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Case Details (Sorted by Age)

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VAERS ID: 470306 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Alabama  
Vaccinated:2012-09-28
Onset:2012-09-28
   Days after vaccination:0
Submitted: 2012-10-18
   Days after onset:20
Entered: 2012-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / 2 NS / IN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Allergy test, Chest X-ray, Cough, Pyrexia, Rhinorrhoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: SEVERE HIVES~Influenza (Seasonal) (FluMist)~~3.00~Patient
Other Medications: NONE!!!!!!!!!!
Current Illness: NONE AT THE TIME
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: BLOOD ALLERGY TEST DONE ON 10/17/2012; CHEST XRAY ON 10/15/2012; EPI PEN INJECTION DONE ON 10/15/2012
CDC Split Type:

Write-up: HIVES, COUGHING, RUNNY NOSE, FEVER LASTING FOR 3 WEEKS NOW AND STILL GOING.


VAERS ID: 470525 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-09-18
Onset:2012-09-19
   Days after vaccination:1
Submitted: 2012-10-18
   Days after onset:29
Entered: 2012-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2109 / 1 NS / IN

Administered by: Private       Purchased by: Private
Symptoms: Cough, Pneumonitis, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt returned to clinic on 9/21/12 with runny nose x 3 days, fever (101) and congested cough onset 9/20/12 worsening. MD assessment found (+) wheezes, clear runny nose, and resp rate 25. Dx with pneumonitis and Rx albuterol sulfate 0.083% neb tx q 4-6 hrs. and Children''s BENADRYL.


VAERS ID: 474899 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2012-10-01
Onset:2012-10-01
   Days after vaccination:0
Submitted: 2012-10-18
   Days after onset:17
Entered: 2012-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1769AA / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA006263

Write-up: This spontaneous report as received from a nurse refers to a patient of unknown gender. The patient was vaccinated with dose 1 of M-M-R II (reported lot number 1769AA; expiry date 10-NOV-2013) on 01-OCT-2012. Dose and route of administration were not reported. The vaccine had been improperly stored (not further specified). No adverse event was reported. The nurse reported 5 patients who received incorrectly stored ROTATEQ oral (case IDs 1210USA002302, 1210USA006259, 1210USA006260, 1210USA006261, and 1210USA006262), all on the same day. Additional information has been requested.


VAERS ID: 470527 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Missouri  
Vaccinated:2012-10-16
Onset:2012-10-16
   Days after vaccination:0
Submitted: 2012-10-18
   Days after onset:2
Entered: 2012-10-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4485EA / 5 RL / UN

Administered by: Private       Purchased by: Private
Symptoms: Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol nebs; PULMICORT nebs
Current Illness:
Preexisting Conditions: Multiple food allergies; PCN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Given flu vaccine 10-16-12 that evening and next am SOB, cough - needed nebulizer tx.


VAERS ID: 470790 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2012-10-19
Onset:2012-10-19
   Days after vaccination:0
Submitted: 2012-10-22
   Days after onset:3
Entered: 2012-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4631EB / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site haematoma, Injection site pruritus, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Area surrounding injection site very red and itchy. About the size of an adult hand. Warm-hot over the weekend. Area slightly bruised. Lasted until at least 10/22.


VAERS ID: 471228 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2012-10-18
Onset:0000-00-00
Submitted: 2012-10-22
Entered: 2012-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B157CA / 4 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB642A / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Erythema, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: (L) arm is red, warm, tenderness. Temp. 100.2.


VAERS ID: 471041 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Washington  
Vaccinated:2012-10-19
Onset:2012-10-21
   Days after vaccination:2
Submitted: 2012-10-23
   Days after onset:2
Entered: 2012-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / 3 NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily vitamin (Gummies-Spongebob Squarepants, distributed by International Vitamin Corporation).
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up with extreme stomach pain and immediately threw up. Continued to throw up anytime a liquid or food was swallowed for the next 48 hours, with dry heaving in between. Fever of 103. Could not administer Tylenol as child would throw up seconds after swallowing.


VAERS ID: 471343 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Wyoming  
Vaccinated:2012-10-22
Onset:2012-10-22
   Days after vaccination:0
Submitted: 2012-10-23
   Days after onset:1
Entered: 2012-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2106 / 2 NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Mild URI; afebrile
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data: Note: contacted physician who suggested BENADRYL be given. Parent gave 1 dose. Hives resolved within 1 hour. No other sx.
CDC Split Type:

Write-up: Received FLUMIST vaccine. Had this also last year. Within 5-10 minutes after administration, noted red blotches on face, then tiny hives on arms - very mild case. No other complaints.


VAERS ID: 471485 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Utah  
Vaccinated:2012-10-22
Onset:2012-10-22
   Days after vaccination:0
Submitted: 2012-10-24
   Days after onset:2
Entered: 2012-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 1 NS / IN

Administered by: Private       Purchased by: Private
Symptoms: Fatigue, Feeling abnormal, Hallucination, Moaning, Pyrexia, Restlessness, Skin warm, Tremor, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Mom reports before bed gave respiratory treatment because child was starting to get sick with wheezing. Fever became very high where child was hallucinating, moaning, shaking, kicking his legs and flailing. His hands and feet were very hot. Mom gave ibuprofen and it did seem to calm him down to the point he was able to rest some. In the morning he continued to act very tired like he does not feel good.


VAERS ID: 471573 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Arkansas  
Vaccinated:2012-10-23
Onset:2012-10-23
   Days after vaccination:0
Submitted: 2012-10-24
   Days after onset:1
Entered: 2012-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B151AA / 4 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Body temperature increased, Injection site erythema, Injection site swelling, Injection site warmth, Restlessness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Mother states patient''s arm started swelling 1 hr after vaccines. Pt had low grade temp. This a.m. mom states arm is swollen, red, & hot to the touch where vaccine was given. Also states pt was restless last night.


VAERS ID: 471295 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2012-10-24
Onset:2012-10-25
   Days after vaccination:1
Submitted: 2012-10-25
   Days after onset:0
Entered: 2012-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Respiratory tract congestion, Restlessness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 102.3 degree fever, restless, congested. Children''s Ibuprofen 5ml.


VAERS ID: 472499 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Indiana  
Vaccinated:2012-07-24
Onset:2012-07-25
   Days after vaccination:1
Submitted: 2012-09-24
   Days after onset:61
Entered: 2012-10-25
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B196BA / 1 RA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB523AA / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1251AA / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0139AE / UNK RA / UN

Administered by: Public       Purchased by: Public
Symptoms: Blister, Injection site erythema, Injection site pain, Injection site swelling, Injection site vesicles, Laboratory test, Pain in extremity, White blood cell count normal
SMQs:, Severe cutaneous adverse reactions (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: No relevant medical history. The subject had previously received influenza vaccinations and had not experienced any adverse events. The subject had no adverse events following receipt of prior immunizations.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0988990A

Write-up: This case was reported by a healthcare professional via sales representative and described the occurrence of swelling injection site in a 4-year-old female subject who was vaccinated with KINRIX (GlaxoSmithKline). Concurrent vaccination included HAVRIX; GlaxoSmithKline; unknown; unknown given on 24 July 2012; MMR vaccine (non-gsk); Merck; unknown; unknown given on 24 July 2012; VARIVAX (non-gsk); Merck; unknown, right arm given on 24 July 2012. There were no concurrent medications. On 24 July 2012 the subject received 1st dose of KINRIX (.5 ml, unknown, right deltoid). On 25 July 2012, 24 hours after vaccination with KINRIX, the subject experienced swelling injection site, injection site redness, injection site pain, pain in r arm on elevation, injection site blisters and blisters on arm. The subject received vaccinations on 24 July 2012, 24 hours later the subject had redness, swollen, multiple blisters and on large blister at the injection site. Pain occurred when the arm was extended above her head. The subject had lab work performed including white blood cell count that was within normal limits, ATB (antibiotic) was given. Demarcated region on arm. On 28 July 2012 the subject returned and arm had largely improved. Large blister ruptured and no other blisters except tiny ones. On 30 July 2012, the healthcare professional called the subject and was found to continue to improve. No further follow up information. On an unspecified date in 2012, the events were resolved. The healthcare professional considered the events were possibly related to vaccination with KINRIX.


VAERS ID: 471905 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Iowa  
Vaccinated:2012-10-15
Onset:2012-10-16
   Days after vaccination:1
Submitted: 2012-10-17
   Days after onset:1
Entered: 2012-10-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH745AC / 5 RL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRN Albuterol Sulfate
Current Illness: Rash
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: (R) ant. thigh reddened 1.5 x 3 inches in diameter hard to touch. Itching is present. Edema of upper thigh. This is reported by mother onset Tuesday 10/16/12.


VAERS ID: 472012 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Michigan  
Vaccinated:2012-09-27
Onset:0000-00-00
Submitted: 2012-10-04
Entered: 2012-10-26
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA736AA / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: No adverse event, Off label use
SMQs:

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

Write-up: Off label use of FLULAVAL on a child. No symptoms reported.


VAERS ID: 472014 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-09-27
Onset:0000-00-00
Submitted: 2012-10-04
Entered: 2012-10-26
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA736AA / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; SINGULAIR; PULMICORT
Current Illness: None
Preexisting Conditions: Asthma; Sulfa
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: FLULAVAL administered to a child when approved for only adults. No symptoms reported.


VAERS ID: 471998 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: South Carolina  
Vaccinated:2012-10-18
Onset:0000-00-00
Submitted: 2012-10-29
Entered: 2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: A couple of days after he was given the flu shot he started stuttering.


VAERS ID: 472137 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2012-10-11
Onset:2012-10-19
   Days after vaccination:8
Submitted: 2012-10-26
   Days after onset:7
Entered: 2012-10-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH751AA / 3 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Contusion, Idiopathic thrombocytopenic purpura, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 10/19 patient seen for petechiae, unexplained bruising and diagnosed w/ ITP.


VAERS ID: 472229 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Virginia  
Vaccinated:2012-09-27
Onset:2012-09-30
   Days after vaccination:3
Submitted: 2012-10-30
   Days after onset:30
Entered: 2012-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0011AE / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Enuresis, Fungal infection, Hyperphagia, Irritability, Lethargy, Polydipsia, Polyuria
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Tubulointerstitial diseases (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: CMTC left arm
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient quickly began exhibiting symptoms of type 1 diabetes... polyuria, polydypsia, polyphagia, yeast infection, irritability, lethargy, bed wetting.


VAERS ID: 472266 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: California  
Vaccinated:2012-10-15
Onset:2012-10-15
   Days after vaccination:0
Submitted: 2012-10-23
   Days after onset:8
Entered: 2012-10-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH721AA / 4 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 10/15/12 Ibuprofen; DIMETAPP
Current Illness: Yes - URI 10/15/12.
Preexisting Conditions: No; Small ASD and closed spontaneous (Atrial Septal Defect)
Allergies:
Diagnostic Lab Data: Pt was not seen for his sx. Mom told us on 10/23/12 on WCC date. Pt has been ref to an allergist
CDC Split Type:

Write-up: Patient''s mom states received Flu shot on 10/15/12 at AM, late evening noticed his lips were swollen and had rash on extremities like urticaria, gave BENADRYL & sx resolved. "Did not f/u here next day. Declined any associated sx of N/V/F/D/SOB/ or CP. F/U M states pt had some lip rash with scrambled eggs. No prior hx.


VAERS ID: 472329 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2012-10-25
Onset:2012-10-26
   Days after vaccination:1
Submitted: 2012-10-31
   Days after onset:5
Entered: 2012-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / 3 RA / SYR

Administered by: Unknown       Purchased by: Other
Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hard swollen lump~DTaP (Daptacel)~2~2.00~Patient
Other Medications:
Current Illness: No
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Noticed extreme swelling, redness, heat, and complaint of pain of the entire half of his arm (shot had been administered on his upper arm).


VAERS ID: 476999 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2010-04-01
Onset:0000-00-00
Submitted: 2012-10-31
Entered: 2012-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Mumps, Mumps antibody test positive
SMQs:, Oropharyngeal infections (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Mumps antibody test: mumps; Mumps antibody test, see relevant tests
CDC Split Type: WAES1210USA013807

Write-up: This spontaneous report as received from a Physician Assistant refers to a 3.5 years old patient. The patient was vaccinated with M-M-R II (0.5 ml dose at 12 to 15 months of age, route and lot # were unknown) approximately in April 2010 (reported as "2 1/2 years ago"). No other co-suspects were reported. No concomitant medications were reported. On an unknown date the patient who had been vaccinated with M-M-R II presented with mumps at the emergency room. No treatment was given for adverse event. At the report time the outcome of event was unknown. The patient had sought unspecified medical attention. Lab diagnosis studies of "Titers for mumps" had been performed. Additional information is not expected.


VAERS ID: 473213 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: California  
Vaccinated:2012-10-23
Onset:2012-10-24
   Days after vaccination:1
Submitted: 2012-10-25
   Days after onset:1
Entered: 2012-11-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F94001 / 5 UN / IM

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

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

Write-up: Swelling, redness, induration, pain at injection site.


VAERS ID: 472775 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-11-02
Onset:2012-11-02
   Days after vaccination:0
Submitted: 2012-11-02
   Days after onset:0
Entered: 2012-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB677BA / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0601AA / 2 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site reaction, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl
Current Illness: 4 cm Blotchy, erythema @ thigh within 10 mins after MMR
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 4 cm blotchy, erythema on thigh within 10 mins after MMR.


VAERS ID: 473451 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Iowa  
Vaccinated:2012-10-30
Onset:0000-00-00
Submitted: 2012-11-02
Entered: 2012-11-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B140BA / 5 RL / IM

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

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

Write-up: (R) thigh red, warm to touch, swollen, low grade temp.


VAERS ID: 477309 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Unknown  
Vaccinated:2012-09-26
Onset:2012-10-07
   Days after vaccination:11
Submitted: 2012-11-05
   Days after onset:29
Entered: 2012-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1216AA / UNK UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA004410

Write-up: This spontaneous report as received from a nurse practitioner refers to 3 years old male patient. Pertinent medical history, drug reactions and allergies were reported as none. On 26-SEP-2012, the patient was vaccinated with lot # (1216AA) VARIVAX (Merck) subcutaneously (dosing details was not reported). Expiry date was 26-JUL-2013. Concomitant medications were reported as none. On 07-OCT-2012, the patient experienced chickenpox like rash at the injection site after receiving VARIVAX (Merck). The patient''s father had called the nurse practitioner and had sought medical attention for the same. No treatment information was reported. No laboratories diagnostic tests were performed. The outcome of chickenpox like rash at the injection site was reported as recovering/resolving. Additional information has been requested.


VAERS ID: 473797 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Indiana  
Vaccinated:2012-11-07
Onset:2012-11-08
   Days after vaccination:1
Submitted: 2012-11-09
   Days after onset:1
Entered: 2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AK2067 / 1 NS / IN

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

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

Write-up: RASH ON LEGS, ARMS, ABDOMEN AND BUTTOCKS. EARS RED. PT. WAS SEEN BY A DR. AND WAS PUT ON AN ANTIBIOTIC FOR AN EAR INFECTION. BENADRYL CREAM ORDERED FOR RASH.


VAERS ID: 475791 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-12-07
Entered: 2012-11-09
   Days after submission:338
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH506AB / UNK LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Illness at the time of vaccination was reported as none.
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201110940

Write-up: Initial report was received from a healthcare professional on 10 November 2011. A 3-year-old male patient had received an Intramuscular (IM) injection of FLUZONE; lot number UH506AB in left thigh. On an unspecified date, the patient developed ecchymosis at the injection site toward anterior of thigh. While receiving the injection, the patient moved and the needle slightly moved "skipping over the area" to more anterior aspect of thigh. No further information was available at the time of the report. The patient outcome was not reported. Documents held by sender: none.


VAERS ID: 476589 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: West Virginia  
Vaccinated:2012-11-02
Onset:2012-11-03
   Days after vaccination:1
Submitted: 2012-11-07
   Days after onset:4
Entered: 2012-11-09
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC51413146AA / 4 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin; None
Current Illness: (Cold) stuffy nose
Preexisting Conditions: Autism spectrum
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 24 hours after vaccination redness, swelling, warmth at injection site - 36 hours after vaccination vomiting x 3 - mother reports no fever - (ADVIL given warm compress to leg).


VAERS ID: 476590 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Indiana  
Vaccinated:2012-07-23
Onset:2012-07-24
   Days after vaccination:1
Submitted: 2012-11-08
   Days after onset:107
Entered: 2012-11-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4127AA / 6 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB591A / 2 RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Contusion, Erythema, Injection site erythema, Injection site rash, Injection site swelling, Injection site warmth, Rash macular
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red, swollen, "bumpy", warm area where vaccines given, 10x6 cm splotchy erythema on (L) thigh with 2cm area of bruising without induration no difficulty using legs.


VAERS ID: 474416 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Utah  
Vaccinated:2012-11-05
Onset:2012-11-07
   Days after vaccination:2
Submitted: 2012-11-12
   Days after onset:5
Entered: 2012-11-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2106 / 1 NS / IN

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

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

Write-up: Patient was given FLUMIST on 11-5-12 started with (hives everywhere) was advised to give him BENADRYL and have him seen in urgent care with concerns per phone note on 11-7-12. They took patient to ED and he is doing much better now as of 11-07-12 1900 hrs.


VAERS ID: 474135 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: South Dakota  
Vaccinated:2012-11-13
Onset:2012-11-14
   Days after vaccination:1
Submitted: 2012-11-14
   Days after onset:0
Entered: 2012-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 RL / IM

Administered by: Public       Purchased by: Other
Symptoms: Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flinstone Complete 1 tab daily (did not have that day)
Current Illness: None
Preexisting Conditions: Heart murmur
Allergies:
Diagnostic Lab Data: Have not taken her to the doctor yet, and will take her only if it becomes more severe.
CDC Split Type:

Write-up: Multiple emesis since 1:00 AM, also complaining of bilateral leg pain-from the knees down.


VAERS ID: 474162 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Alabama  
Vaccinated:2012-11-14
Onset:2012-11-14
   Days after vaccination:0
Submitted: 2012-11-14
   Days after onset:0
Entered: 2012-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H006951 / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: No adverse reaction noted. Live virus given out of sequence.


VAERS ID: 474279 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-10-25
Entered: 2012-11-15
   Days after submission:387
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2459PA / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autism, Regressive behaviour, Speech disorder developmental, Staring
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient has a history of speaking three word sentences.
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201110235

Write-up: Initial report was received on 19 October 2011 from a consumer who is also the patient''s parent. A seven year-old male patient (who was three-years old at the time of vaccination) had received in 2007 FLUZONE, lot number UT2459PA (route, site and exact date of administration not reported) and an unspecified amount of time following vaccination, experienced a "blank stare" in his eyes, his speech regressed and he was diagnosed with Autism. According to the parent, prior to vaccination the patient had been speaking in three word sentences and following vaccination he did not speak. No further information was available at the time of vaccination. The patient''s outcome was not recovered. Documents held by sender: none.


VAERS ID: 474485 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Florida  
Vaccinated:2012-10-24
Onset:2012-10-25
   Days after vaccination:1
Submitted: 2012-11-14
   Days after onset:20
Entered: 2012-11-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH753AA / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Viral URI; RAD
Preexisting Conditions: Reactive Airway Disease
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Local reaction = 4 x 5 cm erythematous induration on left upper arm.


VAERS ID: 476863 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-11-13
Onset:0000-00-00
Submitted: 2012-11-15
Entered: 2012-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0636AE / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1211USA005934

Write-up: This spontaneous report as received from a physician refers to a 3 years old patient with immunisation. The patient was vaccinated with, 1 DF GARDASIL. No other co-suspects were reported. No concomitant medications were reported. On an unknown date the patient experienced inappropriate schedule of vaccine administered. No treatment information was reported. The outcome of inappropriate schedule of vaccine administered is unknown. Inappropriate schedule of vaccine administered is not related to GARDASIL. No further information was provided.


VAERS ID: 474826 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2012-11-13
Submitted: 2012-11-14
   Days after onset:1
Entered: 2012-11-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH745AD / UNK AR / IM

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

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

Write-up: Upper arm swelling and erythema after second half of flu vaccine (FLUVIRIN).


VAERS ID: 474831 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-11-14
Onset:2012-11-14
   Days after vaccination:0
Submitted: 2012-11-14
   Days after onset:0
Entered: 2012-11-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2025 / UNK NS / IN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Contraindication to vaccination
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergies and asthma including daily use of a 1-FLOVENT twice daily scheduled, 2-daily FLONASE and 3-albuterol emergency inhaler if needed. Premature at birth.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Public Health Nurse went to local program to administer flu vaccine to children at a flu shot clinic. School nurse gave each parent a IZ consent form and IZ questionnaire to fill out in advance of flu shot clinic visit. Parent of this child wrote down that child did not have asthma on the questionnaire. During flu shot clinic at the program, a child was inadvertently given a single 0.2 ml dose of intranasal MedImmune - lot # AJ 2025 - FLUMIST flu vaccine instead of injectable flu vaccine. This is contraindicated as asthma sufferers are to be given only injectable flu vaccine. PHN contacted parent to request that family watch child for an increased risk of wheezing after the administration of the vaccine. PHN explained that any wheezing or difficulty breathing should be addressed by physician. If severe, child should be taken to the nearest emergency room. Parent said that they would monitor the child closely.


VAERS ID: 474931 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2012-11-15
Onset:2012-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2012-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH745AA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound (L) UE 11/18/12 - negative
CDC Split Type:

Write-up: Received flu shot 11/15/12. Began with (L) arm swelling, erythema & warmth 11/16/12 --$g put on KEFLEX. Redness continued to spread 11/17/12 & changed to BACTRIM. Admitted to hospital 11/17/12 for IV antibiotics & SOLUMEDROL. Unclear if infectious or allergic reaction. Allergy felt it was non infectious & just upper extremity swelling secondary to immunization.


VAERS ID: 474961 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2012-11-16
Onset:2012-11-17
   Days after vaccination:1
Submitted: 2012-11-20
   Days after onset:3
Entered: 2012-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AK2026 / 1 NS / IN

Administered by: Unknown       Purchased by: Public
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin with fluoride
Current Illness: Runny nose
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: On the day after the Flumist, patient had 5 hours of vomiting every hour.


VAERS ID: 475116 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Ohio  
Vaccinated:2012-11-18
Onset:2012-11-19
   Days after vaccination:1
Submitted: 2012-11-22
   Days after onset:3
Entered: 2012-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 00006494300 / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Blood culture negative, Human rhinovirus test positive, Increased upper airway secretion, Pyrexia, Ultrasound scan normal, Vaccination site cellulitis, Vaccination site irritation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen; albuterol; ascorbic acid; baclofen; bisacodyl; buffered lidocaine; cetirizine; chlorhexidine; cholecalciferol; clonazepam; diazepam; fluticasone hfa; heparin; hydrocortisone; ibuprofen; ipratropium hfa; lacri-lube; lansoprazo
Current Illness: No
Preexisting Conditions: Wolff-Hirschhorn syndrome and partial trisomy 13, severe trachobronchomalacia.
Allergies:
Diagnostic Lab Data: Blood culture no growth. Ultrasound of vaccine site with cellulitis, no abscess.
CDC Split Type:

Write-up: Mom thought location of vaccination looked irritated. Told a doctor both 11/19 and 11/20/12. Patient started to have intermittent fevers, however also had some increased secretions through trach and tested rhinovirus positive. Evening of 11/20/12 he had higher fevers (39.5) and the area around the vaccine site developed a cellulitis, which spread across thigh quickly. Has a h/o MRSA. Was given one dose of Clinda, but due to h/o of Clinda resistent MRSA in past, high fevers, and quick spread, was started on IV Vanc, after which clinical improvement was noted.


VAERS ID: 475125 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-11-15
Onset:2012-11-16
   Days after vaccination:1
Submitted: 2012-11-23
   Days after onset:7
Entered: 2012-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4154BA / UNK - / IM

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

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

Write-up: Erythema, pain, and 1.5" swelling at injection site.


VAERS ID: 475537 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Maryland  
Vaccinated:2012-11-17
Onset:2012-11-18
   Days after vaccination:1
Submitted: 2012-11-26
   Days after onset:8
Entered: 2012-11-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AB / 4 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Gait disturbance, Pain, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Received FLUZONE in (L) lateral thigh 11/17/12. Initially (1hr later) had pain, trouble walking & swelling- resolved with ibuprofen. 36 hrs later seen at medical center for swelling, redness, tenderness. Rx - Cephalexin. Resolved without complications.


VAERS ID: 475545 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2012-10-16
Onset:2012-11-07
   Days after vaccination:22
Submitted: 2012-11-15
   Days after onset:8
Entered: 2012-11-28
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. H011183 / 2 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood glucose increased, Glucose urine present, Hyperphagia, Polydipsia, Polyuria, Thirst, Type 1 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Tubulointerstitial diseases (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Blood sugar elevated - 540; Glucose high in urine
CDC Split Type: NC12013

Write-up: 10-16-12 patient received Hepatitis B vaccine, came into our office 11-7-12 with excessive thirst for couple weeks - dx with diabetes Type I. Onset of polydipsia, polyphagia, polyuria, onset after 10/23/12.


VAERS ID: 475644 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Hawaii  
Vaccinated:2012-11-03
Onset:2012-11-04
   Days after vaccination:1
Submitted: 2012-11-14
   Days after onset:10
Entered: 2012-11-28
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA709AA / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0411AE / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H007704 / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None - had had vesicular illness thought to be Coxsackie 10/15/2012
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left thigh severe local (leg) swelling and erythema with fine vesicles which eventually denuded central area rxn 24 -$g 48 hours peaked.


VAERS ID: 475666 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Kentucky  
Vaccinated:2012-11-19
Onset:2012-11-19
   Days after vaccination:0
Submitted: 2012-11-19
   Days after onset:0
Entered: 2012-11-28
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH747AB / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Fatigue, Skin warm, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Vaccinated at approximately 9:10 am. Telephone call from mother around noon. Mother reported that he had vomited a couple of times and seemed tired & weak. Father had carried him into home upon arrival home due to reported weakness. They live in another county. Nurse advised go to ER. Telephone call from ER physician, who inquired about any previous doses of influenza vaccine. Dr stated "I don''t think he is having a reaction to the vaccine". Mother also reported child felt "hot to the touch". No actual temperature taken.


VAERS ID: 475837 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: New York  
Vaccinated:2012-07-31
Onset:2012-08-16
   Days after vaccination:16
Submitted: 2012-11-30
   Days after onset:106
Entered: 2012-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0682AE / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Abasia, Ataxia, Balance disorder, Condition aggravated, Coordination abnormal, Gait disturbance, Hypersomnia, Laboratory test normal, Lethargy, Nuclear magnetic resonance imaging spinal cord normal, Weight bearing difficulty
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid 75 mg
Current Illness: None
Preexisting Conditions: Ataxic Cerebral Palsy and Congenital Hypothryoidism
Allergies:
Diagnostic Lab Data: Spinal MRI, lab work did not show any other possible cause for symptoms.
CDC Split Type:

Write-up: Patient became increasingly lethargic, sleeping excessively, having poor balance and coordination/increased ataxic gait and refused to walk starting on 8/16/2012. On 8/28/12 patient was hospitalized for the complete inability to walk or bear weight. Partial ability returned in a few days but full ability did not come back for three additional weeks.


VAERS ID: 475977 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2012-11-28
Onset:2012-11-29
   Days after vaccination:1
Submitted: 2012-11-30
   Days after onset:1
Entered: 2012-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B196BA / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0128AE / 2 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H006537 / 2 RA / SC

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

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

Write-up: Pt had KINRIX imm (L) deltoid on Wednesday yest. Today has large 3x3 inch localized red and warm area on inner aspect of (L) deltoid region.


VAERS ID: 476051 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Kansas  
Vaccinated:2012-11-29
Onset:2012-11-29
   Days after vaccination:0
Submitted: 2012-11-30
   Days after onset:1
Entered: 2012-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2139 / 1 NS / IN

Administered by: Public       Purchased by: Public
Symptoms: Abdominal pain upper, Body temperature increased, Diarrhoea, Feeling hot
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Last night 11/29/12 client began to experience diarrhea, elevated temperature (not taken but mother reports "he felt really hot") and that his "tummy hurt". The symptoms began approximately 6:00 p.m. He was completely recovered by morning. Hospital was called. Hospital staff encouraged to continue to monitor and call if worsens.


VAERS ID: 476163 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: California  
Vaccinated:2011-11-26
Onset:2011-11-27
   Days after vaccination:1
Submitted: 2012-12-03
   Days after onset:372
Entered: 2012-12-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 RL / SYR
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LL / SYR

Administered by: Public       Purchased by: Public
Symptoms: Enuresis, Erythema infectiosum, Injection site discolouration, Injection site haematoma, Injection site rash, Injection site swelling, Injection site vesicles, Rash generalised, Urine odour abnormal
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: She was getting over a cold. I told physician but they said it did not matter.
Preexisting Conditions: No defects or disorders.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen left leg; rash covering whole leg; rash turning purple for two weeks, hematoma, wetting pants every night after shots for a week, wetting pants during day, foul smelling urine for a week, developed Fifths disease from vaccine (foreign virus entering body and causing immune extreme immune response where body goes into hyper reaction, thus the large scale rash all over body (a year later child is developing rash similar to the one from vaccine administration, is currently being investigated by physicians for known virus or cause?); spot where injection was given last November is still visible and flares up out of no where from time to time (looks like large white blister sometimes, injection site.)


VAERS ID: 479730 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-08-08
Onset:2012-08-09
   Days after vaccination:1
Submitted: 2012-12-04
   Days after onset:117
Entered: 2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Immunisation
CDC Split Type: WAES1211USA012590

Write-up: This spontaneous report as received from a nurse refers to a 3 years old female patient. The patient was vaccinated with, .5 ml VARIVAX on 08-AUG-2012. No other co-suspects were reported. No concomitant medications were reported. On 09-AUG-2012 the patient experienced fever of 104.5 degrees fahrhenheit, 2 days after onset of therapy and small red dots on back. The patient received ADVIL as treatment. The outcome of fever of 104.5 degrees fahrenheit and small red dots on back was reported as recovered/resolved. The relatedness for fever of 104.5 degrees fahrenheit and small red dots on back is unknown for VARIVAX (Merck). Additional information has been requested.


VAERS ID: 476942 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Louisiana  
Vaccinated:2012-12-05
Onset:2012-12-05
   Days after vaccination:0
Submitted: 2012-12-06
   Days after onset:1
Entered: 2012-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH753AA / UNK LL / IM

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

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

Write-up: Hives. Received Influenza vaccine IM. Hives to (R) wrist noted approximately 20 minutes post injection. Received BENADRYL po & CELESTONE IM. Home on ORAPRED & ZYRTEC po.


VAERS ID: 477238 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Kansas  
Vaccinated:2012-10-19
Onset:2012-10-19
   Days after vaccination:0
Submitted: 2012-12-07
   Days after onset:49
Entered: 2012-12-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2108 / 2 NS / IN

Administered by: Private       Purchased by: Private
Symptoms: Corneal reflex decreased, Throat irritation, Tic
SMQs:, Dyskinesia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Corneal disorders (narrow)

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

Write-up: Pt received FLUMIST and per mom ("a couple hours after he developed a tic in which he blinks his eyes more or less constantly and makes a throat clearing noise").


VAERS ID: 477325 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Iowa  
Vaccinated:2012-12-06
Onset:0000-00-00
Submitted: 2012-12-10
Entered: 2012-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4545AA / 1 RL / IM

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

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

Write-up: Was given (2) 0.25 mL of influenza IM (R) thigh into 1 injection. No adverse reactions noted or reported. Should have only been given (1) 0.25 mL dose.


VAERS ID: 477328 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2012-12-06
Onset:2012-12-09
   Days after vaccination:3
Submitted: 2012-12-10
   Days after onset:1
Entered: 2012-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2025 / 4 NS / IN

Administered by: Private       Purchased by: Unknown
Symptoms: Cough, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: FLUMIST on 12/6/12. Fever, cough, congestion on 12/9/12.


VAERS ID: 477569 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: New York  
Vaccinated:2012-12-03
Onset:2012-12-03
   Days after vaccination:0
Submitted: 2012-12-06
   Days after onset:3
Entered: 2012-12-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AB / 2 LA / IM

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

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

Write-up: Approximately 1130 PM on 12/3/12 child awoke complaining of headache, T=100.1 degrees F and within 15 minutes vomited x 2. Tired in morning by 12 noon 12/4/12 seemed to be better according to mother.


VAERS ID: 477861 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2012-12-11
Entered: 2012-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1212USA002793

Write-up: This spontaneous report as received from a consumer refers to her 3 years old male grandson. The patient was vaccinated in error with a dose of GARDASIL (Lot # not reported) on an unspecified date. Any adverse effects were reported. Additional information has been requested.


VAERS ID: 477928 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2012-12-06
Onset:0000-00-00
Submitted: 2012-12-12
Entered: 2012-12-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 1 NS / IN

Administered by: Public       Purchased by: Public
Symptoms: Expired drug administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Pt/child was given flu nasal vaccine that expired 12-3-12 (on 12-6-12). No adverse reaction per mother - revaccination advised/offered.


VAERS ID: 478020 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Michigan  
Vaccinated:2012-11-21
Onset:2012-11-24
   Days after vaccination:3
Submitted: 2012-12-13
   Days after onset:19
Entered: 2012-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH753AA / 3 LL / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Amnesia, Apnoea, Chest X-ray, Confusional state, Convulsion, Dyskinesia, Gaze palsy, Postictal state, Somnolence, Tremor, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: febrile seizure~Influenza (Seasonal) (Fluzone)~2~3.00~Patient
Other Medications: Tylenol/ Motrin alternating doses
Current Illness: N/A
Preexisting Conditions: Febrile seizure following illnesses & vaccines in the past
Allergies:
Diagnostic Lab Data: Urinalysis, Chest X-ray PA & LAT
CDC Split Type:

Write-up: Full body shakes consistent with seizures which lasted less than 1 minute. Pt immediately fell asleep and was somnolent for approximate 10 minutes until woken by parents when EMS arived. Amnesia and postical confusion. Mouth tensed, fists clenched, eyes rolled back, and apnea were also symptoms.


VAERS ID: 478170 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Florida  
Vaccinated:2012-12-12
Onset:2012-12-13
   Days after vaccination:1
Submitted: 2012-12-14
   Days after onset:1
Entered: 2012-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / 1 NS / IN

Administered by: Unknown       Purchased by: Private
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Identical twin brother was being seen for hand foot mouth disease but patient showed no signs of illness at the time of vaccination
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Febrile Seizure.


VAERS ID: 478385 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2012-12-03
Onset:2012-12-05
   Days after vaccination:2
Submitted: 2012-12-05
   Days after onset:0
Entered: 2012-12-17
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC073AA / 4 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB527CA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cough
Preexisting Conditions: Allergy to all antibiotics except cephalexin
Allergies:
Diagnostic Lab Data: None
CDC Split Type: TN12021

Write-up: Itchy rash covering anterior-posterior trunk.


VAERS ID: 478439 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Arizona  
Vaccinated:2012-11-26
Onset:2012-11-26
   Days after vaccination:0
Submitted: 2012-11-26
   Days after onset:0
Entered: 2012-12-18
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188BA / 3 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Bronchospasm, Dyspnoea, Hyporesponsive to stimuli, Hypotonia, Pallor, Piloerection, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pale, less responsive, limp, "couldn''t breathe", goose bumps, no hives, no angioedema on exam, slightly pale, air not moving. Epinephrine & O2 Bronchospasm & fever.


VAERS ID: 478775 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: California  
Vaccinated:2012-12-17
Onset:2012-12-17
   Days after vaccination:0
Submitted: 2012-12-19
   Days after onset:2
Entered: 2012-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / SYR
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Public       Purchased by: Other
Symptoms: Crying, Gait disturbance, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: FEVER AND CRYING UNCONTROLLABLY AND WALKING WITH A LIMP. WITHIN AN HOUR (ABOUT 9PM) WOULD NOT WALK AT ALL AND OR MOVE HIS LEG. HAS BEEN A FEW DAYS AND IS STILL NOT WALKING WITH A LIMP AND GETTING FEVERS. HAVING TO ALTERNATE WITH MOTRIN AND TYLENOL TO KEEP FEVER DOWN AND PAIN AWAY SO THAT HE CAN FEEL COMFORTABLE, BUT STILL CRIES AND COMPLAINS FOR LEG PAIN WITH A LIMP.


VAERS ID: 479055 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2012-12-13
Onset:2012-12-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2012-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1205901 / 3 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Rash at site of injection only x 6 days.


VAERS ID: 479045 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Pennsylvania  
Vaccinated:2012-12-19
Onset:2012-12-20
   Days after vaccination:1
Submitted: 2012-12-23
   Days after onset:3
Entered: 2012-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 LL / SYR

Administered by: Unknown       Purchased by: Other
Symptoms: Abnormal behaviour, Erythema, Hypersensitivity, Irritability, Lethargy, Pruritus, Pyrexia, Rash erythematous, Rash generalised, Sluggishness, Urticaria, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ceffindar for tonsillitis
Current Illness: Recovering from diagnosis of tonsillitis (diagnosed 12/12/2012) and was on day 7 of a 10 day antibiotic.
Preexisting Conditions: Born with cleft lip. Diagnosed with tonsillitis 7 days prior to vaccine.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started as a low grade fever, sluggish and lethargic after waking from afternoon nap-gave Motrin and he seemed much better. Then, during his bath 8:00 PM that evening, we noticed red circles about half in I diameter on his torso. They blanched when touched and were not raised but rather flush with his skin. Called dr; he said could be viral, allergic reaction or combination. No fever at this time. Recommended Benadryl. Did not have any, and child did not seem bothered, so we chose not to give meds. Next morning, 12/21/2011, tons more spots and they''ve changed in appearance. Some are still small red dots, se have tripled in size and joined together. Child again lethargic and clingy unlike himself. Gave Benadryl. He soon fell asleep. When he woke, he was still whiny and cranky. Gave Motrin and soon was playing and acting normal. Next morning, 12/22/2012, child covered in spots head to toe. Child very irritated and itchy now. Spots on back of head and neck and ears are bothersome to child. Ears dark red. Many of the spots on sides and underarm are raised and look like welts. They also appear to be more of a red raised ring instead of the whole spot being red as they had started. Chose to go to ER. Diagnosed with allergic reaction probably to vaccine. Ran fever again through that night. Ongoing as this reaction is still active in my son.


VAERS ID: 479392 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2012-12-12
Onset:2012-12-12
   Days after vaccination:0
Submitted: 2012-12-26
   Days after onset:14
Entered: 2012-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U454507A / 1 LL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLARINEX 5mL daily; PROAIR as needed; QVAR twice daily
Current Illness: None
Preexisting Conditions: Allergic Rhinitis; Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient with 11cm x 14cm erythematous firm, indurated area to the left thigh 2 days after the influenza vaccine was administered - started the same day the vaccine was given.


VAERS ID: 479715 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2012-11-13
Submitted: 2012-11-14
   Days after onset:1
Entered: 2012-12-28
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH745AD / UNK AR / IM

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

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

Write-up: Upper arm swelling and erythema after second half of flu vaccine (FLUZONE).


VAERS ID: 480053 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Louisiana  
Vaccinated:2012-12-28
Onset:2012-12-29
   Days after vaccination:1
Submitted: 2013-01-02
   Days after onset:4
Entered: 2013-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0385AE / 2 LG / SYR

Administered by: Unknown       Purchased by: Military
Symptoms: Thirst, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: seisures~Polio Virus, Inact. (no brand name)~1~0.42~Patient|seisures~Rotavirus (no brand name)~2~0.42~Patient
Other Medications: No Prescription meds given/taken
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting and excessive thirst. Child woke up from sleep vomited, requested water. Vomited again, requested water, and continued to vomit and drink water for the next 48 hours. No treatment, child rested.


VAERS ID: 480095 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Ohio  
Vaccinated:2012-12-21
Onset:2012-12-28
   Days after vaccination:7
Submitted: 2013-01-02
   Days after onset:5
Entered: 2013-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015623 / 1 LL / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Blood urine present, Chills, Pyrexia, Rash, Rash erythematous, Urinary incontinence, Viral infection
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: He has had other adverse reactions to vaccinations given earlier but I do not have the specific information at this time. Symptoms were extreme swelling around injection site, vomiting, and inconsolability. Current medications are a multivi
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: He had moderate blood in his urine during the course of his fever.
CDC Split Type:

Write-up: High fever (over 102.9), chills, urinary incontinence with blood in urine. This was from Friday evening (12/28) until Tuesday morning (1/1/13) when his fever was gone. Wednesday (1/2/13) a small red bump rash appeared on his chest and stomach. The Pediatrician suggested it was a virus, but I am positive it was a vaccine reaction. He had no other symptoms of viral infection and his brother and sister have remained healthy.


VAERS ID: 480685 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2013-01-03
Entered: 2013-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Autoimmune thrombocytopenia, Immunoglobulin therapy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1212USA010632

Write-up: This spontaneous report as received from a pharmacist refers to a 3 years old female patient. The patient was 11 years old now. On an unknown date, the patient was vaccinated with 0.5 ml VARIVAX (merck) VIAL 1350U subcutaneously at 12 months of age. Lot# was unspecified. Two years later, on an unspecified date at approximately 3 years old, the patient developed immune thrombocytopenic purpura (ITP). The patient received treatment with intravenous immunoglobulins (specific products and manufacturers unspecified). The outcome of patient was unknown. Additional information is not expected.


VAERS ID: 480581 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2013-01-07
Onset:2013-01-07
   Days after vaccination:0
Submitted: 2013-01-07
   Days after onset:0
Entered: 2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA707BA / 1 RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Sz approx 2 min after flu vac. was given.


VAERS ID: 480620 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Louisiana  
Vaccinated:2012-04-26
Onset:2012-05-08
   Days after vaccination:12
Submitted: 2013-01-08
   Days after onset:245
Entered: 2013-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
6VAX-F: DTAP+IPV+HEPB+HIB (HEXAVAC) / SANOFI PASTEUR - / 1 RL / SYR
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / 1 LL / SYR
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LL / SYR

Administered by: Public       Purchased by: Public
Symptoms: Febrile convulsion, Pallor, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Fever of 103.7 at the ER.
CDC Split Type:

Write-up: Child woke up with a fever of 103F. Child was shaking and would not respond to parents. Skin was very pale. Child recovered within minutes. Febrile seizures returned about 3-4 times in the course of the morning. The fever remained high. The febrile seizures did not return in the evening, but the fever remained for about 3 days, staying over 100F.


VAERS ID: 480746 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2013-01-07
Onset:2013-01-08
   Days after vaccination:1
Submitted: 2013-01-08
   Days after onset:0
Entered: 2013-01-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4527EB / 2 RL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: Fever; Dry cough; Nasal congestion; Runny nose
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Urticaria - hives, on legs, trunk, face. Unknown if vaccine reaction, vaccinated 1/7/13 mother noticed hives on legs, trunk, face on 1/8/13.


VAERS ID: 480796 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: New York  
Vaccinated:2013-01-04
Onset:2013-01-07
   Days after vaccination:3
Submitted: 2013-01-09
   Days after onset:2
Entered: 2013-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain upper, Balance disorder, Diarrhoea, Dizziness, Fall, Fatigue, Increased tendency to bruise, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Vomiting, diarrhea, dizziness, loss of balance, stomach pain, tiredness. Seemed to bruise easily, quickly developed bruises after bumping into furniture or falling from dizziness.


VAERS ID: 481087 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Unknown  
Location: Utah  
Vaccinated:2012-10-11
Onset:2012-10-11
   Days after vaccination:0
Submitted: 2012-11-30
   Days after onset:50
Entered: 2013-01-10
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58807 / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012033666

Write-up: This medically confirmed spontaneous report (initial receipt 11-Oct-2012) concerns a 3 year old patient. On 11-Oct-2012, the patient was inadvertently administered AFLURIA (batch P58807) via intramuscular route at a dose of 0.5 ml. No adverse effect was reported. The event outcome was unknown.


VAERS ID: 481091 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:2012-10-09
Onset:2012-10-09
   Days after vaccination:0
Submitted: 2012-11-30
   Days after onset:52
Entered: 2013-01-10
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED - / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012033619

Write-up: This medically confirmed spontaneous report (initial receipt: 09-Oct-2012) concerns a 3-year-old patient. On 09-Oct-2012 the patient was vaccinated with AFLURIA (batch number was not provided) injection intramuscularly. No known adverse effects were reported.


VAERS ID: 480919 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2013-01-10
Onset:2013-01-11
   Days after vaccination:1
Submitted: 2013-01-11
   Days after onset:0
Entered: 2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / 1 NS / IN

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

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

Write-up: High fever, vomiting.


VAERS ID: 481157 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: California  
Vaccinated:2013-01-10
Onset:0000-00-00
Submitted: 2013-01-11
Entered: 2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B157BA / 5 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB667AB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0259AE / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

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

Write-up: None.


VAERS ID: 481054 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Colorado  
Vaccinated:2013-01-01
Onset:2013-01-10
   Days after vaccination:9
Submitted: 2013-01-13
   Days after onset:3
Entered: 2013-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / 2 NS / IN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / SYR

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

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

Write-up: Horrible rash that continued to worsen. Finally took to ER and they said he was having an allergic reaction to something in the MMR vaccine. It continues to worsen even after Prednisone. No itch cream helps and he is bleeding from constant scratching.


VAERS ID: 481196 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Virginia  
Vaccinated:2013-01-11
Onset:2013-01-12
   Days after vaccination:1
Submitted: 2013-01-14
   Days after onset:2
Entered: 2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH745AD / UNK LL / IM

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

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

Write-up: Itchy fine, red, raised rash.


VAERS ID: 481435 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Florida  
Vaccinated:2013-01-13
Onset:2013-01-13
   Days after vaccination:0
Submitted: 2013-01-15
   Days after onset:2
Entered: 2013-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Decreased appetite, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alvesco (for asthma)
Current Illness: No
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Became lethargic, no appetite, fever of 103.6. Fever continued for 30 hours. Highest recorded: 104.5.


VAERS ID: 481441 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Utah  
Vaccinated:2012-01-14
Onset:2012-01-14
   Days after vaccination:0
Submitted: 2013-01-15
   Days after onset:367
Entered: 2013-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: An acute episode of vomiting lasting 30 minutes. Vomited 5-6 times in that span.


VAERS ID: 481564 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: California  
Vaccinated:2012-11-30
Onset:0000-00-00
Submitted: 2012-12-05
Entered: 2013-01-16
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH614AA / 5 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0233AE / 2 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H011962 / 2 RA / UN

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

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

Write-up: Extra dose of MMR, VARIVAX & HIB were given in error. Last dose of MMR & VARIVAX were given on 7-26-10. Last dose of HIB given on 4-26-11.


VAERS ID: 481567 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2013-01-14
Onset:2013-01-14
   Days after vaccination:0
Submitted: 2013-01-15
   Days after onset:1
Entered: 2013-01-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH753AA / 2 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570AA / 2 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H0175 / 2 UN / SC

Administered by: Private       Purchased by: Public
Symptoms: Respiratory disorder, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 3 yr old who developed hives, vomiting approx 30 mins after receiving his 3 vaccines, given BENADRYL given but child vomited again advised to call 911 seen at ED with resp sxs given epinephrine x 1 with improvement of symptoms - home on allergy med x 1 wk.


VAERS ID: 481649 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Kansas  
Vaccinated:2013-01-04
Onset:0000-00-00
Submitted: 2013-01-16
Entered: 2013-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206901 / 2 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: None, no treatment needed.


VAERS ID: 481651 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2013-01-14
Onset:2013-01-15
   Days after vaccination:1
Submitted: 2013-01-16
   Days after onset:1
Entered: 2013-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH733AC / 4 LA / IM

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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Febrile seizure 4-6-11; eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left upper and lower arm moderately swollen with warmth and redness. Tx with BENADRYL 1 tsp Q 6 hours and use cool compresses for swelling.


VAERS ID: 481684 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Texas  
Vaccinated:2010-09-02
Onset:0000-00-00
Submitted: 2013-01-17
Entered: 2013-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 5 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Antibody test, Infection, No therapeutic response, Pneumonia
SMQs:, Lack of efficacy/effect (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Drug hypersensitivity; Ear infection
Preexisting Conditions: AMOXIL, Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA004787

Write-up: This spontaneous report was received from a registered nurse (who is the mother) refers to a 1 year 4 month old female patient. The patient had pertinent medical history of multiple ear infection and pneumonia. The patient has AMOXIL allergy. On 22-MAR-2007, the patient was vaccinated with a dose 1 of PNEUMOVAX 23 (manufacturer unknown) (also reported as PNEUMOVAX 7 and PNEUMOVAX 13 (lot number, expiration date and route not reported). The patient was vaccinated with PNEUMOVAX 23 (also reported as PNEUMOVAX 7) on 22-MAR-2007, 31-MAY-2007, 31-JUL-2007, 25-JAN-2008. She was also vaccinated with PNEUMOVAX 23 (manufacturer unknown) (also reported as PNEUMOVAX 13) (lot number, expiration date and route not reported) on 09/02/2010. No concomitant medications were reported. The patient did not develop immunity to either one of the vaccines. On an unknown date in May-2008, the reporter stated that the patient kept getting unspecified infections and was diagnosed with pneumonia where she was hospitalized from 10-NOV-2012 to 11-NOV-2012. It was unknown whether the product involved was PNEUMOVAX 23 or PREVNAR (other manufacturer) as the reporter referred to the vaccine as PNEUMOVAX 7 and PNEUMOVAX 13. Pneumococcal titers were performed and the result was unknown. There was no treatment rendered for the events. Outcome of the reported events were unknown. The patient sought medical attention. Additional information has been requested.


VAERS ID: 481799 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Florida  
Vaccinated:2012-10-04
Onset:2012-12-03
   Days after vaccination:60
Submitted: 2013-01-13
   Days after onset:41
Entered: 2013-01-18
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH753AB / UNK UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Influenza A virus test positive, Influenza B virus test positive
SMQs:, Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Illness at the time of vaccination was N/A and past medical history was reported as unknown.
Allergies:
Diagnostic Lab Data: 03 December 2012: Binaxnow quick test (for Influenza A and B) was positive.
CDC Split Type: 201300530

Write-up: Initial report received from a vaccine provider on 07 January 2013. This case is not medically confirmed as the reporter was not identified as a healthcare professional or not. The report involves a cluster of 6 children from the same reporter and same lot number UH753AB. This case captures one of the children and the other children are captured in cases 2012-11111, 2013-00526, 2013-00527, 2013-00528 and 2013-00529. A three year-old female patient whose illness at the time of vaccination was reported as "N/A" and past medical history was unknown had received a dose of FLUZONE (lot number UH753AB, IM) on 04 October 2012 and tested positive for Influenza A and influenza B via the Binaxnow quick test on 03 December 2012. The patient''s outcome was not recovered. Documents held by sender: none.


VAERS ID: 481902 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: California  
Vaccinated:2013-01-18
Onset:2013-01-18
   Days after vaccination:0
Submitted: 2013-01-19
   Days after onset:1
Entered: 2013-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED - / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Qvar, Singulair
Current Illness: No
Preexisting Conditions: Asthma, eggs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting, fever (101).


VAERS ID: 481992 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Florida  
Vaccinated:2013-01-11
Onset:2013-01-14
   Days after vaccination:3
Submitted: 2013-01-15
   Days after onset:1
Entered: 2013-01-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1169AA / 1 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Injection site movement impairment, Injection site pain, Weight bearing difficulty
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Cannot bear wt on (L) leg x 72 hrs after vaccine. FROM, tender at site. Slight resistance to (L) external rotation.


VAERS ID: 482038 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-10-18
Onset:2013-01-14
   Days after vaccination:88
Submitted: 2013-01-15
   Days after onset:1
Entered: 2013-01-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH734AA / 4 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Influenza, Influenza A virus test positive
SMQs:, Infective pneumonia (broad)

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

Write-up: Positive influenza Type A. After influenza vaccine given on 10/18/12.


VAERS ID: 482044 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: New York  
Vaccinated:2013-01-18
Onset:2013-01-19
   Days after vaccination:1
Submitted: 2013-01-22
   Days after onset:3
Entered: 2013-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Diarrhea for 3 days; Vomited on day 3.


VAERS ID: 482317 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Illinois  
Vaccinated:2013-01-11
Onset:2013-01-11
   Days after vaccination:0
Submitted: 2013-01-23
   Days after onset:12
Entered: 2013-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH712AB / 3 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Body temperature increased, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mother denied
Preexisting Conditions: Latent factor V
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Redness below injection site from entire tricep to shoulder on outer aspect of child''s arm. Appeared hot, red, swollen. No white areas noted. High temperature noted throughout reaction was 99.2 orally. Child did not complain of pain. Mom medicated with Benadryl throughout the reaction until resolved on 1/14/2013 in the night hours but realized resolved at 0630 when child awoke for school.


VAERS ID: 482320 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Unknown  
Vaccinated:2013-01-22
Onset:2013-01-22
   Days after vaccination:0
Submitted: 2013-01-23
   Days after onset:1
Entered: 2013-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AA / 2 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Convulsion, Electroencephalogram
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Abdominal pain, diffuse
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: EEG
CDC Split Type:

Write-up: Seizure.


VAERS ID: 482336 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2013-01-22
Onset:2013-01-22
   Days after vaccination:0
Submitted: 2013-01-23
   Days after onset:1
Entered: 2013-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB515AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918561 / 3 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Hypotonia, Pain, Screaming, Weight bearing difficulty
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Giving Ibuprofen PRN
Current Illness: Some mild leg pains off and on x 1-2 months
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccines administered 01/22/13. On 01/22/13, woke from nap "screaming". Would not bear weight on left leg. 1/23/13 - Walking today, but with a limp. Won''t play due to pain. Temp 100.4 deg F.


VAERS ID: 482326 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Hawaii  
Vaccinated:2013-01-21
Onset:2013-01-23
   Days after vaccination:2
Submitted: 2013-01-24
   Days after onset:1
Entered: 2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 RL / -

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

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

Write-up: Hives.


VAERS ID: 482450 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2013-01-22
Onset:2013-01-23
   Days after vaccination:1
Submitted: 2013-01-24
   Days after onset:1
Entered: 2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B157BA / 4 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH712AB / 1 LA / IM

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

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

Write-up: PARENT NOTED LAST NIGHT (01/23/2013), RIGHT UPPER ARM AREA WHERE SHOT WAS GIVEN: REDNESS, REDNESS MEASURED 2in.x4in-OVAL SHAPE, WARM TO TOUCH, HARD. NO FEVER. USING ICE, IBUPROFEN AT NIGHT.


VAERS ID: 482485 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Maryland  
Vaccinated:2013-01-21
Onset:2013-01-22
   Days after vaccination:1
Submitted: 2013-01-24
   Days after onset:2
Entered: 2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B164AA / UNK LA / UN

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

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

Write-up: Redness, and inflammation of left arm.


VAERS ID: 482529 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2012-04-05
Onset:2012-04-16
   Days after vaccination:11
Submitted: 2013-01-25
   Days after onset:284
Entered: 2013-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1251AA / 1 LA / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Abnormal behaviour, Amnesia, Aphagia, Arthralgia, Blood test, Chills, Cognitive disorder, Coordination abnormal, Decreased eye contact, Diarrhoea, Disturbance in attention, Dyspnoea, Encephalomyelitis, Encephalopathy, Epstein-Barr virus test negative, Fatigue, Fear, Fluid intake reduced, Flushing, Headache, Hearing impaired, Irritability, Lethargy, Malaise, Mononucleosis heterophile test negative, Myalgia, Mydriasis, Neurological symptom, Night sweats, Nightmare, Pain in extremity, Pain of skin, Psychomotor hyperactivity, Pyrexia, Rash, Screaming, Sensory disturbance, Speech disorder, Streptococcus test negative, Urinary incontinence, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Akathisia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Demyelination (narrow), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None, healthy exam, possible spring allergic rhinitis beginning.
Preexisting Conditions: Infancy: bronchiolitis, croup, allergic rhinitis. Frequent colds.
Allergies:
Diagnostic Lab Data: Months of tests have followed. He has improved a little each month, but there is still an obvious difference between his well days and his relapsing days which are always triggered by immune system activation according to our documentation and doctors research. The closest diagnosis at this point is Encephalomyelitis with neurological sequelae which looks similar to the relapsing - remitting episodes that occur with some autoimmune disorders. Immune deficiencies and Partial Seizures have been ruled out. He is now being sent to Neuro-Immunology clinic to look at what autoimmune condition patient now has as a result of receiving this MMR Vaccine. We are very upset and angry that so much has gone into covering up the truth of the damage that this 3 live vaccine has done to children, now including mine, across this nation. He has had to endure countless doctors appointments, endless bloodwork with no definitive diagnosis or treatment, few well days, and is scheduled to have his tonsils out because they are so diseased now.
CDC Split Type:

Write-up: The day after vaccine 4/6/2012, patient was more hyper, less attentive, less affect, less eye contact, and some strange facial expressions. Low temp of 99. All within normal side effects for vaccine assuming they were temporary and self limiting; no concern at this point of reaction. Upon waking, patient was lethargic, irritable, flushed. Temperature reading at 8:00 was 103. Patient had never experienced a fever higher than 102 in his life, or lethargy, despite having several viruses in his young life. Patient was taken to doctor this day, thought to be virus, however the next morning awoke perfectly well. This is when the immune activation is thought to have begun. On 4/29/2012 mild leg pain and fatigue; extremely unusual for patient. This is when the Encephalopathy is thought to have begun. 4/30/2012 Awoke at 5:30 screaming, afraid, nightsweat. Irritable, flushed, lethargic. Similar to previous event with 103.5 fever this time. This time however, he looked, felt, acted, seriously ill. Was unable to eat, would not drink, scared, skin hurt. This is when suspected Encephalomyelitis began. On the way to the doctor''s office, his pupils were as large as his iris, shivering, aching knees, leg muscles, breathing was labored. Dr. that he saw observed that he was very ill and did bloodwork for mono, EBV, strep. All turned out to be negative. He woke up "well" the next morning. Another episode on 5/2/2012 in which he had headache, small bumpy rash on his ears, arms, and legs, completely lethargic, diarrhea. This is the day that the neurological symptoms became more noticable. For the next 7-10 days, patient loss cognitive abilities, memory loss, muscle pain, sensory sensations, nightmares / possible febrile seizures, hearing, vision changes, urination accidents, loss of coordination, unable to pronounce words, unable to follow directions, unable to express himself the way that he had always been able to so well.


VAERS ID: 482600 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2013-01-22
Onset:2013-01-23
   Days after vaccination:1
Submitted: 2013-01-26
   Days after onset:3
Entered: 2013-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cold with postnasal drip causing a mild cough. Temp was taken before vaccination: 99.0 F
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever that lasted 24 hours. High temp. was 102 F. One dose of children''s ibuprofen.


VAERS ID: 482735 (history)  
Form: Version 1.0  
Age: 3.0  
Gender: Male  
Location: Florida  
Vaccinated:2012-09-24
Onset:2013-01-11
   Days after vaccination:109
Submitted: 2013-01-14
   Days after onset:3
Entered: 2013-01-28
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA702AA / 1 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Influenza, Influenza A virus test positive, Influenza B virus test, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu A positive~Vaccine not specified (no brand name)~8~8.00~Sibling
Other Medications: None
Current Illness: Pseudo strabismus; Ingest foreign body
Preexisting Conditions: NKDA; RAD
Allergies:
Diagnostic Lab Data: Bianax A-B test kit
CDC Split Type:

Write-up: Fever x 36 hours up to 101 degrees; Flu A positive exposure/mom & brother. Positive Flu A/Bianax A-B test kit. Rx TAMILFU 60 mgm po BID x 5 days.


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