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Found 762,804 cases where Symptom is Immune system disorder or Immunodeficiency or Immunoglobulins decreased or Lymphadenopathy

Case Details (Sorted by Age)

This is page 253 out of 763

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VAERS ID: 482616 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2013-01-25
Entered: 2013-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Idiopathic thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA011146

Write-up: This spontaneous report as received from a physician refers to a 14 months old female patient. The patient was vaccinated with a dose of M-M-R II (Lot # not reported) on an unspecified date. No other co-suspects were reported. No concomitant medications were reported. The physician reported that on an unspecified date "about 10 days" after vaccination, the patient developed idiopathic thrombocytopenic purpura. The patient was taken to the emergency room and admitted to the hospital. It was unknown how long the patient was hospitalized. The outcome of idiopathic thrombocytopenic purpura was reported as recovered/resolved. The relatedness for idiopathic thrombocytopenic purpura was unknown for M-M-R II. Additional information is not expected.


VAERS ID: 482626 (history)  
Form: Version 1.0  
Age: 1.18  
Sex: Female  
Location: Alaska  
Vaccinated:2013-01-08
Onset:2013-01-24
   Days after vaccination:16
Submitted: 2013-01-25
   Days after onset:1
Entered: 2013-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H007702 / 1 UN / SC

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

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

Write-up: Mom states child had full body rash - took her to hospital - MD said it was chickenpox.


VAERS ID: 482631 (history)  
Form: Version 1.0  
Age: 1.09  
Sex: Female  
Location: California  
Vaccinated:2013-01-23
Onset:2013-01-23
   Days after vaccination:0
Submitted: 2013-01-25
   Days after onset:2
Entered: 2013-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482BA / 1 UN / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB642CA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH684AA / 4 UN / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015643 / 1 UN / SC

Administered by: Public       Purchased by: Public
Symptoms: Immediate post-injection reaction, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient immediately developed rash around her eyes and on her forehead. 2 mls of BENADRYL.


VAERS ID: 482595 (history)  
Form: Version 1.0  
Age: 1.48  
Sex: Female  
Location: Michigan  
Vaccinated:2012-11-29
Onset:0000-00-00
Submitted: 2013-01-26
Entered: 2013-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH719AB / UNK RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB605AA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009578 / UNK RA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918176 / UNK LL / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4304BA / UNK RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H015947 / UNK LA / SC

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

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

Write-up: No adverse reaction occurred.


VAERS ID: 482611 (history)  
Form: Version 1.0  
Age: 1.11  
Sex: Male  
Location: South Carolina  
Vaccinated:2011-03-28
Onset:0000-00-00
Submitted: 2013-01-27
Entered: 2013-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB462AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 10082 / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E56496 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1108Z / 1 RL / SC

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Had a little rash that his doc was saying was papular urticaria
Preexisting Conditions: Dr dermatology diagnosed him with an auto immune disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bumps under his arm and belly with a fever.


VAERS ID: 482693 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Unknown  
Vaccinated:2012-09-25
Onset:2012-09-25
   Days after vaccination:0
Submitted: 2013-01-27
   Days after onset:124
Entered: 2013-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4154BA / UNK LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1697AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH174AA / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0233AE / UNK LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F62923 / UNK RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H007702 / UNK RL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA012188

Write-up: This spontaneous report as received from a medical assistant refers to an unspecified number of patients of unknown age and gender. The reporter stated that up to 10 patients had received improperly stored vaccines during the time period of 17-SEP-2012 through 02-OCT-2012. Vaccines involved were M-M-R II, VAQTA, RECOMBIVAX HB and GARDASIL. No symptoms were reported. This is one of multiple reports from the same source (other case IDs 1210USA009229, 1210USA009230 and 1210USA009231). The follow-up information was received from the medical assistant refers to a 15 months old patient. On 25-SEP-2012 the patient was vaccinated with improperly stored M-M-R II (in left thigh, lot #:0233AE, exp. date: 26-JAN-2014) and VAQTA (in right thigh, lot #:672470/1697AA, exp. date: 22-SEP-2014) which was improperly stored. Concomitant vaccines administered on the same day included VARIVAX (Merck) (lot # H007702, expiration: 30-MAR-2014, Subcutaneously) in the right thigh, diphtheria toxoid, pertussis acellular vaccine (unspecified), tetanus toxoid (manufactured by Sanofi) (lot # C4154BA, expiration: 06-OCT-2014, intramuscularly) in the left thigh, Hib conj vaccine (unspecified carrier) (manufacture by Sanofi) (lot # UH174AA, expiration: 22-OCT-2012, intramuscularly) in the left thigh and PREVNAR 13 (manufacture by Wyeth) (lot # F62923, expiration: August, 2013, intramuscularly) in the right thigh. It was reported that yes, there were patients that received improperly stored vaccines from 17-SEP-2012 through 02-OCT-2012. It was reported that they notified all the patients and told them they could go to another healthcare facility to be revaccinated because they had not received any additional vaccinations due to an on-going problem with their refrigerator. This is one of several reports received from the same reporter. The other patient''s information was captured in 1210USA005704. Additional information is not expected.


VAERS ID: 482695 (history)  
Form: Version 1.0  
Age: 1.26  
Sex: Unknown  
Location: Unknown  
Vaccinated:2013-01-22
Onset:2013-01-22
   Days after vaccination:0
Submitted: 2013-01-27
   Days after onset:5
Entered: 2013-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020910 / UNK LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA010970

Write-up: This spontaneous report as received from a registered nurse refers to a 15 months old patient. A patient received a dose of GARDASIL (lot # was reported as H020910, exp. date 18-JUN-2015) subcutaneously "in the arm" on 22-JAN-2013. No adverse effects has been observed or reported. Additional information has been requested.


VAERS ID: 482668 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Georgia  
Vaccinated:2012-08-24
Onset:2012-08-28
   Days after vaccination:4
Submitted: 2013-01-28
   Days after onset:153
Entered: 2013-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH721AB / UNK LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Fatigue, Pyrexia, Staring, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Started acting tired. Then he laid down on the floor and stared and became unresponsive for a few seconds, no convulsions, did have some gasping type breathing for a few minutes. Was running a low grade temp.


VAERS ID: 482694 (history)  
Form: Version 1.0  
Age: 1.29  
Sex: Female  
Location: Minnesota  
Vaccinated:2013-01-03
Onset:2013-01-04
   Days after vaccination:1
Submitted: 2013-01-22
   Days after onset:18
Entered: 2013-01-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4531BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH741AB / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. G007630 / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

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

Write-up: Patient given varicella vaccine 1/3/13. Left leg was red, swollen and warm for 1 week after injection. Child was fussy & irritable. Red area larger than a half dollar.


VAERS ID: 482727 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: Georgia  
Vaccinated:2013-01-17
Onset:2013-01-22
   Days after vaccination:5
Submitted: 2013-01-28
   Days after onset:6
Entered: 2013-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LG / UN

Administered by: Unknown       Purchased by: Other
Symptoms: Cough, Eye irritation, Influenza virus test, Lethargy, Ocular hyperaemia, Pyrexia, Rash, Rhinorrhoea, Streptococcus test
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Corneal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Strep swab, Flu Swab at doctor''s office to rule those out. No blood work was done.
CDC Split Type:

Write-up: She began with high fevers (102.9F). Fevers lasted approx 4 days during which time she had a runny nose, cough, red/irritated eyes, she was lethargic. Then when the fever began to subside she started with the rash. The rash was severe and lasted 3 days.


VAERS ID: 482762 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Male  
Location: Delaware  
Vaccinated:2013-01-08
Onset:2013-01-17
   Days after vaccination:9
Submitted: 2013-01-22
   Days after onset:5
Entered: 2013-01-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H012642 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H013041 / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H010558 / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Blood culture, Chest X-ray, Diarrhoea, Febrile convulsion, Full blood count, Influenza virus test, Rash, Respiratory syncytial virus test
SMQs:, Anaphylactic reaction (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC; Blood culture; CXR; Flu; & RSV screen
CDC Split Type:

Write-up: Febrile Seizure. Only other symptom leading up was a rash and mild diarrhea. EMS took to ER. Pt discharged.


VAERS ID: 482866 (history)  
Form: Version 1.0  
Age: 1.53  
Sex: Female  
Location: Ohio  
Vaccinated:2013-01-29
Onset:2013-01-29
   Days after vaccination:0
Submitted: 2013-01-29
   Days after onset:0
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4310BA / 4 LL / IM

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

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

Write-up: Developed hives 10-15 minutes after immunization. Examine by Dr BENADRYL given.


VAERS ID: 482873 (history)  
Form: Version 1.0  
Age: 1.15  
Sex: Male  
Location: New Mexico  
Vaccinated:2013-01-15
Onset:2013-01-24
   Days after vaccination:9
Submitted: 2013-01-29
   Days after onset:5
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547FA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB667 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0686AE / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016240 / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Small, dime sized, raised welt at injection site for Varicella (RA/SC). Welt appeared 10 days after injection.


VAERS ID: 482874 (history)  
Form: Version 1.0  
Age: 1.15  
Sex: Female  
Location: New Mexico  
Vaccinated:2013-01-15
Onset:2013-01-25
   Days after vaccination:10
Submitted: 2013-01-29
   Days after onset:4
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547FA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB667 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0686AE / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016240 / 1 RA / SC

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

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

Write-up: Very small raised spot at injection site for Varicella (RA/SC). Spot appeared 10 days after injection.


VAERS ID: 482878 (history)  
Form: Version 1.0  
Age: 1.15  
Sex: Male  
Location: New Mexico  
Vaccinated:2013-01-15
Onset:2013-01-25
   Days after vaccination:10
Submitted: 2013-01-29
   Days after onset:4
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547FA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB667 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0686AE / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016240 / 1 RA / SC

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

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

Write-up: Small, dime size, raised red welt at injection site for Varicella (RA/SC). Welt appeared 10 days after injection.


VAERS ID: 482899 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Illinois  
Vaccinated:2012-01-28
Onset:2012-01-28
   Days after vaccination:0
Submitted: 2013-01-29
   Days after onset:367
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 RL / UN

Administered by: Unknown       Purchased by: Private
Symptoms: Crying, Gait disturbance, 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), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None. Provided ibuprofen after vaccine for pain relief.
Current Illness: No.
Preexisting Conditions: No.
Allergies:
Diagnostic Lab Data: None at this time.
CDC Split Type:

Write-up: Physical pain. Child refusing to walk, crying, swelling. Continued into the next morning and same symptoms at 7:00 AM on 1/29/2012.


VAERS ID: 482911 (history)  
Form: Version 1.0  
Age: 1.72  
Sex: Male  
Location: Kansas  
Vaccinated:2013-01-15
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010659 / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4434AA / UNK UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR 04247AA / UNK UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H015560 / UNK UN / SC

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

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

Write-up: Red (L) deltoid onset.


VAERS ID: 482918 (history)  
Form: Version 1.0  
Age: 1.56  
Sex: Female  
Location: Montana  
Vaccinated:2013-01-09
Onset:2013-01-09
   Days after vaccination:0
Submitted: 2013-01-29
   Days after onset:20
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / -

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

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

Write-up: Started with a low grade fever a few hours after the shot, but the next morning it continued to rise. By evening on 1/10/13 it was up to 103.6. On 1/11/13 she continued to have a fever but it was low grade. No other symptoms. She saw a doctor on 1/10/13 to rule out any other cause of fever.


VAERS ID: 482940 (history)  
Form: Version 1.0  
Age: 1.45  
Sex: Male  
Location: New York  
Vaccinated:2013-01-22
Onset:2013-01-22
   Days after vaccination:0
Submitted: 2013-01-29
   Days after onset:7
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1874AA / 1 RL / SC

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA011783

Write-up: This spontaneous report as received from a registered nurse refers to a 17 months old patient. The patient was vaccinated with first dose of M-M-R II (lot number 671686/1874AA, exp 30-NOV-2013) subsequently in thigh on 22-JAN-2013. No other co-suspects were reported. No concomitant medications were reported. The reporter said that during the injection, the patient moved the leg, and only half of the 0.5ml dose of vaccine was administered. No adverse effects reported. It was unknown if the patient had sought medical attention. Additional information has been requested.


VAERS ID: 482944 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Unknown  
Vaccinated:2013-01-21
Onset:2013-01-21
   Days after vaccination:0
Submitted: 2013-01-29
   Days after onset:8
Entered: 2013-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015644 / UNK LL / UN
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H06327 / UNK RL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins (unspecified)
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA010431

Write-up: This spontaneous report as received from a registered nurse refers to a 12 months old female patient. On 21-JAN-2013, the patient was vaccinated with a dose of VARIVAX (Merck) (lot # reported as H06327, Exp. Date: 30-AUG-2014) into right thigh, and a dose of PROQUAD (lot # reported as H015644, Exp, Date: 23-FEB-2014) into left thigh (reported as "MMRV", verbally described as MMR plus varicella). Concomitant medications included vitamins (unspecified), HIBV (unspecified carrier),Hep A (unspecified) , PNEUMOVAX 23 (Pediatric PNEUMOVAX) and influenza virus vaccine (unspecified). On 21-JAN-2013, the 12 month old patient received 6 total vaccines. Two of the vaccines, VARIVAX (Merck) and "MMRV" contained the varicella component. The patient''s medical history included a "well baby visit" on 21-JAN-2013. There is no relevant laboratory data. As of 21-JAN-2013, it was unknown if the patient continued to take VARIVAX or "MMRV" and the outcome of the two doses of varicella was unknown. Additional information has been requested.


VAERS ID: 482957 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Unknown  
Vaccinated:2012-12-04
Onset:2012-12-27
   Days after vaccination:23
Submitted: 2013-01-30
   Days after onset:34
Entered: 2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0692AE / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Blood immunoglobulin G abnormal, Blood immunoglobulin M abnormal, Rash vesicular, Varicella post vaccine, Varicella virus test positive
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 01/07/2013, Blood immunoglobulin G, positive; 01/07/2013, Blood immunoglobulin M, positive
CDC Split Type: WAES1301USA011047

Write-up: This spontaneous report as received from a medical assistant refers to a 13 months old female patient with no pertinent medical history and no drug reactions or allergies. On 04-DEC-2012 the patient was vaccinated subcutaneously with a 0.5 ml dose of VARIVAX (lot # 0692AE, exp. date: 02-APR-2014) for immunization. There was no concomitant medication. The patient was seen in the office on 27-DEC-2012 with vesicular rash. The Physician recommended oatmeal baths and calamine lotion. A Varicella Zoster IgG, IgM was drawn at that time. On 07-JAN-2013 the results for that blood work returned positive, and a diagnosis of chicken pox was made. The patient''s mother reported that the rash and infection has resolved at this time. The relatedness for the events were unknown for VARIVAX. Additional information has been requested.


VAERS ID: 482963 (history)  
Form: Version 1.0  
Age: 1.27  
Sex: Female  
Location: New York  
Vaccinated:2013-01-15
Onset:2013-01-29
   Days after vaccination:14
Submitted: 2013-01-30
   Days after onset:1
Entered: 2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1899AA / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H014627 / 1 RL / SC

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

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

Write-up: Rash, fever.


VAERS ID: 482993 (history)  
Form: Version 1.0  
Age: 1.59  
Sex: Female  
Location: Alabama  
Vaccinated:2013-01-08
Onset:2013-01-28
   Days after vaccination:20
Submitted: 2013-01-30
   Days after onset:2
Entered: 2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. - / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1556AA / 1 RL / -

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

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

Write-up: Broke out in suspicious rash. Parent brought child in on 01/29/2013. Patient was diagnosed by another MD here at our practice with Chickenpox.


VAERS ID: 482994 (history)  
Form: Version 1.0  
Age: 1.28  
Sex: Male  
Location: Texas  
Vaccinated:2013-01-28
Onset:2013-01-29
   Days after vaccination:1
Submitted: 2013-01-30
   Days after onset:1
Entered: 2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LL / -
VARCEL: VARICELLA (VARILRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK LL / -

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

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

Write-up: Cellulitis.


VAERS ID: 483018 (history)  
Form: Version 1.0  
Age: 1.29  
Sex: Female  
Location: Massachusetts  
Vaccinated:2013-01-29
Onset:2013-01-30
   Days after vaccination:1
Submitted: 2013-01-30
   Days after onset:0
Entered: 2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4286AA / 4 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH689AA / 4 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F73654 / 4 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Blood test normal, Body temperature increased, Crying, Foaming at mouth, Gaze palsy, Musculoskeletal stiffness, Streptococcus test negative, Tremor, Unresponsive to stimuli, Urine analysis normal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Received TYLENOL after vaccines
Current Illness: None
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data: Urine, blood test, rapid strep - all negative
CDC Split Type:

Write-up: Pt had well visit & received DTaP #4, HIB #4, PCV13 #4 was fine after. At 2am pt whining - mom checked on her & pt was stiff w/head & eyes rolled back, shaking, foaming at mouth & unresponsive 911 came, temp was 104, hr 200 brought to ER.


VAERS ID: 483021 (history)  
Form: Version 1.0  
Age: 1.06  
Sex: Male  
Location: Arizona  
Vaccinated:2013-01-18
Onset:2013-01-27
   Days after vaccination:9
Submitted: 2013-01-30
   Days after onset:3
Entered: 2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4483BA / 2 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB667CB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H013038 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0643AE / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016057 / 1 RL / SC

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

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

Write-up: Rash on face neck and chest, then spread to entire body. No fever. No treatment.


VAERS ID: 483025 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Indiana  
Vaccinated:2013-01-17
Onset:2013-01-29
   Days after vaccination:12
Submitted: 2013-01-30
   Days after onset:1
Entered: 2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4358AA / 4 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010187 / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015778 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 918561 / 4 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sample sent 01/30/13
CDC Split Type: 16149202192

Write-up: Varicella type rash papules.


VAERS ID: 483061 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: Michigan  
Vaccinated:2013-01-30
Onset:2013-01-30
   Days after vaccination:0
Submitted: 2013-01-31
   Days after onset:1
Entered: 2013-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: Vomiting and fever.


VAERS ID: 483062 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Georgia  
Vaccinated:2013-01-30
Onset:2013-01-30
   Days after vaccination:0
Submitted: 2013-01-31
   Days after onset:1
Entered: 2013-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LG / SYR
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 LG / SYR

Administered by: Unknown       Purchased by: Private
Symptoms: Cough, Irritability, Lethargy, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: mild fever~Pneumo (no brand name)~3~0.50~Patient
Other Medications: Vitamin
Current Illness: Slight runny nose but teething. Had whole hand in his mouth that morning from teeth coming in.
Preexisting Conditions: n/a
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was given Prevnar 13 at 11 AM. Fever of 101.6 at 1:15 PM gave Tylenol. Lethargic. At 6:25 PM had fever of 103.5 - gave more Tylenol. At 7:50 PM started coughing and vomited. At 1:30 AM 1/13/13 had 103.2 fever gave Advil. At 6:40 AM started coughing and vomited. Called doctor at 9:30 AM. Still out of sorts and will see if fever comes back. Info I wanted was what does the high fever mean - not handling vaccine well? Only said did not have to give any more doses - but this was his last one in series.


VAERS ID: 483125 (history)  
Form: Version 1.0  
Age: 1.29  
Sex: Male  
Location: California  
Vaccinated:2013-01-10
Onset:2013-01-19
   Days after vaccination:9
Submitted: 2013-01-31
   Days after onset:12
Entered: 2013-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3944AA / 3 - / SC
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4526AA / 2 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0258AE / 1 - / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H10561 / 1 - / UN

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Full blood count normal, Laboratory test normal, Status epilepticus, Upper respiratory tract infection
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: seizure~DTaP + IPV + Hib (Pentacel)~2~0.58~Patient
Other Medications: No prescription meds, unknown OTC, probably antipyretics
Current Illness: No
Preexisting Conditions: History of complex febrile seizures
Allergies:
Diagnostic Lab Data: Normal CBC, SMA-7 for age
CDC Split Type:

Write-up: Status Epilepticus (40 minutes GTC), no documented fevers prior to, during or after event, but had mild URI symptoms, normal CBC, SMA-7 and PE 6hrs post and discharged home from ED. Seizure was 9 days after vaccines (MMR, Varicella, DTAP, PCV, and influenza). Patient also had history of complex febrile seizure 10 days after vaccines in May of 2011, (Pentacel, PCV, Rotavirus) given and complex febrile seizure was 10 days later (30 min long), also had URI/fever during this seizure.


VAERS ID: 483137 (history)  
Form: Version 1.0  
Age: 1.69  
Sex: Male  
Location: California  
Vaccinated:2013-01-14
Onset:2013-01-23
   Days after vaccination:9
Submitted: 2013-01-31
   Days after onset:8
Entered: 2013-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015644 / UNK - / SC

Administered by: Private       Purchased by: Other
Symptoms: Pyrexia, Rash morbilliform, Upper respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, URI symptoms, followed by rash appearing to be measles.


VAERS ID: 483196 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: California  
Vaccinated:2012-12-31
Onset:0000-00-00
Submitted: 2013-01-31
Entered: 2013-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B187AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 0288AE / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72493 / 3 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: No adverse event
SMQs:

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

Write-up: No adverse events.


VAERS ID: 483203 (history)  
Form: Version 1.0  
Age: 1.52  
Sex: Female  
Location: Illinois  
Vaccinated:2013-01-23
Onset:2013-01-24
   Days after vaccination:1
Submitted: 2013-02-01
   Days after onset:8
Entered: 2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C43588AA / 4 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0392AA / 2 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Emotional distress, Irritability, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Mom thinks she had 2 seizures 1 day after her 18 month vaccines. Both episodes were episodes of unresponsiveness. The first time, mom found her lying face down on the floor, arms out to sides. Mom noticed that she was suddenly quiet. There was no sound of a fall. No bruises or bumps on face. She was normal in color, her eyes were open and seemed to be looking around. She would not alert to mom call her name, clapping, shook her food, and offered a cracker to her had, with no response. Suddenly she got up and was normal. The whole episode was about 30-40 secs. Later that night, aroun 7 pm, Dad was in the laundry room, next to the playroom, heard no noise, went to the playroom, and eventually found her after 1-2 minutes. She was laying under a small trampoline, with her hands in front of her face. Dad called her multiple times, with no reponse. 20-30 secs later she pulled her hands away, and then seemed to get back to normal. She had no fever. Since then she has been more sensitive and irritable, harder to soothe. She has more meltdowns.


VAERS ID: 483216 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Arizona  
Vaccinated:2013-01-28
Onset:2013-01-29
   Days after vaccination:1
Submitted: 2013-01-30
   Days after onset:1
Entered: 2013-02-01
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB667AB / 1 UN / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015629 / 1 UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Crying, Eye movement disorder, Irritability, Muscle rigidity, Postictal state, Staring
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Seizure.~DTaP + HepB + IPV (Pediarix)~3~0.50~Patient|Seizure.~Hib (no brand name)~3~0.50~Patient|Seizure.~Rotavirus (no brand na
Other Medications:
Current Illness: None
Preexisting Conditions: History of short seizure following 6 month vaccine and Flu vaccine; Family hx seizure disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Short seizure, approximately 10 seconds, not associated with fever occurred 24 hours following simultaneous immunization with Hepatitis A #1 and PROQUAD (MMR-Varicella), vaccinated 1/28/13, seizure on 1/29/13. Described as irritability/crying followed by stiffening of body x 10 sec. lateral eye movements followed by blank stare, 30 minute post-ictal period.


VAERS ID: 483284 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2013-01-29
Onset:2013-01-29
   Days after vaccination:0
Submitted: 2013-02-01
   Days after onset:3
Entered: 2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA014301

Write-up: This spontaneous report as received from a registered nurse refers to a 12 months old patient. The patient was accidentally received two doses of live (Merck) VARIVAX (lot number unspecified) on 29-JAN-2013. No other co-suspects were reported. No concomitant medications were reported. The patient''s outcome was unknown. It was unknown if the patient had sought medical attention. Additional information has been requested.


VAERS ID: 483249 (history)  
Form: Version 1.0  
Age: 1.27  
Sex: Female  
Location: Michigan  
Vaccinated:2013-02-01
Onset:2013-02-01
   Days after vaccination:0
Submitted: 2013-02-03
   Days after onset:2
Entered: 2013-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 4 RL / -

Administered by: Unknown       Purchased by: Private
Symptoms: Decreased appetite, Diarrhoea, Injection site pain, Lethargy, Pain, Pain in extremity, Pallor, Pyrexia, Restlessness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Akathisia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D drops, Probiotic, Iron supplement
Current Illness: Stuffy nose
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore need of whole right side of the body, including arm and leg where shot was given. Lethargy and paleness followed around 1pm and fever came on by 3pm. Fever was not brought down by Advil and 3 hours after first dose of Advil fever was still 102. Child was restless that night and fever continues for 3 days. Also lack of appetite and diarrhea throughout the 3 days.


VAERS ID: 483287 (history)  
Form: Version 1.0  
Age: 1.06  
Sex: Female  
Location: Unknown  
Vaccinated:2013-01-24
Onset:2013-01-24
   Days after vaccination:0
Submitted: 2013-02-04
   Days after onset:11
Entered: 2013-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK RL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA012296

Write-up: This spontaneous report as received from a physician assistant refers to her 1 years old daughter. The patient was vaccinated with VAQTA (0.7 ml, Intramuscular, right leg, lot # was unknown) on 24-JAN-2013. No other co-suspects were reported. No concomitant medications were reported. Physician assistant states she thought the healthcare worker withdrew too much vaccine from the vial, 0.7ml. No adverse effects reported at this time. The outcome of event is unknown. Additional information has been requested.


VAERS ID: 483347 (history)  
Form: Version 1.0  
Age: 1.56  
Sex: Male  
Location: Maryland  
Vaccinated:2013-01-28
Onset:2013-01-29
   Days after vaccination:1
Submitted: 2013-02-04
   Days after onset:6
Entered: 2013-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0628AE / 2 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Crying, Diarrhoea, Pyrexia, Respiratory tract congestion, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL PRN teething
Current Illness: None
Preexisting Conditions: Speech Delay; shaking (had normal EEG)
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1-28-13 rec''d Hep A vaccine. 1-29-13 woke up with chest congestion. 1-30-13 diarrhea. 1-31-13 crying, fever 101.4 gave TYLENOL q 4 hours. 2-1-13 fever broke. 2-2-13 hives (gave BENADRYL). 2-4-13 hives gone.


VAERS ID: 483349 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: Texas  
Vaccinated:2013-01-25
Onset:2013-01-31
   Days after vaccination:6
Submitted: 2013-02-04
   Days after onset:4
Entered: 2013-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010437 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009781 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F66402 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H012043 / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Crying
SMQs:, Depression (excl suicide and self injury) (broad)

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

Write-up: 6 days after PREVNAR, MMR, VARIVAX, Hep A - uncontrollable crying, persistent.


VAERS ID: 483351 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: Massachusetts  
Vaccinated:2013-02-01
Onset:0000-00-00
Submitted: 2013-02-04
Entered: 2013-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918856 / 4 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Crying, Hypotonia, Pallor
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

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

Write-up: After vaccination mother & MA reported that child had breath while crying and went limp/closed yes and became pale. Aroused immediately, cried more but remained pale. Re-examined w/ clear lung sounds & normal heart.


VAERS ID: 483365 (history)  
Form: Version 1.0  
Age: 1.05  
Sex: Male  
Location: Colorado  
Vaccinated:2013-02-01
Onset:2013-02-01
   Days after vaccination:0
Submitted: 2013-02-04
   Days after onset:3
Entered: 2013-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B138AA / 4 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB605BA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H016226 / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 4 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Blood test, Body temperature increased, Convulsion, Listless, Lumbar puncture
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Per father has had blood tests & spinal tap
CDC Split Type:

Write-up: 1 hr post vaccination became listless. On 2/3/2013 ran temp of 100 degrees in AM per father. In PM had a seizure was taken by ambulance to hospital and subsequently airlifted to another hospital. Spiked temp of 106 degrees.


VAERS ID: 483393 (history)  
Form: Version 1.0  
Age: 1.44  
Sex: Female  
Location: California  
Vaccinated:2013-01-30
Onset:2013-01-31
   Days after vaccination:1
Submitted: 2013-02-04
   Days after onset:4
Entered: 2013-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4214BA / 5 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F80381 / 5 LL / UN

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

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

Write-up: Pt''s mother brought in the patient, c/o redness and swelling to left thigh, warm to touch. Afebrile. Was seen by provider, prescribed cephalexin for 7 days and BENADRYL PRN.


VAERS ID: 483421 (history)  
Form: Version 1.0  
Age: 1.54  
Sex: Male  
Location: Oklahoma  
Vaccinated:2013-01-23
Onset:2013-01-29
   Days after vaccination:6
Submitted: 2013-02-05
   Days after onset:7
Entered: 2013-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4050AA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4531BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH527AA / 4 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F65734 / 4 LL / IM

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

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

Write-up: Fever of 103, development of rash on head and torso 2 days after fever.


VAERS ID: 483492 (history)  
Form: Version 1.0  
Age: 1.26  
Sex: Male  
Location: New York  
Vaccinated:2013-02-05
Onset:2013-02-05
   Days after vaccination:0
Submitted: 2013-02-05
   Days after onset:0
Entered: 2013-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH563AB / 4 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G54897 / 4 RL / IM

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

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

Write-up: Child''s bilateral cheeks became red. No treatment given, child observed by MD for 15 minutes.


VAERS ID: 483518 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: Washington  
Vaccinated:2013-01-22
Onset:2013-02-05
   Days after vaccination:14
Submitted: 2013-02-05
   Days after onset:0
Entered: 2013-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4127AA / 5 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547FA / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009781 / 2 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H015224 / 2 LL / SC

Administered by: Public       Purchased by: Private
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)

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

Write-up: RED RAISED AREA WITH POSSIBLE CHICKENPOX IN IT.


VAERS ID: 483521 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: Kansas  
Vaccinated:2013-02-05
Onset:2013-02-05
   Days after vaccination:0
Submitted: 2013-02-05
   Days after onset:0
Entered: 2013-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LL / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: Experienced a seizure (jerking) for about 30 seconds while in car. Took to emergency room immediately.


VAERS ID: 483524 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Unknown  
Vaccinated:2012-12-17
Onset:2013-01-25
   Days after vaccination:39
Submitted: 2013-02-06
   Days after onset:12
Entered: 2013-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Blood glucose decreased, Decreased appetite, Dehydration, Diarrhoea, Fluid intake reduced, Gastritis viral, Hypoglycaemia, Metabolic acidosis, Vomiting, Weight gain poor
SMQs:, Acute pancreatitis (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Hypoglycaemia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol sulfate; Acetaminophen
Current Illness: 01/17/2013, Underweight; Anaemia; Teething; Prophylaxis
Preexisting Conditions: Jaundice; Respiratory syncytial virus bronchiolitis; Viral infection
Allergies:
Diagnostic Lab Data: 01/25/2013, Blood glucose, 123, Normal; 01/25/2013, Blood glucose, 56, Abnormal
CDC Split Type: WAES1302USA000543

Write-up: Information has been received from an investigator concerning the following report: AN# 100410 BL# 0009-00011, a 1 year old male with anemia and reportedly underweight (beginning 17-JAN-2013) and a medical history of jaundice (from September to November of 2011), viral infection (from 25-DEC-2012 to 26-DEC- 2012) and bronchiolitis RSV (from 07-JAN-2013 to 21-JAN-2013) who on 14- SEP-2012 was randomized to study. On 14-SEP-2012, the patient was placed on a study therapy for the prophylactic treatment of MMRV. Concomitant therapy includes albuterol sulfate and acetaminophen. On 23-JAN-2013, the patient reportedly started to vomit. The patient had previous episodes of diarrhea beginning 17-DEC-2012 that had not fully resolved and begin again on 24-JAN-2013. The patient was having episodes of diarrhea roughly 1 time every hour with no blood but sometimes "mucousy" in color. The patient was not eating or drinking well, so on 25-JAN-2013, the patient was taken to the emergency room by his mother. In the ER, the patient was diagnosed with viral gastritis, metabolic acidosis, hypoglycemia, severe dehydration, poor weight gain and chronic diarrhea. The patient was admitted to the hospital the same day. Upon admittance, the patient was given an IV with a total of 180 milligrams of normal saline. Prior to the dose of saline, the patient''s glucose performed 25-JAN-2013, showed an abnormal result of 56. The glucose result taken after the administration of normal saline showed a result of 123. This result is considered normal by the reporting investigator. The patient was reportedly discharged home on 26-JAN-2013. No further details related to the patient''s current clinical status was provided at this submission. The serious adverse event of chronic diarrhea was considered recovered on 26-JAN-2013. The events of poor weight gain, severe dehydration, hypoglycemia, metabolic acidosis, and viral gastroenteritis are considered not recovered. The patient received an additional dose of study therapy of on 17-DEC-2012. No action was taken with blinded study therapy as a result of the event. At the time of the event, the patient had complete study therapy dosing and no further doses were scheduled. The relationship of the events to study therapy was not provided at the time of this report. This case was unblinded on 06-FEB-2013. Additional information is expected.


VAERS ID: 483575 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Unknown  
Vaccinated:2013-01-24
Onset:2013-01-28
   Days after vaccination:4
Submitted: 2013-02-06
   Days after onset:9
Entered: 2013-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Blister, Oedema, Pruritus, Rash erythematous, Varicella post vaccine
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA000729

Write-up: This spontaneous report as received from a physician refers to a 19 months old male patient. The patient had no pertinent medical history and no history of drug reactions/allergies. The patient was vaccinated subcutaneously with a dose of 0.5 ml VARIVAX (reported lot number h011072, expiry date 07-JUN-2014) on 24-JAN-2013. The patient used no concomitant medications. On 28-JAN-2013, four days after the vaccination, the patient developed red, edematous bumps, pruritus and vesicles all over his body. The patient sought medical attention and visited the doctor''s office. The patient was diagnosed with chickenpox. No lab diagnostic studies were performed. The event was treated with BENADRYL, TYLENOL and hydrocortisone cream. At the time of report the patient was recovering. The reporter did not provided a causality assessment. Additional information is not expected.


VAERS ID: 483585 (history)  
Form: Version 1.0  
Age: 1.31  
Sex: Female  
Location: Missouri  
Vaccinated:2009-11-13
Onset:2009-12-04
   Days after vaccination:21
Submitted: 2013-02-06
   Days after onset:1160
Entered: 2013-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UT023AA / 1 NS / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Patient had not had a vaccine for a year before she had the H1N1 vaccine. She was on no other mMedicine at the time.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Patient was diagnosed with epilepsy and has been on the prescription Keppra. She has had seizures since then and hospitalized in ICU on another occasion.
CDC Split Type:

Write-up: Had a seizure at home then called 911 and the ambulance took her to hospital, where she had a second seizure.


VAERS ID: 483645 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Male  
Location: Ohio  
Vaccinated:2012-12-14
Onset:2012-12-27
   Days after vaccination:13
Submitted: 2013-01-09
   Days after onset:13
Entered: 2013-02-07
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB527CA / UNK - / -
HIBV: HIB (OMNIHIB) / SANOFI PASTEUR UH613AB / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683AE / UNK - / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F65734 / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H006535 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: METROHEALTHESP201257900

Write-up: Nonspecif skin erupt NEC on 2012-12-27, clinician comment: rash was noted at injection sites as well as other places.


VAERS ID: 483704 (history)  
Form: Version 1.0  
Age: 1.51  
Sex: Male  
Location: Ohio  
Vaccinated:2013-01-23
Onset:2013-01-24
   Days after vaccination:1
Submitted: 2013-02-07
   Days after onset:14
Entered: 2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4310AA / 1 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: VIIth nerve paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Bell''s palsy one day after receiving DTaP. Rx: Acyclovir, oral med - resolved in one week.


VAERS ID: 483720 (history)  
Form: Version 1.0  
Age: 1.47  
Sex: Female  
Location: Wisconsin  
Vaccinated:2012-04-17
Onset:2012-10-07
   Days after vaccination:173
Submitted: 2013-02-01
   Days after onset:117
Entered: 2013-02-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4003AA / 4 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest X-ray normal, Cough, Laboratory test abnormal, Nasopharyngitis, Pertussis, Polymerase chain reaction, Post-tussive vomiting, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject''s medical history was not reported. The subject''s vaccination history included 3 doses of PENTACEL; lot number C3612AA received on 06 January 2011, lot number C3783AA received on 03 March 2011 and lot number C3686AA received on 02 May 2011.
Allergies:
Diagnostic Lab Data: 16 October 2012: PCR: Positive; Chest x-ray: Negative
CDC Split Type: 201301080

Write-up: Initial report received on 24 January 2013 from the Investigator participating in the study under the reference number M5A16. A case of pertussis disease in a 23-month-old female subject (initials not collected) was identified by the investigator based on review of data from the Electronic Disease Surveillance electronic database. The subject had received 3 doses of PENTACEL; lot number C3612AA received on 06 January 2011, lot number C3783AA received on 03 March 2011 and lot number C3686AA received on 02 May 2011 and 1 dose of DAPTACEL; lot number C4003AA received on 17 April 2012 (routes and sites of administration not reported). The subject developed cold-like symptoms on 07 October 2012, approximately six months after the last dose. On 07 October 2012, the subject developed a cough and paroxysmal cough on 13 October 2012 without a whoop. The subject also experienced posttussive vomiting and sleep disturbance. Laboratory testing included positive PCR on 16 October 2012. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of azithromycin starting on 16 October 2012 for 5 days. The subject was not hospitalized. At the time of final contact on 15 November 2012, the subject''s cough and resolved. The duration of the cough was reported at that time as 14 days. Investigator causality assessment is not required as per protocol. Documents held by sender: None.


VAERS ID: 483723 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2013-02-05
Entered: 2013-02-07
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypoacusis
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: None
CDC Split Type: 201301431

Write-up: Initial case received 30 January 2013 from a healthcare professional, (physician) who is also the grandfather of the patient. A 1 year old female patient, date of birth not reported, with no reported medical history or concomitant medications, received a DPT vaccination, about thirty years ago, date not specified. The manufacturer, dose, route, site and batch number were not reported. The patient developed a hearing deficit "almost complete deafness" several weeks after vaccination, date not specified. Laboratory tests and treatment details were not reported. The reporter had no further details and refused to be contacted. The outcome was reported as not recovered. No further details were available at the time of this report. Documents held by sender: None.


VAERS ID: 483776 (history)  
Form: Version 1.0  
Age: 1.74  
Sex: Male  
Location: New Mexico  
Vaccinated:2013-01-31
Onset:2013-02-01
   Days after vaccination:1
Submitted: 2013-02-07
   Days after onset:6
Entered: 2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Dehydration, Diarrhoea, Fluid intake reduced, Hypophagia, Lethargy, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: He has not had any abnormal events after other vaccines.
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Throwing up, diarrhea, dehydrated, no food or liquid intake. Lethargic, would not wake up. Taken to urgent care, was given 400cc IV Fluid. Released to recover at home. Is starting to move about, but still not taking in much food or water.


VAERS ID: 483793 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2013-02-04
Onset:2013-02-04
   Days after vaccination:0
Submitted: 2013-02-08
   Days after onset:4
Entered: 2013-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0156AA / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA002602

Write-up: This spontaneous report was received from a licensed practical nurse refers to a 1-year-old patient. On 04-FEB-2013 (reported as yesterday) the patient was vaccinated with an expired dose of M-M-R II (lot # (669631/0156AA, expiration date 01-FEB-2013, route not reported). No concomitant medications were reported. No adverse effects reported. No other information provided. Additional information has been requested.


VAERS ID: 483804 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Male  
Location: Indiana  
Vaccinated:2013-02-06
Onset:0000-00-00
Submitted: 2013-02-07
Entered: 2013-02-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4193AA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547CA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB481BB / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015639 / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H013642 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H013642 / 2 LL / SC

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

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

Write-up: None per parent.


VAERS ID: 483880 (history)  
Form: Version 1.0  
Age: 1.42  
Sex: Female  
Location: Connecticut  
Vaccinated:2013-01-25
Onset:2013-01-25
   Days after vaccination:0
Submitted: 2013-02-09
   Days after onset:15
Entered: 2013-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Other
Symptoms: Crying, Irritability, Pyrexia, Rash generalised, Rhinorrhoea, Sleep disorder, Viral rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever of 102.4 within 14 hours of vaccine. Runny nose, fever continued for several days. On 02/04/2013 viral rash covering entire body and fever of 101 and required Emergency Room visit. Rash was visible for one week. Change in child''s disposition. Very irritable, sleep disturbances and crying.


VAERS ID: 483909 (history)  
Form: Version 1.0  
Age: 1.05  
Sex: Male  
Location: California  
Vaccinated:2013-02-07
Onset:2013-02-08
   Days after vaccination:1
Submitted: 2013-02-09
   Days after onset:1
Entered: 2013-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB667BB / 1 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010134 / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F45144 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016600 / 1 LL / UN

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

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

Write-up: 8 cm x 5 cm erythematous, edematous area on (L) thigh area started 2/8/13.


VAERS ID: 483891 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2012-07-22
Onset:2012-07-22
   Days after vaccination:0
Submitted: 2013-02-10
   Days after onset:203
Entered: 2013-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: Very high fever developed within hours of vaccine, no previous sign of illness, no other symptoms developed other than fever. Highest recorded temp 105.5, fever lasted 4 days.


VAERS ID: 483899 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2013-02-08
Onset:2013-02-09
   Days after vaccination:1
Submitted: 2013-02-11
   Days after onset:2
Entered: 2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RA / SYR
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / SYR

Administered by: Unknown       Purchased by: Other
Symptoms: Blood test, Convulsion, Pyrexia, X-ray normal
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Seizure and a Fever 102.


VAERS ID: 483965 (history)  
Form: Version 1.0  
Age: 1.75  
Sex: Male  
Location: Tennessee  
Vaccinated:2013-02-05
Onset:2013-02-06
   Days after vaccination:1
Submitted: 2013-02-11
   Days after onset:5
Entered: 2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B138AA / 4 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4526AA / 3 LA / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0628AE / 2 RA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH577AB / 4 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hypersensitivity, Pyrexia, Rash generalised, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient''s mother states child developed a fever on the evening of 2-6-13. She''s not sure how high the fever was because her thermometer wasn''t working. Mother said child developed an itchy rash during the day on 2-7-13 all over body. She brought child to Health Clinic. It was believed to be an allergic reaction and Prednisone was prescribed. Child took Prednisone for 3 days and it cleared the rash up.


VAERS ID: 484017 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2013-02-01
Onset:2013-02-10
   Days after vaccination:9
Submitted: 2013-02-11
   Days after onset:1
Entered: 2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: Total body rash.


VAERS ID: 484093 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Maine  
Vaccinated:2013-01-31
Onset:2013-02-02
   Days after vaccination:2
Submitted: 2013-02-11
   Days after onset:9
Entered: 2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1579AA / 1 LL / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Received MMR #1 on 1/31/13 - developed fever within 24 hours then had febrile seizure within 48 hours. Fever 101.


VAERS ID: 484103 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2013-02-02
Onset:2013-02-07
   Days after vaccination:5
Submitted: 2013-02-11
   Days after onset:4
Entered: 2013-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB690CA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0496AE / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. G00983 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen; On 2/2/13 was on AMOXIL POLYTRIM
Current Illness: None
Preexisting Conditions: ROM 1/28/13
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3cm x 3cm red raised area rt thigh. Onset 5 days receiving VARIVAX in rt thigh.


VAERS ID: 484111 (history)  
Form: Version 1.0  
Age: 1.85  
Sex: Male  
Location: Wisconsin  
Vaccinated:2011-01-03
Onset:2012-06-17
   Days after vaccination:531
Submitted: 2013-02-08
   Days after onset:236
Entered: 2013-02-12
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009AA / 1 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest X-ray normal, Cough, Laboratory test abnormal, Nasopharyngitis, Pertussis, Polymerase chain reaction
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject''s vaccine history included three doses of PENTACEL; dose one lot number C3278AA received on 05 May 2009, dose two lot number C3292AA received on 01 July 2009 and dose three lot number C3431AA received on 01 September 2009. No other medical history was reported.
Allergies:
Diagnostic Lab Data: Chest x-ray findings were negative for pneumonia.
CDC Split Type: 201302196

Write-up: A case of pertussis disease in a three year-old male subject (initials not collected) was identified by the investigator based on review of data from the Electronic Disease Surveillance (EDSS) electronic database. The subject had received three doses of PENTACEL; dose one lot number C3278AA received on 05 May 2009, dose two lot number C3292AA received on 01 July 2009 and dose three lot number C3431AA received on 01 September 2009 and one dose of TRIPEDIA, lot number U3009AA on 03 January 2011 (routes and sites of administration for all doses not reported). The subject developed cold-like symptoms on 17 June 2012, approximately 17 months after the last dose. On 17 June 2012, the subject developed a cough and paroxysmal cough on 01 July 2012 with a whoop. Laboratory testing included positive PCR on 28 June 2012. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of azithromycin starting on 28 June 2012 for five days. The subject was not hospitalized. At the time of final contact on 01 July 2012, the subject''s cough was still persisting. The duration of the cough was reported at that time as 14 days. Investigator causality assessment is not required as per protocol. Documents held by sender: None.


VAERS ID: 484120 (history)  
Form: Version 1.0  
Age: 1.12  
Sex: Male  
Location: Louisiana  
Vaccinated:2013-02-07
Onset:2013-02-07
   Days after vaccination:0
Submitted: 2013-02-07
   Days after onset:0
Entered: 2013-02-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B157BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB591AA / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0680AE / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H013642 / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, 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)

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

Write-up: Redness, fever, induration size of nickel. Pt given BENADRYL oral and ims to continue to give q 6 hrs see MD if no improvement.


VAERS ID: 484130 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: Oregon  
Vaccinated:2013-01-25
Onset:2013-02-05
   Days after vaccination:11
Submitted: 2013-02-05
   Days after onset:0
Entered: 2013-02-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0628AE / 1 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0411AE / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F80381 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H014728 / 1 LL / UN

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

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

Write-up: Red swollen area running between the 2 injection sites on (L) thigh - appeared 7 days after vaccination. Treated with cool compresses. Did not feel deep - likely no muscular involvement.


VAERS ID: 484205 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:2013-02-04
Onset:2013-02-11
   Days after vaccination:7
Submitted: 2013-02-12
   Days after onset:1
Entered: 2013-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H013041 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H011723 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Fatigue, Irritability, Rash
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin (day 7 of 10)
Current Illness: Sinus infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash started upper body the evening of 2/11/13 - spread to face, torso, arms & legs including palms by 2/12/13. Fussy and tired.


VAERS ID: 484207 (history)  
Form: Version 1.0  
Age: 1.07  
Sex: Male  
Location: Oregon  
Vaccinated:2013-02-01
Onset:2013-02-01
   Days after vaccination:0
Submitted: 2013-02-11
   Days after onset:10
Entered: 2013-02-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB667BB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009781 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H014728 / 1 RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Immediate post-injection reaction, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: On - 2-1-13 child received immunizations & immediately reacted with swelling and heat to injection site provider had cold packs applied & gave TYLENOL. Swelling to (R) quad.


VAERS ID: 484249 (history)  
Form: Version 1.0  
Age: 1.52  
Sex: Male  
Location: Illinois  
Vaccinated:2013-02-08
Onset:2013-02-08
   Days after vaccination:0
Submitted: 2013-02-12
   Days after onset:4
Entered: 2013-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB646AA / 2 RL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine; Allergies
Current Illness: None
Preexisting Conditions: Allergy; Penicillins; Amoxicillin; Eczema; Otitis Media; Hydrocele
Allergies:
Diagnostic Lab Data: None noted in ER record
CDC Split Type:

Write-up: Temperature elevated- as high as 103.9. Had seizure at 102.9- and was taken by ambulance to ER. Just observed, given TYLENOL & ibuprofen. Sent home. Returned next PM for high temp-ordered ZITHROMAX & oral steroid (to ER).


VAERS ID: 484258 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Female  
Location: Arkansas  
Vaccinated:2012-08-20
Onset:2012-09-04
   Days after vaccination:15
Submitted: 2013-02-12
   Days after onset:161
Entered: 2013-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1900AA / 1 UN / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 4 UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H007084 / 1 UN / SC

Administered by: Private       Purchased by: Public
Symptoms: T-cell lymphoma, Varicella post vaccine
SMQs:, Malignant lymphomas (narrow), Haematological malignant tumours (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 63 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: AR1302

Write-up: Received vaccines on 08/20/12. Admitted to Hospital on 09/04/12, chicken pox diagnosed while at hospital. Was diagnosed with T-cell Lymphoma during hospital stay. Still had "bumps" on body as of 11/19/12.


VAERS ID: 484420 (history)  
Form: Version 1.0  
Age: 1.16  
Sex: Male  
Location: Washington  
Vaccinated:2013-01-31
Onset:2013-01-31
   Days after vaccination:0
Submitted: 2013-02-13
   Days after onset:13
Entered: 2013-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4211AA / 4 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F81618 / 4 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Oedema peripheral, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Swelling, tenderness of right leg.


VAERS ID: 484429 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: Indiana  
Vaccinated:2013-02-04
Onset:2013-02-12
   Days after vaccination:8
Submitted: 2013-02-13
   Days after onset:1
Entered: 2013-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 102 fever which spiked at 103.8 and resulted in a febrile seizure lasting 5+ minutes.


VAERS ID: 484461 (history)  
Form: Version 1.0  
Age: 1.53  
Sex: Female  
Location: Washington  
Vaccinated:2013-02-07
Onset:2013-02-11
   Days after vaccination:4
Submitted: 2013-02-11
   Days after onset:0
Entered: 2013-02-13
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4211AA / UNK RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547FA / 2 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536AA / UNK RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F81618 / UNK LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild URI
Preexisting Conditions: Macrocephaly but without neuro deficit
Allergies:
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: "Rash on both legs. Pt was given pomegranate juice for the first time. Possible reaction." This cute 18-month-old female comes in with her mom and dad because of rash noted this morning on her thighs. Three days ago she had the second flu shot of her life in the thigh. Then, over the weekend she was given pomegranate juice and carrot juice for the first time in her life. Last night she woke up a lot, which is unusual for her. She had a runny nose and sneezing, but no cough or fever. No breathing problems. No family history of allergies.


VAERS ID: 484440 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: Indiana  
Vaccinated:2009-03-17
Onset:2013-01-23
   Days after vaccination:1408
Submitted: 2013-02-14
   Days after onset:22
Entered: 2013-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1785X / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Varicella post vaccine
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Drug hypersensitivity
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1301USA012537

Write-up: This spontaneous report was received from a registered nurse refers to a 4 years old female patient with allergy to amoxicillin, with pertinent medical history, who on 17-MAR-2009, was vaccinated subcutaneously with dose 1, 0.5 live (Merck) VARIVAX (Lot 662448/1785x EXP. 11-DEC-2010). No concomitant medications were reported. On 23-JAN-2013, the primary reporter, stated that a patient at the age of 12 months received live (Merck) VARIVAX and that on 23-JAN-2013, at the age of 4 years old was seen in the office and was diagnosed with widespread chickenpox. The patient subsequently recovered without requiring treatment in Jan. 2013. Additional information is not expected.


VAERS ID: 484488 (history)  
Form: Version 1.0  
Age: 1.24  
Sex: Male  
Location: Virginia  
Vaccinated:2013-02-08
Onset:2013-02-08
   Days after vaccination:0
Submitted: 2013-02-14
   Days after onset:6
Entered: 2013-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B164AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H015829 / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918561 / 4 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Crying, Flatulence, Full blood count normal, Insomnia, Irritability, Streptococcus test negative
SMQs:, Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen - PRN; Acetaminophen - PRN
Current Illness:
Preexisting Conditions: Amoxicillin and ROCEPHIN allergies
Allergies:
Diagnostic Lab Data: CBC was drawn to rule out bacterial illness. Rapid strep test was also performed. Strep was (-). CBC was nml with viral shift.
CDC Split Type:

Write-up: Pt. presented at office afebrile, fussy at 0923 2/9/13. Per father, pt. had been fussy/gassy x24 hours. Decreased sleep, inconsolable, crying. Father reported a rectal temp of 103.6 degrees.


VAERS ID: 484528 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2013-02-01
Onset:2013-02-10
   Days after vaccination:9
Submitted: 2013-02-14
   Days after onset:4
Entered: 2013-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015630 / 1 LA / SC

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

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

Write-up: Fever x2 days. Rash x1 day. No treatment. $g100 red spots - head to toe.


VAERS ID: 484552 (history)  
Form: Version 1.0  
Age: 1.52  
Sex: Female  
Location: Arizona  
Vaccinated:2013-02-08
Onset:2013-02-09
   Days after vaccination:1
Submitted: 2013-02-14
   Days after onset:5
Entered: 2013-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB642FA / 2 RA / IM

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

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

Write-up: Received vaccine 2/8/13 developed rash. Went to ER on 2/10/13. Monitored, given BENADRYL & discharged.


VAERS ID: 484573 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: California  
Vaccinated:2013-01-21
Onset:2013-02-13
   Days after vaccination:23
Submitted: 2013-02-13
   Days after onset:0
Entered: 2013-02-14
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010437 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009782 / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017132 / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Blister, Papule, Pyrexia, Rash pustular, Vaccination complication
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mild case of papules, pustules, vesicles on head, neck & trunk, low grade fever 100 degrees F, suspect from VARIVAX 1/21/13.


VAERS ID: 484609 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: West Virginia  
Vaccinated:2006-08-25
Onset:2013-02-06
   Days after vaccination:2357
Submitted: 2013-02-08
   Days after onset:2
Entered: 2013-02-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B136AA / 1 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0640Y / 2 RA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08682A / 4 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0796F / 1 RA / UN

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

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

Write-up: Rash.


VAERS ID: 484648 (history)  
Form: Version 1.0  
Age: 1.28  
Sex: Male  
Location: Wisconsin  
Vaccinated:2012-03-15
Onset:2012-12-31
   Days after vaccination:291
Submitted: 2013-02-13
   Days after onset:44
Entered: 2013-02-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / 4 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest X-ray normal, Cough, Laboratory test abnormal, Nasopharyngitis, Pertussis, Polymerase chain reaction, Post-tussive vomiting, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject''s medical history was not reported. The subject''s vaccination history included 3 doses of PENTACEL; received on 04 February 2011, 04 April 2011, and 02 June 2011 (lot numbers not reported).
Allergies:
Diagnostic Lab Data:
CDC Split Type: 201302302

Write-up: Initial report received on 11 February 2013 from the Investigator participating in the post-marketing study under the reference number M5A16. A case of pertussis disease in a 2-year-old male subject (initials not collected) was identified by the investigator based on review of data from the Electronic Disease Surveillance electronic database. The subject had received 4 doses of PENTACEL on 04 February 2011, 04 April 2011, 02 June 2011, and 15 March 2012 (lot numbers, routes, and sites of administration not reported). The subject developed a cough on 03 January 2013, approximately 9 months after the last dose, and a paroxysmal cough without a whoop on 04 January 2013. The subject also developed cold like symptoms on 31 December 2012 and posttussive vomiting and sleep disturbance (start date not reported). Laboratory testing included positive PCR on 09 January 2013. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of azithromycin starting on 09 January 2013 for 5 day. The subject was not hospitalized. At the time of final contact on 25 January 2013, the subject''s cough was not persisting. The duration of the cough was reported at that time as 20 days. Investigator causality assessment is not required as per protocol. Documents held by sender: None.


VAERS ID: 484678 (history)  
Form: Version 1.0  
Age: 1.73  
Sex: Female  
Location: Massachusetts  
Vaccinated:2013-02-12
Onset:2013-02-13
   Days after vaccination:1
Submitted: 2013-02-15
   Days after onset:2
Entered: 2013-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH613AC/UH547AC / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918856 / UNK RL / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Eye movement disorder, Tonic clonic movements
SMQs:, Convulsions (narrow), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: A few tonic clonic jerks and eye rolling at breakfast while in her high chair.


VAERS ID: 484688 (history)  
Form: Version 1.0  
Age: 1.27  
Sex: Male  
Location: North Carolina  
Vaccinated:2013-02-15
Onset:2013-02-15
   Days after vaccination:0
Submitted: 2013-02-16
   Days after onset:1
Entered: 2013-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 4 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012971 / 4 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Endotracheal intubation, Status epilepticus, Tonic clonic movements
SMQs:, Angioedema (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Viral URI, mild
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Status epilepticus, whole body tonic-clonic activity requiring several anti-epileptic medications and intubation.


VAERS ID: 484700 (history)  
Form: Version 1.0  
Age: 1.09  
Sex: Male  
Location: California  
Vaccinated:2013-02-07
Onset:2013-02-11
   Days after vaccination:4
Submitted: 2013-02-17
   Days after onset:6
Entered: 2013-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0496AE / 1 LL / SYR
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Unknown       Purchased by: Public
Symptoms: Erythema, Heat rash, Rash, Urticaria, Vomiting projectile
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Doctor diagnosed as heat rash on the 15th, although there had been no fever. He prescribed cortisone, which I thought unnecessary for heat rash. I plan to take my son back tomorrow morning to further evaluate.
CDC Split Type:

Write-up: Started as what appeared to be a patch of hives on his left shoulder blade. By the next day it was worse and red, looking rash like and by Friday the 15th it covered his entire back and had spread to his chest, stomach, diaper area and legs. Does not appear to bother him. I need to note that my son had a cold prior to immunization and it was his first day of feeling better. He also will NOT eat eggs and when he had twice previously he projectile vomited. I was not asked if he has an egg allergy, nor did I understand that would potentially be an issue.


VAERS ID: 484739 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Illinois  
Vaccinated:2012-12-27
Onset:2013-01-01
   Days after vaccination:5
Submitted: 2013-02-07
   Days after onset:37
Entered: 2013-02-18
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010187 / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H016238 / 3 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal pain, Alopecia, Menstruation irregular
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

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

Write-up: Patient received HPV#3 and hep A #2 on 12/27/12. Since that time she has had excessive hair loss; abd pain and irregular menses. Parent requested report file.


VAERS ID: 484742 (history)  
Form: Version 1.0  
Age: 1.32  
Sex: Male  
Location: Connecticut  
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted: 2013-02-11
Entered: 2013-02-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4275AA / 1 LA / IM

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

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

Write-up: None. MENACTRA given in error, FDA approved for this age. DPH suggested to file report even though no adverse event. Patient had no reactions other than expected mild side effect of inflammation at the vaccine site.


VAERS ID: 484762 (history)  
Form: Version 1.0  
Age: 1.53  
Sex: Male  
Location: Massachusetts  
Vaccinated:2013-01-31
Onset:2013-02-02
   Days after vaccination:2
Submitted: 2013-02-05
   Days after onset:3
Entered: 2013-02-18
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010437 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918856 / 4 RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Mom states child developed fever of 101.0 (R). 2 days after vaccines/irritable.


VAERS ID: 484790 (history)  
Form: Version 1.0  
Age: 1.29  
Sex: Male  
Location: Kentucky  
Vaccinated:2013-02-08
Onset:2013-02-08
   Days after vaccination:0
Submitted: 2013-02-18
   Days after onset:10
Entered: 2013-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH771AA / 5 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H07011 / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Blister, Erythema, Immediate post-injection reaction, Injection site vesicles
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient had immediate blistering at the site of injection (R) deltoid area. After couple of hours the blisters went away, then reappeared 10 days later and was brought back into the office with 4-5 erythematous vesicles.


VAERS ID: 484818 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Kentucky  
Vaccinated:2013-02-13
Onset:2013-02-13
   Days after vaccination:0
Submitted: 2013-02-18
   Days after onset:5
Entered: 2013-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4286AA / 4 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH682AB / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / 4 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Dyskinesia, Electroencephalogram, Hypotonia, Unresponsive to stimuli
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Received shots 2/13/13, at dinner time she "slumped over" in high chair, would not respond, when pulled from high chair had jerking movement.


VAERS ID: 484819 (history)  
Form: Version 1.0  
Age: 1.27  
Sex: Female  
Location: Indiana  
Vaccinated:2013-01-31
Onset:2013-01-31
   Days after vaccination:0
Submitted: 2013-02-11
   Days after onset:11
Entered: 2013-02-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C418AA / 4 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH627AD / 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F99044 / 4 LL / IM

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

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

Write-up: Fever & seizures. Taken to hospital - no paperwork.


VAERS ID: 484821 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2013-02-12
Onset:2013-02-12
   Days after vaccination:0
Submitted: 2013-02-18
   Days after onset:6
Entered: 2013-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / 1 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA007459

Write-up: This spontaneous report as received from a registered nurse refers to a 1 year old patient. On 12-FEB-2013 the patient was vaccinated with PROQUAD dose 1 (lot # not reported) subcutaneously along with VARIVAX (Merck) dose 1 (lot # not reported0 subcutaneously. No adverse effect reported. Additional information has been requested.


VAERS ID: 484798 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2013-02-19
Entered: 2013-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK RL / UN

Administered by: Other       Purchased by: Other
Symptoms: Immunoglobulin therapy, Injection site reaction, Polymerase chain reaction, Rash vesicular, Scab, Skin lesion, Varicella post vaccine, Varicella virus test positive
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunodeficiency; Mucopolysaccharidosis I
Preexisting Conditions: Cord blood transplant therapy
Allergies:
Diagnostic Lab Data: A lesion was unroofed and the fluid revealed VZV by PCR
CDC Split Type: WAES1302USA007633

Write-up: Information has been received from a published literature article. Vaccination with attenuated varicella zoster virus (VZV) could lead to infectious complications in immunodeficient patients. It was reported two immunocompromised patients who developed initial or reactivated vaccine strain varicella, leading to unique vesicular rashes involving the vaccinated limbs, without becoming wide-spread or remaining limited to a single dermatome. Case 2-A 17 month old female with Hurler Syndrome, on day +6 after receiving an unrelated 7/8 Human Leukocyte Antigen matched cord blood transplant, developed a vesicular rash on her right thigh, which was the site for VARIVAX vaccination 4 months prior to transplant. A lesion was unroofed and the fluid revealed VZV by PCR. Subsequent analysis revealed the virus to be vaccine strain varicella. She was started on treatment with intravenous acyclovir and intravenous immunoglobulin and her lesions crusted over within 2 weeks. These two cases highlighted unusual presentations of vaccine strain varicella in immunocompromised patients. Vaccine strain varicella could cause a vesicular rash in a non-classical distribution. It was also notable that vaccine strain can trigger hemophagocytic lymphohistiocytosis in immune deficient patients. This is one of two reports received from the same literature. Additional information has been requested.


VAERS ID: 484832 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2013-01-31
Onset:2013-02-15
   Days after vaccination:15
Submitted: 2013-02-15
   Days after onset:0
Entered: 2013-02-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0628AE / 1 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010136 / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017133 / 1 LA / UN

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

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

Write-up: Rash.


VAERS ID: 484896 (history)  
Form: Version 1.0  
Age: 1.05  
Sex: Female  
Location: New Jersey  
Vaccinated:2013-01-22
Onset:2013-01-23
   Days after vaccination:1
Submitted: 2013-02-19
   Days after onset:27
Entered: 2013-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4544EA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1579AA / UNK LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F72495 / UNK RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016912 / UNK LL / SC

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

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

Write-up: Saw mother & toddler today. Mother stated that child had a rash & fever of 104 degrees on 1/23/13, after vaccines were given on 1/22/13. Mother took child to ED for treatment.


VAERS ID: 484920 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: Michigan  
Vaccinated:2013-01-28
Onset:2013-01-28
   Days after vaccination:0
Submitted: 2013-02-19
   Days after onset:22
Entered: 2013-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F11149 / 4 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Cyanosis, Dyspnoea, Febrile convulsion, Somnolence, Tremor, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRI-VI-SOL vitamin; EPIPEN Jr available if needed
Current Illness: None
Preexisting Conditions: Allergic to eggs & cow''s milk
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Child was sleepy after immunization & took nap. Upon arising child seemed less alert per mother. During diaper change, child became unresponsive, lips turned blue, & developed hand tremor. Mother noted she was not breathing & called EMS. Episode lasted 1-3 minutes. Upon arrival of EMS child was breathing & started to regain consciousness. Temp 101.9 ax EMS contacted primary care physician; child was not seen by physician or taken to ER. Dx - likely febrile seizure. Child recovered without further incident.


VAERS ID: 484923 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: California  
Vaccinated:2013-02-19
Onset:2013-02-19
   Days after vaccination:0
Submitted: 2013-02-19
   Days after onset:0
Entered: 2013-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0411AE / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017243 / 1 LA / SC

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

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

Write-up: MMR, VZV & TB skin test (PPD) given at 1230 pm - Mom noticed rash "all over legs" around 1 pm - returned to clinic. Advised to give BENADRYL as needed by MD.


VAERS ID: 484924 (history)  
Form: Version 1.0  
Age: 1.76  
Sex: Male  
Location: Washington  
Vaccinated:2013-02-12
Onset:2013-02-12
   Days after vaccination:0
Submitted: 2013-02-19
   Days after onset:7
Entered: 2013-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4154BA / 4 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547FA / 3 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015782 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Temp 100.7 degrees otherwise fine
Preexisting Conditions: Anemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had febrile seizure post vaccines. Mom/Parent forgot to give dose of ADVIL before child went to bed.


VAERS ID: 484983 (history)  
Form: Version 1.0  
Age: 1.26  
Sex: Male  
Location: Ohio  
Vaccinated:2013-02-05
Onset:2013-02-14
   Days after vaccination:9
Submitted: 2013-02-20
   Days after onset:6
Entered: 2013-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0287AE / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Electroencephalogram normal, Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 15 mo old with MMR given 2/5/13, on 2/14/13 had a febrile sz at daycare (T 39.3) seen in ED. Sent back to ED 3 hours later with another sz / fever (38.1). Admitted overnight for observation, EEG nl - has. OM persists.


VAERS ID: 485004 (history)  
Form: Version 1.0  
Age: 1.86  
Sex: Female  
Location: Utah  
Vaccinated:2013-01-21
Onset:2013-01-28
   Days after vaccination:7
Submitted: 2013-02-20
   Days after onset:23
Entered: 2013-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547CA / 1 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0532AE / 2 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Death, Influenza A virus test positive, Laboratory test, Respiratory arrest, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2013-01-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PMD''s office reported that child had been recommended to take a multivitamin, unknown if child was taking.
Current Illness: None reported by PMD''s office
Preexisting Conditions: None reported by PMD''s office
Allergies:
Diagnostic Lab Data: Child had been seen at Emergency Room on 01/27/2013 and had positive rapid influenza A testing. No influenza testing through second Medical Center but did have series of testing to determine cardiac related event. Autopsy was declined by family.
CDC Split Type:

Write-up: Per hospital and family reports, child was talking to grandfather when she collapsed and stopped breathing. Grandfather performed CPR until EMS arrived and child was transported via AirMed to Medical Center. Child expired on 01/30/2013.


VAERS ID: 485055 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2013-02-11
Onset:2013-02-11
   Days after vaccination:0
Submitted: 2013-02-11
   Days after onset:0
Entered: 2013-02-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB67CB / 1 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009784 / 1 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017440 / 1 UN / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Hive, 3cm x 2cm erythema with small central flare noted about 5 minutes after MMR vaccine given in (L) thigh. Hive located about 1cm above injection site. No other hives noted. No other.


VAERS ID: 485101 (history)  
Form: Version 1.0  
Age: 1.33  
Sex: Male  
Location: Georgia  
Vaccinated:2012-11-27
Onset:2012-11-27
   Days after vaccination:0
Submitted: 2012-11-27
   Days after onset:0
Entered: 2013-02-20
   Days after submission:85
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE90195

Write-up: A report has been received from a Health Professional concerning a 1 year old, subject of unknown gender, who had been receiving Nasal FLUMIST. FLUMIST started on 27-Nov-2012. The patient experienced gave 16 month old FLUMIST which started on 27-Nov-2012. The outcome of the event of gave 16 month old FLUMIST is unknown. The report was considered to be non-serious.


VAERS ID: 485110 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2012-10-29
Entered: 2013-02-20
   Days after submission:114
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness: Wheezing
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE82653

Write-up: A consumer report has been received. The report concerns a 1 year old, Female consumer, who had been receiving Nasal FLUMIST. The patient''s concurrent disease(s) included WHEEZING PROBLEMS. FLUMIST started on an unknown date. The patient experienced ADMINISTRATION TO AN 18 MONTH OLD which started on 29-Oct-2012 and NASAL CONGESTION. The outcome of the event of NASAL CONGESTION and ADMINISTRATION TO AN 18 MONTH OLD is unknown. The report was considered to be non-serious.


VAERS ID: 485137 (history)  
Form: Version 1.0  
Age: 1.54  
Sex: Male  
Location: Indiana  
Vaccinated:2013-02-08
Onset:2013-02-20
   Days after vaccination:12
Submitted: 2013-02-20
   Days after onset:0
Entered: 2013-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4296AB / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. G009152 / 1 LL / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Allergy test, Blister, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Full blood count, Rash, Rash pustular
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever, cold, rash.~Measles + Mumps + Rubella (no brand name)~UN~0.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: Urticaria
Allergies:
Diagnostic Lab Data: CBC; Allergy panel; IgG; IgM; IgA; IgG - subclass
CDC Split Type:

Write-up: Rash - vesicles/pustules - 8-10 in number on the chest, back and groin.


VAERS ID: 485168 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Unknown  
Vaccinated:2013-01-14
Onset:2013-01-23
   Days after vaccination:9
Submitted: 2013-01-28
   Days after onset:5
Entered: 2013-02-20
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010136 / UNK UN / SC
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

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

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

Write-up: MMR & varicella vaccines 1/14/13 rash noted face, torso, and diaper area 1/23/13. No fever - seen in office felt to be related to measles vaccine.


VAERS ID: 485180 (history)  
Form: Version 1.0  
Age: 1.53  
Sex: Female  
Location: Kansas  
Vaccinated:2012-11-06
Onset:2012-11-06
   Days after vaccination:0
Submitted: 2012-11-08
   Days after onset:2
Entered: 2013-02-20
   Days after submission:104
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2106 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE85404

Write-up: A report has been received from a Health Professional concerning a 1 year old, female subject, who had been receiving Nasal FLUMIST. FLUMIST started on 06-Nov-2012. Nurse INADVERTENTLY GAVE FLUMIST TO AN 18 MONTH OLD on 06-Nov-2012. The outcome of the event of INADVERTENTLY GAVE FLUMIST TO AN 18 MONTH OLD is unknown. The report was considered to be non-serious.


VAERS ID: 485195 (history)  
Form: Version 1.0  
Age: 1.82  
Sex: Unknown  
Location: Kansas  
Vaccinated:2012-11-02
Onset:2012-11-02
   Days after vaccination:0
Submitted: 2012-11-14
   Days after onset:12
Entered: 2013-02-20
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2109 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE84316

Write-up: A report has been received from a Health Professional concerning a 1 year old, male subject, who had been receiving Nasal FLUMIST. FLUMIST started on 02-Nov-2012. The nurse INADVERTENTLY ADMINISTERED A HALF-DOSE OF FLUMIST TO A 22 MONTH-OLD PATIENT which started on 02-Nov-2012. The patient recovered from the event of INADVERTENTLY ADMINISTERED A HALF-DOSE OF FLUMIST TO A 22 MONTH-OLD PATINET on 06-Nov-2012. The report was considered to be non-serious by the reporter. Corrected report on 28-Nov-2012: the vaccine was administered by the nurse, the reason was oversight. Outcome of the adverse event added.


VAERS ID: 485212 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Unknown  
Vaccinated:2012-11-16
Onset:2012-11-16
   Days after vaccination:0
Submitted: 2012-11-16
   Days after onset:0
Entered: 2013-02-20
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE88311

Write-up: A report has been received from a Health Professional concerning a 1 year old, Female subject, who had been receiving Nasal FLUMIST. FLUMIST started on 16-Nov-2012. The nurse accidentally vaccinated 14 month old with FLUMIST on 16-Nov-2012 and then saw that it is contraindicated in this age group. The nurse explained that the first dose didn''t get inside the nostril but the second dose in the second nostril went in properly. The outcome of the event of accidentally vaccinated 14 month old is unknown. The report was considered to be non-serious. Corrected report 30-Nov-2012: Coding of event ''accidentally vaccinated 14 month old'' corrected from Drug use in unapproved population to inappropriate age at vaccine administration, narrative updated.


VAERS ID: 485215 (history)  
Form: Version 1.0  
Age: 1.92  
Sex: Female  
Location: California  
Vaccinated:2012-11-09
Onset:2012-11-09
   Days after vaccination:0
Submitted: 2012-11-19
   Days after onset:10
Entered: 2013-02-20
   Days after submission:93
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2106 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Used
Current Illness: Passive smoking
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE85902

Write-up: A report has been received from a Health Professional concerning a 1 year old, Female subject, who had been receiving Nasal FLUMIST. The patient''s concurrent disease(s) included ACCIDENTAL POISONING BY SECOND HAND SMOKE. Concomitant Drug(s) Not Used. FLUMIST started on 09-Nov-2012. FLUMIST was GIVEN TO 23 MONTH OLD on 09-Nov-2012. The patient did not experience any adverse event. The outcome of the event of FLUMIST GIVEN TO 23 MONTH OLD is unknown. The report was considered to be non-serious by company physician. Summary of follow-up information received by AstraZeneca/MedImmune on 19-Nov-2012 from Health Professional: Disease, information regarding concomitant medications, occupation of reporter (Administered by) added, narrative updated. Corrected report 30-Nov-2012: Action taken of FLUMIST corrected from Unknown to Not applicable.


VAERS ID: 485255 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maine  
Vaccinated:2012-11-29
Onset:2012-11-29
   Days after vaccination:0
Submitted: 2012-11-29
   Days after onset:0
Entered: 2013-02-20
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE90490

Write-up: A report has been received from a Health Professional concerning a 1 year old, Female subject, who had been receiving FLUMIST. FLUMIST started on 29-Nov-2012. The patient experienced INADVERTENTLY GAVE FLUMIST TO A 16M ONTH OLD which started on 29-Nov-2012. The outcome of the event of INADVERTENTLY GAVE FLUMIST TO A 16 MONTH OLD is unknown. The report was considered to be non-serious.


VAERS ID: 485257 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Alaska  
Vaccinated:0000-00-00
Onset:2012-11-29
Submitted: 2012-12-04
   Days after onset:5
Entered: 2013-02-20
   Days after submission:78
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2109 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE91292

Write-up: A report has been received from a Physician concerning a 1 year old, Male subject, who had been receiving Nasal FLUMIST. FLUMIST started on an unknown date. The patient experienced nurse gave FLUMIST to 13 month old child which started on 29-Nov-2012. The outcome of the event of nurse gave FLUMIST to 13 month old child is unknown. The report was considered to be non-serious by the reporter.


VAERS ID: 485268 (history)  
Form: Version 1.0  
Age: 1.85  
Sex: Female  
Location: Unknown  
Vaccinated:2012-09-20
Onset:2012-09-20
   Days after vaccination:0
Submitted: 2012-10-08
   Days after onset:18
Entered: 2013-02-20
   Days after submission:135
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2107 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE74596

Write-up: A report has been received from registered nurse, concerning 22 month old, female patient. No concomitant medication and medical history. Caller states that FLUMIST was inadvertently administered to a 22 month old. No adverse reaction has occurred. The outcome was unknown. The report was considered to be non-serious by the reporting health professional. Follow-up of insignificant information received AstraZeneca/MedImmune on 08-Oct-2012 from health professional: patient''s date of birth updated.


VAERS ID: 485296 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Unknown  
Vaccinated:2012-10-17
Onset:2012-10-17
   Days after vaccination:0
Submitted: 2012-10-19
   Days after onset:2
Entered: 2013-02-20
   Days after submission:124
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2109 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE80502

Write-up: A report has been received from a Health Professional concerning a 19 months old, Female subject, who had been receiving Nasal FLUMIST. FLUMIST started on an unknown date. The reporter stated that they accidentally gave FLUMIST to a 19 month old patient on 17-Oct-2012 and the patient had not experienced any adverse events. The outcome of the event of ACCIDENTALLY GAVE FLUMIST TO 19 MONTH-OLD was unknown. The report was considered to be non-serious.


VAERS ID: 485303 (history)  
Form: Version 1.0  
Age: 1.67  
Sex: Female  
Location: Texas  
Vaccinated:2012-11-15
Onset:2012-11-15
   Days after vaccination:0
Submitted: 2012-11-15
   Days after onset:0
Entered: 2013-02-20
   Days after submission:97
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2159 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE87426

Write-up: A report has been received from a Health Professional concerning a 1 year old, Female subject, who had been receiving Nasal FLUMIST. FLUMIST started on an unknown date. The patient experienced ADMINISTRATION TO A 20 MONTH OLD which started on 15-Nov-2012. The outcome of the event of ADMINISTRATION TO A 20 MONTH OLD is unknown. The report was considered to be non-serious. Corrected report 29-Nov-2012: Key ingredient of FLUMIST corrected from influenza virus vaccine polyvalent to FLUMIST, coding of event ''administration to a 20 month old'' corrected from intentional drug misuse to inappropriate age at vaccine administration, narrative updated.


VAERS ID: 485309 (history)  
Form: Version 1.0  
Age: 1.77  
Sex: Male  
Location: Washington  
Vaccinated:2012-09-11
Onset:2012-09-11
   Days after vaccination:0
Submitted: 2012-10-23
   Days after onset:42
Entered: 2013-02-20
   Days after submission:120
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2109 / UNK NS / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 2012SE77609

Write-up: A report has been received from a Health Professional concerning a 1 year old, Male subject, who had been receiving Nasal FLUMIST. FLUMIST started on 11-Sep-2012. The patient experienced FLUMIST ADMINISTERED TO 22 MONTH-OLD which started on 11-Sep-2012. The outcome of event of FLUMIST ADMINISTERED TO 22 MONTH-OLD is unknown. The report was considered to be non-serious. Summary of follow-up information received by AstraZeneca/MedImmune 23-Oct-2012: reporter page, administration date, event onset date were corrected, manufacturer name added.


VAERS ID: 485328 (history)  
Form: Version 1.0  
Age: 1.55  
Sex: Female  
Location: North Carolina  
Vaccinated:2013-02-19
Onset:2013-02-19
   Days after vaccination:0
Submitted: 2013-02-20
   Days after onset:1
Entered: 2013-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B157BA / 4 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F66401 / 4 LL / IM

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

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

Write-up: Vaccines administered on 2-19-13 at 1130AM, Pt developed rash on 2-19-13 at 630 pm. Rash started on trunk and groin and began spreading. Saw pt in office 2-20-13 at 8 am. Widespread hives to trunk, inguinal area, scalp line, legs, back Pt was given BENADRYL in office. Pt was Rx BENADRYL, Prednisone, Ranitidine, EPIPEN. No SOB or difficulty breathing. Pt sent home. Called at 3pm to check on pt. mom reports rash has improved, no trouble breathing.


VAERS ID: 485142 (history)  
Form: Version 1.0  
Age: 1.14  
Sex: Male  
Location: Massachusetts  
Vaccinated:2012-07-26
Onset:0000-00-00
Submitted: 2013-02-21
Entered: 2013-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1697AA / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1506AA / UNK RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0591AE / UNK LL / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Childhood disintegrative disorder, Hemiparesis, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad)

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

Write-up: Pt reported to stop walking right after 12 month vaccines, now with tremor and right sided weakness.


VAERS ID: 485205 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Unknown  
Location: Unknown  
Vaccinated:2013-02-18
Onset:2013-02-18
   Days after vaccination:0
Submitted: 2013-02-21
   Days after onset:3
Entered: 2013-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA009135

Write-up: This spontaneous report as received from a healthcare worker refers to a 15 month old patient (gender was not reported). It reported that on 18-FEB-2013, the patient was vaccinated with a dose 0.5 ml of GARDASIL (route and lot number not reported). It stated that this was related to a staff error and not product confusions. No adverse effect was reported. Additional information has been requested.


VAERS ID: 485276 (history)  
Form: Version 1.0  
Age: 1.28  
Sex: Male  
Location: Mississippi  
Vaccinated:2013-02-08
Onset:2013-02-10
   Days after vaccination:2
Submitted: 2013-02-11
   Days after onset:1
Entered: 2013-02-21
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4232AA / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0648AE / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F73653 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H013269 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Dyspnoea, Influenza, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: Fever, mother reported breathing difficulty at home prior to ER visit, diagnosed with influenza at ER visit.


VAERS ID: 485334 (history)  
Form: Version 1.0  
Age: 1.51  
Sex: Female  
Location: Virginia  
Vaccinated:2013-02-20
Onset:2013-02-20
   Days after vaccination:0
Submitted: 2013-02-21
   Days after onset:1
Entered: 2013-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4214BA / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Rash macular, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Eczema; Food allergies (milk, eggs, peanuts); Seasonal
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild swelling, erythema around eyes, blotchiness on back. BENADRYL given, 12.5 mg, po. "Observed for a few minutes." Some of redness around eyes did resolve.


VAERS ID: 485244 (history)  
Form: Version 1.0  
Age: 1.67  
Sex: Female  
Location: New Mexico  
Vaccinated:2013-02-19
Onset:2013-02-20
   Days after vaccination:1
Submitted: 2013-02-22
   Days after onset:2
Entered: 2013-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U3749AA / 4 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4481BA / 1 - / IM

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

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

Write-up: Mom noticed a rash on patient torso, red, bumpy, no other symptoms, no itching, no swelling.


VAERS ID: 485321 (history)  
Form: Version 1.0  
Age: 1.68  
Sex: Female  
Location: Massachusetts  
Vaccinated:2013-01-24
Onset:2013-01-24
   Days after vaccination:0
Submitted: 2013-02-21
   Days after onset:28
Entered: 2013-02-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357AA / 2 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Body temperature increased, Injection site swelling, Irritability
SMQs:, Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Temp of 104, fussy & cranky for 24-36 degrees after injection Lg amt swelling at injection site.


VAERS ID: 485330 (history)  
Form: Version 1.0  
Age: 1.55  
Sex: Female  
Location: Utah  
Vaccinated:2013-02-05
Onset:2013-02-07
   Days after vaccination:2
Submitted: 2013-02-22
   Days after onset:15
Entered: 2013-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010437 / 2 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Abscess, Culture wound positive, Incisional drainage, Staphylococcal infection, Staphylococcus test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: Developed abscess -MRSA at injection site 2 days later. Performed incision & drainage & antibiotics.


VAERS ID: 485350 (history)  
Form: Version 1.0  
Age: 1.04  
Sex: Female  
Location: California  
Vaccinated:2013-02-08
Onset:2013-02-19
   Days after vaccination:11
Submitted: 2013-02-22
   Days after onset:3
Entered: 2013-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536BA / UNK - / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010135 / 1 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H011416 / UNK - / UN

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

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

Write-up: Rash appeared on trunk then on extremities and face - morbilliform rash - appears to be like Rubella, no itching. Appeared suddenly.


VAERS ID: 485381 (history)  
Form: Version 1.0  
Age: 1.13  
Sex: Female  
Location: Mississippi  
Vaccinated:2013-02-21
Onset:2013-02-21
   Days after vaccination:0
Submitted: 2013-02-21
   Days after onset:0
Entered: 2013-02-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4224AB / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H011885 / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F73653 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017597 / 1 RL / SC

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

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

Write-up: Within 15 mins of vaccine administration mother noticed rash on chest & back. Injection sites ck''d redness & warmth noted bil - mottled rash. BENADRYL 25/5ml 2.5ml PO given. Rash resolved dc''d home with inst to give BENADRYL q6 & ZYRTEC 2.5ml for next 3 days. To go to ER if reoccurs.


VAERS ID: 485385 (history)  
Form: Version 1.0  
Age: 1.06  
Sex: Male  
Location: Kansas  
Vaccinated:2013-02-15
Onset:2013-02-20
   Days after vaccination:5
Submitted: 2013-02-22
   Days after onset:2
Entered: 2013-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B151AA / 1 LL / UN
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010659 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH626AA / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H012571 / 1 RL / UN

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

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

Write-up: 02/20/2013 Mother noticed a lump on client''s right thigh the middle of this week (02/20/13). Today it is the size of a pea, not red in color, and bothers the client upon palpation of the bump. Mother has given client TYLENOL. Encouraged to speak with doctor on Monday if mother is still concerned.


VAERS ID: 485401 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: Hawaii  
Vaccinated:2013-02-14
Onset:2013-02-23
   Days after vaccination:9
Submitted: 2013-02-23
   Days after onset:0
Entered: 2013-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB690CA / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010134 / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018237 / 1 LL / UN

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

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

Write-up: Rash on the body that broke out on 2/23/13. Erythematous blanching macules all over body.


VAERS ID: 485460 (history)  
Form: Version 1.0  
Age: 1.04  
Sex: Male  
Location: Maine  
Vaccinated:2013-02-20
Onset:2013-02-20
   Days after vaccination:0
Submitted: 2013-02-20
   Days after onset:0
Entered: 2013-02-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536AA / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010132 / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 918856 / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016717 / 1 RA / SC

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

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

Write-up: Localized hives immediately after MMR & Varicella vaccines bilateral arms.


VAERS ID: 485497 (history)  
Form: Version 1.0  
Age: 1.37  
Sex: Female  
Location: Louisiana  
Vaccinated:2013-02-08
Onset:2013-02-08
   Days after vaccination:0
Submitted: 2013-02-12
   Days after onset:4
Entered: 2013-02-25
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B157BA / 4 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547EA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH579AA / 4 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 4 RL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Attached
CDC Split Type:

Write-up: About 11 PM on 2/8/13, had seizure and went to ER at hospital. Transferred to another hospital on 2/9/13 at 1330. Discharged 2/11/13 - records attached.


VAERS ID: 485653 (history)  
Form: Version 1.0  
Age: 1.13  
Sex: Male  
Location: New York  
Vaccinated:2013-02-22
Onset:2013-02-22
   Days after vaccination:0
Submitted: 2013-02-26
   Days after onset:4
Entered: 2013-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536AA / 1 RA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015630 / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Blister, Cough, Pyrexia, Rash, Rash vesicular, Respiratory tract congestion, Varicella virus test negative
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 2/24/13 - IgM Varicella negative
CDC Split Type:

Write-up: 1-2 days after MMRV, pt. had vesicular rash on face, trunk and extremities. 3 days after had fever 39-40 C, cough, and congestion. Bacitracin for vesicles that ruptured. Ibuprofen PRN fever.


VAERS ID: 485706 (history)  
Form: Version 1.0  
Age: 1.54  
Sex: Male  
Location: Florida  
Vaccinated:2013-02-25
Onset:2013-02-27
   Days after vaccination:2
Submitted: 2013-02-27
   Days after onset:0
Entered: 2013-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B155AA / 4 LL / IM

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

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

Write-up: Dtap vaccine administered on 02/25. Morning of 02/26 at 0700 mother noticed normal knot and swelling of site. Morning of 02/27 child woke with whole left lateral thigh swollen, hard and hot to touch.


VAERS ID: 485763 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Utah  
Vaccinated:2013-02-21
Onset:2013-02-21
   Days after vaccination:0
Submitted: 2013-02-27
   Days after onset:6
Entered: 2013-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4335AA / UNK LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F45144 / UNK LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Gaze palsy, Musculoskeletal stiffness, Pyrexia, Upper respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Seen for minor URI, temp 100.4 in office noted to have vaccines not up to date. Given DtaP, PREVNAR at approximately noon. Noted to have fever, stiffening, eyes rolling back. EMS called, temp 100.6. EMS checked child who had stopped seizure by then. Parents brought him to ER, temp 40.1 observed for 3 hrs. Exam looked good. No further episodes.


VAERS ID: 485774 (history)  
Form: Version 1.0  
Age: 1.31  
Sex: Female  
Location: California  
Vaccinated:2013-02-15
Onset:0000-00-00
Submitted: 2013-02-27
Entered: 2013-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018015 / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Full blood count abnormal, Lymphadenopathy, Lymphocyte count decreased, Neutrophil count increased
SMQs:, Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Eczema
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete blood count (25-FEB-2013): slightly increased neutrophils and decreased lymphocytes.
CDC Split Type: WAES1302USA012395

Write-up: This spontaneous report as received from a physician refers to a currently 16 months old female patient with eczema and none Drug reactions/allergies. On 15-FEB-2013, the patient was vaccinated subcutaneously (SQ) with a 0.5 ml dose of M-M-R II lot# H01013, expire date: 17-MAY-2014 and a dose of VARIVAX (Merck), lot# H018015 expire date: 01-OCT-2014 (dose and route not reported). No concomitant medications taken. The physician reported that the patient developed diffuse lymphadenopathy (approximately in February 2013) after administration of M-M-R II and VARIVAX (Merck). On 25-FEB-2013, the patient was evaluated in the office and was found to have post-auricular, anterior cervical, axillary, and inguinal lymphadenopathy. On 25-FEB-2013, complete blood count showed slightly increased neutrophils and decreased lymphocytes. There was no hepatomegaly or splenomegaly. The patient did not receive Treatment. The outcome of outcome of the event was reported as not recovered. Causality assessment was not provided. Additional information is not expected.


VAERS ID: 485760 (history)  
Form: Version 1.0  
Age: 1.05  
Sex: Male  
Location: Ohio  
Vaccinated:2013-02-13
Onset:2013-02-21
   Days after vaccination:8
Submitted: 2013-02-28
   Days after onset:7
Entered: 2013-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHBVB622CA / 1 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009782 / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918856 / 4 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H015440 / 1 LL / UN

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

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

Write-up: Fever, rash about 10 days after MMR given.


VAERS ID: 485790 (history)  
Form: Version 1.0  
Age: 1.71  
Sex: Male  
Location: Wisconsin  
Vaccinated:2013-02-22
Onset:2013-02-25
   Days after vaccination:3
Submitted: 2013-02-27
   Days after onset:2
Entered: 2013-02-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3327AA / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Complement factor, Full blood count normal, Metabolic function test normal, Pyrexia, Rash, Red blood cell sedimentation rate increased, Serum sickness, Swelling face, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Mild rhinorrhea
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Saw allergist and had CMP, CBC overall normal; ESR 18 (elevated); U/A normal; Complements pending
CDC Split Type:

Write-up: Patient developed a rash and swelling of face 3 days after vaccine administered. Rash and swelling progressed over 2 days and fever up to 104.7 developed. Diagnosed with serum sickness and was started on prednisone and BENADRYL and then ZYRTEC.


VAERS ID: 485837 (history)  
Form: Version 1.0  
Age: 1.05  
Sex: Male  
Location: Nevada  
Vaccinated:2013-02-14
Onset:2013-02-26
   Days after vaccination:12
Submitted: 2013-02-28
   Days after onset:2
Entered: 2013-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB677BA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009781 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017706 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness: None
Preexisting Conditions: ROM; Premature (25 wk); GERD; ROP; BPD; Develop. delay; Pseudoestrogen
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. presents to clinic with a rash on his trunk that started in AM of 2/26/13 Pt has an erythematous papular rash on the abdomen, back & proximal extremities. Rash is not urticarial in nature mother denies itchiness or fevers noted. Mother instructed to continue Amoxicillin mother instructed to observe for rash worsens or becomes urticarial in nature or has swelling. Pt to be re-evaluated.


VAERS ID: 485883 (history)  
Form: Version 1.0  
Age: 1.11  
Sex: Male  
Location: California  
Vaccinated:2013-01-17
Onset:2013-02-05
   Days after vaccination:19
Submitted: 2013-02-07
   Days after onset:2
Entered: 2013-02-28
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Discomfort, Irritability, Lymph node pain, Lymphadenopathy, Oropharyngeal pain, Viral infection
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Mild devel delay; Signif lang delay; Sib with Autism speech disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt seen 2/5/13 by me, having been to ER previous night, dx with viral infx in ER. In office T 102.1, very uncomfortable with neck tilted to (L), multiple enlarged tender (L) post ax LN, sl enlg (R) post ax LN. Normal neck flexion, but child irritable. Diffuse somewhat lacy M-Prash sib had had a sore throat. Patient did not have red throat but (+) throat culture.


VAERS ID: 485845 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: Nebraska  
Vaccinated:2012-06-20
Onset:2013-02-12
   Days after vaccination:237
Submitted: 2013-03-01
   Days after onset:17
Entered: 2013-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0826AA / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Herpes zoster, Herpes zoster multi-dermatomal, Pyrexia, Rash, Rash maculo-papular, Rhinorrhoea, Upper respiratory tract congestion, Upper respiratory tract infection, Viral test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: POLY-VI-SOL with Iron tablets
Current Illness: Drug hypersensitivity
Preexisting Conditions: ZITHROMAX, Drug hypersensitivity
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA011057

Write-up: This spontaneous report as received from a Licensed Practical Nurse (LPN) refers to a 20 month old female patient with allergy to ZITHROMAX and no pertinent medical history. On 20-JUN-2012 the patient was vaccinated subcutaneously with a 0.5 mL dose of VARIVAX (Merck) (lot # 671083/0826AA, exp. date: 02-JUN-2013). Concomitant therapies included copper (unspecified), ferrous fumarate, folic acid, vitamins (unspecified), POLY-VI-SOL with Iron tablets. On 12-FEB-2013 the patient developed upper respiratory infection and shingles after receiving VARIVAX (Merck). The patient developed congestion, fever, and drainage so AUGMENTIN was prescribed. The patient also presented with rash on top of both buttocks and some spread down the left leg. Rash consisted of "maculopapular papules with unilateral dermatomal distribution". Treatment with ZOVIRAX ointment, AUGMENTIN and oral acyclovir were given for the events. Viral culture was performed but no result provided. The patient was seen by physician. The outcome of the events was reported as not recovered. The relatedness for the events with the therapy was unknown. Additional information has been requested.


VAERS ID: 485891 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: West Virginia  
Vaccinated:2010-03-24
Onset:2013-02-24
   Days after vaccination:1068
Submitted: 2013-02-25
   Days after onset:1
Entered: 2013-03-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB362AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E01562 / 3 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1370Y / 1 UN / UN

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

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

Write-up: Patient was seen in office 02/25/13 for low-grade fever, decreased appetite, and rash that was mildly pruritic. Rash was classic for varicella in immunized patients.


VAERS ID: 485901 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Male  
Location: California  
Vaccinated:2013-03-01
Onset:2013-03-01
   Days after vaccination:0
Submitted: 2013-03-01
   Days after onset:0
Entered: 2013-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB690BA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010135 / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H018015 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 2.5% Hydrocortisone topical cream
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 5 minutes of vaccination injection patient started to have a local reaction (redness and pseudopod) at the MMR and varicella injection site. Pt was immediately assessed by Pediatric provider and was given 2.5ml oral Benadryl. Pt''s mother was instructed observe for further reactions and if needed go to local emergency room.


VAERS ID: 485917 (history)  
Form: Version 1.0  
Age: 1.16  
Sex: Female  
Location: Ohio  
Vaccinated:2013-02-04
Onset:2013-02-18
   Days after vaccination:14
Submitted: 2013-03-01
   Days after onset:11
Entered: 2013-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396AA / UNK - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4526AA / UNK - / -
HIBV: HIB (OMNIHIB) / SANOFI PASTEUR UH693AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H017133 / UNK - / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918856 / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H011889 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Rubella, Viral rash
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: METROHEALTHESP201258219

Write-up: Viral exanthema NOS on 2013-02-18, clinician comment: Likely Rubella symptoms following MMR.


VAERS ID: 485926 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Florida  
Vaccinated:2013-02-18
Onset:2013-02-27
   Days after vaccination:9
Submitted: 2013-03-01
   Days after onset:2
Entered: 2013-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LG / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LG / -

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

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

Write-up: High fever followed by a rash.


VAERS ID: 485927 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Female  
Location: Alabama  
Vaccinated:2013-02-06
Onset:2013-02-13
   Days after vaccination:7
Submitted: 2013-03-01
   Days after onset:16
Entered: 2013-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (GENHEVAC B) / SANOFI PASTEUR 0386AE / 3 UN / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB657AB / 1 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1450AA / 1 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 07B4AA / 1 UN / SC

Administered by: Private       Purchased by: Other
Symptoms: Abasia, Blood test abnormal, C-reactive protein, Cyanosis, Dysstasia, Echocardiogram normal, Electrocardiogram normal, Immunoglobulin therapy, Kawasaki's disease, Laboratory test abnormal, Oedema peripheral, Platelet count increased, Pyrexia, Rash, Red blood cell sedimentation rate increased, Somnolence
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: My daughter was prescribed Amoxicillin 400mg/5mL Oral Susp to take 6mL bid x 10 days by the nurse practitioner on the same day she was given her vaccinations (2/06/2013) and told to start it that evening. Otherwise, she was not on any medi
Current Illness: Yes. Recorded as Bilateral Otitis Media (382.9). Nurse Practitioner stated upon examination that my daughter had pus behind her ear drum in both ears and that both ears were red and looked really infected.
Preexisting Conditions: Prior to administering my daughter''s 12 month vaccinations (Hep A, Hep B, MMR #1, and Varicella #1) on the afternoon of 2/06/2013, the nurse practitioner performed the "well-visit" check up and informed us that my daughter had pus behind both ear drums and that both ears were really red and infected. The only other previous physician-diagnosis that was discussed was the fact that my daughter had been anemic at her last two visits/last two CBC''s. I inquired about that. After our visit and the vaccinations were received, we were sent to the lab for repeat CBC to check the anemia level. Otherwise, there were no pre-existing conditions.
Allergies:
Diagnostic Lab Data: CRP of 8.3, SED Rate of 66; High Platelets; normal EKG & Echo. Other lab numbers way down & way up.
CDC Split Type:

Write-up: My daughter came home from daycare and went to sleep at 6:30 p.m. on February 13, 2013. She woke early a.m. on February 14, 2013 with a low fever (99.8). She came home from daycare that day (Feb. 14) and again went to sleep really early (7:00 p.m.). She woke early a.m. on February 15, 2013, with a fever of 102.5. By 2:30 p.m. on February 15, 2013, her fever was 103.3. By 3:30 p.m., she had a rash. By 9:30 p.m., her hands and feet were swollen & blue and she was unable to stand, walk or use her hands and her rash was worse. ED trip & bloodwork revealed elevated SED Rate of 34. Was seen in ED on Friday, February 15, 2013; seen again in ED at Saturday, February 16, 2013; admitted via direct admit to Medical Center on Sunday, February 17, 2013 & released on February 18, 2013. Seen by pediatrician on Feb. 19 & Feb. 21 & Feb. 25. On February 25, 2013 she was sent for direct admit at another hospital for IVIG infusion and additional treatment of Kawasaki disease.


VAERS ID: 485960 (history)  
Form: Version 1.0  
Age: 1.31  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2013-03-01
Onset:2013-03-01
   Days after vaccination:0
Submitted: 2013-03-01
   Days after onset:0
Entered: 2013-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH771AA / 4 RA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 954897 / 4 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PREVACID 15 mg
Current Illness: None
Preexisting Conditions: Acid Reflux; Deformational plagiocephaly
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccines given, within 1 minute after administration RA site became inflamed, swollen. Within 2 minutes swelling and redness diminished. No f/u treatment.


VAERS ID: 485929 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: Utah  
Vaccinated:2013-02-18
Onset:2013-03-01
   Days after vaccination:11
Submitted: 2013-03-01
   Days after onset:0
Entered: 2013-03-02
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Irritability, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient has been fussy and had a mild fever the past few days and today, 03/01/2013 I noticed a rash or small red bumps on her stomach. I bathed her and put her in new clothes etc. Now we''ve noticed the rash/red bumps have spread all over her stomach and chest and onto her back and around her hairline. We have no idea if this is normal/common or if we need to take her back in to the doctors but it is closed and will have to wait until the morning since she has not had any severe or serious life threatening reactions thus far.


VAERS ID: 485932 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: Virginia  
Vaccinated:2013-02-08
Onset:2013-02-19
   Days after vaccination:11
Submitted: 2013-03-02
   Days after onset:11
Entered: 2013-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH735AB / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1768AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F95942 / 2 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0690AE / 1 LL / IM

Administered by: Military       Purchased by: Military
Symptoms: Pyrexia, Varicella, Varicella post vaccine
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Patient had fever 101.2F on Feb 19th. Patient developed pox all over body on Feb 20th. Fever broke on Feb 21st. Pox cleared up on Feb 23rd.


VAERS ID: 485937 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2012-02-08
Onset:2012-02-14
   Days after vaccination:6
Submitted: 2013-03-02
   Days after onset:382
Entered: 2013-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 UN / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / -

Administered by: Unknown       Purchased by: Other
Symptoms: Body temperature increased, Rhinorrhoea, Sneezing, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: First started having runny nose and sneezing on 02/10/2012. On 02/11/2012 had temp of 100.2. On 02/14/2012 had hives all over body. Took her to doctors and was told to give her Benadryl for reaction. Patient received flu vaccine and Prevnar on 02/08/2012 and had reaction to flu vaccine.


VAERS ID: 485946 (history)  
Form: Version 1.0  
Age: 1.44  
Sex: Female  
Location: Iowa  
Vaccinated:2013-02-25
Onset:2013-02-26
   Days after vaccination:1
Submitted: 2013-03-03
   Days after onset:5
Entered: 2013-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Ear infection, Pyrexia, Sinusitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mild fever on 2/26; moderate fever 2/27-3/3 and still ongoing; ear infection diagnosed 2/28; sinus infection also suspected.


VAERS ID: 485949 (history)  
Form: Version 1.0  
Age: 1.53  
Sex: Female  
Location: Michigan  
Vaccinated:2013-02-07
Onset:2013-02-14
   Days after vaccination:7
Submitted: 2013-03-03
   Days after onset:17
Entered: 2013-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LL / UN

Administered by: Unknown       Purchased by: Other
Symptoms: Ear infection, Pyrexia, Rash, Tympanic membrane perforation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: My daughter woke up throwing up a lot (and she has never thrown up before, ever). The next day she had high fever for 3 days. That resulted in an ear infection on her right ear, and then with a ruptured eardrum on her left ear. She took antibiotics for 10 days. 4 days after the antibiotic was done, she got a high fever again, all weekend (still happening). She hasn''t been this sick before getting the MMR vaccine. She also developed a rash after the first episode.


VAERS ID: 485950 (history)  
Form: Version 1.0  
Age: 1.06  
Sex: Male  
Location: New York  
Vaccinated:2013-02-25
Onset:2013-03-01
   Days after vaccination:4
Submitted: 2013-03-03
   Days after onset:2
Entered: 2013-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LL / SC

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

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

Write-up: Fever for three days (104 f) then measles like rash beginning 3/2/2013.


VAERS ID: 485954 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: Unknown  
Vaccinated:2013-02-20
Onset:2013-02-20
   Days after vaccination:0
Submitted: 2013-03-04
   Days after onset:12
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1441AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1310AA / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0515AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F90292 / UNK LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1278AA / 1 RL / SC

Administered by: Military       Purchased by: Military
Symptoms: Basophil count decreased, Basophil percentage increased, Blood culture negative, Chest X-ray normal, Cough, Dehydration, Eosinophil count decreased, Eosinophil percentage decreased, Erythema, Haematocrit normal, Haemoglobin normal, Lymphocyte count increased, Lymphocyte percentage increased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume decreased, Monocyte count increased, Monocyte percentage increased, Neutrophil count normal, Neutrophil percentage decreased, Platelet count normal, Pyrexia, Rash papular, Red blood cell count normal, Red cell distribution width normal, Rhinitis, Viral infection, White blood cell count normal
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: Conjunctivitis
Preexisting Conditions: Possible communication delay
Allergies:
Diagnostic Lab Data: CBC W/Auto Diff Site/Specimen 01 Mar 2013 1912 Units WBC BLOOD 14.1 x10(3)/mcL RBC BLOOD 4.64 x10(6)/mcL Hemoglobin BLOOD 13.1 (H) g/dL Hematocrit BLOOD 38.3 % MCV BLOOD 82.4 fL MCH BLOOD 28.3 pg MCHC BLOOD 34.4 % RDW CV BLOOD 13.20 % Platelets BLOOD 294 x10(3) MPV BLOOD 7.30 (L) fL Eosinophils BLOOD 0.10 x10(3)/mcL Basophils BLOOD 0.20 x10(3)/mcL Lymphocytes BLOOD 6.80 (H) x10(3)/mcL Monocytes BLOOD 2.20 (H) x10(3)/mcL Neutrophils BLOOD 4.80 x10(3)/mcL Lymphocytes BLOOD 49.0 % Monocytes BLOOD 15.3 (H) % Neutrophils BLOOD 33.9 % Eosinophils BLOOD 0.7 % Basophils BLOOD 1.1 % Chem, blood cx normal
CDC Split Type:

Write-up: Intermittent fevers for 12 days, Tmax 104.6, cough, coryza. Day 6 developed bilat cheek erythma. Day 10 developed papular erythematous rash on trunk and cheeks, T104.2, dehydration. WBC 14k, normal CXR. Never oral lesions. Tx as viral illness and supportive (antipyretics). Overall, 3 clinic visits and 3 ER visits in 12 days, plus numerous phone calls.


VAERS ID: 485978 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:2013-02-27
Onset:2013-03-02
   Days after vaccination:3
Submitted: 2013-03-04
   Days after onset:2
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0412AE / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H011723 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Condition aggravated, Otitis media, Pyrexia, Rash, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever x2 days starting 2/28, now resolved. Rash appeared 3/2, initially on face & spread to torso. Diagnosed with otitis media & URI 2/28/13.


VAERS ID: 485984 (history)  
Form: Version 1.0  
Age: 1.28  
Sex: Male  
Location: Wisconsin  
Vaccinated:2009-12-22
Onset:2013-01-16
   Days after vaccination:1121
Submitted: 2013-02-26
   Days after onset:41
Entered: 2013-03-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3498AA / 2 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest X-ray normal, Cough, Laboratory test abnormal, Nasopharyngitis, Pertussis, Polymerase chain reaction, Sleep disorder
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject had previously received a dose of PENTACEL, lot number C3226AA on 11 March 2009, and 2 doses of DAPTACEL; lot number C2957AA received on 12 January 2009 and lot number C2956AA received on 12 November 2008.
Allergies:
Diagnostic Lab Data: Chest x-ray negative
CDC Split Type: 201303209

Write-up: Initial report received on 19 February 2013 from the Investigator participating in a post-marketing study under the reference number M5A16. A case of pertussis disease in a four-year-old male subject was identified by the investigator based on review of data from the Electronic Disease Surveillance (EDSS) electronic database. The subject had received 2 doses of PENTACEL; lot number C3498AA received on 22 December 2009 and lot number C3226AA received on 11 March 2009, and 2 doses of DAPTACEL; lot number C2956AA received on 12 November 2008 and lot number C2957AA received on 12 January 2009 (routes and sites of administration not reported). The subject developed cold-like symptoms and cough on 16 January 2013, approximately three years after the last dose. On 17 January 2013, the subject developed a paroxysmal cough without a whoop. The subject also experienced sleep disturbance. Laboratory testing included positive PCR on 17 January 2013. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of Azithromycin starting on 17 January 2013 for five days. The subject was not hospitalized. At the time of final contact on 30 January 2013, the subject''s cough was still persisting. The duration of the cough was reported at that time as 14 days. According to the investigator, this case was epidemiologically linked to a laboratory confirmed case. Investigator causality assessment is not required as per protocol. Documents held by sender: None.


VAERS ID: 486026 (history)  
Form: Version 1.0  
Age: 1.15  
Sex: Male  
Location: Tennessee  
Vaccinated:2013-02-20
Onset:2013-03-01
   Days after vaccination:9
Submitted: 2013-03-04
   Days after onset:3
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

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

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

Write-up: 9 days after being vaccinated, patient had a 102* fever. The next day his fever was 101* and he broke out in 1-2 dozen red, raised spots on his trunk. The third day, March 3, he had no fever and hundreds of red, raised pimply type spots all over his body. They appeared in waves through out the day. Day 4 is today and he woke up with dozens of new spots on his face, neck and scalp. He has spots over his entire body, including genitals, feet, limbs, and hands. He isn''t in any discomfort or itching.


VAERS ID: 486028 (history)  
Form: Version 1.0  
Age: 1.54  
Sex: Female  
Location: Illinois  
Vaccinated:2013-02-28
Onset:2013-03-01
   Days after vaccination:1
Submitted: 2013-03-04
   Days after onset:3
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B406AA / 2 LL / IM

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

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

Write-up: Erythema and swelling to injection site, L thigh.


VAERS ID: 486030 (history)  
Form: Version 1.0  
Age: 1.27  
Sex: Male  
Location: Kansas  
Vaccinated:2013-02-28
Onset:2013-02-28
   Days after vaccination:0
Submitted: 2013-03-04
   Days after onset:4
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B149BA / 4 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH768AA / 4 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F11149 / 4 RL / IM

Administered by: Military       Purchased by: Military
Symptoms: Abnormal behaviour, Body temperature increased, Full blood count normal, Gaze palsy, Liver function test normal, Metabolic function test normal, Muscle twitching, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None noted on exam.
Preexisting Conditions: Hx of laryngospasms.
Allergies:
Diagnostic Lab Data: LFT, CBC, BMP all WNL
CDC Split Type:

Write-up: At approximately 2100 patients mother heard child "struggling to cry" over the baby monitor. Upon entering the room the parent states the childs torso was still eyes were rolled back and left arm and leg were twitching. Father of patient came into room noting all four limbs were shaking/twitching. Episode lasted approximatly 2-3 minutes and child was not"acting like usual" after and parents transported to closest ED. On call pediatrician reccomended over night observation and mother of patient requested a transfer to another hospital. Patient afebrile at time of arrival at ED, temp did increase during visit to 100.3 at 2330.


VAERS ID: 486053 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Unknown  
Location: Unknown  
Vaccinated:2013-02-22
Onset:2013-02-22
   Days after vaccination:0
Submitted: 2013-03-04
   Days after onset:10
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0415Z / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA011638

Write-up: This spontaneous report as received from a nurse (Bachelor of Science in Nursing) refers to a 18 month old patient. It was reported that on 22-FEB-2013 the patient was vaccinated with VAQTA (lot # 667534/0415Z, 25/0.5 U/ml, 0.5 ml dose, intramuscular route) that had expired on 13-FEB-2013. No other suspect or concomitant medications were reported. No adverse effects were reported. Additional information has been requested.


VAERS ID: 486067 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: Massachusetts  
Vaccinated:2013-02-21
Onset:2013-03-03
   Days after vaccination:10
Submitted: 2013-03-04
   Days after onset:1
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH693AA / 4 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016527 / 1 LA / UN

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

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

Write-up: Fever 3.1.13 & red spots on left arm 3/3/13.


VAERS ID: 486080 (history)  
Form: Version 1.0  
Age: 1.06  
Sex: Male  
Location: Illinois  
Vaccinated:2013-03-04
Onset:2013-03-04
   Days after vaccination:0
Submitted: 2013-03-04
   Days after onset:0
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4488EA / 2 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H010136/H004948 / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F94000 / 4 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Induration, Swelling, Tenderness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Within 2 minutes of vaccine administration there was a 4cm area of induration, erythema and tenderness. Just lateral to the injection site there was a small hive 1cm in size, raised. Benadryl was given and the hive improved and so did the size of the induration.


VAERS ID: 486082 (history)  
Form: Version 1.0  
Age: 1.07  
Sex: Female  
Location: California  
Vaccinated:2013-02-14
Onset:2013-02-22
   Days after vaccination:8
Submitted: 2013-03-04
   Days after onset:10
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4531BA / 1 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0628AE / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH683AB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1897AA / 1 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F66402 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H010561 / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Macule, Papule, Rash, Rash vesicular, Scab, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEART MURMUR, EGG ALLERGY-HIVES.
Allergies:
Diagnostic Lab Data: NO DIAGNOSTICS AT THIS TIME.
CDC Split Type:

Write-up: RASH TO ABDOMEN NOTED BY MOM 2/22/13. LINEAR CONFLUENT MACULES AND PAPULES IN VARYING STAGES WITH SOME SCABBING/CRUSTING OF LESIONS. LESIONS APPEAR ONLY ON LEFT SIDE OF BODY ON BUTTOCKS, ABDOMEN AND LEG. QUESTIONABLE FEW VESICULAR LESIONS. SUPPORTIVE CARE ONLY AT THIS TIME. MAY USE CALAMINE LOTION, OATMEAL BATH, OR OTC BENADRYL. NO NEED FOR ACYCLOVIR. CONTINUE TO MONITOR. POSSIBLE DX INCLUDES: SCABIES, ECZEMA HERPETICUM, RHUS DERMATITIS, OR MEASLES (DOUBT).


VAERS ID: 486088 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Arkansas  
Vaccinated:2013-02-03
Onset:2013-02-10
   Days after vaccination:7
Submitted: 2013-03-04
   Days after onset:22
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown       Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis
SMQs:, Noninfectious encephalitis (narrow), Demyelination (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute Disseminated Encephalomyelitis.


VAERS ID: 486175 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2013-01-29
Onset:2013-01-29
   Days after vaccination:0
Submitted: 2013-03-04
   Days after onset:34
Entered: 2013-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / UNK UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA010412

Write-up: This spontaneous report as received from a certified medical assistant (C.M.A.) concerning a 12 months old patient (gender not reported) who on 29-JAN-2013, was vaccinated with a dose of PROQUAD (Lot not reported), 0.5 ml, subcutaneous and VARIVAX (lot number, dose and route not reported) during the same office visit. No adverse effect was reported. Additional information has been requested.


VAERS ID: 486139 (history)  
Form: Version 1.0  
Age: 1.05  
Sex: Male  
Location: Georgia  
Vaccinated:2013-02-15
Onset:2013-02-22
   Days after vaccination:7
Submitted: 2013-02-27
   Days after onset:5
Entered: 2013-03-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4352AA / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. H018689 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0648AE / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F73654 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H001329 / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Injection site nodule, Pain, X-ray
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI (upper respiratory infection)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Xray; Surgical consult
CDC Split Type:

Write-up: Nodule on (L) thigh, increased erythema 2-22-13, pain today 2 x 2 cm.


VAERS ID: 486188 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Virginia  
Vaccinated:2013-03-04
Onset:2013-03-04
   Days after vaccination:0
Submitted: 2013-03-05
   Days after onset:1
Entered: 2013-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0681AE / 1 - / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 4 - / UN
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 8014073 / 1 - / UN

Administered by: Public       Purchased by: Other
Symptoms: Chest X-ray normal, Computerised tomogram head normal, Endotracheal intubation, Febrile convulsion, Full blood count normal, Metabolic function test normal, Status epilepticus, Urine analysis normal
SMQs:, Angioedema (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

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

Write-up: Complex febrile seizure with status epilepticus requiring intubation.


VAERS ID: 486249 (history)  
Form: Version 1.0  
Age: 1.79  
Sex: Unknown  
Location: New York  
Vaccinated:2013-03-04
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2013-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC4B164AA / 4 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H009751 / 4 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F66401 / 4 UN / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Abasia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: At hosp pt started walking in ER but WBC count high.
CDC Split Type:

Write-up: Patient received DTaP #4, Hib #4, PREVNAR #4 on 3/4/13 and after vaccinations pt is not able to walk.


VAERS ID: 486322 (history)  
Form: Version 1.0  
Age: 1.51  
Sex: Female  
Location: North Carolina  
Vaccinated:2013-01-07
Onset:2013-01-14
   Days after vaccination:7
Submitted: 2013-03-07
   Days after onset:52
Entered: 2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0426AE / 1 RL / SC

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

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

Write-up: Toddler began to feel warm to the touch in the afternoon of Monday the 14th, temperature was taken at apx 8 pm with a temporal scanner and read 104. She was given 3.75 mL of childrens Tylenol, which broke the fever and allowed her to sleep. 3-4 times a day, everyday up to and including Thursday the 17th, her temperature spiked to 104 and remained elevated most of the rest of the time. She was also lethargic and experienced loss of appetite, and was primarily breastfed during those 4 days. She was treated with Tylenol once to twice a day, to help her sleep, and was otherwise treated with sponging room temperature water on her face, neck and torso. After speaking with advice nurse she was given doses of Tylenol every 4 hours starting Thursday at 5 pm, except while she slept overnight. At the same time the family left for a car trip and toddler was exposed to colder temperatures, which also seemed to help break the fever. A few times friday she felt warm but her temperature was only slightly elevated.


VAERS ID: 486343 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: New York  
Vaccinated:2013-03-03
Onset:2013-03-03
   Days after vaccination:0
Submitted: 2013-03-07
   Days after onset:4
Entered: 2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / UNK UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1303USA002131

Write-up: This spontaneous report as received from a registered nurse refers to a 12 month old patient (gender unspecified). On 03-MAR-2013 the patient was vaccinated with PROQUAD (Merck) and VARIVAX (Merck). Lot # and administration route was not provided. No adverse symptoms reports. it was unspecified if the patient sought medical attention. Additional information has been requested.


VAERS ID: 486354 (history)  
Form: Version 1.0  
Age: 1.22  
Sex: Male  
Location: California  
Vaccinated:2012-11-12
Onset:2013-02-28
   Days after vaccination:108
Submitted: 2013-03-07
   Days after onset:7
Entered: 2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1303USA001357

Write-up: This spontaneous report as received from a physician refers to a patient of unknown age. Respectively on 12-NOV-2012 and 28-FEB-2013 the patient was vaccinated with the first and second dose of VAQTA (15/0.5 U/ML) (dose, lot number not reported). No other co-suspect product were reported. No concomitant medications were reported. No adverse event reported. It was unspecified if the patient had sought medical attention. Action and causality of VAQTA was not reported. Additional information has been requested.


VAERS ID: 486364 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Texas  
Vaccinated:2013-03-05
Onset:2013-03-06
   Days after vaccination:1
Submitted: 2013-03-07
   Days after onset:1
Entered: 2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H015829 / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Respiratory distress, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: First episode of wheezing with severe respiratory distress 20-24 hrs after MMR vaccine. Treated with albuterol & oral steroids. Responded well. Very mild runny nose at time of vaccine administration but no other signs of illness.


VAERS ID: 486401 (history)  
Form: Version 1.0  
Age: 1.86  
Sex: Female  
Location: New Mexico  
Vaccinated:2013-03-07
Onset:2013-03-07
   Days after vaccination:0
Submitted: 2013-03-07
   Days after onset:0
Entered: 2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / 2 RL / IM

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

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

Write-up: No symptoms to report, no treatment.


VAERS ID: 486408 (history)  
Form: Version 1.0  
Age: 1.54  
Sex: Male  
Location: Georgia  
Vaccinated:2013-03-05
Onset:2013-03-06
   Days after vaccination:1
Submitted: 2013-03-07
   Days after onset:1
Entered: 2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B149CA / 4 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB541DA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G13185 / 4 LL / IM

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

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

Write-up: MOTHER STATED CHILD''S RIGHT LEG WAS SWOLLEN AND WARM TO TOUCH.


VAERS ID: 486469 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Wisconsin  
Vaccinated:2013-03-06
Onset:2013-03-06
   Days after vaccination:0
Submitted: 2013-03-07
   Days after onset:1
Entered: 2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH696AA / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017594 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site reaction, 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)

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

Write-up: Developed redness with welt to center within 2 min of injection on right leg BENADRYL 12.5 mg given, monitor x 20 min.


VAERS ID: 486463 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: Michigan  
Vaccinated:2013-02-25
Onset:2013-02-26
   Days after vaccination:1
Submitted: 2013-03-08
   Days after onset:10
Entered: 2013-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB677AB / UNK LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017031 / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H011889 / UNK LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F66401 / UNK RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H015561 / UNK RL / SC

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

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

Write-up: Mom called our office on 2/27/13 saying? no redness, no bruising, had fever yesterday but none today. "Knot the size of a walnut." Office visit notes of 2/28/13: Had vaccination for 1 year shots on Monday (3 days ago). 2 days ago in the location of the shots given on the right upper anterior thigh patient started to have a "knot" at the injection site. Hard. No redness, bruising, discharge, fever. No pain noted. Moving limbs equally. Feeding stooling and voiding normally. Subcutaneous hard mass 2cm by 1cm in diameter located on the upper anterior lateral thigh. No discoloration, discharge or tenderness to palpation.


VAERS ID: 486554 (history)  
Form: Version 1.0  
Age: 1.21  
Sex: Male  
Location: California  
Vaccinated:2013-03-06
Onset:2013-03-07
   Days after vaccination:1
Submitted: 2013-03-08
   Days after onset:1
Entered: 2013-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4214AA / 4 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH692AA / 4 RL / UN

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

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

Write-up: (L) side of thigh red and swollen since yesterday, no fever. 8cm x 8cm dia. warm to the touch & firm.


VAERS ID: 486577 (history)  
Form: Version 1.0  
Age: 1.04  
Sex: Female  
Location: California  
Vaccinated:2013-02-11
Onset:2013-02-24
   Days after vaccination:13
Submitted: 2013-03-08
   Days after onset:12
Entered: 2013-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017243 / 1 UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1303USA001486

Write-up: This spontaneous report as received from a other health professional refers to a 1 year old female patient. On 11-FEB-2013, the patient was vaccinated with the first dose of VARIVAX (merck) (LOT# H017243) subcutaneous (dose unspecified by reporter). No other co suspects were reported. No concomitant therapy was reported. On 24-FEB-2013 also reported as 10 days after the vaccination VARIVAX (merck), the patient experienced redness, swelling and rash at site of injection with fever of 102.6 F per 2 days. The outcome of redness, swelling, rash and fever was reported as recovered / resolved on 27-FEB-2013. Additional information is not expected.


VAERS ID: 486535 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: Washington  
Vaccinated:2013-03-08
Onset:2013-03-09
   Days after vaccination:1
Submitted: 2013-03-09
   Days after onset:0
Entered: 2013-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547FA / 2 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB536AA / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H009781 / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017705 / 1 LL / SC

Administered by: Private       Purchased by: Other
Symptoms: Body temperature increased, Cough, Rash, Rhinorrhoea, Skin lesion, Upper respiratory tract infection, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No allergies, no birth defects, h/o single afebrile seizure at age 5 months with normel EEG, on no medications
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke up from nap with hives on face and chest/abdomen. Resolved within 2 hours without medication. Also has developed mild URI symptoms since vaccines given - cough on the night of 3/8 and rhinorrhea on 3/9 with lowgrade temps of 100-100.7 degrees. Parents brought her in for eval of rash but all lesions gone by time of exam.


VAERS ID: 486600 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2013-02-26
Onset:2013-02-26
   Days after vaccination:0
Submitted: 2013-02-26
   Days after onset:0
Entered: 2013-03-11
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH390AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1375AA / 1 RL / SC
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. H011050 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA13512

Write-up: Patient was given ZOSTAVAX. Patient was due to receive VARIVAX at 0930 on 2/26/13. Patient mother notified of event at 1435. Mother reports no adverse reactions at time of call. Mother was informed dose will count and will not need to be repeated at this time.


VAERS ID: 486619 (history)  
Form: Version 1.0  
Age: 1.11  
Sex: Female  
Location: California  
Vaccinated:2013-02-21
Onset:0000-00-00
Submitted: 2013-03-04
Entered: 2013-03-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093BA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH690AB / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G11451 / 4 RL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015629 / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H017132 / 1 LL / SC

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

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

Write-up: None known.


VAERS ID: 486688 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: New York  
Vaccinated:2013-02-27
Onset:2013-02-28
   Days after vaccination:1
Submitted: 2013-03-07
   Days after onset:7
Entered: 2013-03-12
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB527EA / 1 UN / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. H015641 / 1 UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Pt seen & examined on 3/1/13.
CDC Split Type:

Write-up: Rec''d vaccines 2/27/13 -$g MMRV & Hep A. Developed hives on 2/20/13.


VAERS ID: 486691 (history)  
Form: Version 1.0  
Age: 1.37  
Sex: Male  
Location: Missouri  
Vaccinated:2013-02-18
Onset:2013-02-21
   Days after vaccination:3
Submitted: 2013-03-08
   Days after onset:15
Entered: 2013-03-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK UN / UN

Administered by: Private       Purchased by: Unknown
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)

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

Write-up: Child received immunizations on 2/07/13 at clinic. Father then took child to another clinic on 02/18/13 and child got vaccines again. Father stated "Did not show vax" that child had had vaccine - child had break out blisters head to toe and fever.


VAERS ID: 486692 (history)  
Form: Version 1.0  
Age: 1.33  
Sex: Male  
Location: New York  
Vaccinated:2012-02-22
Onset:2012-03-28
   Days after vaccination:35
Submitted: 2013-03-04
   Days after onset:341
Entered: 2013-03-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1475AA / 4 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918172 / 4 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Abscess limb, Oedema peripheral, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram-fluid collection (L) thigh c/w abscesses
CDC Split Type:

Write-up: Child received Hib & PREVNAR at 15 mnth visit on 2/22/2012. Had small rings, then on 3/28/12, seen for (L) thigh swelling. Sono done on 3/28 c/w with abscess, sent to ER -$g surgery evaluation.


VAERS ID: 486709 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: North Carolina  
Vaccinated:2013-02-07
Onset:2013-02-14
   Days after vaccination:7
Submitted: 2013-03-05
   Days after onset:19
Entered: 2013-03-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. H010659 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H011889 / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H016911 / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Blister, Pyrexia, Rash, Skin exfoliation, Skin hyperpigmentation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: POLY-VI-SOL with Iron
Current Illness:
Preexisting Conditions: Incontinentia Pigmenti
Allergies:
Diagnostic Lab Data: None
CDC Split Type: NC13002

Write-up: Pt started with fever & blistery rash over trunk & extremities on 2/14/13. Most of the rash noted over the hyperpigmented aspects of child''s body due to his diagnosis of Incontinentia Pigmenti (IP). The rash is now just present as flaky skin at medial aspect of lower legs, both axilla & (R) forearm. Some of the darker pigmented skin from IP got darker after reaction. Fever resolved after 4 days.


VAERS ID: 486746 (history)  
Form: Version 1.0  
Age: 1.53  
Sex: Male  
Location: North Carolina  
Vaccinated:2013-03-11
Onset:2013-03-12
   Days after vaccination:1
Submitted: 2013-03-12
   Days after onset:0
Entered: 2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4286AA / 5 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH4531BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH685AA / 5 RL / IM

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

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

Write-up: Parent reported that patient had swelling in (R) leg. Parent reported that patient has no fever, rash, respiratory problems, and is playing appropriately. RN advised parent to use cool moist compresses to area.


VAERS ID: 486775 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Idaho  
Vaccinated:2013-03-01
Onset:2013-03-09
   Days after vaccination:8
Submitted: 2013-03-12
   Days after onset:2
Entered: 2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B155BA / 1 LL / SYR
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB591BA / 1 RL / SYR
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 1 RL / SYR
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0259AE / 1 LL / SYR
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 4 LL / SYR
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H010853 / 1 RL / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Poly multivitamins; DESOWEN oint
Current Illness: Abnormal reaction/complication
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received shots on 3/1/13. (R) thigh, Varicella, HIB, and Hepatitis A. Noticed reaction, inflammation at injection sites on 3/9/13, area hard to the touch. Evaluated in clinic by provider on 3/11/13.


VAERS ID: 486778 (history)  
Form: Version 1.0  
Age: 1.48  
Sex: Female  
Location: Texas  
Vaccinated:2013-03-09
Onset:2013-03-09
   Days after vaccination:0
Submitted: 2013-03-12
   Days after onset:2
Entered: 2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3944AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 918174 / 1 RL / UN

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site hypersensitivity, Injection site induration,