school 1/19, again 2/1. headache, extreme fatigue

VAERS ID:381225 (history)  Vaccinated:2009-11-17
Age:11.0  Onset:2009-11-30, Days after vaccination: 13
Gender:Male  Submitted:2010-02-24, Days after onset: 86
Location:Maine  Entered:2010-02-24
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: 30 min 72 hours EEG - negative CMP- negative, strep titer mildly elevated - MRI CT of brainney. Lime Neg.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102129P10UNLA
Administered by: Other     Purchased by: Other
Symptoms: Borrelia burgdorferi serology negative, Chills, Confusional state, Electroencephalogram, Malaise, Muscle twitching, Nuclear magnetic resonance imaging brain normal, Scan brain, Streptococcus identification test, Tic, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad)
Write-up: Events started 11-30-09 - major tremors arms, legs, confusion (brief) episodes of blurry vision loss 40 seconds, tic like movements arms like pt. has a chill - these call occurs 5-30X per day, general malaise, twitchy sensations of skin. "Never loses consciousness w/tremors".

VAERS ID:381312 (history)  Vaccinated:2010-02-25
Age:11.0  Onset:2010-02-25, Days after vaccination: 0
Gender:Male  Submitted:2010-02-25, Days after onset: 0
Location:Pennsylvania  Entered:2010-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: None
Diagnostic Lab Data: NOne
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB349AA   
HPV4: HPV (GARDASIL)MERCK & CO. INC.1099Y   
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURV2907BA   
TDAP: TDAP (ADACEL)SANOFI PASTEURVF500CA   
Administered by: Public     Purchased by: Private
Symptoms: Nausea, Pallor, Presyncope, Tachycardia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Severe nausea and patient became pre-syncopal with significant pallor and tachycardia.

VAERS ID:381315 (history)  Vaccinated:2010-02-23
Age:11.0  Onset:2010-02-23, Days after vaccination: 0
Gender:Male  Submitted:2010-02-25, Days after onset: 2
Location:North Carolina  Entered:2010-02-25
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: mild Asthma
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3016AA0IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Injection site discomfort, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 24 hours after vaccine developed swelling, redness and discomfort at injection site.

VAERS ID:381336 (history)  Vaccinated:2010-02-24
Age:11.0  Onset:2010-02-24, Days after vaccination: 0
Gender:Female  Submitted:2010-02-25, Days after onset: 1
Location:Iowa  Entered:2010-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: NA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER 2  
Administered by: Public     Purchased by: Private
Symptoms: Dizziness, Eye pain, Immediate post-injection reaction, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Pt felt faint immediately after injection; pain, soreness at injection site continued for several hours; the following morning pt complains of pain in eyes especially upon looking up (T-daP and Hep A given at same time of HPV vaccine)

VAERS ID:381382 (history)  Vaccinated:2010-02-15
Age:11.0  Onset:2010-02-16, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Michigan  Entered:2010-02-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Stuffy nose
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3069AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1207Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site induration, Mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Parents mom called the next day and stated school called her and said pt had a lump on his left arm the size of a silver dollar. Mom bought him here for us to look at & there was a 40mm x 43mm induration to his left lateral deltoid area where the varicella was given. BENADRYL cream was applied, advised mom she should continue with cream & give oral BENADRYL.

VAERS ID:381386 (history)  Vaccinated:2010-02-15
Age:11.0  Onset:2010-02-16, Days after vaccination: 1
Gender:Male  Submitted:2010-02-19, Days after onset: 3
Location:West Virginia  Entered:2010-02-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: ADHD, mental disorder
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3057AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3356AA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Oedema, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Cellulitis R arm, and warmth and tenderness and edema. On 2/16/10: Rx: SEPTRA 3tsp BID X 10 d Rx: prednisone 40mg 2 daily x 5 d2/17/10 2/19/10 Improved cellulitis some residual edema.

VAERS ID:381514 (history)  Vaccinated:2010-02-11
Age:11.0  Onset:2010-02-28, Days after vaccination: 17
Gender:Male  Submitted:2010-03-01, Days after onset: 1
Location:Puerto Rico  Entered:2010-03-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1SCLA
Administered by: Private     Purchased by: Other
Symptoms: Rash vesicular
SMQs:, Hypersensitivity (narrow)
Write-up: Varicella Like eruption

VAERS ID:381550 (history)  Vaccinated:2006-05-02
Age:11.0  Onset:2010-02-22, Days after vaccination: 1392
Gender:Male  Submitted:2010-03-01, Days after onset: 7
Location:Oregon  Entered:2010-03-01
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: Pertussis PCR positive
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0937R1IMLL
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURUE519AA IMRL
TDAP: TDAP (ADACEL)SANOFI PASTEURC2455AA IMLL
Administered by: Private     Purchased by: Private
Symptoms: Pertussis, Pertussis identification test positive
SMQs:
Write-up: Positive pertussis. Follow-up- Hep A and TDaP vaccine manufacturer provided. Record updated.

VAERS ID:381601 (history)  Vaccinated:2009-08-12
Age:11.0  Onset:2009-08-12, Days after vaccination: 0
Gender:Male  Submitted:2010-02-26, Days after onset: 198
Location:Ohio  Entered:2010-03-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Was born with some type of Abnormal blood vessel route in the head.
Diagnostic Lab Data: Mother had taken him to his doctor the following day and had a CT scan done and he was fine.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB296AA0IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2923AA0IMUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B041BA0IMUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0581Y1SCUN
Administered by: Public     Purchased by: Public
Symptoms: Computerised tomogram, Gaze palsy, Heart rate decreased, Pallor, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: He turned pale, began to shake a little, then his eyes began to roll back. His pulse dropped some. I got him on the floor, applied a cool cloth on head and neck. Lasted approx. 10 seconds. I felt it was more of a syncope episode rather than seizure.

VAERS ID:381603 (history)  Vaccinated:2010-02-16
Age:11.0  Onset:2010-02-17, Days after vaccination: 1
Gender:Male  Submitted:2010-02-26, Days after onset: 9
Location:New York  Entered:2010-03-02, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asperger''s; Tourette''s; ADD
Diagnostic Lab Data: throat culture negative for strep; RAST negative for basil, tomato, garlic, pine tree, olive tree and pine nut
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1684Y1IMRA
Administered by: Private     Purchased by: Private
Symptoms: Culture throat negative, Pruritus, Radioallergosorbent test negative, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Patient received 2nd dose of Hepatitis A vaccine on 2/16/10. 1st dose of Hep A vaccine given 8/4/09. On the morning of 2/17/10 patient awoke from sleep itchy and had hives around lower lip and on palmar surface of B/L wrists.

VAERS ID:381644 (history)  Vaccinated:2010-02-22
Age:11.0  Onset:2010-02-22, Days after vaccination: 0
Gender:Female  Submitted:2010-02-25, Days after onset: 3
Location:Virginia  Entered:2010-03-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None identified
Preexisting Conditions: Bells Palsy; Lyme''s disease
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1013Y1IMUN
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain upper, Fatigue, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Onset fever day of vaccine, max temp (103.5 x 4 d), stomach pain, fatigue since shot given.

VAERS ID:381682 (history)  Vaccinated:2010-01-13
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2010-02-05
Location:North Carolina  Entered:2010-03-02, Days after submission: 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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500872P1IN 
Administered by: Public     Purchased by: Public
Symptoms: Inappropriate schedule of drug administration
SMQs:
Write-up: Parent nor patient communicated H1N1 already administered elsewhere (dr office). Patient 11 y.o. and only 1 dose required.

VAERS ID:381688 (history)  Vaccinated:2010-01-29
Age:11.0  Onset:2010-01-29, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Colorado  Entered:2010-03-02
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: Allergies (nuts; fish; egg); ADD; asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3060AA IJRA
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU2590CA UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Significant redness and swelling with discomfort throughout upper arm (from shoulder to elbow) surrounding injection site. Lasted 5 days. Treated with antihistamine.

VAERS ID:381697 (history)  Vaccinated:2010-01-11
Age:11.0  Onset:2010-01-26, Days after vaccination: 15
Gender:Female  Submitted:2010-03-02, Days after onset: 35
Location:Arizona  Entered:2010-03-02
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: Unk
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3021AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1129Y0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Rash vesicular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow)
Write-up: Fever to 100.5 F, three vesicular lesions noted (one on arm, one on head, one on back). On 1/27/2010 a few lesions scattered to chest and back. Mother states child was not exposed to varicella.

VAERS ID:381809 (history)  Vaccinated:2010-03-03
Age:11.0  Onset:2010-03-03, Days after vaccination: 0
Gender:Female  Submitted:2010-03-03, Days after onset: 0
Location:Connecticut  Entered:2010-03-04, 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: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0249Y1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Urticaria developed on L neck, chest.

VAERS ID:381879 (history)  Vaccinated:2010-03-02
Age:11.0  Onset:2010-03-03, Days after vaccination: 1
Gender:Male  Submitted:2010-03-04, Days after onset: 1
Location:Tennessee  Entered:2010-03-04
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 (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B038CA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1203Y1SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Induration, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Large localized whelp with moderate to severe reaction. (L) arm central area of induration of 2.5 x 3 cm. Then subsequently erythema of 8X10 cm diameter.

VAERS ID:381939 (history)  Vaccinated:2010-03-03
Age:11.0  Onset:2010-03-03, Days after vaccination: 0
Gender:Male  Submitted:2010-03-05, Days after onset: 2
Location:Michigan  Entered:2010-03-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (FOREIGN)MERCK & CO. INC.0650Y2SCLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1684Y0SCLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1238Y1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: Within hours, developed welt around R deltoid injection site of Varicella vaccine. 1 1/2 days later it is 4" diameter with central welt 1.5". + erythema + tender + pruritis no trtmnt.

VAERS ID:382039 (history)  Vaccinated:2010-03-01
Age:11.0  Onset:2010-03-01, Days after vaccination: 0
Gender:Male  Submitted:2010-03-03, Days after onset: 2
Location:Pennsylvania  Entered:2010-03-08, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2927AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Induration, Local reaction, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Fever 102.8 ax on day 3, large local reaction-12cm x 14cm erythema induration on Day 1.

VAERS ID:382063 (history)  Vaccinated:2010-02-24
Age:11.0  Onset:2010-02-26, Days after vaccination: 2
Gender:Female  Submitted:2010-03-03, Days after onset: 5
Location:Tennessee  Entered:2010-03-08, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0312Y0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2907BA0UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B037AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 6 1/2" x 5 1/2" area of swelling, redness, warm to touch.

VAERS ID:382146 (history)  Vaccinated:2010-03-03
Age:11.0  Onset:2010-03-03, Days after vaccination: 0
Gender:Female  Submitted:2010-03-05, Days after onset: 2
Location:Texas  Entered:2010-03-09, 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: ingrown toe nail
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1130X2IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Fall, Head injury, Immediate post-injection reaction, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow)
Write-up: Pt fell when she was done with her vaccine, pt was getting up from the bed and she fell and hit her head (forehead) so we pick her up and gave pt an ice pack for her forehead. Pt did not know what had happen. We took her blood pressure, we made her lay down and retook her B/P over. Then after 20 minutes she was fine.

VAERS ID:382194 (history)  Vaccinated:2010-03-03
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2010-03-09
Location:California  Entered:2010-03-09
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.1013Y0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3048AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3250AA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1129Y1UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm deltoid swollen warm to touch (9cm x 9cm swelling).

VAERS ID:382258 (history)  Vaccinated:2010-03-08
Age:11.0  Onset:2010-03-08, Days after vaccination: 0
Gender:Female  Submitted:2010-03-09, Days after onset: 1
Location:California  Entered:2010-03-09
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.0612Y1IMUN
Administered by: Private     Purchased by: Private
Symptoms: Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: Patient got very sleepy after 20 mins. Was okay prior.

VAERS ID:382390 (history)  Vaccinated:2000-05-22
Age:11.0  Onset:2010-03-02, Days after vaccination: 3571
Gender:Female  Submitted:2010-03-11, Days after onset: 9
Location:Arizona  Entered:2010-03-11
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
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Rash generalised, Varicella post vaccine
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: -patient contracted VARICELLA -patient had body rash diagnosed as VARICELLA 3/5/10 after receiving VARICELLA vaccination.

VAERS ID:382428 (history)  Vaccinated:2010-03-08
Age:11.0  Onset:2010-03-09, Days after vaccination: 1
Gender:Male  Submitted:2010-03-11, Days after onset: 2
Location:Ohio  Entered:2010-03-11
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 (MENACTRA)SANOFI PASTEURU2868AA0UN 
TDAP: TDAP (ADACEL)SANOFI PASTEURC3098AA0UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local reaction. 9x11 cm area of redness, swelling and itching at left shoulder.

VAERS ID:382453 (history)  Vaccinated:2010-03-09
Age:11.0  Onset:2010-03-09, Days after vaccination: 0
Gender:Male  Submitted:2010-03-11, Days after onset: 2
Location:California  Entered:2010-03-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSAC14B106AA5IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU30155AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Pallor
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: L deltoid red and slight edema surrounding 9x10cm. Blanching present 2 days after administration. Started cephalexin for 7 days.

VAERS ID:382465 (history)  Vaccinated:2009-08-24
Age:11.0  Onset:0000-00-00
Gender:Male  Submitted:2009-09-23
Location:Illinois  Entered:2010-03-11, Days after submission: 169
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type: 200903735
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3014A UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Rash macular, Upper respiratory tract infection, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Initial report received from a health care professional on 01 September 2009, at which time only non-serious listed events were reported. Follow-up information was received on 16 September 2009 which added an unlisted event; this narrative incorporates information from both versions. An 11-year0old male patient, with no reported medical history, received a right arm injection of MENACTRA lot number U3014AA) on 24 August 2009. Within 24 hours of vaccination, he developed an urticarial rash, redness, and swelling of the whole upper arm. He subsequently experienced blotchy urticaria on back and behind his ears, and also developed an upper respiratory infection. No cough or rhinorrhea were noted. The patient was seen by his physician, and treatment included Zyrtec and topical Benadryl. The events recovered on 01 September 2009.

VAERS ID:382491 (history)  Vaccinated:2010-03-11
Age:11.0  Onset:2010-03-12, Days after vaccination: 1
Gender:Male  Submitted:2010-03-12, Days after onset: 0
Location:Florida  Entered:2010-03-12
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 TO MANGO TREE OILS
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR    
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: NAUSEA, VOMITING, SEVERE HEADACHE GIVING TYLENOL

VAERS ID:382578 (history)  Vaccinated:2009-11-01
Age:11.0  Onset:2010-01-10, Days after vaccination: 70
Gender:Male  Submitted:2010-03-12, Days after onset: 61
Location:Washington  Entered:2010-03-12
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: na
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Private
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow)
Write-up: Hive like rash that started on body as isolated spots and has become progressivly worse, to include large welts all over body but especially on inside of legs, armpits, private areas, back, groin

VAERS ID:382688 (history)  Vaccinated:2006-03-21
Age:11.0  Onset:2010-02-15, Days after vaccination: 1427
Gender:Male  Submitted:2010-03-11, Days after onset: 24
Location:Utah  Entered:2010-03-15, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: None
Diagnostic Lab Data: (+) PCR Bordetella pertussis on 3/08/10 (lab included)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2341AA0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Pertussis, Polymerase chain reaction, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow)
Write-up: Vaccine failure - received TDaP on 3/21/06 4 yrs later Dx with pertussis - confirmed case. Sending Dr history and physical dictation.

VAERS ID:382694 (history)  Vaccinated:2010-03-12
Age:11.0  Onset:2010-03-13, Days after vaccination: 1
Gender:Male  Submitted:2010-03-15, Days after onset: 1
Location:Georgia  Entered:2010-03-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3057AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2094AA UNLA
Administered by: Public     Purchased by: Private
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Urticaria surrounding MCV4 administration. Rx cetirizine.

VAERS ID:382756 (history)  Vaccinated:2010-03-08
Age:11.0  Onset:2010-03-08, Days after vaccination: 0
Gender:Female  Submitted:2010-03-09, Days after onset: 1
Location:Alaska  Entered:2010-03-16, 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: No
Diagnostic Lab Data: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0653X0UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2991AA0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3351AA0UNRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Very sore arm-right upper. Redness-rash. Parent applied cold. Gave TYLENOL and patient rested. To school next day.

VAERS ID:382763 (history)  Vaccinated:2010-01-18
Age:11.0  Onset:2010-01-19, Days after vaccination: 1
Gender:Female  Submitted:2010-03-16, Days after onset: 55
Location:Virginia  Entered:2010-03-16
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
RAB: RABIES (RABAVERT)NOVARTIS VACCINES AND DIAGNOSTICS439011A0IMRA
Administered by: Private     Purchased by: Other
Symptoms: Flushing, Nausea, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)
Write-up: Patient began complaining of shakiness, mild nausea and transient flushing approximately 3 hours after receiving rabies vaccine and rabies immune globulin.

VAERS ID:382773 (history)  Vaccinated:2010-03-11
Age:11.0  Onset:2010-03-14, Days after vaccination: 3
Gender:Male  Submitted:2010-03-15, Days after onset: 0
Location:California  Entered:2010-03-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC2767AA275UNLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Joint swelling
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad)
Write-up: Dad notice on 3/14/10, swollen on the elbow, redness. As per dad, given BENADRYL & MOTRIN. he apply ice to reduce swollen.

VAERS ID:382821 (history)  Vaccinated:2010-03-04
Age:11.0  Onset:2010-03-05, Days after vaccination: 1
Gender:Female  Submitted:2010-03-09, Days after onset: 4
Location:New York  Entered:2010-03-17, 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
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEUR97216012IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2907BA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: 11 year old child returned to clinic with complaint of right arm swelling. Patient received influenza injection in right arm on 3/4/10. On 3/5/10 patient was evaluated and seen by MD. Prescription for KEFLEX 250mg PO every 6hrs x 1 week was given and patient was instructed to return to clinic in two days. Patient was seen on 3/8/10; resolved swelling and decreased redness was noted by MD. Patient to return to clinic in three days for follow up. Patient was instructed to complete medication and to report to emergency room if any increased swelling or pain occurs.

VAERS ID:382831 (history)  Vaccinated:2010-03-09
Age:11.0  Onset:2010-03-09, Days after vaccination: 0
Gender:Female  Submitted:2010-03-11, Days after onset: 2
Location:North Carolina  Entered:2010-03-17, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of asthma; no known allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB359CA0UNRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1073Y1UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 3"x2" erythema on left arm at site of immunization (VARICELLA #2).

VAERS ID:382913 (history)  Vaccinated:2010-03-16
Age:11.0  Onset:2010-03-17, Days after vaccination: 1
Gender:Male  Submitted:2010-03-17, Days after onset: 0
Location:California  Entered:2010-03-17
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: Asperger''s, ADHD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSC3446AA UNUN
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Myalgia, Nausea, Oedema peripheral, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)
Write-up: Moderate pain in muscle of arm 8/10 even after ibuprofen, swelling, rash on arm, tiredness, mild nausea

VAERS ID:382918 (history)  Vaccinated:2010-03-08
Age:11.0  Onset:2010-03-09, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Texas  Entered:2010-03-17
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 (MENACTRA)SANOFI PASTEURU2936DA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3067AA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1073Y SCLA
Administered by: Private     Purchased by: Private
Symptoms: Myoclonus, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad)
Write-up: Fever and myoclonic jerks the day after the vaccines were given. The jerks quit after his fever was treated and he recovered.

VAERS ID:382933 (history)  Vaccinated:2010-03-09
Age:11.0  Onset:2010-03-10, Days after vaccination: 1
Gender:Female  Submitted:2010-03-12, Days after onset: 2
Location:South Dakota  Entered:2010-03-18, 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: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB384AA IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3102AA IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B050AA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1299Y SCLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Red raised on IM location warm to touch. (+) size. MOP stated PT gets this with bug bites. MOP state she gave BENADRYL started the 10 Mar 10 with increase in redness.

VAERS ID:383012 (history)  Vaccinated:2010-01-29
Age:11.0  Onset:2010-02-01, Days after vaccination: 3
Gender:Male  Submitted:2010-03-18, Days after onset: 44
Location:California  Entered:2010-03-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: history of encephalocele status post resection at 9 months of age without complications or sequelae. History of migraine headaches
Diagnostic Lab Data: Brain MRI and CSF studies sent
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3060AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF551AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1153Y1SCLA
Administered by: Unknown     Purchased by: Other
Symptoms: Tic
SMQs:, Dyskinesia (broad), Dystonia (broad)
Write-up: Patient had onset of shoulder shrugging tics about 3 days after vaccination. About 1 month after vaccination began having neck twisting tics.

VAERS ID:383095 (history)  Vaccinated:2010-03-08
Age:11.0  Onset:2010-03-10, Days after vaccination: 2
Gender:Female  Submitted:2010-03-19, Days after onset: 8
Location:Ohio  Entered:2010-03-19
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
HPV4: HPV (GARDASIL)MERCK & CO. INC.0671Y0UNLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC5213046DA1UNLA
Administered by: Public     Purchased by: Unknown
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large localized swelling from shoulder to elbow.

VAERS ID:383105 (history)  Vaccinated:2010-02-25
Age:11.0  Onset:2010-02-25, Days after vaccination: 0
Gender:Male  Submitted:2010-03-19, Days after onset: 21
Location:California  Entered:2010-03-19
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 PASTEURU2929AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF486CA5IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1132Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Felt hot and diaphoric, felt faint amd nauseous. Did not faint.

VAERS ID:383141 (history)  Vaccinated:2010-03-19
Age:11.0  Onset:2010-03-20, Days after vaccination: 1
Gender:Female  Submitted:2010-03-22, Days after onset: 2
Location:North Carolina  Entered:2010-03-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1318T0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3062AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1152Y1SCRA
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: RED, SLIGHTLY SWOLLEN AREA ON R ARM SUBCUTANEOUS AREA. KEFLEX 500 MG BID X 10 DAYS.

VAERS ID:383193 (history)  Vaccinated:2010-03-04
Age:11.0  Onset:2010-03-05, Days after vaccination: 1
Gender:Male  Submitted:2010-03-19, Days after onset: 13
Location:North Carolina  Entered:2010-03-22, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: asthma
Diagnostic Lab Data: prescribed Sildec Pe- DM
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB359CA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3046AA0IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1167Y1SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Dizziness, Headache, Sinus disorder
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: C/o headache dizzy for a couple of weeks. Onset day after receiving vaccines 3/5/10. Tx with 200mg Motrin every 6-8 hrs. Taken to Doctor 3/11/10 told sinus problems and prescribed Sildec Pe- DM calling today because still having headaches. Advised to notify Doctor.

VAERS ID:383234 (history)  Vaccinated:2009-12-15
Age:11.0  Onset:2009-12-15, Days after vaccination: 0
Gender:Female  Submitted:2010-03-22, Days after onset: 96
Location:New Jersey  Entered:2010-03-22
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: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP039AA IMUN
Administered by: Public     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: Fainting.

VAERS ID:383239 (history)  Vaccinated:2009-11-17
Age:11.0  Onset:2009-11-17, Days after vaccination: 0
Gender:Male  Submitted:2010-03-22, Days after onset: 124
Location:New Jersey  Entered:2010-03-22
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: Unknown
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP019AA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot
SMQs:
Write-up: C/o feeling "hot" T 97 degrees.

VAERS ID:383251 (history)  Vaccinated:2010-03-16
Age:11.0  Onset:2010-03-17, Days after vaccination: 1
Gender:Male  Submitted:2010-03-17, Days after onset: 0
Location:Georgia  Entered:2010-03-22, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3029AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC32B049AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site erythema, Injection site swelling, Injection site warmth, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: This am - arm sore noticed redness around 12:00pm - Here at 1:00. Redness, heat & swelling covering approximately 1/2 of upper arm & deltoid. Advised Ibuprofen, Benadryl and cold compress.

VAERS ID:383262 (history)  Vaccinated:2010-03-22
Age:11.0  Onset:2010-03-22, Days after vaccination: 0
Gender:Female  Submitted:2010-03-22, Days after onset: 0
Location:Kansas  Entered:2010-03-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3351AA0IMRA
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.500849P0IN 
HPV4: HPV (GARDASIL)MERCK & CO. INC.0249Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3061AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF544AA5IMRA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Skin discolouration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Patient recieved five vaccines at time of visit. After receiving her vaccines she stated that she felt weak and then she fainted. The patient had not eaten. After the patient came to, she was given juice and pretzels. We kept her until she was feeling better and regained color in her face.

VAERS ID:383290 (history)  Vaccinated:2010-02-10
Age:11.0  Onset:2010-02-10, Days after vaccination: 0
Gender:Female  Submitted:2010-02-11, Days after onset: 1
Location:Nebraska  Entered:2010-03-23, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergic to penicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1099Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3045AA0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Dizziness, Flushing, Injection site erythema, Pyrexia, Rash macular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (narrow)
Write-up: Pt lightheaded after receiving MENACTRA R D and GARDASIL L Deltoid. Pt became flushed and developed red flat blotches on face and neck which resolved approximately 15 minutes about 2 x 4 inch raised erythematous area developed at site of MENACTRA injection (R deltoid). BENADRYL given and BP''s monitored. No difficulty with breathing. T=99.7 Rechecked=99.0 BP 104/50 (71).

VAERS ID:383310 (history)  Vaccinated:2010-03-17
Age:11.0  Onset:2010-03-17, Days after vaccination: 0
Gender:Male  Submitted:2010-03-18, Days after onset: 1
Location:Texas  Entered:2010-03-23, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: EPSDT
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2914AA UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B045BA UNRA
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 and swelling of injection area.

VAERS ID:383317 (history)  Vaccinated:2010-03-15
Age:11.0  Onset:2010-03-16, Days after vaccination: 1
Gender:Male  Submitted:2010-03-17, Days after onset: 1
Location:Pennsylvania  Entered:2010-03-23, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0095Z0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU333AA UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B047E0UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: 3" erythematous sharply demarcated, warm with 1 cm darker outer.

VAERS ID:383320 (history)  Vaccinated:2010-03-12
Age:11.0  Onset:2010-03-13, Days after vaccination: 1
Gender:Male  Submitted:2010-03-15, Days after onset: 1
Location:New York  Entered:2010-03-23, Days after submission: 8
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
TDAP: TDAP (ADACEL)SANOFI PASTEURUF451DA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Chills, Injection site erythema, Injection site pain, Injection site swelling, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)
Write-up: Mom said next day child had fever, chills, body ache, swelling, and soreness of vaccine site. Seen in office on 3/15/10. Had fever 103, redness and swelling injection site. KEFLEX 250mg q 8 x 1 wk given - MOTRIN PRN.

VAERS ID:383398 (history)  Vaccinated:2009-11-21
Age:11.0  Onset:2009-11-21, Days after vaccination: 0
Gender:Female  Submitted:2010-03-23, Days after onset: 121
Location:New Jersey  Entered:2010-03-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP006AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal discomfort, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Child recieved H1N1 vaccination at School. Reported to nurses office approx. 45 minutes after vaccination c/o felling light headed and stomach distress. Appeared very pale. B/P=112/82 P=96/min. R= 18/min. pulse Ox = 99 . Mother arrived 10:30AM Child stated felt better- color now good= pink. returned to class with no futer symptoms.

VAERS ID:383449 (history)  Vaccinated:2010-03-22
Age:11.0  Onset:2010-03-23, Days after vaccination: 1
Gender:Male  Submitted:2010-03-24, Days after onset: 1
Location:California  Entered:2010-03-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF456AA5IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0993Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site induration, Injection site warmth, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad)
Write-up: Left arm only. Enduration around vaccine sight about 1 1/2" x 2", red & hot to touch. Gave MOTRIN & BENADRYL, iced area. Fever 102 & headache. Mild itching fever & headaches resolved today - 3-24-10. If not better next 24 - 48 hrs, to be seen. Continue BENADRYL & cold compresses.

VAERS ID:383451 (history)  Vaccinated:2010-03-22
Age:11.0  Onset:2010-03-22, Days after vaccination: 0
Gender:Female  Submitted:2010-03-23, Days after onset: 1
Location:Illinois  Entered:2010-03-24, 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: None
Preexisting Conditions: None
Diagnostic Lab Data: Pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3090AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Fatigue, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Vaccine given 3-22-10. In the evening pt. felt weak/tired. Middle of the night, arm tingling/pain. On 3-23-10 woke up with arm, abdomen and leg pain. Felt very weak. Low grade fever. Pt. will follow up on 3-24-10 in office.

VAERS ID:383470 (history)  Vaccinated:2010-03-19
Age:11.0  Onset:2010-03-22, Days after vaccination: 3
Gender:Male  Submitted:2010-03-24, Days after onset: 2
Location:Utah  Entered:2010-03-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3081AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3049DA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Redness, hot to touch

VAERS ID:383520 (history)  Vaccinated:2010-03-08
Age:11.0  Onset:2010-03-09, Days after vaccination: 1
Gender:Male  Submitted:2010-03-13, Days after onset: 4
Location:Illinois  Entered:2010-03-25, 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: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2906AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2927AA5UNLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness and swelling, painful noted on 03-09-10 at 7:00 am (on LD). On next day redness diminished and reaction resolved on 03-15-10. No treatment given.

VAERS ID:383663 (history)  Vaccinated:2010-03-24
Age:11.0  Onset:2010-03-24, Days after vaccination: 0
Gender:Female  Submitted:2010-03-26, Days after onset: 2
Location:New Mexico  Entered:2010-03-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 05/30/2008~Hep A (no brand name)~2~10.00~Patient|05/30/2008~Varicella (no brand name)~2~10.00~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3232AA1IMLA
FLUX(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (UNKNOWN)UNKNOWN MANUFACTURERUP053AA0IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1013Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3060AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B037AA0IMRA
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: Syncope approximately three minutes after injections. Pt. placed supine with lower extremities elevated; instant return of skin color to pink and conscienceness. BP - 98/70 pulse 78 O2 SaO2 - 95 %. Vitals rechecked at five minutes. BP - 104/68 pulse 86 SaO2 97%.

VAERS ID:383678 (history)  Vaccinated:2010-03-24
Age:11.0  Onset:2010-03-26, Days after vaccination: 2
Gender:Female  Submitted:2010-03-26, Days after onset: 0
Location:Utah  Entered:2010-03-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3081AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3049DA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)
Write-up: Redness, Hot to touch, itchy 6cm x 6cm

VAERS ID:383722 (history)  Vaccinated:2009-12-10
Age:11.0  Onset:2009-12-10, Days after vaccination: 0
Gender:Female  Submitted:2010-03-23, Days after onset: 102
Location:Connecticut  Entered:2010-03-29, 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:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1013Y0IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Abdominal pain upper, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)
Write-up: Had HPV #1 approximately 4pm. -6-7 hours later developed hives and stomachache ate shrimp for dinner- has eaten again without hives.

VAERS ID:383920 (history)  Vaccinated:2010-03-27
Age:11.0  Onset:2010-03-27, Days after vaccination: 0
Gender:Male  Submitted:2010-03-31, Days after onset: 4
Location:Texas  Entered:2010-03-31
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: HAS ALLERGIES TO PINEAPPLE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (NO BRAND NAME)UNKNOWN MANUFACTURER    
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Pain, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: REDNESS, SWELLING, TENDERNESS, PAIN 7X7 INCHES IN DIA TO LEFT ARM. WAS GIVEN IBUPROFEN DAILY

VAERS ID:383942 (history)  Vaccinated:2010-03-29
Age:11.0  Onset:2010-03-31, Days after vaccination: 2
Gender:Male  Submitted:2010-03-31, Days after onset: 0
Location:Unknown  Entered:2010-03-31
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: none reported
Diagnostic Lab Data: none reported
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS104045P10IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2929AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2899AA0IMRA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Injection site erythema, Injection site swelling, Injection site warmth, Pain, 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: Pt states hurting since Tuesday, noticed swelling and redness today 3/31/10. Areas are reddened, warm to touch and swollen bilateral deltoids - R deltoid 70cm x 70 CM and R deltoid 40 cm x 50 cm.

VAERS ID:384010 (history)  Vaccinated:2010-03-31
Age:11.0  Onset:2010-04-01, Days after vaccination: 1
Gender:Female  Submitted:2010-04-01, Days after onset: 0
Location:Massachusetts  Entered:2010-04-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Well patient
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1231Y1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: At 24 hrs after vaccination, seen in office with left deltoid region has a small area of warmth, mild swelling and erythema. Afeb.

VAERS ID:384013 (history)  Vaccinated:2010-03-10
Age:11.0  Onset:2010-03-12, Days after vaccination: 2
Gender:Female  Submitted:2010-03-17, Days after onset: 4
Location:Texas  Entered:2010-04-01, Days after submission: 15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3017AA1UNRL
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSC3249AA1UNLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1200Y2UNRL
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: Mild swelling were the VARICELLA vaccine was administered. (R) thigh.

VAERS ID:384088 (history)  Vaccinated:2008-10-07
Age:11.0  Onset:2008-10-07, Days after vaccination: 0
Gender:Male  Submitted:2010-03-28, Days after onset: 537
Location:Pennsylvania  Entered:2010-04-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Tree nuts, milk
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2564AA0UNUN
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B021AA5UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Blindness transient, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Fainted & lost vision briefly 10 minutes after vaccine.

VAERS ID:384195 (history)  Vaccinated:2010-04-01
Age:11.0  Onset:2010-04-01, Days after vaccination: 0
Gender:Male  Submitted:2010-04-03, Days after onset: 2
Location:Florida  Entered:2010-04-02, 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: No
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3089AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC344CAA0IMRA
Administered by: Private     Purchased by: Private
Symptoms: 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: Injection site red swollen and tender to the touch. Patient dx with cellulitis due adverse reaction and was prescribed AUGMENTIN 500mg BID; will recheck pt within 24-48 hours.

VAERS ID:384201 (history)  Vaccinated:2010-03-23
Age:11.0  Onset:2010-03-25, Days after vaccination: 2
Gender:Male  Submitted:2010-03-25, Days after onset: 0
Location:Virginia  Entered:2010-04-05, 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: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC528050AA5IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site urticaria, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: 2 days after TDAP received, child developed red welt covering half of upper arm. Also has pruritis (this began 1 day afterwards; redness began 2 days after vaccine given).

VAERS ID:384313 (history)  Vaccinated:2010-03-23
Age:11.0  Onset:2010-03-24, Days after vaccination: 1
Gender:Male  Submitted:2010-03-25, Days after onset: 1
Location:Virginia  Entered:2010-04-06, Days after submission: 12
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3096AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 4 cm red induration at site of shot.

VAERS ID:384341 (history)  Vaccinated:2010-03-31
Age:11.0  Onset:2010-04-01, Days after vaccination: 1
Gender:Female  Submitted:2010-04-01, Days after onset: 0
Location:Texas  Entered:2010-04-06, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2914AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3158AA0IMLA
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: Swelling and redness to left deltoid. *4/5/10 called parent back and no swelling no redness to site.

VAERS ID:384372 (history)  Vaccinated:2010-03-19
Age:11.0  Onset:0000-00-00
Gender:Female  Submitted:2010-04-06
Location:Arizona  Entered:2010-04-06
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: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB311BA2IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2914AA1IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B029AA1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1295Y2SCLA
Administered by: Public     Purchased by: Public
Symptoms: Convulsion, Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Patient received 4 shots. Faint start having a seizure 30 seconds, hit the head when she fell. Patient recovery after 30 seconds PCP check patient, vital are good.

VAERS ID:384442 (history)  Vaccinated:2008-05-15
Age:11.0  Onset:2008-05-15, Days after vaccination: 0
Gender:Male  Submitted:2010-03-05, Days after onset: 659
Location:Unknown  Entered:2010-04-06, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0907USA04818
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1610U UNUN
Administered by: Other     Purchased by: Other
Symptoms: Wrong drug administered
SMQs:
Write-up: Information has been received from a medical assistant concerning a 11 year old male patient who on 15-MAY-2008, was vaccinated with a dose of RECOMBIVAX HB (lot #657461/1610U) by accident. The patient was given an order of VARIVAX (Merck) by the physician but was given a dose of RECOMBIVAX HB. The patient received the series in 1997. The error was found when the medical assistant called to confirm which vaccine was associated with a particular lot number. The patient was not experiencing any known symptoms. Follow-up information was received from the physician who reported that the patient was healthy. The physician considered that hepatitis A virus vaccine and RECOMBIVAX HB was given by mistake. No adverse reactions was recorded or noted by either parent or physician. No further information is available.

VAERS ID:384574 (history)  Vaccinated:2009-03-11
Age:11.0  Onset:2009-03-11, Days after vaccination: 0
Gender:Female  Submitted:2010-03-03, Days after onset: 357
Location:Unknown  Entered:2010-04-06, 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: Unknown
Preexisting Conditions: The subject did not receive any other vaccines on the same day. No concomitant medications or relevant medical history was reported. No adverse events were reported with previous vaccinations. The subject did not use alcohol or tobacco.
Diagnostic Lab Data: UNK
CDC Split Type: A0814769A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVE140AC0UNLL
Administered by: Other     Purchased by: Other
Symptoms: Injection site nodule, Injection site pain, Scab, Skin lesion
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: This case was reported by a healthcare professional and described the occurrence of bump at injection site in an 11-year-old female subject who was vaccinated with HAVRIX, (GlaxoSmithKline). On 11 March 2009, at an unspecified time after vaccination with HAVRIX, the subject experienced bump at injection site, pink around injection site, painful to touch and crusted lesion. At the time of reporting the bump at injection site, pink around injection site, injection site pain and crusted lesion were unresolved. The healthcare professional considered the bump at injection site, pink around injection site, injection site pain and crusted lesion were probably related to vaccination with HAVRIX. The lot number was reported as AKAVE140AC. The healthcare professional reported that an 11 year old subject received her first HAVRIX vaccination on 11 March 2009. The reporter could not read the subject''s medical record, and was unable to determine very much from what was provided to her by the subject''s father. The subject developed a pink bump at the injection site that was painful to the touch and seemed to be crusty on top. The subject''s family denied any drainage from the lesion. Follow up information was received on 23 November 2009 via the reporting nurse practitioner. The subject did not use alcohol or tobacco. Onset date of earliest sign or symptom was reported as an unspecified date in March 2009. The nurse practitioner did not consider the events to be serious. The nurse practitioner reported that it was unknown if the events could have been associated with erroneous administration. A biopsy was not performed.

VAERS ID:384517 (history)  Vaccinated:2010-04-05
Age:11.0  Onset:2010-04-06, Days after vaccination: 1
Gender:Female  Submitted:2010-04-07, Days after onset: 1
Location:Kentucky  Entered:2010-04-07
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: allergic rhinitis
Diagnostic Lab Data: RSS (-); throat cx (P); 9.9$g10.5/7A<414
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.1684Y0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3080AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3382AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Culture throat positive, Neck pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)
Write-up: 11 year old with fever of 103 yesterday. Vomiting x 5 yesterday and neck pain since yesterday. Fever and vomiting have resolved but still having neck pain.

VAERS ID:384746 (history)  Vaccinated:2010-04-06
Age:11.0  Onset:2010-04-07, Days after vaccination: 1
Gender:Male  Submitted:2010-04-08, Days after onset: 1
Location:Arizona  Entered:2010-04-08
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
HEPA: HEP A (VAQTA)MERCK & CO. INC.1538Y0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3081AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF460AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1404Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)
Write-up: Pt complained of itchiness on both arms the afternoon of 4/7/2010. The itchiness progressed to swelling and redness of both deltoids. Pt was seen in our office today 4/8/2010 at 0815 the redness had improved.

VAERS ID:384908 (history)  Vaccinated:2010-04-09
Age:11.0  Onset:2010-04-10, Days after vaccination: 1
Gender:Male  Submitted:2010-04-12, Days after onset: 2
Location:New Hampshire  Entered:2010-04-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: On 4/10/10 patient left arm became red and swollen, mother of child called office and spoke with doctor on call who advised mother to give dose of Benadryl and apply ice. Mother administered homecare recommendatins as noted, and patient arm did not improve, only became worse so mother brought child to ER, where patient was evaluated and determined to have a "cellulits" to left upper arm and given Rx fo: Bactrim DS one by mouth twice daily for 10 days and Keflex 500mg one by mouth four times a
Preexisting Conditions:
Diagnostic Lab Data: Patient continue to have cellulitis which has not resolved at this point. Patient is still on courseof antibiotics of Bactrim DS for 10 days and Keflex 500mg x10 days as noted. Mother of child will call back to clinic if no improvement is noted. Mother of child will continue with home care of applying ice and monitoring for symptoms not improving or if develops any new symptoms.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2937CA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3078AA5IMLA
Administered by: Unknown     Purchased by: Other
Symptoms: Injection site cellulitis, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mother of child noted left arm swelling and redness where patient had immunizations given on 4/9/10. Mother of child called doctor on call, and was advised to apply ice and give Benadryl. Mother of child understood plan, child did not improve so mom brought child to Emergency Room. Patient was diagnosed with "Cellulitis" to left arm and treated with antibiotics. Patient seen on 4/12/10 in office by provider for follow up.

Result pages: prev   2380 2381 2382 2383 2384 2385 2386 2387 2388 2389 2390 2391 2392 2393 2394 2395 2396 2397 2398 2399 2400 2401 2402 2403 2404 2405 2406 2407 2408 2409 2410 2411 2412 2413 2414 2415 2416 2417 2418 2419 2420 2421 2422 2423 2424 2425 2426 2427 2428 2429 2430 2431 2432 2433 2434 2435 2436 2437 2438 2439 2440 2441 2442 2443 2444 2445 2446 2447 2448 2449 2450 2451 2452 2453 2454 2455 2456 2457 2458 2459 2460 2461 2462 2463 2464 2465 2466 2467 2468 2469 2470 2471 2472 2473 2474 2475 2476 2477 2478 2479 2480 2481 2482 2483 2484 2485 2486 2487 2488 2489 2490 2491 2492 2493 2494 2495 2496 2497 2498 2499 2500 2501 2502 2503 2504 2505 2506 2507 2508 2509 2510 2511 2512 2513 2514 2515 2516 2517 2518 2519 2520 2521 2522 2523 2524 2525 2526 2527 2528 2529 2530 2531 2532 2533 2534 2535 2536 2537 2538 2539 2540 2541 2542 2543 2544 2545 2546 2547 2548 2549 2550 2551 2552 2553 2554 2555 2556 2557 2558 2559 2560 2561 2562 2563 2564 2565 2566 2567 2568 2569 2570 2571 2572 2573 2574 2575 2576 2577 2578   next

New Search

Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=2479&PERPAGE=100&ESORT=AGE


Copyright © 2015 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166