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Case Details (Sorted by Age)

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VAERS ID:205635 (history)  Vaccinated:2003-06-13
Age:5.0  Onset:2003-06-13, Days after vaccination: 0
Gender:Female  Submitted:2003-06-14, Days after onset: 1
Location:Unknown  Entered:2003-07-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: CBC, CRP, blood culture done 6/14/03.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 4  
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt presented to ER with swelling and redness to upper left arm at immunization site. Diagnosed with cellulitis. Blood drawn, Ceftriaxone 950 mg given IV.

VAERS ID:205638 (history)  Vaccinated:2003-06-11
Age:5.0  Onset:2003-06-12, Days after vaccination: 1
Gender:Male  Submitted:2003-06-13, Days after onset: 1
Location:California  Entered:2003-07-01, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: CA030059
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0852AA4 LA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW06253 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1232M1 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site oedema, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen upper arm, tenderness

VAERS ID:205640 (history)  Vaccinated:2003-06-10
Age:5.0  Onset:2003-06-12, Days after vaccination: 2
Gender:Male  Submitted:2003-06-13, Days after onset: 1
Location:California  Entered:2003-07-01, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD Aventis Pasteur C0941AA right forearm
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: CA030061
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0852AA4 LA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW06253 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1232M1 LA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 3"-5" red hot swollen left arm

VAERS ID:205650 (history)  Vaccinated:2003-05-05
Age:5.7  Onset:2003-05-07, Days after vaccination: 2
Gender:Male  Submitted:2003-05-07, Days after onset: 0
Location:Georgia  Entered:2003-07-01, Days after submission: 55
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE-PCP-Backup child hospital
Diagnostic Lab Data: NONE
CDC Split Type: GA03065
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS582A24IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1000M1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site pain, Oedema, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 05/07/2003: At 07:00, mom noted right arm swelling, redness, itch and tenderness. Child was given ibuprofen 1.5 tsp and sent to school. Child received DTaP to right arm 05/05/2003.

VAERS ID:205658 (history)  Vaccinated:2003-06-06
Age:5.0  Onset:2003-06-07, Days after vaccination: 1
Gender:Female  Submitted:2003-06-23, Days after onset: 16
Location:Illinois  Entered:2003-07-01, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Klippel, Trananay Weber Syndrome
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0856BA4IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW08163IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0773M1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Significant erythema to right deltoid area.

VAERS ID:205659 (history)  Vaccinated:2003-04-22
Age:5.0  Onset:2003-04-23, Days after vaccination: 1
Gender:Female  Submitted:2003-06-24, Days after onset: 62
Location:Washington  Entered:2003-07-01, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
IPV: POLIO VIRUS, INACT. (NO BRAND NAME)UNKNOWN MANUFACTURER    
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Injection site erythema, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 26.5 cm diameter of left upper arm. Area of erythema 12 x 13 cm on left lateral upper arm. Pain with range of movement in deltoid, warm to the touch.

VAERS ID:205661 (history)  Vaccinated:2003-06-16
Age:5.0  Onset:2003-06-17, Days after vaccination: 1
Gender:Female  Submitted:2003-06-18, Days after onset: 1
Location:Oregon  Entered:2003-07-01, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OR200323
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC0950AB4IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS764A20IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW03343SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0931M1SCRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Pruritus
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)
Write-up: Approximately 20-24 hours after vaccines given, mother noted swelling, redness, and warmth at site of immunization. Child also complains of itching. Symptoms have persisted 48 hours later, but not worsened. Right deltoid/arm

VAERS ID:205663 (history)  Vaccinated:2003-06-10
Age:5.0  Onset:2003-06-11, Days after vaccination: 1
Gender:Female  Submitted:2003-06-12, Days after onset: 1
Location:Oregon  Entered:2003-07-01, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;DTaP (unknown mfr);4;1;In Patient
Other Medications: Serevent, Pulmocort, Cromlyn, Singulair, Prevacid, Vitamins, Albuterol
Current Illness: History of Asthma
Preexisting Conditions: Amoxicillin, augmentin, reglan
Diagnostic Lab Data: NONE
CDC Split Type: OR200321
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC0950AB3IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.764A20IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW03340IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0878M1SCRA
Administered by: Public     Purchased by: Other
Symptoms: Feeling hot, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Immunizations on 06/10/2003. DTaP and IPV in left arm intramuscular. Reaction started 06/11/2003. About the size of a silver dollar. today the area is baseball size. 3.5 in long x 3in wide. 1 small area in aspect of left arm. size of quarter. Area is warm and tender. Mobility intact. NO fever.

VAERS ID:205668 (history)  Vaccinated:2003-06-23
Age:5.0  Onset:2003-06-24, Days after vaccination: 1
Gender:Male  Submitted:0000-00-00
Location:Missouri  Entered:2003-07-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0853BA4IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1231M1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother noticed reddened right arm 06/24/2003 evening. Called 06/25/2003 and reported right arm swollen-hand-red-itching. Doctor appointment on 06/26/2003. Doctor not worried. Treatment with antibiotics and benadryl. no fever.

VAERS ID:205683 (history)  Vaccinated:2003-06-18
Age:5.0  Onset:2003-06-19, Days after vaccination: 1
Gender:Male  Submitted:2003-06-20, Days after onset: 1
Location:Ohio  Entered:2003-07-01, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0856BA4IMRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pruritus, Tenderness
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)
Write-up: R arm 5 1/2 x 7/14" redness and swelling, warm to the touch, (+) itchy, some tenderness. Tx: Motrin q 6 prn, Benadryl prn and ice to area.

VAERS ID:205687 (history)  Vaccinated:2003-06-10
Age:5.0  Onset:2003-06-12, Days after vaccination: 2
Gender:Female  Submitted:2003-06-12, Days after onset: 0
Location:Florida  Entered:2003-07-01, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1245A24IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0945M1SCLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: L arm red and swollen.

VAERS ID:205694 (history)  Vaccinated:2003-06-25
Age:5.0  Onset:2003-06-27, Days after vaccination: 2
Gender:Male  Submitted:2003-06-27, Days after onset: 0
Location:California  Entered:2003-07-01, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS596A20IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS764A20IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW07040SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1082M0SCLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt developed an area of redness and swelling to site of application of immunizations.

VAERS ID:205695 (history)  Vaccinated:2003-06-27
Age:5.0  Onset:2003-06-28, Days after vaccination: 1
Gender:Male  Submitted:2003-06-29, Days after onset: 1
Location:California  Entered:2003-07-01, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS592A94IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT114322SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1039M1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling/redness/warm to touch of injection site right thigh - post immunization of IPV. Redness measures 9 x 10 cm.

VAERS ID:205717 (history)  Vaccinated:2003-06-16
Age:5.0  Onset:2003-06-16, Days after vaccination: 0
Gender:Female  Submitted:2003-07-01, Days after onset: 15
Location:Tennessee  Entered:2003-07-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nond
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0856DA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW0869 SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.00967 SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site warmth, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Painless swelling of left arm 3x4cm. No secondary infection.Increased heat & warmth in area of site. Treated with cool compresses & benadryl

VAERS ID:205751 (history)  Vaccinated:2003-06-24
Age:5.0  Onset:2003-06-25, Days after vaccination: 1
Gender:Female  Submitted:2003-06-26, Days after onset: 1
Location:Delaware  Entered:2003-07-02, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0987AA4 RA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW09073 LA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Feeling hot, Injection site pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5.5 inch from vaccination site of erythema warmth and tenderness.

VAERS ID:205761 (history)  Vaccinated:0000-00-00
Age:5.0  Onset:0000-00-00
Gender:Unknown  Submitted:0000-00-00
Location:California  Entered:2003-07-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSA592A94IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW01973SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0858M1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Malaise
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local redness and swelling, followed by one week serum-sickness type hypersensitivity reaction. Full recovery thereafter.

VAERS ID:205763 (history)  Vaccinated:2003-06-19
Age:5.0  Onset:2003-06-19, Days after vaccination: 0
Gender:Male  Submitted:2003-06-24, Days after onset: 5
Location:North Carolina  Entered:2003-07-02, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS582A24 LL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW07043 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0878M1SCRL
Administered by: Private     Purchased by: Public
Symptoms: Nonspecific reaction
SMQs:
Write-up: MD noted : possible febrile DTaP reaction.

VAERS ID:205765 (history)  Vaccinated:2003-06-17
Age:5.0  Onset:2003-06-18, Days after vaccination: 1
Gender:Male  Submitted:2003-06-27, Days after onset: 9
Location:Ohio  Entered:2003-07-02, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1383AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW07503SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1080M1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swelling, redness L thigh-mildly warm to touch. Probable immunization reaction, but tx''d with Omnicef 250 BID x 10D to cover for possible cellulitis. The follow up received on 7/23/03 states Omnicef change to Duricef.

VAERS ID:205774 (history)  Vaccinated:2003-06-20
Age:5.0  Onset:2003-06-22, Days after vaccination: 2
Gender:Male  Submitted:2003-06-23, Days after onset: 1
Location:Hawaii  Entered:2003-07-02, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0830AA3 RA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: R deltoid swelling, redness, itchy onset 24 hrs post shot.

VAERS ID:205776 (history)  Vaccinated:2003-06-24
Age:5.0  Onset:2003-06-24, Days after vaccination: 0
Gender:Male  Submitted:2003-06-24, Days after onset: 0
Location:Michigan  Entered:2003-07-02, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0856DA  LL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW0906  LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1236M SCRL
Administered by: Private     Purchased by: Unknown
Symptoms: Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)
Write-up: Pt received 3 immunization booster, IPV, MMR #2, and DTaP #5. AFter 20 min. pt vomited clear sputum after another 5 min, pt lips and gums became pale so I had mom sit with pt while I went for PA who immediately administered oxygen. Pt sent to hospital for transport.

VAERS ID:205845 (history)  Vaccinated:2003-06-30
Age:5.0  Onset:2003-06-30, Days after vaccination: 0
Gender:Male  Submitted:2003-06-30, Days after onset: 0
Location:Pennsylvania  Entered:2003-07-07, Days after submission: 7
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: NONE
Preexisting Conditions: H/O allergic to cal, dust mite and grass with atopic dermatitis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0133N SCLA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Cyanosis, Erythema, Pruritus, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received MMR vaccine 2nd dose. Started coughing, wheezing, severe itching, and marked erythema of Sleining cincum and oral cyanosis. Given Epinephrine SC injection, albuterol and inhalation of oxygen. Sent to ER.

VAERS ID:205892 (history)  Vaccinated:2003-06-13
Age:5.0  Onset:2003-06-14, Days after vaccination: 1
Gender:Female  Submitted:2003-06-27, Days after onset: 13
Location:North Carolina  Entered:2003-07-08, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Viral pharyngitis
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0853AA4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW062623IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Edema and erythema with indurated area covering most of anterior thigh (left thigh).

VAERS ID:205900 (history)  Vaccinated:2003-06-27
Age:5.0  Onset:2003-06-30, Days after vaccination: 3
Gender:Male  Submitted:2003-06-30, Days after onset: 0
Location:Illinois  Entered:2003-07-08, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURC1615AA3 RL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW07502 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1208L1 RL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0016N0 LL
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local redness. Swelling, warm to touch. Benadryl 1 1/4 tsp given 6/30/03. Orapred 1 1/4 tsp given 6/30/03. Cefzil 200 mg.

VAERS ID:205944 (history)  Vaccinated:2003-06-17
Age:5.0  Onset:2003-06-19, Days after vaccination: 2
Gender:Female  Submitted:2003-06-19, Days after onset: 0
Location:Oregon  Entered:2003-07-09, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OR200325
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURC0950AB4IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0878M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left arm red and hot to elbow 6/19/03 in AM.

VAERS ID:205962 (history)  Vaccinated:2003-07-01
Age:5.0  Onset:2003-07-01, Days after vaccination: 0
Gender:Male  Submitted:2003-07-02, Days after onset: 1
Location:Oregon  Entered:2003-07-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0856DA4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.W08693IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1231M/1172M2IMRL
Administered by: Private     Purchased by: Private
Symptoms: Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pain and swelling of extremity the day of vaccination. No fever.

VAERS ID:205972 (history)  Vaccinated:2003-06-30
Age:5.0  Onset:2003-07-01, Days after vaccination: 1
Gender:Female  Submitted:2003-07-02, Days after onset: 1
Location:Washington  Entered:2003-07-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;DTaP (Tripedia);4;2;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0852BB4IM 
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW034423SC 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0857M0SC 
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Pruritus
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)
Write-up: 5 x 6 cm itching, erythemic, slightly raised localized reaction at injection site.

VAERS ID:205975 (history)  Vaccinated:2003-06-03
Age:5.0  Onset:2003-06-05, Days after vaccination: 2
Gender:Male  Submitted:2003-07-02, Days after onset: 27
Location:Georgia  Entered:2003-07-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS596A24IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW07031SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0838M0IMRL
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 3" x 3" warm raised area with erythema.

VAERS ID:205982 (history)  Vaccinated:2003-05-15
Age:5.0  Onset:2003-05-16, Days after vaccination: 1
Gender:Female  Submitted:2003-07-01, Days after onset: 46
Location:California  Entered:2003-07-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS583524 LA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW06253 RA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Injection site red, hard and hot. Fever 100.

VAERS ID:205983 (history)  Vaccinated:2003-06-28
Age:5.0  Onset:2003-06-30, Days after vaccination: 2
Gender:Female  Submitted:2003-07-01, Days after onset: 1
Location:Colorado  Entered:2003-07-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1385AA4SCRL
HEPA: HEP A (VAQTA)MERCK & CO. INC.0281N0SCLL
Administered by: Public     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: Pt seen 06/28/03 and received DTaP #5 and Hep A. DTaP #5 to right thigh and Hep A to left thigh. Went to ER 6/30/03 for reaction and received antibiotics.

VAERS ID:206022 (history)  Vaccinated:2003-05-12
Age:5.0  Onset:2003-05-13, Days after vaccination: 1
Gender:Female  Submitted:2003-05-20, Days after onset: 7
Location:Washington  Entered:2003-07-10, Days after submission: 51
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Amoxicillin
Diagnostic Lab Data:
CDC Split Type: WA031935
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0852BB4 LA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW03343SC 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1008M1SC 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 2 7/8" x 2 1/2" red, raised, hot area on left arm. Very painful.

VAERS ID:206023 (history)  Vaccinated:2003-04-23
Age:5.0  Onset:2003-04-23, Days after vaccination: 0
Gender:Female  Submitted:2003-04-28, Days after onset: 5
Location:Washington  Entered:2003-07-10, Days after submission: 73
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WA031936
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0584BA4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW01972IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0530M1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Decreased appetite, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Bumpy, red, itchy rash head to toe started 8 PM. Plays and sleeps, but eats poorly. Rash less now on abdomen, still on extremities. Using Tylenol for fever, Benadryl for itch and rash.

VAERS ID:206028 (history)  Vaccinated:2003-05-06
Age:5.0  Onset:2003-05-08, Days after vaccination: 2
Gender:Female  Submitted:2003-05-12, Days after onset: 4
Location:Washington  Entered:2003-07-10, Days after submission: 59
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: History snoring and sleep apnea
Diagnostic Lab Data: NONE
CDC Split Type: WA031932
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0852BB4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW03342SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1008M1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5/8/03 Pt return to clinic with mother with complaints of itchiness and erythema all over left shoulder around where had DPT shot on 5/6/03; no fever, no pain. Poorly demarcated erythema over about 7 cm x 10cm area. No tenderness, no excoriation, adverse reaction to pertussis component of DPT.

VAERS ID:206031 (history)  Vaccinated:2003-07-01
Age:5.0  Onset:2003-07-02, Days after vaccination: 1
Gender:Male  Submitted:2003-07-03, Days after onset: 1
Location:Arizona  Entered:2003-07-10, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD Parkdale 4525G261 left forearm 7/1/03
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURJ0053BA4IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swelling and heat about 3" x 3" right deltoid area. Pt came to clinic to have PPD skin test read; dad pointed out swollen, hot area on pt arm.

VAERS ID:206083 (history)  Vaccinated:2003-06-25
Age:5.0  Onset:2003-06-25, Days after vaccination: 0
Gender:Male  Submitted:2003-06-30, Days after onset: 5
Location:Idaho  Entered:2003-07-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: ID03039
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS601A2 IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW06252 SCLL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Large 10 cm erythematous local reaction suspected allergic. Benadryl - will Rx with Keflex if worsening.

VAERS ID:206102 (history)  Vaccinated:2003-07-08
Age:5.0  Onset:2003-07-08, Days after vaccination: 0
Gender:Male  Submitted:2003-07-10, Days after onset: 2
Location:Ohio  Entered:2003-07-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: swelling of arm;DTaP (unknown mfr);;0;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to Penicillin, Lorabid
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0846BA4IMRA
HEP: HEP B (FOREIGN)MERCK & CO. INC.0781M1IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW01973SCLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mom states right upper arm swollen from shoulder to elbow red and warm. She states arm started swelling same day as shot. No fever per mom. He will see his doctor today for evaluation.

VAERS ID:206104 (history)  Vaccinated:2003-07-08
Age:5.0  Onset:2003-07-09, Days after vaccination: 1
Gender:Female  Submitted:2003-07-10, Days after onset: 1
Location:Oklahoma  Entered:2003-07-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1354BA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW06263SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0004M1IMRL
Administered by: Private     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:206107 (history)  Vaccinated:2003-07-01
Age:5.0  Onset:2003-07-03, Days after vaccination: 2
Gender:Female  Submitted:2003-07-10, Days after onset: 7
Location:North Carolina  Entered:2003-07-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Peanut-hives
Diagnostic Lab Data: NONE
CDC Split Type: NC03083
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0856CA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW06263IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0969M1SCRA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Large red area left arm swollen, larger than silver dollar around site.

VAERS ID:206154 (history)  Vaccinated:2003-07-01
Age:5.0  Onset:2003-07-02, Days after vaccination: 1
Gender:Female  Submitted:2003-07-03, Days after onset: 1
Location:California  Entered:2003-07-14, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURC0947AA3IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0274M0 LA
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEURW01973SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1236M1SCRA
Administered by: Military     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Large area swelling, redness over right deltoid.

VAERS ID:206155 (history)  Vaccinated:2003-06-30
Age:5.0  Onset:2003-07-02, Days after vaccination: 2
Gender:Male  Submitted:2003-07-03, Days after onset: 1
Location:Nebraska  Entered:2003-07-14, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS598B24IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW08163IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.110M SCLL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, swollen area 8" diameter - hard. Augmentin 600 mg.

VAERS ID:206164 (history)  Vaccinated:2003-06-20
Age:5.1  Onset:2003-07-01, Days after vaccination: 11
Gender:Male  Submitted:2003-07-03, Days after onset: 2
Location:Illinois  Entered:2003-07-14, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, Nasacort, Zyretc, Singulair
Current Illness: NONE
Preexisting Conditions: Asthma, Allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1354BA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW08693SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1009M1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Oedema, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Immunization given Monday. Tuesday night fever 103-swelling left arm. Mildly tender.

VAERS ID:206166 (history)  Vaccinated:2003-07-01
Age:5.0  Onset:2003-07-03, Days after vaccination: 2
Gender:Female  Submitted:2003-07-03, Days after onset: 0
Location:Hawaii  Entered:2003-07-14, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1383AA4 RA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW08163 LA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient had received DTaP on right deltoid on 07/01/2003. Patient had 9 x 9 cm red, raised area on right deltoid. Prescribed keflex (250m/5cc) 1 tsp per mouth every ibx 10 days.

VAERS ID:206167 (history)  Vaccinated:2003-06-30
Age:5.0  Onset:2003-07-03, Days after vaccination: 3
Gender:Male  Submitted:2003-07-03, Days after onset: 0
Location:Missouri  Entered:2003-07-14, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC Antihistamines
Current Illness: Seasonal allergies
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0884CA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW06263SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1010M1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: large area of skin erythema and induration. Approximately 5 x 10 cm -surrounding the injection site.

VAERS ID:206173 (history)  Vaccinated:2003-07-01
Age:5.0  Onset:2003-07-02, Days after vaccination: 1
Gender:Female  Submitted:2003-07-03, Days after onset: 1
Location:Colorado  Entered:2003-07-14, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1385AA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW09063IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1083M1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left arm erythema, swelling appearing 24 hours after injection.

VAERS ID:206198 (history)  Vaccinated:2003-06-30
Age:5.0  Onset:2003-07-01, Days after vaccination: 1
Gender:Male  Submitted:2003-07-08, Days after onset: 7
Location:Arkansas  Entered:2003-07-15, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0849BA4IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW07503SCRA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, hot to touch, large swollen right arm, deltoid.

VAERS ID:206224 (history)  Vaccinated:2003-06-24
Age:5.0  Onset:2003-06-24, Days after vaccination: 0
Gender:Female  Submitted:2003-07-14, Days after onset: 20
Location:North Carolina  Entered:2003-07-15, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: bp
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER007M4  
Administered by: Private     Purchased by: Private
Symptoms: Crying, Disorientation, Lethargy, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Whimpering after vaccination (10 minutes); Fainted (non-responsive): 5 minutes; Disoriented when woke up; Lethargic for a few hours after vaccination;

VAERS ID:206232 (history)  Vaccinated:2003-06-24
Age:5.0  Onset:2003-06-24, Days after vaccination: 0
Gender:Female  Submitted:2003-06-25, Days after onset: 1
Location:Arizona  Entered:2003-07-15, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: N/A
CDC Split Type: AZ0310
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW06253SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0839M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Ocular hyperaemia, Oedema, Pyrexia, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Child c/o headache, itchy rash on belly & buttocks, swollen mouth & face, red eyes & fever 102.7. Mother denies any SOB and child was not taken to the doctor or hospital. Mother gave her Ibuprofen and Sx were resolved by next morning.

VAERS ID:206253 (history)  Vaccinated:2002-08-09
Age:5.0  Onset:2002-08-09, Days after vaccination: 0
Gender:Male  Submitted:2003-03-12, Days after onset: 215
Location:Oklahoma  Entered:2003-07-16, Days after submission: 125
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OK0314
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS5484 LA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS727A0 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0027M1SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0205M0SC 
Administered by: Public     Purchased by: Public
Symptoms: Oedema, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt had arm all swollen and ran fever. Saw ER doctor and said had gotten injection site infected. Not reaction to shot.

VAERS ID:206257 (history)  Vaccinated:2000-12-20
Age:5.0  Onset:2000-12-20, Days after vaccination: 0
Gender:Male  Submitted:2003-02-05, Days after onset: 777
Location:Oklahoma  Entered:2003-07-16, Days after submission: 160
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: OK0319
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS961A23IMRL
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Had DTaP right arm deltoid on 12/20/2000, arm red and swollen to elbow, told nurse 2/5/03 when next DTaP was due.

VAERS ID:206258 (history)  Vaccinated:2002-11-12
Age:5.0  Onset:2002-12-06, Days after vaccination: 24
Gender:Female  Submitted:2002-12-09, Days after onset: 3
Location:Oklahoma  Entered:2003-07-16, Days after submission: 218
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OK0320
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0617M1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0089L0SC 
Administered by: Public     Purchased by: Public
Symptoms: Pyrexia, Skin ulcer
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Telephone call from mother stated, "Pt broke out in about 10-15 pus lesions all over body." Ran 99.6 F temp. Lesions scabbed over and was afebrile in 2 days.

VAERS ID:206268 (history)  Vaccinated:2003-06-16
Age:5.8  Onset:2003-06-16, Days after vaccination: 0
Gender:Female  Submitted:2003-06-18, Days after onset: 2
Location:Oklahoma  Entered:2003-07-16, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OK0331
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1354BA4 LA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW06263SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0629M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Anxiety, Rash, Speech disorder
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: States rash started at site of DTaP. Child developed a generalized rash in the pm of 6/16/03 approx 6pm became very anxious and had diff with speech. Taken to ER via ambulance. 6/17/03 developed rash again at 6pm taken to ER no additional tx on 6/17/03. 6/16/03 child was given steroid injections as well as anaphylaxis. 6/23/03 child has recovered completely.

VAERS ID:206272 (history)  Vaccinated:2003-07-09
Age:5.5  Onset:2003-07-09, Days after vaccination: 0
Gender:Female  Submitted:2003-07-09, Days after onset: 0
Location:Oregon  Entered:2003-07-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0853AA4IMRA
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0942M1IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0039N1IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0931M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Developed a red rash 5 min after administering vaccines. Rash located on forehead upper thorax, shoulders, cheeks and upper back. Administered 12.5mg/5mL Benadryl po. Hives.

VAERS ID:206280 (history)  Vaccinated:2003-07-07
Age:5.0  Onset:2003-07-08, Days after vaccination: 1
Gender:Female  Submitted:2003-07-10, Days after onset: 2
Location:North Carolina  Entered:2003-07-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Septra
Current Illness: NONE
Preexisting Conditions: Vesirovreteral Reflux requires Septra
Diagnostic Lab Data: NONE
CDC Split Type: NC03084
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0856CA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW07043IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0969M1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Body temperature increased, Erythema, Feeling hot, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Upper Left arm: swollen, red, hot to touch. Temperature: 97.9 (oral), not indurated. Approximate area of erythema 3in x 1.5in. Saw in office 07/09/2003.

VAERS ID:206295 (history)  Vaccinated:2003-07-08
Age:5.0  Onset:2003-07-10, Days after vaccination: 2
Gender:Male  Submitted:2003-07-10, Days after onset: 0
Location:Tennessee  Entered:2003-07-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: Otitis Media, Pet Placed, ?hearing; Ceftin: diarrhea/colitis
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1383AA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW08163IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0977M1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: $g24 hours after administration of DTaP entire anterior thigh and knee swelled up and felt painful. No limping, fever, trouble breathing.

VAERS ID:206296 (history)  Vaccinated:2003-06-30
Age:5.0  Onset:2003-07-01, Days after vaccination: 1
Gender:Female  Submitted:2003-07-03, Days after onset: 2
Location:Illinois  Entered:2003-07-16, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1354BA IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW0869  LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1009M  RA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Red, swollen area at injection site (DTaP)

VAERS ID:206297 (history)  Vaccinated:2003-07-03
Age:5.0  Onset:2003-07-03, Days after vaccination: 0
Gender:Male  Submitted:2003-07-09, Days after onset: 6
Location:Arizona  Entered:2003-07-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS590A93 LL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW08691SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0132N1SCLL
Administered by: Private     Purchased by: Private
Symptoms: Cough, Eye oedema, Injection site erythema, Pharyngolaryngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 07/03/2003: Received immunizations at 09:00am, fever of 102. Started at 11:00am. Around 13:00 noticed redness at injection site of left leg. That evening started coughing. 07/05/2003: Woke up with red, swollen eye left and sore throat. Was seen by pediatrician-given treatment of Prednisone for diagnosis of allergic reaction to MMR.

VAERS ID:206299 (history)  Vaccinated:2003-07-03
Age:5.0  Onset:2003-07-04, Days after vaccination: 1
Gender:Female  Submitted:2003-07-10, Days after onset: 6
Location:Missouri  Entered:2003-07-16, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ;DTaP (unknown mfr);4;5;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1385AA4 LA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW09574 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0099N2 RA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 60x60mm reddened area to left arm. Onset 24 hours after vaccine. By 48-72 hours baseball sized, red, and indurated. Treated at home with warm compresses, resolved in 7 days.

VAERS ID:206303 (history)  Vaccinated:2003-07-09
Age:5.0  Onset:2003-07-09, Days after vaccination: 0
Gender:Female  Submitted:2003-07-09, Days after onset: 0
Location:New York  Entered:2003-07-16, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Retinoblastoma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW10023SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0060N1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Eye swelling, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Physical exam appointment at 11AM. 11:50am phone call from mom. Just arrived home. Eyes swollen and bug-like bites on face and into hairline. No respiratory symptoms. 1 tsp. Dimetap at home. Seen back in office 12:20; 25mg Benadryl. No wheezing, hive- like rash. 1 PM: hives resolved.

VAERS ID:206306 (history)  Vaccinated:2003-07-07
Age:5.0  Onset:2003-07-07, Days after vaccination: 0
Gender:Female  Submitted:2003-07-08, Days after onset: 1
Location:Georgia  Entered:2003-07-16, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS594A24IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1181M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Child received vaccine on 7/7/03. Mother states child had small amount of redness/swelling on 7/7/03, however today 7/8/03 child has increased redness/swelling (redness 60mmx40mm left arm).

VAERS ID:206308 (history)  Vaccinated:2003-06-16
Age:5.0  Onset:2003-06-19, Days after vaccination: 3
Gender:Male  Submitted:2003-06-23, Days after onset: 4
Location:New York  Entered:2003-07-16, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURC1383AA4IM 
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0970M1SC 
Administered by: Private     Purchased by: Private
Symptoms: Erythema multiforme, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Erythema multiforme with target lesions all over body, sparing mucous membrane.

VAERS ID:206329 (history)  Vaccinated:2003-07-09
Age:5.0  Onset:2003-07-10, Days after vaccination: 1
Gender:Male  Submitted:2003-07-11, Days after onset: 1
Location:Unknown  Entered:2003-07-17, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURC1354BA4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW01963SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1337861SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site mass, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 8 x 8 reaction. Left thigh 5 cm bigger than right thigh. Red, swollen knot.

VAERS ID:206333 (history)  Vaccinated:2003-06-09
Age:5.0  Onset:2003-06-10, Days after vaccination: 1
Gender:Female  Submitted:2003-06-30, Days after onset: 20
Location:California  Entered:2003-07-17, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD-Aventis Pasteur-C0983AA, right forearm
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS582A24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW07503SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1008M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site inflammation, Injection site oedema, Pruritus
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)
Write-up: Mom noted swelling/inflammation "greater than expected" approx 24 hours after vaccinations given. Mom phoned clinic and was advised by RN "to use ice packs and give Tylenol". Following day (6/11) says swelling was worse, child complained of itching, so brought in to clinic. Right upper arm reddened, swollen from elbow to shoulder. Advised to change to Ibuprofen every 6-8 hours and po Benadryl for itch and cold, moist packs. Improved considerably with 24 hours of this Tx, per Mom''s phone report.

VAERS ID:206334 (history)  Vaccinated:2003-07-08
Age:5.0  Onset:2003-07-09, Days after vaccination: 1
Gender:Female  Submitted:2003-07-10, Days after onset: 1
Location:Wisconsin  Entered:2003-07-17, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: NONE
Preexisting Conditions: Allergic rhinitis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS592B94IMRA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW03633SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0060N1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mom noticed right lateral arm: elbow to shoulder hot, red, swollen, painful on 7/9/03 at 7 PM. Applied ice, gave Tylenol throughout the night. Called this office 7/10/03 AM to report. On 7/10 arm still swollen but less painful, less red. Moves arm actively. No fever. Using ice prn for comfort. Tylenol prn.

VAERS ID:206335 (history)  Vaccinated:2003-07-07
Age:5.0  Onset:2003-07-08, Days after vaccination: 1
Gender:Female  Submitted:2003-07-08, Days after onset: 0
Location:Wisconsin  Entered:2003-07-17, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS5831324 LA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW07033SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0235M1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Started with fever 1 AM on 7/8/03 and noticed swelling and redness of left upper arm approx 2" x 3" in size.

VAERS ID:206336 (history)  Vaccinated:2003-07-14
Age:5.0  Onset:2003-07-14, Days after vaccination: 0
Gender:Male  Submitted:2003-07-16, Days after onset: 2
Location:Colorado  Entered:2003-07-17, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0854DA  LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0545  RA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left deltoid started to get red and splotchy the night after shot and ran a fever 102-103 for 2 nights.

VAERS ID:206364 (history)  Vaccinated:2002-07-29
Age:5.0  Onset:2002-07-29, Days after vaccination: 0
Gender:Female  Submitted:2002-07-29, Days after onset: 0
Location:Washington  Entered:2003-07-18, Days after submission: 354
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WA031940
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1483L1 LA
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)
Write-up: Onset wheal inferior to site of administration approx. circ. 1.5 cm - ice applied to area.

VAERS ID:206369 (history)  Vaccinated:2003-06-20
Age:5.0  Onset:2003-06-30, Days after vaccination: 10
Gender:Male  Submitted:2003-07-02, Days after onset: 2
Location:Illinois  Entered:2003-07-18, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEUR/W07500IM 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0195N0SC 
Administered by: Private     Purchased by: Public
Symptoms: Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Varicella lesions on trunk and extremities.

VAERS ID:206388 (history)  Vaccinated:2003-07-09
Age:5.0  Onset:2003-07-10, Days after vaccination: 1
Gender:Female  Submitted:2003-07-11, Days after onset: 1
Location:Wisconsin  Entered:2003-07-18, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: In the process of using cool compresses and Zyrtec
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS583A24IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0099N1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Feeling hot, Oedema, Pruritus, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local swelling of right upper arm over deltoid, warm to touch, patient without fevers, also complains of itching.

VAERS ID:206392 (history)  Vaccinated:2003-07-15
Age:5.0  Onset:2003-07-16, Days after vaccination: 1
Gender:Male  Submitted:2003-07-18, Days after onset: 2
Location:Connecticut  Entered:2003-07-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0821AA1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: fever to 105 following Td. Resolved spontaneously

VAERS ID:206400 (history)  Vaccinated:2003-04-04
Age:5.0  Onset:2003-04-04, Days after vaccination: 0
Gender:Female  Submitted:2003-07-02, Days after onset: 88
Location:Unknown  Entered:2003-07-21, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: A0404637A
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS  IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site mass, Injection site reaction, Injection site warmth, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: This report describes the occurrence of an injection site reaction in a 5-year-old female who was vaccinated with diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B (recombinant) and inactivated poliovirus vaccine combined (Pediarix) for prophylaxis. The subject''s medical history, concurrent conditions, and concurrent medications were not reported. On 04/04/2003, the subject received an injection of Pediarix, which is not indicated for use as the booster dose in DTPa immunization series. "Almost immediately", the subject developed an injection site reaction characterized by swelling and a "knot the size of a tennis ball", which was "very hot" to the touch. The subject was seen by her physician. As of 04/10/2003, the swelling had "gone down some".

VAERS ID:206412 (history)  Vaccinated:2003-07-08
Age:5.0  Onset:2003-07-08, Days after vaccination: 0
Gender:Male  Submitted:2003-07-14, Days after onset: 6
Location:Florida  Entered:2003-07-21, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS586B94IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW06253IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0945M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Blister, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: IPV given right deltoid IM. Small bandaid applied. Child developed small blisters at site. Had elevated temp to 102.7 at night on Tues (7/8/03). 7/13: 101.3. 7/14 - temp 98.3.

VAERS ID:206414 (history)  Vaccinated:2003-07-09
Age:5.0  Onset:2003-07-09, Days after vaccination: 0
Gender:Male  Submitted:2003-07-11, Days after onset: 2
Location:Wisconsin  Entered:2003-07-21, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS9592A92IMRA
HEP: HEP B (FOREIGN)MERCK & CO. INC.0986M2IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW07033IMRA
Administered by: Private     Purchased by: Public
Symptoms: Feeling hot, Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Right arm noted swelling and warm to touch, reddened. Able to move but slight pain. Ibuprofen every 6 hours and ice pack to arm.

VAERS ID:206423 (history)  Vaccinated:2003-07-10
Age:5.0  Onset:2003-07-11, Days after vaccination: 1
Gender:Female  Submitted:2003-07-11, Days after onset: 0
Location:California  Entered:2003-07-21, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness: NONE
Preexisting Conditions: Seasonal allergies only
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0848AA4IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEUR9040303IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1479L1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness in area whole left upper arm with swelling, fever, painful at site.

VAERS ID:206431 (history)  Vaccinated:2003-06-26
Age:5.2  Onset:2003-06-27, Days after vaccination: 1
Gender:Male  Submitted:2003-06-27, Days after onset: 0
Location:Ohio  Entered:2003-07-21, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: History of RAD and seasonal allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS586A94IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW07033IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0772M1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever 103, Myalgia and arthralgia ~18 hours post vaccinations with DTaP, IPV & MMR. Examined 24 hours after shots, no focal findings.

VAERS ID:206433 (history)  Vaccinated:2003-06-17
Age:5.0  Onset:2003-06-17, Days after vaccination: 0
Gender:Male  Submitted:2003-07-08, Days after onset: 21
Location:Ohio  Entered:2003-07-21, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Augmentin, Ceftin, Azithromycin
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS592A94IMLA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Feeling hot, Oedema, Pruritus, Wheezing
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local: Upper arm, swelling, redness, warmth, itchy 48 hours after injection. System: Cough/wheeze starting 4 hours after shot. Gave Benadryl/albuterol aerosol.

VAERS ID:206435 (history)  Vaccinated:2003-07-17
Age:5.0  Onset:2003-07-17, Days after vaccination: 0
Gender:Male  Submitted:2003-07-18, Days after onset: 1
Location:Texas  Entered:2003-07-21, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: 1JAN0318
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0856BA4IMLA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS767A20IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW036320IMLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0876M1SCRA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Respiratory distress, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received immunizations x 4. Stayed 20-30 minutes - no problem. Patient was home and 30-110 minutes after vaccines, started itching and scratching. Developed whelps and when arrived in ER was having respiratory difficulty. Treatment in ER are with an IV, Cortisone, and Benadryl. Discharged 2 hours after indicent. Benadryl every 6 hours, prednisone for 3 days. Mom notified CIS 07/18/2003 at about 12 noon of the problems. A follow up report received 8/26/2003 adds: Made phone call to the pt''s residence, spoke with pt''s father to inquire as to how many days the rash lasted. He stated the rash lasted only one day. And his son is doing just fine. I told father to please check with their doctor about the next dose of Hep A, as to whether or not to take it.

VAERS ID:206440 (history)  Vaccinated:2003-07-15
Age:5.0  Onset:2003-07-16, Days after vaccination: 1
Gender:Male  Submitted:2003-07-17, Days after onset: 1
Location:Minnesota  Entered:2003-07-21, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergies-PCN, Sulfa eyedrops
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS598A24IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW03633IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1234M1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling at injection site 12 x 16 cm. Treatment: Ice packs, Tylenol as needed.

VAERS ID:206520 (history)  Vaccinated:2003-07-14
Age:5.0  Onset:2003-07-18, Days after vaccination: 4
Gender:Female  Submitted:2003-07-21, Days after onset: 3
Location:Michigan  Entered:2003-07-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair 5 mg qday
Current Illness: asthma
Preexisting Conditions: asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSDTPA592894IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEUR9040303SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1125M1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling at site of injection in left leg beginning 4 days after vaccination, today had 3 cm induration, 1 cm erythema with white drainage

VAERS ID:206521 (history)  Vaccinated:2003-07-16
Age:5.0  Onset:2003-07-18, Days after vaccination: 2
Gender:Male  Submitted:2003-07-21, Days after onset: 3
Location:Illinois  Entered:2003-07-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS574A24IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW07503IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1118L1SCLL
Administered by: Private     Purchased by: Public
Symptoms: Difficulty in walking, Pain, Rash erythematous, Swelling
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 (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Received DTaP and IPV IM in RT Thigh on July 16, 2003 at 11:50am. Mother stated that child complained of leg hurting the am of July 18th. Child was seen 7:30pm July 18th as parents had noticed swelling of rt thigh and knee with a red raised rash. Child complained of pain with walking.

VAERS ID:206484 (history)  Vaccinated:2003-07-03
Age:5.0  Onset:2003-07-10, Days after vaccination: 7
Gender:Female  Submitted:2003-07-14, Days after onset: 4
Location:Virginia  Entered:2003-07-22, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Post-mature at delivery
Diagnostic Lab Data:
CDC Split Type: VA03017
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS583B24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW03635SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt presented for PPD reading on 7/11/03 at 11:00 AM, PPD negative, however left and right arm redness and swelling noted at vaccination sites. Also, hard red area 4 x 3 cm noted beneath DTaP site on left arm which appeared to be infected. Afebrile. Referred to ER for evaluation.

VAERS ID:206490 (history)  Vaccinated:2003-06-30
Age:5.0  Onset:2003-07-02, Days after vaccination: 2
Gender:Male  Submitted:2003-07-11, Days after onset: 9
Location:D.C.  Entered:2003-07-22, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)SANOFI PASTEURC1383AA4IMLA
Administered by: Military     Purchased by: Military
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left arm became bright red, hot and hard from shoulder to elbow. Reaction began 2 days after shot was given.

VAERS ID:206491 (history)  Vaccinated:2003-07-09
Age:5.0  Onset:2003-07-10, Days after vaccination: 1
Gender:Male  Submitted:2003-07-11, Days after onset: 1
Location:Ohio  Entered:2003-07-22, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergies: face paint, "spring" enrivonmental
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0852DA4IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW062523SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0632M1SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Onset 7/10 4 PM - itching, swollen, hot, red arm. Fever 100.6. Seen in ER on advice of pediatrician, no treatment, exam only. Mom giving Tylenol and Benadryl. 7/15 residual redness decreasing.

VAERS ID:206494 (history)  Vaccinated:2003-07-12
Age:5.0  Onset:2003-07-12, Days after vaccination: 0
Gender:Female  Submitted:2003-07-15, Days after onset: 3
Location:New Mexico  Entered:2003-07-22, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURC1281AA4IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW03343SCRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0349M1SCLL
Administered by: Private     Purchased by: Public
Symptoms: Feeling hot, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Site warm to touch, slightly tender, itchy.

VAERS ID:206511 (history)  Vaccinated:2003-07-17
Age:5.0  Onset:2003-07-18, Days after vaccination: 1
Gender:Female  Submitted:2003-07-18, Days after onset: 0
Location:Illinois  Entered:2003-07-22, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1281AA2IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW062521SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0529M2SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received injections on morning of 07/17/2003. Afternoon of 07/18/2003, childs left arm, red, swollen, hot and hard to touch. Encourage motrin/tylenol for pain. Apply ice to effect area. Call Pediatrician.

VAERS ID:206556 (history)  Vaccinated:2003-07-09
Age:5.0  Onset:2003-07-10, Days after vaccination: 1
Gender:Male  Submitted:2003-07-11, Days after onset: 1
Location:Illinois  Entered:2003-07-23, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0854BA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW07503SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1037M1SCLL
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Left upper leg red, swollen, warm to touch. Patient had no complaints of tenderness or pain. Tylenol used to treat patient.

VAERS ID:206560 (history)  Vaccinated:2003-07-14
Age:5.1  Onset:2003-07-15, Days after vaccination: 1
Gender:Female  Submitted:2003-07-17, Days after onset: 2
Location:Ohio  Entered:2003-07-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Syntroid
Current Illness: NONE
Preexisting Conditions: Atroventricular septal defect; Downs Syndrome (Trisomy 2i), Hypothyroidism
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1385AA4IMLL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW09063SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1230M1SCRL
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Injection site induration, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4-5 cm area erythema and induration, left anterior thigh. Temperature 98.9F.

VAERS ID:206569 (history)  Vaccinated:2003-07-09
Age:5.0  Onset:2003-07-11, Days after vaccination: 2
Gender:Female  Submitted:2003-07-15, Days after onset: 4
Location:Ohio  Entered:2003-07-23, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Ceclor, Sulfa
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS598B24IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1180M1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Child presented to our office on 07/11/2003 with erythemous area over medial aspect of left arm. No other symptoms expressed by mother.

VAERS ID:206571 (history)  Vaccinated:2003-07-15
Age:5.0  Onset:2003-07-17, Days after vaccination: 2
Gender:Male  Submitted:2003-07-17, Days after onset: 0
Location:Georgia  Entered:2003-07-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singular 5mg
Current Illness: NONE
Preexisting Conditions: Asthma, Apnea
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS594A23IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW01972SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0878M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Mother states she noticed redness and swelling this AM 07/17/2003. Left arm (70mmx 70mm). Mother using cold compresses at site. Denies any other symptoms.

VAERS ID:206572 (history)  Vaccinated:2003-07-11
Age:5.0  Onset:2003-07-12, Days after vaccination: 1
Gender:Female  Submitted:2003-07-14, Days after onset: 2
Location:Ohio  Entered:2003-07-23, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS596B94IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW036323IMRL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 1  
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Feeling hot, Injection site oedema
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)
Write-up: Erythematous swelling around the site (DTAP/IPV), warm to touch, but non-tender, 5 inches by 3 3/4 inches.

VAERS ID:206594 (history)  Vaccinated:2003-07-17
Age:5.0  Onset:2003-07-20, Days after vaccination: 3
Gender:Male  Submitted:2003-07-21, Days after onset: 1
Location:Tennessee  Entered:2003-07-24, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS601A24IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW08163SCLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.123121SCRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site oedema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt was seen in ER 7/20/03 - 12 x 11.5 cm red, raised area (RT) nontender. No fever. Swollen. 7/22/03 Followed up in PCP office - 4.5 x 4.5 red, raised, nontender, no fever.

VAERS ID:206643 (history)  Vaccinated:2003-07-21
Age:5.0  Onset:2003-07-21, Days after vaccination: 0
Gender:Female  Submitted:2003-07-22, Days after onset: 1
Location:Virginia  Entered:2003-07-25, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1385AA4IMLL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW08693SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1180M1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4" x 3" reddened and hived area appeared <5 minutes after administration of vaccine. Reaction was localized to site of administration. Pt given Benadryl and cool pack and observed for 20 minutes. Reaction began to subside 15 minutes after administration of Benadryl. Child complained of itching prior to Benadryl, itching relieved by Benadryl.

VAERS ID:206650 (history)  Vaccinated:2003-07-08
Age:5.5  Onset:2003-07-09, Days after vaccination: 1
Gender:Female  Submitted:2003-07-18, Days after onset: 9
Location:Ohio  Entered:2003-07-25, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Asthmatic, environmental allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0854DA4IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW090623SCLA
Administered by: Private     Purchased by: Public
Symptoms: Hypersensitivity, Injection site erythema, Injection site oedema
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 5 x 10cm red, swollen area (hive). Almd immunization site (large local reaction). Treated with Benadryl, Keflex (5 days).

VAERS ID:206652 (history)  Vaccinated:2003-07-21
Age:5.0  Onset:2003-07-22, Days after vaccination: 1
Gender:Female  Submitted:2003-07-24, Days after onset: 2
Location:New Hampshire  Entered:2003-07-25, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NH0321
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS600A24IMRA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW090623SCRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1179M1SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Rash vesicular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Right arm red with vesicular rash dostal to injection site 9cm long and 14 cm wide. Seen 07/22, prescribed with Zyrtec 2tsp every day, and Keflex (250/5ml) 1tsp initial dose x 7 days. Call from mom 07/23, no change. Zyrtec discharge and Benadryl 2tsp every 6 hours for 2 days ordered. As of 07/24 not resolved.

VAERS ID:206654 (history)  Vaccinated:2003-04-29
Age:5.0  Onset:2003-04-30, Days after vaccination: 1
Gender:Male  Submitted:2003-04-30, Days after onset: 0
Location:New Hampshire  Entered:2003-07-25, Days after submission: 86
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NH0318
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS586B94 LA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local redness, swelling, tenderness 24-72 hours post IM injection.

VAERS ID:206655 (history)  Vaccinated:2003-04-24
Age:5.0  Onset:2003-04-26, Days after vaccination: 2
Gender:Unknown  Submitted:0000-00-00
Location:New Hampshire  Entered:2003-07-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: NH0319
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS583A24IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW062523IMRA
Administered by: Private     Purchased by: Public
Symptoms: Feeling hot, Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 24-72 hours after IM in jection of 5th DTaP, developed warm, tender, swollen erythema 8inches in diameter at site.

VAERS ID:206657 (history)  Vaccinated:2003-07-21
Age:5.0  Onset:2003-07-22, Days after vaccination: 1
Gender:Female  Submitted:2003-07-24, Days after onset: 2
Location:Arizona  Entered:2003-07-25, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: History of Polysaccharide defficiency
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS590A94 RA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW09063 RA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0059N1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Cellulitis, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Cellulitis with induration right outer arm at the site. History of polysaccharide continued immune dificiency on ganglobulin.

VAERS ID:206665 (history)  Vaccinated:2003-07-17
Age:5.0  Onset:2003-07-21, Days after vaccination: 4
Gender:Female  Submitted:2003-07-25, Days after onset: 4
Location:Massachusetts  Entered:2003-07-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy to Keflex (rash, swelling)
Diagnostic Lab Data: ESR 36; CBC, Metabolic panel, UA normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0852DA4IMRL
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEURW00633IMRL
MER: MEASLES + RUBELLA (MR-VAX II)MERCK & CO. INC.0344M0SCLL
Administered by: Private     Purchased by: Public
Symptoms: Purpura, Rash papular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4 days after vaccination with DTaP, IPV, and MMR child developed rash consistent with Henloch-Schonlein purpura.

VAERS ID:206679 (history)  Vaccinated:2003-07-22
Age:5.0  Onset:2003-07-22, Days after vaccination: 0
Gender:Female  Submitted:2003-07-24, Days after onset: 2
Location:Wisconsin  Entered:2003-07-28, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Had pneumonia
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS598B24IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW081623SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1009M1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Soreness with redness at injection site 18 x 11 cm.

VAERS ID:206685 (history)  Vaccinated:2003-07-22
Age:5.0  Onset:2003-07-23, Days after vaccination: 1
Gender:Female  Submitted:2003-07-24, Days after onset: 1
Location:Maine  Entered:2003-07-28, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: ME03025
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (TRIPEDIA)AVENTIS PASTEURU0856AA4  
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Pruritus
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)
Write-up: Arm red, swollen and complaining of it itching.

VAERS ID:206691 (history)  Vaccinated:2003-07-18
Age:5.0  Onset:2003-07-19, Days after vaccination: 1
Gender:Female  Submitted:2003-07-21, Days after onset: 2
Location:Illinois  Entered:2003-07-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURC1385AA4 RL
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURW08163 LL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.10181M1 LL
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Local redness with swelling

VAERS ID:206692 (history)  Vaccinated:2003-07-11
Age:5.0  Onset:2003-07-12, Days after vaccination: 1
Gender:Female  Submitted:2000-07-16, Days after onset: 1091
Location:Washington  Entered:2003-07-28, Days after submission: 1107
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (DAPTACEL)AVENTIS PASTEURCT1385AA  LA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS764A2  RA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Injection site induration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mild erythema and induration at injection site.

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