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Found 783,315 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 784

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VAERS ID: 301133 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Illinois  
Vaccinated:2007-12-12
Onset:2007-12-27
   Days after vaccination:15
Submitted: 2007-12-27
   Days after onset:0
Entered: 2007-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2502AA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAAVB217AA / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425U / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0365U / 1 LL / SC

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

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

Write-up: erythematous plague on (L) upper thigh at vaccine site 1.2 x 1.2 cm noted 1-2 days after shot and still persists 2 wks after shot-seems less thickened now


VAERS ID: 301145 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Virginia  
Vaccinated:2007-12-12
Onset:2007-12-20
   Days after vaccination:8
Submitted: 2007-12-21
   Days after onset:1
Entered: 2007-12-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 4 - / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS B207BA / 1 - / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A02982 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1565U / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema induratum
SMQs:, Vasculitis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Qd post varicella vaccine developed right 1cm erythematic/indurated/at thigh - anterior afebrile.


VAERS ID: 301163 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Ohio  
Vaccinated:2007-11-14
Onset:2007-11-15
   Days after vaccination:1
Submitted: 2007-12-28
   Days after onset:43
Entered: 2007-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2477FA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. P0040U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF144AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR PZ0547-2 / 1 LL / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. P0651U / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH PB47300B / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Intubation, Pyrexia
SMQs:, Angioedema (broad), 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), Respiratory failure (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keppra, Depakene
Current Illness: no acute illness
Preexisting Conditions: Dravet''s Syndrome4/7/08-records received-PMH: Dravet''s syndrome. Diagnosed in infancy with myoclonic epilepsy.
Allergies:
Diagnostic Lab Data: 4/7/08-records received-WBC 13,000. 12/13/07-EEG mild diffuse cerebral dysfunction and background slowing.
CDC Split Type:

Write-up: Child has Dravet''s Syndrome. Physician provided script requesting child receive his immunizations, except Dtap. He is to receive Dt instead. He has history of seizures, almost monthly. Had been seizure free since 9-25-07. Mom reported on 11/21/07 that child had a total of 7 seizures the evening after his immunizations. Mom states he didn''t have a fever until the following evening, but started seizing.. was taken by squad to hospital and intubated. He spent 2 days in the hospital and was released. 4/7/08-records received for DOS 11/15/07 and 12/22/07-Short stay for increased seizure activity most likely due to AFI. Presented to ED with 24 hour history of acute febrile illness.


VAERS ID: 301179 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Female  
Location: California  
Vaccinated:2007-12-26
Onset:2007-12-28
   Days after vaccination:2
Submitted: 2007-12-28
   Days after onset:0
Entered: 2007-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 4 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB200AA / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0952 / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 4 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1562U / 1 LA / SC

Administered by: Private       Purchased by: Other
Symptoms: Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: Amoxicillin
Current Illness: Otitis Media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives at bilateral axilla, sides of trunk inguinal area, bilateral thigh and swelling at (R) $g$g (L) knee


VAERS ID: 301705 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2007-08-23
Onset:2007-08-23
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:120
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 0356U / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Body temperature increased, Diarrhoea, Inappropriate schedule of drug administration, Irritability, Pyrexia, Rash, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Medication errors (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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: body temp 09/03/07 - low grade fever
CDC Split Type: WAES0709USA00261

Write-up: Information has been received from a certified medical assistant concerning a 12 month old male with no medical history or allergies who on 23-AUG-2007 was vaccinated IM on left thigh with a 0.65 ml dose of Zostavax (Lot # 656858/0356U) instead of a dose of Varivax. There were no concomitant medications. On 03-SEP-2007 the patient was seen in physician''s office for possible chickenpox (irritability, fever and rash). The physician stated that the patient''s rash was very subtle and small (estimates 10-12 pimple like elevations). The patient ran a low grade fever and experienced diarrhea. The pediatrician started the patient on acyclovir 200 mg four times daily 02-SEP-2007. No diagnostic laboratory tests were undertaken. A product quality complaint was not involved. Additional information has been received from the physician who stated that the patient had come to their office for childhood vaccination. Typically the office only kept Varivax in their freezer and kept Zostavax specifically for certain patients. On the day, the patient came in for his routine childhood vaccination; there was a vial of Zostavax which was ordered for another patient. But the nurse administered Zostavax without reading the vial. The error was noticed when the patient for whom the Zostavax was ordered came in and the office realized that it was given to the wrong patient. Additional information has been requested.


VAERS ID: 301855 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Unknown  
Vaccinated:2007-09-12
Onset:2007-09-12
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:100
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Wrong drug administered
SMQs:, Medication errors (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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA01921

Write-up: Information has been received from a physician via a registered nurse (RN) from the poison control center concerning a 12-month-old male who on 12-SEP-2007 was vaccinated with a dose of Zostavax (Oka/Merck) instead of Varivax (Oka/Merck). The reporter stated that the vials looked similar. Subsequently, the patient experienced no symptoms. Unspecified medical attention was sought. No product quality complaint was involved. Follow-up information states that a relative called the poison control center to report the mix up of vaccinations and that the infant did receive a dose of Varivax (Oka/Merck) after receiving a dose of Zostavax (Oka/Merck). Additional information has been requested.


VAERS ID: 301919 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Arizona  
Vaccinated:2007-09-19
Onset:2007-09-19
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:93
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1406F / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA03295

Write-up: Information has been received from a licensed practical nurse (LPN) concerning a 12 month old male who on 19-SEP-2007 was inadvertently vaccinated with Zostavax (Oka/Merck) (Lot #654604/1406F) instead of Varivax (Oka/Merck) (MSD). The reporter noted that it was not product confusion but human error. No adverse reaction was noted. Follow-up information was received on 28-SEP-2007 via a phone call. The LPN stated that Zostavax (Oka/Merck) and Varivax (Oka/Merck) (MSD) vaccines had been side by side in the refrigerator. Since the incident, they have been separated and placed in different colored bags. The patient was last seen on 26-SEP-2007 and was fine. Additional information has been requested.


VAERS ID: 302294 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Ohio  
Vaccinated:2007-10-29
Onset:2007-10-29
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:53
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 0886U / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Wrong drug 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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA06175

Write-up: Information has been received from a registered nurse concerning a 12 month old female with no pertinent medical history and no drug reactions/allergies who on 29-OCT-2007 was vaccinated SC with a 0.5 mL dose of ZOSTAVAX (lot number: 658208/0886U) instead of MMR II. There was no concomitant therapy. It was confirmed that this event was a result of human error, not product confusion. No symptoms were reported. No further information was available. No medical attention was sought. There was no product quality complaint. Additional information has been requested.


VAERS ID: 302307 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-12-21
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0710USA06633

Write-up: Information has been received from a pharmacist concerning a 12 month old patient who in April 2007, was inadvertently vaccinated with a dose of ZOSTAVAX (Oka/Merck) instead of VARIVAX (Oka/Merck) (MSD). This was reported to be "totally human error" and the nurse did not read the vial. The patient tolerated ZOSTAVAX (Oka/Merck) "fine". It was unspecified if medical attention was sought. There was no product quality complaint involved. No further information was provided. Follow up information indicated that the event was human error, the there were not any labeling errors or storage issues. The office uses a computerized system to distribute vaccines, however, the nurse just administered the wrong vaccine. There was no any adverse event to report. No additional information is expected.


VAERS ID: 302312 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-12-21
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA00073

Write-up: Information has been received from a physician assistant concerning a 12-month-old female who was vaccinated with 0.65 ml dose of zoster vaccine live (Oka/Merck) instead of varicella virus vaccine live (Oka/Merck). No adverse experience reported. A product quality complaint was not involved. Additional information has been requested.


VAERS ID: 302344 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-12-21
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA00857

Write-up: Information has been received from a nurse concerning a 12 month old female who was vaccinated with a dose of ZOSTAVAX instead of a dose of VARIVAX. No adverse reactions were reported. There was no product quality complaint involved. Additional information could not be obtained from the reporting nurse. She indicated that she reported all the information about the patient via online and she refuse to provide any more information to us. Additional information has been requested.


VAERS ID: 302379 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Unknown  
Vaccinated:2007-11-09
Onset:2007-11-09
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:42
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA02198

Write-up: Information has been received from a medical assistant concerning a 12 month old female who on 09-Nov-2007 was vaccinated subcutaneously with a single dose of zoster vaccine live (Oka/Merck) (lot # not provided) instead of a dose of varicella virus vaccine live. The medical assistant confirmed that this was not product confusion. No problems were reported. The patient''s status was not reported. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 302393 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2007-11-02
Onset:2007-11-02
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:49
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA00664

Write-up: Information has been received from a nurse practitioner concerning a 12 month old patient who on 02-NOV-2007 was vaccinated with zoster vaccine live (Oka/Merck) rather than varicella virus vaccine live (Oka/Merck). The nurse practitioner reports she was not aware of any product confusion. No problems were reported. There was no product quality complaint. Additional information is not expected.


VAERS ID: 302439 (history)  
Form: Version 1.0  
Age: 1.05  
Sex: Male  
Location: Washington  
Vaccinated:2007-11-19
Onset:2007-11-19
   Days after vaccination:0
Submitted: 2007-12-21
   Days after onset:32
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1085U / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Wrong drug administered
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA04066

Write-up: Information has been received from a physician concerning a 12-month-old patient who on 19-NOV-2007 at 11:10 was inadvertently vaccinated subcutaneously in the right thigh with a first 0.5 ml dose of ZOSTAVAX (Merck) (lot # 658209/1085U) instead of varicella virus live (Oka/Merck). On 19-NOV-2007 at 11:10 the patient developed swelling and erythema at the injection site. The patient sought medical attention via an office visit. On 26-NOV-2007 the patient recovered. A product quality complaint was not involved. Additional information is not expected.


VAERS ID: 302443 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Oregon  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-12-21
Entered: 2007-12-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA04113

Write-up: Information has been received from a physician concerning a 1 year old patient who was vaccinated with ZOSTAVAX instead of varicella vaccine live (Oka/Merck). Staff error only. The patient''s outcome was not reported. The patient sought unspecified medical attention. Additional information has been requested.


VAERS ID: 301172 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Georgia  
Vaccinated:1992-03-27
Onset:1992-04-01
   Days after vaccination:5
Submitted: 2007-12-29
   Days after onset:5750
Entered: 2007-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / 1 UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. UNKNOWN / 1 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Abnormal behaviour, Constipation, Convulsion, DNA antibody positive, Headache, Hernia repair, Laboratory test, Pica, Self mutilation, Sleep disorder
SMQs:, Suicide/self-injury (narrow), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autism~Measles + Mumps + Rubella (MMR II)~1~2.50~Patient|Sister - Autism~Measles + Mumps + Rubella (MMR II)~1~2.50~Sibling|Siste
Other Medications: I am forwarding a list of vitamins and medications. Vitamins A - Cod Liver Oil - 1 cap 2 x''s a day; Krill Oil - 1 cap 2 x''s a day; Zinc - 1 cap 2 x''s a day; Primal Defense - 1 tab 2 x''s a day; Sea Buddies Concentration Formula - 4 caps
Current Illness: None
Preexisting Conditions: None (later diagnosed with allergic reaction to Augmentin) FAMILY HX: older sister also w/autism & PDD.
Allergies:
Diagnostic Lab Data: I am forwarding you a packet of laboratory testing that has been done recently. I am unsure of the exact date of Adverse reaction so I estimated. LABS: (+) yeast biomarkers, elevated ammonia, PANDAS test (+) for ASO & antiDNAse elevations, increased lead. Hearing & vision tests WNL.
CDC Split Type:

Write-up: Around 2 years of age patient had severe gastrointestinal problems (constipation) and severe behavior issues. We saw no language and bazaar behaviors, sleep problems, PICA (mainly eating paper products and outdoor items, leaves, limbs, dirt, etc.) patient also had 2 heat related seizures while on Augmentin. He has not had any since taking him off Augmentin. Patient was put on Miralax for constipation. He no longer takes this, but he still has some difficulty with stools (sometimes very large). Most of his life until probably the last 6 months we as parents had to make him go to the bathroom to have a bowel movement (we did this every night). We recently took him off the Miralax and he will usually go by himself without telling him to go. We have had numerous problems with patient. Over the years the behaviors have been very severe. He has broken windows, furniture etc.) We find it very hard to find people who will work with him because of his behaviors. A little over 5 years ago we started going to a Defeat Autism Now (DAN) doctor. We now go to him about once every year or two depending on how patient is doing. He has put patient on a number of vitamins and supplements and treatments. Patient seems to be doing better, but we still have outbursts. Just recently he broke the front window in my Wolkswagen with his hand. We believe patient has severe headaches. He is also self abusive (bites his arm and hand). Hits his head. Over the years patient has been treated by Dr. He is no longer in practice. We then went to Dr., Peditrician. He now practices in a different city, but we still go to him presently. We also see a Dr. We have used numerous programs, Speech, Occupational Therapy, Judevine, ABA, Hyperbarics. I am listing some of the doctors who have seen patient over the years. 1/15/08 Reviewed medical records which reveals patient experienced autoimmune disease, obsessive-compulsive disorder, encephalopathy, nutritional deficiencies, allergic gastroenteritis/colitis, bed wetting, receptive/expressive language disorder, ADHD, temper tantrums, aggression, constipation, stimming, sleep difficulties, poor interaction w/others, screaming. Patient tx w/hyperbarics, gluten/caesin free diet, chelation, multiple meds & supplements, NIMH protocol, ST/OT. FINAL DX: autism, pervasive developmental disorder. Per 60 day follow up: He is severly austistic. Follow-up: Gluten Free/Casein Free diet prescribed by Dr. Vitamins and supplements prescribed by Dr. Previously was on MIRALAX for quite a number of years for constipation. He no longer takes this, but he still has some difficulty with stools (sometimes very large). We feel he was unable to feel when he needed to go to the bathroom for a bowel movement while on MIRALAX, because since he has been off he sometimes goes on his own in the toilet. He never went on his own while on MIRALAX we had to make him go, unless he went on the floor. We make sure he goes at least once a day. Pt is allergic to AUGMENTIN, we found this out after he had two heat related seizures while on this medication when he was younger. Pt also had a hernia operation around 2 years of age. Follow-up: Patient is severely autistic with major deficits in language and social skills. We have seen major behavior problems over the years, but over the last few years we have seen more violent behaviors including kicking and punching out (with his fists) sheet rock walls, glass windows including all 3 window shields in our cars. We continue to see more aggression towards people (parents, caregivers, teachers, students (hitting, punching, biting, kicking). He will never be able to live alone. He will always need a caregiver.


VAERS ID: 301173 (history)  
Form: Version 1.0  
Age: 1.07  
Sex: Male  
Location: Wisconsin  
Vaccinated:2007-08-07
Onset:2007-08-08
   Days after vaccination:1
Submitted: 2007-12-26
   Days after onset:140
Entered: 2007-12-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1275F / 3 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0791U / UNK RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845F / 4 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Biopsy lung abnormal, Blood culture, Breath sounds abnormal, Bronchoscopy, Chronic sinusitis, Crying, Cyanosis, Diarrhoea, Diet refusal, Dyspnoea, Ear infection, Faeces discoloured, Haemophilus infection, Hypokinesia, Insomnia, Lethargy, Lymphadenopathy, Pharyngeal erythema, Pharyngolaryngeal pain, Pneumonia pneumococcal, Pyrexia, Respiratory distress, Respiratory syncytial virus infection, Tracheomalacia, Virus serology test, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (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, 3 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NEBULIZER PULMICORT/ XOPENEX/ ATROVENT/ AND PREDNISOLONE AND MAYBE AN ANTIBIOTIC AT THAT TIME SYNAGIS INJECTIONS
Current Illness: FROM THE FIRST VACINATION 09/27/2006 HE WAS ALWAYS CONSTANT SICK GOING INTO EACH VACINATION RESPIRATORY DISTRESS/ FEVER''S/ CHEST CONGESTION/ SINUSITIS
Preexisting Conditions: JUST THAT HE WAS A PREEMIE 34 WEEKS. HE DID REQUIRE ONE DOSE OF SURFECTANT. PMH: 34 week premie given surfactant. Neonatal jaundice. ? RAD.
Allergies:
Diagnostic Lab Data: BRONCHOSCOPY /STREPTOCCOCOUS PNEUMONAE VIA LUNG''S, NASAL AND RARE E. COCCI VIA LUNG/ RSV POSITIVE AND LASTLY IN SEPTEMBER 13,2007 POSITIVE HIB (HAEMOPHILUS INFLUENZAE B VIA LUNG''S, NASAL AND EAR''S/ BRONCHOSCOPY/ LUNG AND TRAECHEA BIOPSY/ BLOOD CULTURE/ X RAY''S/ ADNOIECTOMY AND MYRINGOTOMY. Labs and Diagnostics: RSV (+) 2/24/07, Brocnchoscopy with lavage 4/19/07 (+) for many Strep pneumonia, many mixed oropharyngel flora, many moraxella, rare E. coli. Sleep study 4/25/07 showed no major cardiorespiratory abnormalities. Blood cx (+) for Staph 6/22/07. Nasopharynx cx (+) for Strep pneumoniae 7/13/07. IGA low at 18. IgG low at 487 7/13/07. Sed rate 12. CXR (+) R lung infiltrate 9/11/2007. Echo cardiogram 9/14/07 normal. Bronchoscopy showed cilia morphology with reduced inner dynein arms. Pulmonary aspirate and ear fluid cultures (+) for Haemophilus influenzae.
CDC Split Type:

Write-up: EVERY TIME HE GOT VACCINATED HE WOULD IMMEDIATELY HAS RESPIRATORY DISTRESS, ABNORMALLY HIGH FEVER''S up to 104 THE HIGHEST., TROUBLES BREATHING ABOUT ONE HOUR POST,TRACHAELMALACIA, lethargy, moving slowly as if joints hurt/ SWOLLEN LYMPHNODES AROUND THE NECK/ CONSTANT DIAREAH COLOR PUTTY GREY/ RED SORE THROAT WOULDN''T EAT,WHEEZING SILENT CRY And ear infections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received for multiple ER visits, consults, and admissions for respiratory issues (cyanosis, increased WOB, stridor, noisy breathing, pneumonia) throughout 2007. DX include: Croup with Bronchospasm, RSV Bronchiolitis 2/24/07, Respiratory Distress. Laryngeal tracheomalacia. Bronchospasm, Cyanosis of unknown etiology. Cough. Fever. Frequent OVs with PCP throughout 2007. 01/22/2008 MR received for DOS 9/13-15/07 with DX: Observation for spells including oxygen desaturation, bradycardia, and hypopnea. Pt has had long standing hx of cyanotic spells, changes in breathing, hypoxemia, and bradycardia. Pt had and Adenoidectomy, bilateral myringotomy and typmanostomy tube placement, Direct microlaryngoscopy with bronch and tracheal study, Echo, pulse oximetry. Child became hypoxic post-procedure in PACU. Pulmonary consult states no clear etiology of multiple respiratory problems but likely a combo of prematurity, laryngomalacia, and viral respiratory illnesses. Vaccine data updated in VAERS. Follow-up: Immune system challenged at times. ? developmental - Behavior delay. But doing so much better! ? developmental / behavioral / immune system challenged hearing - speech delay.


VAERS ID: 301264 (history)  
Form: Version 1.0  
Age: 1.17  
Sex: Female  
Location: North Carolina  
Vaccinated:2007-12-19
Onset:2007-12-22
   Days after vaccination:3
Submitted: 2007-12-31
   Days after onset:9
Entered: 2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2490AA / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1501U / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site mass
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a quarter size lump on her thigh.


VAERS ID: 301265 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Ohio  
Vaccinated:2007-12-19
Onset:2007-12-29
   Days after vaccination:10
Submitted: 2007-12-31
   Days after onset:2
Entered: 2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF220AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0866U / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540164 / 4 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Blister, Rash erythematous, Rash macular, Varicella
SMQs:, Severe cutaneous adverse reactions (broad), 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented with mildly erythematous macular blanching rash on trunk. Three lesions, vesicles, on erythematous base consistent with Varicella per physician exam.


VAERS ID: 301266 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Georgia  
Vaccinated:1982-10-29
Onset:1982-11-01
   Days after vaccination:3
Submitted: 2007-12-31
   Days after onset:9191
Entered: 2007-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. UNKNOWN / 1 UN / UN

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: Sensory Processing Problems +~Measles + Mumps + Rubella (MMR II)~1~1.30~In Patient|Sister - Autism~Measles + Mumps + Rubella (MM
Other Medications: Adderall
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Forwarding information
CDC Split Type:

Write-up: Forwarding information


VAERS ID: 301278 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Wisconsin  
Vaccinated:2007-12-10
Onset:2007-12-19
   Days after vaccination:9
Submitted: 2007-12-21
   Days after onset:2
Entered: 2007-12-31
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2456AA / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis, Injection site induration, Injection site ulcer
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: None
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Ulcer and induration at injection site. Treated with antibiotics for presumed cellulitis.


VAERS ID: 301284 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2007-12-05
Onset:2007-12-13
   Days after vaccination:8
Submitted: 2007-12-19
   Days after onset:6
Entered: 2007-12-31
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR U13731C / 3 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0741F / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0312F / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689F / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1043F / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Culture negative, Injection site erythema, Injection site mass, Injection site warmth, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Eczema patch on forehead
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA071207

Write-up: 12-14-2007-Mother called and stated child ran low grade fever on day 2, 99 axillary, on day 8 child developed redness, warmth, and a knot on left thigh about quarter size but the child did not even flinch when touched. She spoke with Dr who told her to put a warm compress for first 24 hours then change to cold compress after that. Mother also reported a spot on his forehead, raised rash, near his hairline but said it broke out before his immunizations (child has eczema, which rash resembled). It was cultured at Dr''s office and culture came back negative. 12-17-2007-Called mother back to get update on child and she reported that redness had completely resolved and knot was smaller. Reported that spot on forehead was improved after applying lotion for eczema on it.


VAERS ID: 301294 (history)  
Form: Version 1.0  
Age: 1.52  
Sex: Female  
Location: Tennessee  
Vaccinated:2007-12-07
Onset:2007-12-17
   Days after vaccination:10
Submitted: 2007-12-27
   Days after onset:10
Entered: 2007-12-31
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2769AA / 4 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Bronchiolitis, Cough, Febrile convulsion, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (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: Mild URI
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccines given 12-7-07. 1 week later (presumably unrelated) patient developed cough, runny nose. 12-17-07, office visit. Bronchiolitis, Otitis media, fever. In office: Febrile seizure. Lasted less than 1 minute. Recovered fully.


VAERS ID: 301357 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Male  
Location: Minnesota  
Vaccinated:2007-12-20
Onset:2007-12-28
   Days after vaccination:8
Submitted: 2008-01-02
   Days after onset:5
Entered: 2008-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 RL / IM
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1271U / 1 LL / SC

Administered by: Unknown       Purchased by: Unknown
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full course of chicken pox. Fever of 104.2 began 12/28/07, lasted until 12/30/07. Fever then went down to 102 during the day. Chicken Pox began on 12/28/07 and continued on until 1/2/08 at which time they are fading away. Fever broke on 12/31/07.


VAERS ID: 301402 (history)  
Form: Version 1.0  
Age: 1.52  
Sex: Male  
Location: South Dakota  
Vaccinated:2007-12-27
Onset:0000-00-00
Submitted: 2008-01-02
Entered: 2008-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Medication error, Wrong drug 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: None noted~HPV (no brand name)~1~0.00~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Wrong vaccine administered to patient. No adverse symptoms noted.


VAERS ID: 301414 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Florida  
Vaccinated:2007-03-21
Onset:2007-04-01
   Days after vaccination:11
Submitted: 2008-01-02
   Days after onset:276
Entered: 2008-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2628AA / 4 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE975AA / 4 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abnormal behaviour, Aggression, Autism spectrum disorder, Blood heavy metal increased, Developmental delay, Disturbance in attention, Hypersensitivity, Metal poisoning, Porphyria, Psychomotor hyperactivity, Rash, Repetitive speech, Screaming, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Akathisia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/14/08-records received-Recurrent otitis media, skin rashes, poor sleep. PE Tubes. Intermittent loose bowel movements.
Allergies:
Diagnostic Lab Data: Porphyrin profile mentioned in #7.
CDC Split Type:

Write-up: A few weeks after the vaccination, 4/07 notice rash covering elbows and thighs. Went to dermatologist who prescribed Clarinex, Hydroxyzine and a topical steroid. The dermatologist briefly mentioned patient may be having an allergic reaction and handed me a brochure on food allergies. In that same month (4/07) screaming and uncontrollable tantruming began, noticed by several relatives. Also during 4/07 1) Eye contact decreased. 2) Patient began saying the same indiscernable phrase over and over. 3) Repetitive and hyperactive behaviors. In 6/07 at pediatrician well visit, doctor noticed developmental delays, patient not answering to his name, little eye contact. In October 2007, Dr. noted during patient visit that "Some of his features including his repetitive actions do raise the concern that he has problems along the pervasive developmental disorder spectrum." In December of 2007, Dr. conducted a urinary porphyrin profile on patient resulting in increased porphyrinuria 5CXP, Precopro, and Coproporphyrin metabolites suggesting a mercury toxic effect. Chelation due to start 1/08. 1/14/08-records received-HX of mild developmental delay most notably in area of expressive language. Repetitive actions with some eye contact and some interaction. Pervasive developmental disorder spectrum. Well baby office notes included. Patient still has heavy metal toxicity, rash on elbows, language delay, immune system injury, oxidative stress, metabolic disorder, neurologic abnormalities and gastrointestinal issues.


VAERS ID: 301434 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Illinois  
Vaccinated:2007-12-19
Onset:2007-12-20
   Days after vaccination:1
Submitted: 2007-12-21
   Days after onset:1
Entered: 2008-01-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR UF196AA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2460EA / 2 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB182AA / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? 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: Mom took child to ER on 12/20/07 due to (R) leg being red, swollen, and warm. Diagnosed with cellulitis per mom. Give antibiotics via shot and sent home and told to see primary doctor. Also prescribed abx.


VAERS ID: 301438 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Missouri  
Vaccinated:2007-11-12
Onset:0000-00-00
Submitted: 2007-12-24
Entered: 2008-01-02
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 50049P / 1 NS / IN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 02820 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700H / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 13290 / 1 LL / UN

Administered by: Public       Purchased by: Public
Symptoms: Inappropriate schedule of drug administration, Medication error, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child was given Flumist instead of injectable flu vaccine for 6-36 months; There were no adverse effects, but the wrong kind of flu was given for the wrong age, doctor said to report


VAERS ID: 301461 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Virginia  
Vaccinated:2007-07-10
Onset:2007-12-23
   Days after vaccination:166
Submitted: 2007-12-28
   Days after onset:5
Entered: 2008-01-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1469F / 1 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0365U / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site vesicles
SMQs:

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: None
CDC Split Type:

Write-up: Onset of area on (L) thigh that looked liked a bug bite that progressed to vesicles over the next several days.


VAERS ID: 301462 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Michigan  
Vaccinated:2007-12-18
Onset:2007-12-28
   Days after vaccination:10
Submitted: 2007-12-28
   Days after onset:0
Entered: 2008-01-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 4 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0282U / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1177U / 1 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Injection site vesicles, 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
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vesicular lesions at site of injection left thigh, truncal rash. Both 10 days after immunization. Tylenol - observation - comfort measures.


VAERS ID: 301586 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Georgia  
Vaccinated:2007-12-12
Onset:2007-12-13
   Days after vaccination:1
Submitted: 2007-12-13
   Days after onset:0
Entered: 2008-01-02
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354CA / 3 LL / ID

Administered by: Private       Purchased by: Private
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: Serum otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dtap #3 (Sanofi - Lot #U2354CA) given on 12/12/07. Entire left thigh erythema, not painful, indurated with some increased adenopathy, fever 101 on 12/13/07.


VAERS ID: 301613 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2007-08-29
Onset:2007-08-31
   Days after vaccination:2
Submitted: 2008-01-03
   Days after onset:125
Entered: 2008-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB1811AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0183U / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0720U / 1 LL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood test, Erythema, Pruritus, Rash generalised, Skin exfoliation, Swelling
SMQs:, Severe cutaneous adverse reactions (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: rash, skin peeling~ ()~~1.10~Patient
Other Medications: none
Current Illness: none
Preexisting Conditions: eczema
Allergies:
Diagnostic Lab Data: Basic bloodwork normal.
CDC Split Type:

Write-up: Palms of hands and soles of feet sloughed skin in sheets, full body rash, large red spots that swelled then decreased and cleared up. Saw several family practice physicians and a dermatologist. Skin rash and constant itching continue past the fourth month since vaccination.


VAERS ID: 301622 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Michigan  
Vaccinated:2007-12-20
Onset:2007-12-28
   Days after vaccination:8
Submitted: 2008-01-03
   Days after onset:6
Entered: 2008-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B033AA / 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B5493F / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1656U / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Blood culture negative, CSF culture negative, Culture urine negative, Febrile convulsion, Rhinitis, Urine analysis normal, White blood cell count increased
SMQs:, Neuroleptic malignant 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: recent otitis media.
Allergies:
Diagnostic Lab Data: All cultures negative, CSF, Blood, Urine; WBC 19,000 in office, Purulent rhinitis. Labs and Diagnostics: WBCs 25.8 with 18.6 neutrophils and 4.1 lymphs. Down to 14.4 by 1230/07. Flu and RSV (-). LP WNL. CSF cx (-). Blood cx (-). CXR WNL.
CDC Split Type:

Write-up: Febrile seizure in office 12/28/07. Varivax vaccine administered 12/20/07. 02/21/2008 MR received for DOS 12/28-30/2007 with D/C DX: Complex Febrile Convulsions. Acute Respiratory Infections. Pt presented to ER from PMD''s office where she had had a seizure, mainly consisting of eye fluttering. Pt became apneic requiring Ambu bag ventilations. The child had presented to PMD with several day hx of croupy cough with vomiting of mucus. Axillary temp 105''F at OV. Pt was transported to ER and then transfered to higher level of care. PE was (+) for wheezing, crusting of the nares, mildly erythematous throat, and cough. No further seizure activity during stay.


VAERS ID: 301626 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Texas  
Vaccinated:2007-12-27
Onset:2007-12-27
   Days after vaccination:0
Submitted: 2008-01-02
   Days after onset:6
Entered: 2008-01-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR UF212AB / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Crying, Eye swelling, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Depression (excl suicide and self injury) (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: Zyrtec 1mg/ml syrup
Current Illness: None
Preexisting Conditions: Allergy - egg, cows milk, eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mom called about 30 minutes after leaving office and said son was broken out, eyes swollen, crying. Told her to give 1/2 teaspoon Benadryl and to call doctor in 1 hour.


VAERS ID: 301637 (history)  
Form: Version 1.0  
Age: 1.33  
Sex: Female  
Location: Florida  
Vaccinated:2007-12-27
Onset:2007-12-28
   Days after vaccination:1
Submitted: 2008-01-02
   Days after onset:5
Entered: 2008-01-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT24600A / 2 LL / UN

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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: H/O UTI/pneumonia. Bartholin abscess
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: < 24 hr after vaccine. Pt developed urticaria. Given Zyrtec, Orapred. Given pedi epipen to have at home.


VAERS ID: 301646 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Unknown  
Vaccinated:2000-03-30
Onset:2008-01-02
   Days after vaccination:2834
Submitted: 2008-01-03
   Days after onset:1
Entered: 2008-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 16585 / 1 UN / SC

Administered by: Private       Purchased by: Other
Symptoms: Blood immunoglobulin M, Erythema, Exposure to communicable disease, Pruritus, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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: Varicella IgM
CDC Split Type:

Write-up: 5 red itchy papular lesions after possible contact with varicella.


VAERS ID: 301739 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Florida  
Vaccinated:2007-12-26
Onset:2008-01-02
   Days after vaccination:7
Submitted: 2008-01-04
   Days after onset:2
Entered: 2008-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308U / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1465U / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Skin warm, 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: None
Preexisting Conditions: Developmental delay
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3x5 cm red, raised area, slight edema, no tenderness, slightly warm to touch. Applied cool compresses, Tylenol for discomfort.


VAERS ID: 301747 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Illinois  
Vaccinated:2007-11-02
Onset:2007-11-02
   Days after vaccination:0
Submitted: 2007-12-10
   Days after onset:38
Entered: 2008-01-04
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2438AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007H / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0835U / 1 LL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? 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: Injection site was erythematous. On 11/11 worsened, became indurated. On exam had an eryth patch 1.9 x 4.8 cm with slight induration. Rx ibuprofen, Elacon. No fever, no drainage.


VAERS ID: 301751 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Colorado  
Vaccinated:2007-09-02
Onset:2007-09-21
   Days after vaccination:19
Submitted: 2008-01-04
   Days after onset:105
Entered: 2008-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB206AB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0436U / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0416U / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1010U / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Decreased appetite, Irritability, Pyrexia, Rash generalised, Rash maculo-papular, 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), 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: Tylenol PRN
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received 1 year vaccines on 9/21/07. That night with fever to 102. 9/22/07 with vomiting and low appetite and slight fever (-100). Vomiting through 9/25, no diarrhea. Fussy and not acting herself. 9/26 generalized macular/papular rash.


VAERS ID: 301765 (history)  
Form: Version 1.0  
Age: 1.34  
Sex: Female  
Location: Florida  
Vaccinated:2007-12-26
Onset:2008-01-03
   Days after vaccination:8
Submitted: 2008-01-06
   Days after onset:3
Entered: 2008-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Decreased appetite, Genital rash, Insomnia, Lethargy, Measles, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: The baby got a rash the day after the vaccination. Ten days later she got a fever. Then a couple days later she got what appears to be full blown measles all over her entire body and genitals. The physician commented she had never seen anything like it before. The baby is usally quiet and easy, has been extremely lethargic, doesnt want to move sometimes, screams when left alone, wont sleep alone, doesnt have much of an appetite. Her genitals are very sore and red. I know that you can get a couple of bumps here and there but not a complete body full of red clusters. I know the mmr was given, she was also given the chicken pox vaccine, and one other I cant recall. Whatever vaccine is standard for 15 month visits.


VAERS ID: 301769 (history)  
Form: Version 1.0  
Age: 1.81  
Sex: Male  
Location: Minnesota  
Vaccinated:2007-12-27
Onset:2007-12-29
   Days after vaccination:2
Submitted: 2008-01-07
   Days after onset:9
Entered: 2008-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2760AA / 4 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1259U / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0427U / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0854U / 1 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia, Urticaria
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Urticarial rash starting 2 days after vaccination and persisting for over 1 week. Fever to 102 beginning about 1 week after vaccination.


VAERS ID: 301777 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Michigan  
Vaccinated:2008-01-02
Onset:0000-00-00
Submitted: 2008-01-03
Entered: 2008-01-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2477DA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A02732 / 4 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0749U / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1495U / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Accidental overdose, Inappropriate schedule of drug administration, Medication error
SMQs:, Drug abuse and dependence (broad), 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: Runny clear nose
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child given 4th dose of IPV at shot appointment. Child did not need this dose of vaccine.


VAERS ID: 301794 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Male  
Location: Illinois  
Vaccinated:2007-12-18
Onset:2007-12-27
   Days after vaccination:9
Submitted: 2008-01-07
   Days after onset:11
Entered: 2008-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1006U / 1 LL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Influenza, Pneumonia, Respiratory syncytial virus infection
SMQs:, Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: none
Preexisting Conditions: Allergic to dogs PMH: allergy to dogs & ragweed.
Allergies:
Diagnostic Lab Data: LABS: CBC WNL. Plts 190 (L), lymphs 68.8% (H), neutros 16.8% (L). RSV (+), influenza B (+). CXR bronchiolitis per attending, bilateral perihilar infiltrates per radiologist.
CDC Split Type:

Write-up: 9 days after Varicella Vaccine given, he developed a cough. On the 10th day after vaccination (12/28/07), he was diagnoesd with pneumonia and hospitalized overnight. Also diagnosed with RSV and Influenza Type B. 1/8/08 Reviewed hospital medical records which reveal patient experienced cough, congestion, irritability, reduced oral intake x 5 days & developed dehydration. Admitted 12/31/2007-1/1/2008. Tx w/antibiotics. FINAL DX: RSV, Influenza B & dehydration.


VAERS ID: 301799 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Texas  
Vaccinated:2008-01-03
Onset:2008-01-07
   Days after vaccination:4
Submitted: 2008-01-07
   Days after onset:0
Entered: 2008-01-07
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 - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Fatigue, Lethargy, Pyrexia, Vomiting
SMQs:, 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), 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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low-grade Fever, Vomiting, Fatigue, Lethargy


VAERS ID: 301816 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Colorado  
Vaccinated:2008-01-03
Onset:2008-01-03
   Days after vaccination:0
Submitted: 2008-01-07
   Days after onset:4
Entered: 2008-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1250U / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0431U / 1 RL / SC

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

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

Write-up: Right thigh with immediate 3cm erythema, warmth surrounding injection site, 1cm x .5cm white raised blob just distal to injection site. Child given 12.5mg Benadryl liquid. Within 20 minutes, erythema decreased but not resolved, no respiratory difficulties. Afebrile, able to move all extremities.


VAERS ID: 301817 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Male  
Location: Oregon  
Vaccinated:2008-01-02
Onset:2008-01-04
   Days after vaccination:2
Submitted: 2008-01-07
   Days after onset:3
Entered: 2008-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 42059AA / 4 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2440AA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB211A4 / 2 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site discolouration, 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Lactose allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinations on 1-2-08. Mother calls 1-4-08 to report redness, swelling & "hot" at L leg (thigh) injection site. Also reports site turning "sort of black". Instructed mother to take child to his pediatrician today. 1-7-07 follow up with mom: child on cephalexin since 1-4-08 MD visit. Feeling better. Leg looks better. MD records indicate L upper thigh redness around puncture site, redness, and 3 cm induration around puncture site.


VAERS ID: 301935 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Alabama  
Vaccinated:2007-11-30
Onset:2007-12-17
   Days after vaccination:17
Submitted: 2008-01-07
   Days after onset:21
Entered: 2008-01-08
   Days after submission:1
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: Bronchitis, 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: Unknown
Current Illness: Bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0712USA09293

Write-up: Information has been received from a physician concerning a 1 year old female with bronchiolitis who on 30-NOV-2007 was vaccinated with a dose of MMR (no lot number was provided). "On 17-DEC-2007 the patient experienced bronchitis and was sent to the hospital with high fever and seizures. Length of time at the hospital was unknown." Subsequently, the patient recovered. There was no product quality complaint. The physician noted that he "believed that this adverse reaction did have any relation to MMR and was due to patient having bronchiolitis." Upon internal review, seizures were determined to be an other important medical event. Additional information has been requested.


VAERS ID: 301936 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New Jersey  
Vaccinated:2007-11-02
Onset:2007-11-11
   Days after vaccination:9
Submitted: 2008-01-07
   Days after onset:57
Entered: 2008-01-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Blood creatinine normal, Computerised tomogram normal, Gait disturbance, Laboratory test, Neutropenia, Neutrophil count decreased, Nuclear magnetic resonance imaging normal, Pyrexia, Red blood cell sedimentation rate normal, Tenosynovitis, Torticollis, Viral infection
SMQs:, Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Ocular motility disorders (broad), Tendinopathies and ligament 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: magnetic resonance, 11/12?/07, negative; computed axial, 11/12?07, negative; diagnostic laboratory, 11/12?/07, soft tissue neck; absolute neutrophil, 11/12?/07, 200; erythrocyte, 11/12?/07, 20; serum creatinine, 11/12?/07, 0.5
CDC Split Type: WAES0712USA09295

Write-up: Information has been received from a physician and medical records concerning a 15 month old white male with no pre-existing medical conditions or allergies who on 02-Nov-2007 was vaccinated SC with his first dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (lot #656879/0709U). There was no illness at the time of vaccination. There was no concomitant medication. On 11-Nov-2007 the patient experienced limping and torticollis of sudden onset for 2 days and was afebrile. On approximately 11-Nov-2007 prior to admission, the patient also had a viral illness. On 12-Nov-2007 the patient was found to be neutropenic characterized by fever (febrile) and was admitted to the hospital for further work-up for 2 days. On approximately 12-Nov-2007 lab diagnostic studies included: ANC of 200, ESR = 20, serum creatinine = 0.5, and white blood cell counts of 33.9 and 31.2 respectively. Other labs on that same day included MRI brain/spine = negative, CAT scan for the abdomen/head = negative and a lab/diagnostic of the soft tissue of the neck = negative. The patient was treated with "IVF" and ibuprofen PRN pain/temperature. The final diagnosis was viral syndrome associated with neutropenia and torticollis tenosynovitis. The patient''s condition was noted to be stable. The patient was scheduled for follow-up with a primary medical doctor in 2 days and a hematologic oncologist in 1 week at the time of this report. Additional information has been requested. All available medical records will be provided upon request.


VAERS ID: 301975 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Virginia  
Vaccinated:2002-03-28
Onset:2007-12-01
   Days after vaccination:2074
Submitted: 2007-12-04
   Days after onset:3
Entered: 2008-01-08
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0498L / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Rash erythematous, Rash papular, Rash vesicular, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Jaundice at birth (resolved), dacrastenosis (3/7/01), UTI (12-26-00), mild PND (12-26-00), stomatitis (12/26/00), gastroenteritis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started with multiple red papules on 12/01/07. Examined 12/04/07. Physician noted multiple red papules with vesicles all over. Dx: chicken pox. Plan: Benadryl, Motrin/Tylenol prn.


VAERS ID: 301978 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Virginia  
Vaccinated:2007-12-19
Onset:2007-12-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHVB171AA / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 08664 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 156511 / 1 RL / -

Administered by: Public       Purchased by: Public
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? 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: Rash at injection sites within 24 hours, then facial rash at 12 days.


VAERS ID: 301982 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2007-12-18
Onset:2007-12-19
   Days after vaccination:1
Submitted: 2008-01-02
   Days after onset:14
Entered: 2008-01-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2460BA / 2 LL / -
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB21AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 4 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site papule, Pallor, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (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: S/P hypospadius repair, oral surgery
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Erythematous blanching 45 x 4cm, slight induration left thigh with 2 puncture spots; non-tender, not warm. Right anterior thigh slightly blanching erythema papule at injection site. Benadryl every 6 hours. ? allergy to eggs in future.


VAERS ID: 301987 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Michigan  
Vaccinated:2007-12-19
Onset:2007-12-19
   Days after vaccination:0
Submitted: 2007-12-19
   Days after onset:0
Entered: 2008-01-08
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B056BA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2460GA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1003F / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Restlessness
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MMR injection given with well child visit, SQ left upper thigh. Child unable to settle after injection. Approximately 10 minutes later reddened raised area approx 8 cm x 6 cm. Benadryl & Tylenol given as per Dr. - cont to assess x30 minutes. Reaction site reduced greatly in size prior to leaving the office.


VAERS ID: 301991 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Washington  
Vaccinated:2007-12-27
Onset:2007-12-27
   Days after vaccination:0
Submitted: 2007-12-27
   Days after onset:0
Entered: 2008-01-08
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB214AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0747U / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1175U / 1 LL / SC

Administered by: Public       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: None
Preexisting Conditions: GI reflux
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hive at injection site. Benadryl given.


VAERS ID: 301996 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2007-10-18
Onset:2007-10-18
   Days after vaccination:0
Submitted: 2007-12-03
   Days after onset:46
Entered: 2008-01-08
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. M1106F / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. M0065U / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. M1003F / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 347442E / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. M0835U / 1 LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Convulsion, Drooling, Musculoskeletal stiffness, Pyrexia, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), 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: None stated 10-18-07
Current Illness: None
Preexisting Conditions: Has had OO previous seizures before, had 103 degree fever per mom.
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC08001

Write-up: Story told by mom 12-3-07. In health department 10-18-07 8:30 for well check & shots. Mom states had seizure in car at 5:30pm. Mom driving, mom present-stiff, drooling, unresponsive x15 mins per mom. Ambulance called & patient woke up with them present. Taken to ER. Mom states no fever at ER/no tx. To Dr. 10-19-07, child had 2 previous seizures, both on same day 7-17-07 per mom, had 103 degree fever per mom. No tx. by Dr. 10-19-07 per mom.


VAERS ID: 302022 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Unknown  
Vaccinated:2007-10-02
Onset:2007-10-08
   Days after vaccination:6
Submitted: 2008-01-08
   Days after onset:92
Entered: 2008-01-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0436U / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest, Death, Multi-organ failure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2007-10-13
   Days after onset: 5
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: therapy unspecified
Current Illness: Mental retardation severity unspecified; Pulmonary hypertension; Ventricular septal defect; Cardiac failure congestive; Patent ductus arteriosus
Preexisting Conditions: PMH: profound mental retardation, dysmorphic facies, congenital heart disease, Bixler''s syndrome, pulmonary HTN, hypochloremic alklosis, HH, cleft lip/palate, multiple bony abnormalities & rib anomalies, s/p heart valve repair, subtotal hemicolectomy & partial ilectomy, tracheostomy, PEG feeding tube.
Allergies:
Diagnostic Lab Data: Unknown LABS: WBC 16.8 (H), H/H 7.7/25.6 (L), lymphs 55.3 (H), segs 38 (L). CXR showed cardiomegaly.
CDC Split Type: WAES0801USA00406

Write-up: Information has been received from a nurse practitioner concerning an 18 month old female with mental retardation, pulmonary hypertension, ventricular septal defect, congestive heart failure, patent ductus arteriosus and no known allergies who on 02-OCT-2007 was vaccinated intramuscularly in the right arm with the 1st 0.5ml dose of PEDVAXHIB (lot#656521/0436U). The nurse practitioner was calling from a long term care facility for mental retardation. The reporter stated that the patient was on numerous medications but did not specify them. On 08-OCT-2007, the patient went into cardiac arrest and was rushed to a local hospital 10 miles away. On the same day the child was transported via helicopter to another hospital. on 13-OCT-2007 at 7:30 pm, the patient died at the hospital. The cause of death was cardiac arrest and multiple symptom organ failure. Cardiac arrest and multiple symptom organ failure were considered to be immediately life-threatening, disabling, other important medical events and congenital anomalies by the nurse practitioner. Additional information has been requested. 1/11/08 Reviewed hospital medical records from initial hospital which reveals patient arrived in cardiac arrest w/cpr in progress on 10/8/2007. Reportedly playing in state school home when suddenly became unresponsive & apneic/pulseless. Resuscitated & transferred to higher level of care. FINAL ER Dx: cardio-pulmonary arrest. 1/11/08 Reviewed hospital medical records from transfer hospital which reveal patient admitted to PICU on pressors, antibiotics & ventilator. Developed multi-system organ failure includeing renal failure, liver failure, cardiac failure, respiratory failure & refractory shock. Admitted 10/9-10/13/2007 when expired. 5/15/09 Death certificate states COD as brain death; hypoxic ischemic injury; multiple congenital anomalies.


VAERS ID: 302136 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Wisconsin  
Vaccinated:2007-12-12
Onset:2007-12-18
   Days after vaccination:6
Submitted: 2008-01-09
   Days after onset:22
Entered: 2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 4 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT24060EA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0376U / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0869U / 1 RL / -

Administered by: Private       Purchased by: Other
Symptoms: Bronchiolitis, Cough, Dyspnoea, Pneumonia
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Slight speech delay 1/17/08-records received-PMH: preterm delivery at 35 weeks.
Allergies:
Diagnostic Lab Data: 1/17/08-records received-CXR: right middle lobe infiltrate.
CDC Split Type:

Write-up: Patient was sent to ER 12/18/07 with cough and breathing difficulty. No fever. Diagnosed with pneumonia and bronchiolitis. Child received influenza vaccine 12/12/07 - mother won''t give 2nd influenza - feels this is cause. 1/17/08-records received for DOS 12/18/07-Assessment:Pneumonia. Broncholitis. Presented to ED with cough and difficulty breathing. PE: some grunting respirations without stridor.


VAERS ID: 302141 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2007-10-23
Onset:0000-00-00
Submitted: 2008-01-09
Entered: 2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2458BA / 1 RL / UN
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0799U / 1 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0204U / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1106U / 1 RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site abscess, Injection site erythema, Injection site nodule, Injection site swelling, Rash
SMQs:, Anaphylactic reaction (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? 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: Rash-cleared on own early Nov. 07. 12-31-07, 1-8-08, 1-9-08 seen for abscess on L leg, red, swollen nodule.


VAERS ID: 302143 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Ohio  
Vaccinated:2008-01-08
Onset:2008-01-08
   Days after vaccination:0
Submitted: 2008-01-09
   Days after onset:1
Entered: 2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1258U / 1 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0282U / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Crying, Dyskinesia, Mydriasis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Inconsolable, thrashing tongue, arms unable to grasp, rapid hand movement. Temp 100.4. Pupils dilated.


VAERS ID: 302145 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Maine  
Vaccinated:2007-12-20
Onset:0000-00-00
Submitted: 2008-01-09
Entered: 2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1589U / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Ataxia, Balance disorder, Blood glucose, Crying, Gait disturbance, Irritability, Nystagmus, Pyrexia, Sleep disorder, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: Blood glucose 103
CDC Split Type:

Write-up: Pt returned to office on 1/7/08 for well care - waking this AM and shaking and off balance X several weeks. Low grade fever in office - "eyes shaking" wakes at night crying, irritable - 1/8/08 - child with shaking and unsteady gait "worse) - to ED. 1/9/08 Dad called did not go to ED yesterday - unable to start - seen in office - nystagmus - (L) arm tremor - ataxia, blood glucose 103 in office. Strong response of VZV reaction/side effect.


VAERS ID: 302504 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Texas  
Vaccinated:2007-03-30
Onset:2007-09-02
   Days after vaccination:156
Submitted: 2008-01-04
   Days after onset:124
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0143U / UNK RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Herpes zoster, Injection site reaction
SMQs:, 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: Asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0709USA01512

Write-up: Information has been received from a physician concerning a 17 month old male with asthma and no known allergies who on 30-MAR-2007 was vaccinated SC in the right leg with a one time 0.5 ml dose of ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process) (Lot#656651/0143U). Concomitant therapy included hepatitis A virus vaccine (manufacturer unknown) and PREVNAR. On 02-SEP-2007 the patient developed shingles on the right leg where he received the vaccination. The patient was seen by the physician on 05-SEP-2007. No lab studies were performed. Subsequently, on 09-SEP-2007, the patient recovered. No further information was provided. There was no product quality complaint involved. Additional information has been requested.


VAERS ID: 302507 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Unknown  
Vaccinated:2007-08-22
Onset:2007-08-29
   Days after vaccination:7
Submitted: 2008-01-04
   Days after onset:128
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0617U / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Pyrexia, Varicella
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA01552

Write-up: Information has been received from a consumer concerning her 16 month old daughter who on 22-AUG-2007 was vaccinated with a dose of ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process) (Lot#657780/0617U). There was no concomitant medication. On 29-AUG-2007, 7 days after vaccination, the patient developed a fever. On 01-SEP-2007, 10 days after vaccination, the patient developed chicken pox. Unspecified medical attention was sought. No further information was provided. There was no product quality complaint involved. No further information is available.


VAERS ID: 302508 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Indiana  
Vaccinated:2007-09-10
Onset:2007-09-10
   Days after vaccination:0
Submitted: 2008-01-04
   Days after onset:116
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / UNK UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Incorrect dose administered, Irritability, Teething
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Medication errors (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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA01554

Write-up: Information has been received from a physician concerning a 12 month old white female with no known allergies or pertinent medical history who on 10-SEP-2007 was vaccinated IM (previously reported as SC) with a 0.5 ml dose of ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process) and a dose of Varivax (Oka/Merck) (MSD). The vaccines were given in separate syringes. No adverse event was reported. No further information was provided. There was no product quality complaint involved. Follow up information received from the medical assistant indicated that on 12-SEP-2007 the patient developed fussiness (it was noted the patient was also teething). On 10-SEP-2007 the patient recovered. Additional information is not expected.


VAERS ID: 302509 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Unknown  
Vaccinated:2007-07-24
Onset:2007-09-11
   Days after vaccination:49
Submitted: 2008-01-04
   Days after onset:115
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0616U / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Skin lesion, Varicella
SMQs:, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA01576

Write-up: Information has been received from a physician concerning a 14-month-old male who on 24-July-2007 was vaccinated with a dose of PROQUAD (lot #657749/0616U). On 11-Sep-2007 "the patient experienced a breakthrough case of chicken pox that was less than 50 lesions". Unspecified medical attention was sought. The outcome was reported as not recovered. No product quality complaint was involved. No further information is available.


VAERS ID: 302510 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Washington  
Vaccinated:2007-04-06
Onset:2007-04-20
   Days after vaccination:14
Submitted: 2008-01-04
   Days after onset:259
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0231U / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA02749

Write-up: Information has been received from a physician and a registered nurse (R.N.) concerning a 13-month-old Caucasian male who on 06-APR-2007 was vaccinated subcutaneously in the left thigh with a first dose of ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process) (lot # 657031/0231U). Subsequently, it was reported that on "23-APR-2007" the patient developed an injection site reaction first reported as injection site induration which the physician was able to notice when the baby patient was brought to the clinic for follow up "3 weeks after administration" of the vaccine. In follow-up, it was reported that the injection site reaction occurred 14 days after vaccination and was a red welt with dimensions of 20 x 25 mm on the left thigh. It was reported that the patient was seen by a physician and that he recovered "within 2 weeks". There was no product quality complaint involved. Additional information is not expected.


VAERS ID: 302511 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-01-04
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0709USA03289

Write-up: Information has been received from a health professional concerning a 12 month old patient who was vaccinated with ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process). Subsequently the patient experienced rash. He sought unspecified medical attention. Reportedly the patient recovered from the rash. No product quality complaint was reported. Additional information was not available. This is one of two reports from the same source. Additional information is not expected.


VAERS ID: 302538 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Female  
Location: Missouri  
Vaccinated:2006-10-26
Onset:2007-10-21
   Days after vaccination:360
Submitted: 2008-01-04
   Days after onset:75
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 4 UN / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1090F / 1 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08682A / 4 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Herpes zoster, Rash, Rash vesicular
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: Bilateral otitis media
Preexisting Conditions: Wheezing
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA05573

Write-up: Information has been received from a licensed practical nurse (L.P.N.) concerning a 24-month-old female with a history of wheezing in 2006 and no allergies, who on 26-OCT-2006 was vaccinated subcutaneously in the left arm with a 0.5 milliliter dose of ProQuad (Oka/Merck upgrade process) (lot# 655624/1090F). Concomitant vaccination included ActHIB and Prevnar. On 25-Oct-2007, the patient was seen in the office and diagnosed with shingles. She had a rash on her back, chest and under her left arm that developed "4 days ago", on 21-Oct-2007. There were no laboratory or diagnostic tests performed. The patient''s shingles persisted. It was noted that the physician was not interested in the VZV identification program. No product quality complaint was involved. Follow-up information received indicates that the patient was vaccinated at 9:20 AM with a first dose of MMR (Oka/Merck upgrade process). Concomitant vaccination at 9:20 AM included a fourth intramuscular dose in the right arm of Prevnar (lot# B08682A). It was reported that the patient had bilateral otitis media at the time of vaccination. On 21-Oct-2007, the patient developed a vesicular rash on the left back, chest and upper arm. The outcome was not reported. Additional information has been requested. Follow-up information received indicated that the patient was recovered (date unspecified). Additional information has been requested.


VAERS ID: 302542 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Unknown  
Vaccinated:2007-11-08
Onset:2007-11-08
   Days after vaccination:0
Submitted: 2008-01-04
   Days after onset:57
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0985U / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA02051

Write-up: Information has been received from a health professional concerning a 1 year old female who on 08-Nov-2007 received a dose of PROQUAD (lot #658032/0985U). It was reported that while receiving the dose of vaccine the child jerked and may have received less than the recommended dose. Medical attention sought and current patient status was not reported. Additional information has been requested.


VAERS ID: 302543 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: Unknown  
Vaccinated:2007-11-05
Onset:2007-11-05
   Days after vaccination:0
Submitted: 2008-01-04
   Days after onset:60
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0293U / UNK UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA02068

Write-up: Information has been received from a registered nurse concerning a 12 month old patient who on 05-NOV-2007 was vaccinated with a dose of ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process) instead of a dose of MMR II (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3) (MSD). Secondary suspect therapy on same day included a dose of Varivax (Oka/Merck). It was reported that both the box and the description of the vaccine was similar. The labeling was different on both the vaccines boxes but it was not enough to notice the difference. It was reported that ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process) (MSD) was stored in the fridge for a least 5 months. The patient did not experience any adverse symptom. A product quality complaint was not involved. Additional information has been requested. Follow-up information was received from concerning a 12-month-old female who was vaccinated with PROQUAD (Merck) (lot# 657265/0293U). The PROQUAD (Merck) was stored where the MMR II was supposed to be stored. Since there was no MMR II (Merck) left in the refrigerator, someone mistook the PROQUAD (Merck) for the MMR II. It was unknown who put the PROQUAD (Merck) in the MMR II spot. Additional information is not expected.


VAERS ID: 302546 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2007-08-07
Onset:2007-11-16
   Days after vaccination:101
Submitted: 2008-01-04
   Days after onset:49
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0478U / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Herpes zoster, Rash
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0711USA03923

Write-up: Information has been received from a registered nurse concerning a 15 month old female with no pertinent medical history and no drug reactions/allergies who on 07-Aug-2007 was vaccinated SC with a 0.5 mL dose of PROQUAD (lot number: 0478U). Concomitant therapy included PREVNAR. On 16-Nov-2007 the patient was seen in the office for a rash. On 17-Nov-2007 the patient was seen again in the office because the rash had gotten worse. The physician diagnosed the rash as shingles. The rash developed on the patient''s back, right buttock, and genital area. There were no complications. The patient was put on acyclovir therapy. No further information was available. Unspecified medical attention was sought. No lab diagnostics studies were performed. The outcome was reported as recovering. There was no product quality complaint. Additional information has been requested. Information has been received froma registered nurse concerning a 15 month old female with no pertinent medical history and no drug reactions/allergies who on 07-AUG-2007 was vaccinated SC in the right thigh with a second 0.5 mL dose of MMR (Oka/Merck upgrade process) (lot number: 657032/04780). On 16-NOV-2007 the patient was seen in the office for a rash on her back and legs. The rash was lcoated on th elower back and genitalia. The rash was blister-like and raised. The rash was vesicular locatted on the lower back and right vulva. Her temperature that day was 97.6 F tympanic. On 17-NOV-2007 the patient was seen again in the office because the rash had gotten worse. The physician diagnosed the rash as shingles. The rash developed on the patient''s back, right buttock, and genital area. There were no complications. The patient was pit on acyclovir therapy.Unspecified medical attention was sought. No lab diagnostics studies were performed. The outcome was reported as recovering. There was no product quality complaint. Follow up information indicated that on 08-NOV-2007 the patient was vaccinated in the right arm at 9:00 am with a third dose of HEPATITIS B vaccine (lot number 657180/0224U). The outcome was reported as recovered. No additional information is expected.


VAERS ID: 302548 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Unknown  
Location: Unknown  
Vaccinated:2007-12-05
Onset:2007-12-05
   Days after vaccination:0
Submitted: 2008-01-04
   Days after onset:30
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Wrong drug 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0712USA01689

Write-up: Information has been received from a physician concerning an 18 month old patient who on 05-DEC-2007 was vaccinated with ProQuad (Oka/Merck upgrade process). Concomitant therapy included Recombivax. The physician reported that on 05-DEC-2007 the patient may have been given ProQuad (Oka/Merck upgrade process) given intramuscularly by mistake. The physician reported that the vials look similar for the two drugs both of the vials have AQUA blue tops. The nurse thought she was administered the ProQuad (Oka/Merck upgrade process) because it looked like the same vial. The patient did not seek medical attention. Additional information has been requested.


VAERS ID: 302558 (history)  
Form: Version 1.0  
Age: 1.06  
Sex: Male  
Location: Unknown  
Vaccinated:2006-10-25
Onset:2007-11-06
   Days after vaccination:377
Submitted: 2008-01-04
   Days after onset:59
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0956R / UNK UN / UN

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0712USA02712

Write-up: Information has been received from a registered nurse concerning a approximate 49-month-old male who on 25-OCT-2006 was vaccinated with a dose of MMR (lot # 652328/0956R). On approximately 06-NOV-2007 ("within the last two weeks") the patient developed breakthrough chickenpox. At the time of the report the patient''s status was unknown. A product quality complaint was not involved. This is one of several reports received from the same source. Additional information has been requested. 02/10/2010 Follow up information received from a nurse on 12-DEC-2007 indicated the patient developed chickenpox on 10-JUL-2007 and has since recovered. She reported they were havign a lot of cases of chickenpos in thier office, sometimes 1-2 casses a week. Most of the cases were following VARIVAX. She thought the patient was the only case following MMR. The nurse explained they have been reporting the cases via the rmp and also to the state. This is one of several reports received from the same source. Additional information has been requested.


VAERS ID: 302560 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-01-04
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0709USA03903

Write-up: Information has been received from a health professional concerning a 12 month old patient who was vaccinated with PROQUAD. Subsequently the patient experienced rash. He sought unspecified medical attention. Reportedly the patient recovered from the rash. No product quality complaint was reported. Additional information was not available. This is one of two reports from the same source. Additional information is not expected.


VAERS ID: 302562 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Unknown  
Location: Unknown  
Vaccinated:2007-08-14
Onset:2007-09-12
   Days after vaccination:29
Submitted: 2008-01-04
   Days after onset:114
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0194U / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA01448

Write-up: Information has been received from a physician assistant concerning and 18 month old patient with no allergies and no pertinent medical history who on 14-Aug-2007, was vaccinated with a subcutaneous dose of PROQUAD (lot #0194U). On 12-Sep-2007, the patient was seen in the office after developing a varicella-like rash of 50 lesions or less. Specific treatment was not reported and the patient recovered. No product quality complaint was reported. No further information was available. Additional information has been requested.


VAERS ID: 302566 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Colorado  
Vaccinated:2006-10-02
Onset:2007-08-16
   Days after vaccination:318
Submitted: 2008-01-04
   Days after onset:141
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2174DA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS U2174DA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0832F / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683C / 4 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Blister, Dermatitis diaper, Erythema, Herpes zoster, Rash, Skin lesion, Urticaria, Varicella
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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: ATARAX, 3/4 dose; PREVACID, 15 mg
Current Illness: Oesophageal acid reflux
Preexisting Conditions: Bronchiolitis; incisional hernia repair; the patient has no reported adverse events with previous vaccines.
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0710USA03266

Write-up: Initial and follow up information has been received from a physician concerning a 22 month old white female with esophageal acid reflux and a history of bronchiolitis and incisional hernia repair, with no known food or drug allergies who on 02-OCT-2006 was vaccinated subcutaneously into the left arm with a first dose of ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process) (Lot # 655140/0832F). Concomitant vaccine therapy that same day included a fourth dose intramuscularly into the right thigh of PREVNAR (Lot #B08683C), a first dose of HAVRIX (Lot #U2174DA) intramuscularly into the right thigh, and a first dose of FLUZONE (lot #U2174DA) administered intramuscularly into the left thigh. Concomitant therapy included: PREVACID and ATARAX, (also reported to have been treatment). On 21 AUG 2007 the patient, presented for a sick visit with a rash to the left anterior chest, left axilla, and scattered hives throughout body. The mother noted that the patient had had a paradoxical reaction to BENADRYL the day before. The rash was described as red, raised, blistery and had been spreading for the last 4-5 days, with an onset of approximately 16 SEP 2007. It was reported that the sibling had a few red lesions on her neck 2 weeks ago. The patient was afebrile, 97 degrees, (tympanic), healthy appearing, alert and interactive and in no acute distress. The physical examination was essentially unremarkable. Pin-point vesicles on a red base in small clusters were present on the left side of the chest, axilla, arm, and back. A few isolated similar lesions were present on the right shoulder and leg. No super infection was present. Final assessment was Varicella without mention Comp, also reported as shingles. A non-specific mild/resolving diaper dermatitis was also noted at the time of examination. There was no illness at the time of vaccination. The patient has no reported adverse events with previous vaccines. Polysporin was prescribed to treat "the rash". At the time of reporting the patient was considered recovered, date unknown. Symptoms reportedly persisted until "Labor Day" 03 SEP 2007. It was also confirmed that the patient had only one episode of shingles. There was no product quality complaint.


VAERS ID: 302567 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Tennessee  
Vaccinated:2006-07-17
Onset:2006-07-25
   Days after vaccination:8
Submitted: 2008-01-07
   Days after onset:531
Entered: 2008-01-09
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB105CA / UNK UN / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 652234/0951R / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Irritability, Rash maculo-papular
SMQs:, Neuroleptic malignant 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Chickenpox~Measles + Mumps + Rubella + Varicella (ProQuad)~1~1.10~In Sibling
Other Medications:
Current Illness: Birth twin
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Body temp 07/25/06 101 degr Febrile.
CDC Split Type: WAES0608USA01217

Write-up: Information has been received from a physician''s assistant concerning her 13-month-old Caucasian, birth twin son with no pre-existing allergies, birth defects or medical conditions, who, on 17-Jul-2006 was vaccinated with a first dose of PROQUAD (lot #652234/0951R). Concomitant vaccination given on the same day included a first dose of HAVRIX (lot #AHAVB105CA). There was no illness at the time of vaccination. On 25-Jul-2006, the patient developed a fever of 101-103 degrees Fahrenheit. The patient also experienced fussiness and a scattered rash described as macular-papular rash that appeared on 28-Jul-2006 at 7:00 am. No medical attention was sought. The patient was treated with diphenhydramine hydrochloride (BENADRYL) for the rash and acetaminophen (TYLENOL) for the fever. Subsequently, the patient recovered on 01-Aug-2006. The patient''s vaccination history included: PEDIARIX given in the right thigh on 30-Aug-2005 (lot #AC21BC15DA), 02-Nov-2005 (lot #AC21B022BA) and 21-Dec-2005 (lot #AC21B053AA); PEDVAXHIB given in the left thigh on 30-Aug-2005 (lot #651250/0186R), 02-Nov-2005 (lot #651897/0529R) and 21-Dec-2005 (lot #652026/0541R); and PNU-IMUNE 23 given in the left thigh on 30-Aug-2005 (lot #A85856F), 02-Nov-2005 (lot #B10637E), and 21-Dec-2005 (lot #B08686). The patient''s sister had the same symptoms, however, the lesions were more severe (WAES #0608USA00904). Additional information has been requested.


VAERS ID: 302568 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2007-04-27
Onset:2007-10-05
   Days after vaccination:161
Submitted: 2008-01-04
   Days after onset:91
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / 1 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808692F / 4 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Biopsy skin abnormal, Herpes virus infection, Injection site rash, Injection site vesicles, Rash, Virus culture
SMQs:, Anaphylactic reaction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Skin tumours of unspecified malignancy (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:
Current Illness: Otitis media
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: biopsy, herpes infection; viral culture, 10/12/07
CDC Split Type: WAES0710USA02587

Write-up: Information has been received from a physician concerning an approximately 17 month old male who in May 2007 (five months ago), was vaccinated with the first dose of 0.5 ml ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process). On approximately 03-OCT-2007 (about a week ago) the patient experienced vesicles were formed around the injection sight and dermatome rash that traveled from patients head up to injection sight. The physician believes that it may be "something like shingles". The patient was referred to a dermatologist and is waiting to hear from him with a diagnosis. The dermatologist did a test to determine the diagnosis and results were pending. Follow-up was received from the physician. On 24-APR-2007, the patient was vaccinated with the first dose ProQuad (Enders-Edmonston, Jeryl Lynn, Wistar RA 27/3, Oka/Merck upgrade process) (Lot # "97586D1", invalid) SQ. Concomitant vaccination included the fourth dose of PREVNAR (Lot # 808692F) IM. Illness at the time of vaccination included left otitis media and was being treated with AUGMENTIN. The patient had no pre-existing allergies, birth defects, or medical conditions. On 05-OCT-2007, the patient had a rash on her left arm vesicular lesions in clusters following dermatomes C6-C8 and T1-T2. The physician reported that the rash consistent with herpes zoster in same arm as MMR-V given 5 1/2 months earlier. On 20-OCT-2007, the patient was seen by the dermatologist for initial consultation who stated "our impression of his dermatomal cutaneous eruption was herpes zoster vs. an allergic reaction dermatitis". The patient''s parent were advised to continue acyclovir, AUGMENTIN and ELCON ointment. A punch biopsy and confirmed a diagnosis of herpes infection. Unfortunately, we could not prove this viral culture as he was already on appropriate antiviral therapy when this test was obtained on 12-OCT-2007. Given the linear distribution and histologic findings we favored a diagnosis of herpes zoster as opposed to cutaneous herpes simplex or primary varicella. On 16-OCT-2007, his eruption was resolving well. The patient''s parents were advised to discontinue mometasone furoate and complete the acyclovir. No further information was available.


VAERS ID: 302569 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Ohio  
Vaccinated:2007-03-12
Onset:2007-09-22
   Days after vaccination:194
Submitted: 2008-01-04
   Days after onset:104
Entered: 2008-01-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1391F / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Blister, Culture wound negative, Tenderness, Viral DNA test positive
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (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: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: VZV strain 09/28/07 positive; Wound culture 09/28/07 no
CDC Split Type: WAES0710USA02640

Write-up: Information has been received from a physician concerning an 18 month old female with no pre-existing allergies, birth defects, or medical conditions who in the P.M. of 12-Mar-2007, received a subcutaneous first dose in her right thigh of PROQUAD (lot #656307/1391). It was reported that she had no illness at the time of the vaccination and had not experienced any adverse events from previous vaccinations. It was reported that on 22-Sep-2007, she developed vesicles and blister cluster erupted to her right thigh inner aspect. On 28-Sep-2007, she presented to the physician for evaluation. The doctor reported that the vesicles and blister cluster were tender to touch and looked like classic shingles. Diagnostics obtained on 28-Sep-2007, included varicella-zoster virus culture (positive) and a superficial wound culture of the right inner thigh (negative). It was reported that as of 04-Oct-2007, she had recovered with all drying lesions. A product quality complaint was not reported. No further information was available. Additional information is not expected.


VAERS ID: 302677 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: California  
Vaccinated:2006-12-12
Onset:2006-12-13
   Days after vaccination:1
Submitted: 2007-12-17
   Days after onset:369
Entered: 2008-01-09
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 4 RA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U219BA / UNK UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0785F / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Inappropriate schedule of drug administration, Injection site cellulitis, Injection site erythema, Injection site oedema, Medication error
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (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: No concurrent medication.
Current Illness: Unknown
Preexisting Conditions: The subject had no adverse events following receipt of prior immunizations. The subject had no pre-existing medical conditions. The subject''s concurrent conditions were not reported. The healthcare professional also reported that 3 other subjects experienced injection site reactions following receipt of Infanrix from lot AC14B047AA. Please see cases A0643632A, A0643638A and A0643639A.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0643616A

Write-up: This case was reported by a healthcare professional and described the occurrence of injection site redness in a 1-year-old male subject who was vaccinated with Pediarix for prophylaxis. The subject had no adverse events following receipt of prior immunizations. The subject had no pre-existing medical conditions. The subject''s concurrent conditions were not reported. There were no concurrent medications. On 12 December 2006 at 10:00 a.m. the subject received 4th dose of Pediarix in the right arm. Pediarix is not recommended as a booster (or 4th dose) in the diphtheria and tetanus toxoids and acellular pertussis vaccine or inactivated poliovirus vaccine immunization series. On 12 December 2006, the subject also received Hib vaccine and influenza virus vaccine at unspecified sites of administration. On 13 December 2006, 1 day after vaccination with Pediarix, the subject experienced redness and edema at the injection site of Pediarix. On 14 December 2006, the subject was seen at a physician''s office and was diagnosed with injection site cellulitis. The healthcare professional considered the events were clinically significant (or requiring intervention). The subject was treated with Rocephin and Augmentin. At the time of initial reporting, 14 March 2007, the events were resolved.


VAERS ID: 302233 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Idaho  
Vaccinated:2007-12-13
Onset:2007-12-13
   Days after vaccination:0
Submitted: 2007-12-14
   Days after onset:1
Entered: 2008-01-10
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2458BA / 1 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1801U / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1510U / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID07050

Write-up: Several hours after receiving vaccinations pt. developed hives.


VAERS ID: 302238 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Idaho  
Vaccinated:2007-11-06
Onset:2007-11-06
   Days after vaccination:0
Submitted: 2007-11-07
   Days after onset:1
Entered: 2008-01-10
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2460EA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0185U / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1340U / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Chest X-ray normal, Full blood count, Full blood count normal, 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: Upper respiratory illness
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC-normal; CXR-negative
CDC Split Type: ID07047

Write-up: Pt. started having a fever at about 12:00pm, it continues to get higher & they went to the ER at 7:00pm when temp. was 106.5 degrees. They did some labs and a CXR, was treated with Tylenol & Motrin & sent home.


VAERS ID: 302255 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Idaho  
Vaccinated:2007-09-19
Onset:2007-09-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2008-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0204U / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 4 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0832U / 2 UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Body temperature increased, Febrile convulsion
SMQs:, Neuroleptic malignant 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: Benadryl, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID07041

Write-up: Vaccines MMR, varicella & Prevnar administered 9/19/07. On 9/23/07 pt had fever & a seizure. Temp not taken until fever started to come down, was 103.6 at that time.


VAERS ID: 302261 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-01-04
Entered: 2008-01-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2459KA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0500U / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0283U / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0720U / 1 LL / -

Administered by: Military       Purchased by: Military
Symptoms: Injection site bruising, Injection site discolouration, Injection site erythema, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Patient developed a sensitive hyperpigmented area at site of vaccines. Was initially red, then became bruise-like and now is red/purple. No lump felt. Not hot. "1"x 1/2" on left anterior thigh.


VAERS ID: 302265 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: North Carolina  
Vaccinated:2008-01-03
Onset:2008-01-04
   Days after vaccination:1
Submitted: 2008-01-07
   Days after onset:3
Entered: 2008-01-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2289CA / 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145B / 4 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, White blood cell count normal
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: WBC 14,000
CDC Split Type:

Write-up: 5 cm redness R thigh. 2.5 cm redness L thigh. Tx: Tylenol and Motrin.


VAERS ID: 302272 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Nevada  
Vaccinated:2007-11-12
Onset:2007-11-19
   Days after vaccination:7
Submitted: 2007-12-18
   Days after onset:29
Entered: 2008-01-10
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2456EA / 3 LL / IM

Administered by: Other       Purchased by: Public
Symptoms: Erythema multiforme, Eye swelling, Platelet count normal, Rash, Red blood cell sedimentation rate normal
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fell & broke tooth~Influenza (Seasonal) (no brand name)~UN~1.60~In Patient
Other Medications:
Current Illness: Upper respiratory infection
Preexisting Conditions: NKDA, possible allergy to chocolate
Allergies:
Diagnostic Lab Data: Platelet 640 (not low); ESR 8 (normal)
CDC Split Type:

Write-up: Puffy eyes, erythema multiforme (no mucosal involvement, no trouble breathing). Treated with epinephrine in the ER several times, oral Prednisone, Benadryl, dexamethasone. Symptoms occurred 6 days after vaccine and the rash lasted about 4 days then resolved.


VAERS ID: 302329 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: California  
Vaccinated:1998-09-25
Onset:2007-08-02
   Days after vaccination:3233
Submitted: 2008-01-07
   Days after onset:158
Entered: 2008-01-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Varicella
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: varicella~Varicella (no brand name)~2~0.00~In Sibling
Other Medications: None
Current Illness: URI, LOM
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Dx made by MD.
CDC Split Type:

Write-up: Varicella (despite vaccinated 9/25/98).


VAERS ID: 302333 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Massachusetts  
Vaccinated:2007-12-27
Onset:0000-00-00
Submitted: 2008-01-01
Entered: 2008-01-10
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291BA / 4 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF291AC / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1030U / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Pyrexia, Swelling, Weight bearing difficulty
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever 102.9 evening of shot and unable to bear weight on leg for 2 days with redness and swelling for 2 days. Fussiness for 3 weeks. No redness or swelling at time of revisit 1/8/08.


VAERS ID: 302335 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Maryland  
Vaccinated:2007-12-17
Onset:2008-01-02
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2008-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB225AA / 1 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. U74805 / 1 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540160 / 3 UN / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 150000 / 1 UN / SC

Administered by: Private       Purchased by: Unknown
Symptoms: 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1/2/08 Vesicular rashes on face and chest. 1/7/08 Vesicular rashes on trunk, legs, and arms.


VAERS ID: 302460 (history)  
Form: Version 1.0  
Age: 1.11  
Sex: Male  
Location: Colorado  
Vaccinated:2007-09-10
Onset:2007-12-13
   Days after vaccination:94
Submitted: 2008-01-11
   Days after onset:29
Entered: 2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1965 / 4 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 3 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0431U / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808690K / 4 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Herpes zoster, Lacrimation increased, Pyrexia, Rash vesicular, Rhinorrhoea, Scab
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Lacrimal disorders (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: PCP diagnosed Shingles.
CDC Split Type:

Write-up: The mother noticed spots on the left hip below the diaper. Clusters appeared on the left thigh about two to three inches above the knee. Mother said he had a runny nose and runny eyes with a fever that that was low grade prior to the cluster. She said they scabbed over and the child did not appear to have any itching or irritation from the clusters.


VAERS ID: 302482 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Tennessee  
Vaccinated:2007-07-05
Onset:2007-07-07
   Days after vaccination:2
Submitted: 2007-12-12
   Days after onset:158
Entered: 2008-01-11
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 4 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692A / 3 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Allergy test, Blood immunoglobulin G decreased, Diarrhoea, Full blood count abnormal, Injection site mass, Stool analysis normal
SMQs:, Haematopoietic leukopenia (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simethicone
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abnormal CBC/Normal Stool Studies/Abnormal allergy tests/Low IgG
CDC Split Type:

Write-up: Diarrhea Started 48 hours later Dr says chronic non specific diarrhea. (Treatment: High Fat diet) undigested food particles in stool. Hard Rd Knots on legs 1 lasted over 6 weeks.


VAERS ID: 302522 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: California  
Vaccinated:2007-12-27
Onset:2008-01-09
   Days after vaccination:13
Submitted: 2008-01-11
   Days after onset:2
Entered: 2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB207AA / 1 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0498F / 1 LA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300B / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0830U / 1 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site vesicles
SMQs:

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
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: over exact location where he received his SQ Varicella vacc a cluster of clear fluid filled veiscles on a red base 3.5 cm round


VAERS ID: 302527 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Utah  
Vaccinated:2003-03-25
Onset:2008-01-03
   Days after vaccination:1745
Submitted: 2008-01-11
   Days after onset:8
Entered: 2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0208M / 2 UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Varicella
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:
Current Illness:
Preexisting Conditions: Previously healthy child
Allergies:
Diagnostic Lab Data: clinical diagnosis
CDC Split Type:

Write-up: contracted (dr. diagnosed) chickenpox after receiving 2 Varicella shots mild case <50 lesions-onset 1-3-08


VAERS ID: 302596 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Missouri  
Vaccinated:2007-12-27
Onset:2007-12-27
   Days after vaccination:0
Submitted: 2008-01-09
   Days after onset:13
Entered: 2008-01-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2460EA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF217AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0808U / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 4 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Febrile convulsion, Full blood count normal, Influenza serology negative, Metabolic function test normal, Urine analysis normal, Virus serology test
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. Had been pulling on ears day of vax. TMs OK. Teething. Family hx of seizures.
Allergies:
Diagnostic Lab Data: CBC, BMP, UA/flu, RSV all WNL. Labs and Diagnostics: CXR (-), CBC WNL, UA WNL, Chem unremarkable. Cultures (-)
CDC Split Type:

Write-up: Febrile sz w/i 24 hours of 1 yr vaccines. 01/14/2008 VAERS report submitted with MR attached for ER visit 12/27 2007 with DX febrile seizure. Child developed fever night of vax, went limp, vomited , then began shaking which last ~5-10 minutes. Temp was 104. Returned to hospital with fever again 1/2/08, no seizure activity


VAERS ID: 302606 (history)  
Form: Version 1.0  
Age: 1.32  
Sex: Male  
Location: Texas  
Vaccinated:2007-11-26
Onset:2008-01-12
   Days after vaccination:47
Submitted: 2008-01-14
   Days after onset:2
Entered: 2008-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B049AA / 4 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB213AA / 7+ RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Injection site mass, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: URI- Treatment Accuhist. Lump on right deltoid - no treatment was given. Mom described that it was red and swollen after vaccination was given on 11-26-2007.


VAERS ID: 302607 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Ohio  
Vaccinated:2008-01-04
Onset:2008-01-11
   Days after vaccination:7
Submitted: 2008-01-14
   Days after onset:3
Entered: 2008-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB213AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0280U / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1490U / 1 LL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blister, Ear infection, Injection site erythema, Pyrexia
SMQs:, Severe cutaneous adverse reactions (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~0.00~Patient
Other Medications: UNKNOWN
Current Illness: Patient teething with large blister-like areas on gums.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Multiple blister-like areas noted with erythema around vaccination site approximately 1.5 cm in diameter. Symptoms started on 1-11-2008. Patient seen by Pediatrician, reports he also had an ear infection and low grade fever.


VAERS ID: 302618 (history)  
Form: Version 1.0  
Age: 1.67  
Sex: Female  
Location: Washington  
Vaccinated:2008-01-07
Onset:2008-01-09
   Days after vaccination:2
Submitted: 2008-01-14
   Days after onset:5
Entered: 2008-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB213AA / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cellulitis, Erythema, Injection site rash, Pyrexia, Skin warm, Urticaria
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoride drops
Current Illness: Rash on back of arms
Preexisting Conditions: Umbilical hernia
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt was given Pediarix and Hep A vaccinations on 1/7/08; were given in her right thigh. Redness and warmth to the touch began thereafter; pt re-examined on 1/9/08 and at that point, she had a normal temperature in our office and a 2-3 inch (diameter) erythematous, slightly raised, rash localized circumferentially around the injection sites. Pt was diagnosed with Cellulitis of Leg and Immunization Reaction--told to use warm or cool compresses, Tylenol for pain. Advised that this reaction was not uncommon with Pediarix. Advised to follow-up with any high fever/streaking/spreading of the rash.


VAERS ID: 302628 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: California  
Vaccinated:2008-01-03
Onset:2008-01-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2008-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481FA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF218AB / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 02870 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016H / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1581U / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Blister, Food allergy, Rash
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash around mouth and trunk. Rash on right leg with blistering x approx. 3 days. Pt had egg allergy causing allergic rash. Prescribed Benadryl 6 mg by mouth every 6 hours and hydrocortisone 1% cream twice a day as needed.


VAERS ID: 302637 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2007-12-13
Onset:2007-12-24
   Days after vaccination:11
Submitted: 2008-01-14
   Days after onset:21
Entered: 2008-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 4 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1116U / 1 RL / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~0.00~In Patient|not known~ ()~~0.00~In Sibling
Other Medications:
Current Illness: None
Preexisting Conditions: none known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RASH and BUMPS AROUND SITE; no Temperature


VAERS ID: 302638 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2007-12-20
Onset:2008-01-02
   Days after vaccination:13
Submitted: 2008-01-04
   Days after onset:2
Entered: 2008-01-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB143BA / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0424U / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1251U / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Blister, Rash
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: none~ ()~~0.00~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 1-2-08 woke up with rash & got worse throughout the day. Rash was small red spots/blisters.


VAERS ID: 302639 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-06-07
Onset:2008-01-07
   Days after vaccination:4231
Submitted: 2008-01-08
   Days after onset:1
Entered: 2008-01-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0095D / 1 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Rash, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: Chicken pox
CDC Split Type:

Write-up: Rash


VAERS ID: 302642 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Ohio  
Vaccinated:2007-12-31
Onset:0000-00-00
Submitted: 2008-01-08
Entered: 2008-01-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1258U / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0282U / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145K / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1328U / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: None
CDC Split Type:

Write-up: Fever, red bump on thigh


VAERS ID: 302643 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Michigan  
Vaccinated:2007-12-20
Onset:2007-12-30
   Days after vaccination:10
Submitted: 2008-01-17
   Days after onset:18
Entered: 2008-01-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 1 UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0284U / 1 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1338U / 1 UN / UN

Administered by: Other       Purchased by: Public
Symptoms: Erythema, Influenza like illness, Malaise, 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: none~ ()~~0.00~In Patient|none~ ()~~0.00~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Not aware
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient''s mother reports that she noticed "Non-Raised" Red Rash Started on patient''s Torso, with patient feeling general malaise, flu-like symptoms - took child to their Pediatrician no other treatment given


VAERS ID: 302657 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Colorado  
Vaccinated:2007-12-06
Onset:2007-12-16
   Days after vaccination:10
Submitted: 2008-01-02
   Days after onset:17
Entered: 2008-01-14
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1503U / UNK RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Impetigo, Varicella
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received varicella vaccine 12/6/07, seen 12/26/07 and diagnosed with varicella head to toe lesions. Seen again 12/28/07 and treated for Impetigo.


VAERS ID: 302662 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: South Carolina  
Vaccinated:2008-01-08
Onset:2008-01-08
   Days after vaccination:0
Submitted: 2008-01-09
   Days after onset:1
Entered: 2008-01-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B061BB / 4 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 4 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145K / 4 RL / IM

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

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

Write-up: Temp 104 F - axillary. No further pertussis vaccine.


VAERS ID: 302667 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Massachusetts  
Vaccinated:2007-12-28
Onset:2007-12-28
   Days after vaccination:0
Submitted: 2008-01-11
   Days after onset:14
Entered: 2008-01-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2291B2 / 4 - / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB141AA / 1 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF291AC / 4 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Blood test, Chest X-ray, Culture urine, 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: MVZ Fl
Current Illness: Ear infection 2 weeks prior
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood work, BC, urine culture, CXR all week.
CDC Split Type:

Write-up: Febrile seizure - fever 103


VAERS ID: 302669 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Alabama  
Vaccinated:2007-12-17
Onset:2007-12-24
   Days after vaccination:7
Submitted: 2008-01-09
   Days after onset:16
Entered: 2008-01-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 4 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z1009 / 3 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Blood test normal, Chest X-ray normal, Cough, Pyrexia, X-ray normal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Blood test all normal; Chest and neck x-rays=Normal
CDC Split Type:

Write-up: Fever/cough (mother insist symptoms were from flu shot)


VAERS ID: 302798 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Colorado  
Vaccinated:2007-12-14
Onset:2007-12-14
   Days after vaccination:0
Submitted: 2007-12-14
   Days after onset:0
Entered: 2008-01-14
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. - / UNK NS / IN

Administered by: Other       Purchased by: Other
Symptoms: Wrong drug 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: Concomitant Drug(s) Not Reported
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MEDI0006307

Write-up: A non-serious report of an 18-month old female who received FluMist by accident was received from a consumer. This case is submitted in accordance with MedImmune''s post-marketing commitment on accelerated reporting for the newly indicated population of 2 years to 59 months of age for FluMist. No medical history nor concomitant medications were provided. The patient received FluMist on 14Dec2007. The 18-month-old patient was inadvertently administered FluMist. No other events were reported. No outcome for the event was provided by the reporter. No dechallenge or rechallenge occurred. The reporter provided no causality assessment for the event. The reporting source of this case is spontaneous, thus the sponsor''s comment is not applicable.


VAERS ID: 302739 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Missouri  
Vaccinated:2005-08-04
Onset:2008-01-14
   Days after vaccination:893
Submitted: 2008-01-15
   Days after onset:1
Entered: 2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0030R / 1 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0119R / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Blister, Excoriation, Rash papular
SMQs:, Severe cutaneous adverse reactions (broad), Accidents and injuries (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: None WCC 12 mo
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Scattered papules, sl, vesicular, few excoriated, thick on back, few on legs, face, thighs.


VAERS ID: 302747 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Georgia  
Vaccinated:2007-05-05
Onset:2007-05-18
   Days after vaccination:13
Submitted: 2007-12-10
   Days after onset:206
Entered: 2008-01-15
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1965GA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0149F / 1 LA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Full blood count, Measles antibody, Mumps antibody test, Pyrexia, Rash, Red blood cell sedimentation rate, Rubella antibody test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rash. fever


VAERS ID: 302750 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Male  
Location: Texas  
Vaccinated:2008-01-14
Onset:2008-01-15
   Days after vaccination:1
Submitted: 2008-01-15
   Days after onset:0
Entered: 2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK RA / UN

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

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

Write-up: ERYTHEMA & INDURATION 1 X 1.5 IN OVER RIGHT ARM (PCV7) NO TREATMENT EXCEPT FOR WARM COMPRESSES.


VAERS ID: 302765 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2007-05-30
Onset:2008-01-02
   Days after vaccination:217
Submitted: 2008-01-07
   Days after onset:5
Entered: 2008-01-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0118U / 1 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 3 RL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0301U / 1 RA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 4 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Herpes zoster
SMQs:, 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: None
CDC Split Type:

Write-up: Shingles R c8 distribution Oral


VAERS ID: 302767 (history)  
Form: Version 1.0  
Age: 1.28  
Sex: Female  
Location: North Carolina  
Vaccinated:2007-12-13
Onset:2007-12-14
   Days after vaccination:1
Submitted: 2007-12-21
   Days after onset:7
Entered: 2008-01-15
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2289AA / 4 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2508AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700B / 6 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Coma, Convulsion, Nuclear magnetic resonance imaging abnormal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), 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), 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI-results positive
CDC Split Type:

Write-up: Approximately, 14 hours after Immunizations: Child had acute onset of prolonged seizures activity was transported to hospital ER (in ambulance) then Life Lifted to "another" hospital. Approximately 24 hours of coma - no vent support.


VAERS ID: 302768 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: North Carolina  
Vaccinated:2007-12-20
Onset:2008-01-02
   Days after vaccination:13
Submitted: 2008-01-09
   Days after onset:7
Entered: 2008-01-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0255U / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 02846 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143A / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1495U / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Skin 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: (12/14/07) cellulitis left Breast
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 1/4/2008 Over last couple days has nodular density popping up in the lateral left thigh. Same are varicella vaccine on Dec 20. Seen by MD Instructed if gets worse can use over the counter Tylenol and Benadryl


VAERS ID: 302773 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Oklahoma  
Vaccinated:2007-12-20
Onset:2007-12-21
   Days after vaccination:1
Submitted: 2008-01-15
   Days after onset:25
Entered: 2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR U17396C / 4 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB231AA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0912U / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702B / 4 LL / IM

Administered by: Other       Purchased by: Other
Symptoms: Erythema, 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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Shot given 12-20-07 - Had fever of 103 for 3days 4th day Rash - was taken to ER - Still has Red bumps on right leg


VAERS ID: 302779 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Nevada  
Vaccinated:2008-01-02
Onset:2008-01-13
   Days after vaccination:11
Submitted: 2008-01-15
   Days after onset:2
Entered: 2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0247U / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1307U / 1 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1580U / 1 LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, 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? 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: Rash all over body, fever.


VAERS ID: 302783 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Florida  
Vaccinated:2008-01-08
Onset:0000-00-00
Submitted: 2008-01-10
Entered: 2008-01-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1329V / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Discomfort, Erythema, Pruritus, Rash papular
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? 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: 2 inch diameter raised rash on left thigh. Itchiness, discomfort, redness visible, afebrile. Came into office on 1/10/08 to show leg and irritation prominent.


VAERS ID: 302793 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Texas  
Vaccinated:2008-01-03
Onset:2008-01-04
   Days after vaccination:1
Submitted: 2008-01-08
   Days after onset:4
Entered: 2008-01-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB175AA / 1 RA / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 4 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Induration
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? 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: Erythema and induration at the PCV-7 site (1 x 1.5 in). No treatment except warm compresses.


VAERS ID: 302805 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Michigan  
Vaccinated:2007-11-30
Onset:2007-12-28
   Days after vaccination:28
Submitted: 2008-01-08
   Days after onset:11
Entered: 2008-01-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2480AA / 1 RL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB207BA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0527U / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1473U / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Idiopathic thrombocytopenic purpura, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: cold symptoms approx 1 mos
Preexisting Conditions: PMH: full term, c-section, jaundice at birth tx w/phototx. Mother GBS (+). Family hx of diabetes. Had roseola in past.
Allergies:
Diagnostic Lab Data: Platelet count decreased to 8,000 LABS: WBC 7.8, plts 9,000 on admit, 58,000 at d/c, differential WNL. BUN/creat ratio 62 (H), alk phos 3518 (H), LD/LDH 445 (H). UA w/RBC & WBC, pH 8.0 (H), c/s neg.
CDC Split Type:

Write-up: Idiopathic Thrombocytopenia Purpura platelet count 8,000. Following WinRho platelet count recovered to 234,000. 1/22/08 Reviewed pcp medical records which reveal patient experienced rash x 3 days when seen 12/31/07 w/o fever or other signs of illness. Exam revealed petechia on extremities, trunk & back & multiple purple bruises on shins & left forehead. Labs done revealed decreased plts. Hospitalized 12/31/07-1/1/08 & received WinRo. Plts increased from 8,000 to 58,000 & microscopic hematuria improved. Consult by peds heme/onc while hospitalized. Plts count repeated on visit 1/4 & were 234,000. Having mild diarrhea & diaper rash. Petechia & bruises were resolving. Was to continue serial labs & heme/onc f/u. FINAL PCP DX: ITP, resolving; anemia secondary to WinRo. 1/22/08 Reviewed hospital medical records which reveal patient experienced rash, bruising, irritability & sleepiness x 3 days. Transient diarrheal illness in pt & parents 1-2 wks & URI 1 mo prior to admit. Both parents w/viral URI. Admitted 12/31/07-1/1/08. Responded well to WinRo & d/c to home w/heme & lab f/u. FINAL DX: Immune thrombocytopenic purpura & benign hyperalkaline phosphotase (qcquired vx familial), microscopic hematuria, resolving.


VAERS ID: 302824 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2008-01-04
Onset:2008-01-13
   Days after vaccination:9
Submitted: 2008-01-16
   Days after onset:3
Entered: 2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Irritability, Pyrexia, Rash generalised, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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: Amoxicillin for ear infection - last dose on 1/13/08.
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9 days after the vaccine, he was unusually fussy and sleepy and had a fever of 101 degrees F. 10 days after the vaccine, he woke up with a rash all over his body and a slight fever. The rash has lasted from Monday morning and he still has it. Today, Wednesday, his cheeks have been bright red, he has a slight fever, and the rash all over still.


VAERS ID: 302834 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Alabama  
Vaccinated:2008-01-04
Onset:2008-01-14
   Days after vaccination:10
Submitted: 2008-01-16
   Days after onset:2
Entered: 2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 0077U / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 0147F / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Pruritus, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash to body that has spread, itching (Papular) - started on 1/14/08. Benadryl 12.5mg, 1/2 - 3/4 tsp every 6 hours for itching.


VAERS ID: 302955 (history)  
Form: Version 1.0  
Age: 1.24  
Sex: Female  
Location: Indiana  
Vaccinated:2008-01-02
Onset:2008-01-02
   Days after vaccination:0
Submitted: 2008-01-17
   Days after onset:15
Entered: 2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR U15656C / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1217F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 3 RL / IM

Administered by: Unknown       Purchased by: Unknown
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: Albuterol Nebulizer Treatments 1 QID PRN
Current Illness: Wheezing, Sneezing, and Coughing
Preexisting Conditions: Apnea @ birth, Heart Murmur, and Dwarfism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 1/02/08 Patient was given TriHib, Prevnar, and MMR. That evening patient had a fever of 104.5F and seizure.


VAERS ID: 302963 (history)  
Form: Version 1.0  
Age: 1.44  
Sex: Female  
Location: North Carolina  
Vaccinated:2008-01-16
Onset:0000-00-00
Submitted: 2008-01-17
Entered: 2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02554 / 4 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 4 RL / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B018AB / 4 RL / -

Administered by: Private       Purchased by: Public
Symptoms: 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No treatment needed.


VAERS ID: 302974 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2008-01-09
Onset:2008-01-11
   Days after vaccination:2
Submitted: 2008-01-12
   Days after onset:1
Entered: 2008-01-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2505AA / 2 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1501U / 1 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Blister, Full blood count normal, Pyrexia, Varicella, Virus culture
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 1. CBC & diff 1/12/08-normal. 2. varicella virus culture from blisters taken 1/12/08.
CDC Split Type:

Write-up: Varicella vaccine given 1/9/08, broke out with varicella on 1/12/08. 102 degree fever on 1/12/08 and 2 blisters of varicella on abdomen on 1/12/08.


VAERS ID: 302978 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Texas  
Vaccinated:2008-01-16
Onset:2008-01-17
   Days after vaccination:1
Submitted: 2008-01-17
   Days after onset:0
Entered: 2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07494 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 870143C / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1094U / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Blister, Injection site vesicles
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (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: Prevacid
Current Illness: None
Preexisting Conditions: GE Reflux disease, Trisomy 21
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received vaccination. Blisters on legs. MMR, Hep AV, Varivax, Prevnar. Blister both thighs size 1 cm.


VAERS ID: 302984 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: California  
Vaccinated:2008-01-02
Onset:2008-01-14
   Days after vaccination:12
Submitted: 2008-01-16
   Days after onset:2
Entered: 2008-01-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2456EA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143R / 4 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1175U / 1 - / IM

Administered by: Public       Purchased by: Other
Symptoms: Varicella
SMQs:, 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: None
CDC Split Type:

Write-up: Patient was diagnosed with the chicken pox on 1/14/08.


VAERS ID: 303011 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Ohio  
Vaccinated:2007-11-07
Onset:2007-11-14
   Days after vaccination:7
Submitted: 2008-01-17
   Days after onset:64
Entered: 2008-01-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2456GA / 2 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0287U / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Acute sinusitis, Atrial septal defect, Blood culture negative, Body temperature increased, Chest X-ray normal, Computerised tomogram abnormal, Culture urine negative, Dilatation ventricular, Echocardiogram abnormal, Expressive language disorder, Eye movement disorder, Febrile convulsion, Haematocrit decreased, Haemoglobin decreased, Herpes simplex serology negative, Hypotension, Intensive care, Intubation, Lumbar puncture normal, Lymphadenopathy, Neutropenia, Neutrophil count decreased, Nuclear magnetic resonance imaging abnormal, Personality change, Platelet count normal, Respiratory depression, Right atrial dilatation, Sinusitis, Tongue disorder, Tonic clonic movements, Unresponsive to stimuli, Viral rash, White blood cell count decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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, 0 days
   Extended hospital stay? No
Previous Vaccinations: febrile convulsion~Varicella (Varivax)~1~1.00~In Patient
Other Medications:
Current Illness: Torticollis; Congenital skull malformation NOS; Penicillin allergy
Preexisting Conditions: febrile convulsion; immunisation; diarrhea; Urinary tract infection; Fever
Allergies:
Diagnostic Lab Data: head computed axial 11/14/07 maxillary sinus opacification; no intracranial abnormality; echocardiography 11/14/07 "ASD" with left to right shunting, RA and RV enlargement; magnetic resonance 11/20/07 paranasal sinus mucosal thickening/opacification; body temp 11/14/07 40C; WBC count 11/17/07 1700 mm3; absolute neutrophil 11/17/07 630 mm3
CDC Split Type: WAES0712USA07978

Write-up: Information has been received from a health professional concerning a 13 month old 8.34 kg. 76.84 cm. female with torticollis, plagiocephaly, and an allergy to amoxicillin (rash), with a history of urinary tract infection (April 2007), diarrhea (05-AUG-2007), fever (06-AUG-2007), and febrile seizure (06-AUG-2007; WAES0712USA05193 who on 07-NOV-2007, was vaccinated with a dose of MMR II (lot#656529/0287U). Concomitant suspect vaccination given on the same day included 0.5 ml intramuscular dose in the right thigh Fluzone (lot# UT2456GA). On 14-NOV-2007 the patient developed a febrile seizure that lasted for 2 hours with a high temperature of 40 C. She was transported by ambulance to the hospital and was hospitalized for one week. In the ambulance she was given belladonna (+) chloroform (+) kaolin (+) morphine hydrochloride (+) pectin (+) phthalylsulfathiazole (+) streptomycin (DIASTAT). She was intubated and spent 5 days in the intensive care unit. While hospitalized she was given acetaminophen (TYLENOL), clindamycin, vancomycin, unspecified antibiotic and levetiracetam (KEPPRA). She was reported to be on dopamine and epinephrine at the time of the report. The mother reported that her daughter "no longer regularly says please and thank you" and "will sometimes point at something rather than asking for it". The patient''s vaccination history included that on 01-AUG-2007 she received a third 0.5 ml. dose of Haemohilus b conjugate (Meningococcal Protein Conjugate) and Hepatitis B (recombinant) vaccine, a first dose 0.5 mg of Varivax (Oka/Merck) (lot #656823/0305U), a fourth dose of 0.5 ml of DTaP (unspecified), and a fourth dose of 0.5 ml of Prevnar. Follow up information from a nurse in the primary care physician''s office reported that on 23-NOV-2007, the patient was seen in the office for a follow up visit. Current patient status was not reported. It was also reported that the patient had previously been referred to a neurologist, but the reporter was not aware of the reason for the referral. Follow up information received from medical records indicated that on 14-NOV-2007, she spiked a temperature during the afternoon and then developed eye deviation, became unresponsive, tongue smacking, and then upper extremity tonic/clonic movements. She was brought to the emergency room via an ambulance where she was administered lorazepam (ATIVAN), midazolam (VERSED), fosphenytoin times two, and Phenobarbital to stop the seizures. At that point she was intubated secondary respiratory depression. Total time of the seizure was about 90-120 minutes. A Ct scan of the head showed no intracranial abnormality and maxillary sinus opacification. A chest x-ray was normal. She remained intubated and was admitted to the pediatric intensive care unit (PICU). She remained intubated overnight, and was extubated the following morning (15-NOV-2007). Shortly, after admission she developed hypotension requiring numerous fluid boluses to keep her mean arterial pressure (MAP) above 40. Therapy with dopamine and epinephrine was initiated and titrated as tolerated. The etiology of the hypotension was unclear, likely due to sedation from the Phenobarbital or midazolam (VERSED) versus infection. On 16-NOV-2007, she was weaned off the epinephrine drip. An echocardiogram revealed "ASD" with left to right shunting as well as enlargement of the RA and RV with normal biventricular function. Cardiology was consulted with a plan for cardiology follow up as an outpatient. On 19-NOV-2007, the dopamine was weaned off with MAP''s consistently in the mid 50''s. She was kept on maintence intravenous fluids (MIVF''s), and 90ml/kg normal saline boluses to keep her MAP''s in the 60''s. Serial electrolytes were followed that were normal. On 17-NOV-2007, she was started on total parental nutrition (TPN) and advancement of her po food. By 19-NOV-2007, she was taking full po and her IVs were stopped. There was concern for infection as the cause of her seizures. Blood and urine cultures were obtained and resulted as normal. A lumbar puncture (LP) was performed that revealed spinal fluid results of on gram stain and a culture (negative). She was started on Clindamycin, Acyclovir, and Cefotaxime while cultures were pending (date not reported). The Acyclovir was discontinued when the "HSV PCR" was negative. On 16-NOV-2007, clindamycin was added for broader antibiotic coverage. She remained persistently febrile (values not reported). Repeat cultures were obtained that were also negative. With the hypotension and cultures negative for sepsis, she was treated with a seven day course of intravenous antibiotic to be followed with an additional seven days of oral Omnicef with maxillary sinusitis on CT scan. She exhibited decreasing WBC count and on 17-NOV-2007, it was 1700/mm3 with an absolute neutrophil count of 630/mm3 that by 19-NOV-2007, it had increased to 4200/mm3 WBC''s with 4200/mme, absolut neutrophils (800/mm3), hemoglobin and hematocrit of 9.2g/dl/27.9%, and a platelet count of 191,000. The depression was thought to be secondary to viral suppression given her fevers or a medication effect from phenytoin (Dilantin) or Keppra. Neurology thought her seizure activity was a complex febrile seizure. She was kept on maintenance doses of phenytoin (Dilantin) and phenobarbital following loading dose of each medication in the emergency department. At the recommendation of neurology, a loading dose of levetiracetam (Keppra) of 40 mg/kg was administered followed by 20mg/kg every 12 hours maintenance. The phenytoin (Dilantin) was weaned off and she was maintained on levetiracetam (Keppra) non-therapy. On 20-NOV-2007, she underwent an MRI of the head that was normal. On 20-NOV-2007, she was moved out of the PICu, and transferred to general floor care. By 21-NOV-2007, she had been weaned off the physician (Dilantin), transitioned to oral levetiracetam (Keppra) in anticipation of it being stopped totally prior to her discharge. On approximately 20-NOV-2007, and viral exanthema was noted from her face to her pelvis. On 21-NOV-2007, she was discharged in good condition was discharged diagnosis of complex febrile seizure, and hypotension. She was discharged on levetiracetam (Keppra) 1 ml, every 12 hours orally for 5 days, cefdinir (Omnicef) 2.5ml twice a day orally, and diazepam 5 mg per rectum as needed. On 23-NOV-2007, she was seen in her primary care givers office for follow-up post intensive care unit admission for febrile seizures. The physician''s assessment and plan was to have the patient evaluated by infectious disease to discuss if the seizure was fever related or due to a component in vaccinations. She had developed right lymphadenopathy likely due to immunizations versus recent illness and will be reassessed in 2 months. Her acute sinusitis was the only possible source of fever on evaluation and was completing a course of cefdinir (OMNICEF). The physician''s diagnosis was acute sinusitis and inguinal lymphadenopathy. On 23-NOV-2007, she presented to the infectious disease clinic for evaluation for concern that her seizures may have been related to her having received immunizations. The physician''s assessment and plan noted that her initial seizure that occurred in August 2007, she had received Varivax (Oka/Merck) one week prior to the development of the febrile seizure. The physician discussed with the patient''s mother that this might have be true and that the patient could have a low threshold for seizure activity with fever. The physician indicated that it was hard to know if the fevers were due to live vaccines or an intercurrent viral illness. It was recommended that she undergo a repeat CBC with differential to be sure that the neutropenia had resolved, and a respiratory viral PCR nasal wash to rule out viral infection which may have been related to her neutropenia and "questionable" neutropenia while hospitalized. The patient had no reported seizure activity since her discharge and the levetiracetam (Keppra) had been discontinued. Per the recommendations of neurology (date not reported). The patient''s mother reported that she was given a prescription for diazepam rectal gel (Diastat). The patient''s vaccination history included: hepatitis B (manufacturer unspecified) on 30-JUN-2006; a first dose of haemophilus B conjugate (Meningococcal Protein Conjugate) and hepatitis B (recombinant) vaccine (MSD) on 31-AUG-2006, a second dose on 24-OCT-2006, and third dose on 01-AUG-2007: DTaP (manufacturer unspecified), a first dose 31-AUG-2006, second dose 24-OCT-2006, third dose 17-JAN-2007, and a fourth dose 01-AUG-2007; inactivated polio vaccine (manufacturer unspecified), a first dose on 31-AUG-2006, second dose on 24-OCT-2006, and a third dose on 17-JAN-2007; Prevnar, a first dose on 31-AUG-2006, a second dose on 24-OCT-2006, a third dose on 17-JAN-2007, and a fourth dose on 01-AUG-2007; and Varivax (Oka/Merck), a first dose on 01-AUG-2007. Additional information has been requested. All available medical records will be provided upon request.


VAERS ID: 303036 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2008-01-10
Onset:2008-01-10
   Days after vaccination:0
Submitted: 2008-01-18
   Days after onset:8
Entered: 2008-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
TD: TETANUS DIPHTHERIA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Public       Purchased by: Public
Symptoms: Bacterial culture, Blood test, Chest X-ray, Febrile convulsion, Pyrexia, Urine analysis
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? 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: Checked blood, urinalysis, checked her for ear infection, chest X-rays
CDC Split Type:

Write-up: She had seizures, very high fever, 2 times once on 1-10-08 lasting approx 12 min, 2nd time 1-12-08 lasting approx 5 min with low grade fever.


VAERS ID: 303040 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Texas  
Vaccinated:2008-01-08
Onset:2008-01-09
   Days after vaccination:1
Submitted: 2008-01-11
   Days after onset:2
Entered: 2008-01-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 RA / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B08700E / 4 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Induration
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD test, Sanofi, C2679AC, L forearm, no previous doses
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Erythema & induration (1-1.5 in) with PCV. Warm compresses.


VAERS ID: 303088 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: New Jersey  
Vaccinated:2008-01-05
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2008-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB214AA / 2 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2557AA / 4 UN / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Wrong drug 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:
Current Illness: keratosis pilaris
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administration error. Gave Tdap instead of DTaP. No adverse event at this point.


VAERS ID: 303051 (history)  
Form: Version 1.0  
Age: 1.52  
Sex: Male  
Location: New York  
Vaccinated:2008-01-08
Onset:2008-01-08
   Days after vaccination:0
Submitted: 2008-01-19
   Days after onset:11
Entered: 2008-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LL / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Lethargy, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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:
Preexisting Conditions: eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 2 hours of the vaccination, patient became unusually lethargic with low grade fever but recovered 4 hours later. 8 days later continuing on to present time (1/19/08), patient develops fever whenever he sleeps. Fever has been up to 101.3 but has been controlled with infant Tylenol. Patient has also lost appetite, exhibited rash at hairline on 10th day after vaccine and exhibits itching during fever episodes.


VAERS ID: 303056 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: New York  
Vaccinated:2008-01-09
Onset:2008-01-14
   Days after vaccination:5
Submitted: 2008-01-20
   Days after onset:6
Entered: 2008-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2477FA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0748U / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1363U / 1 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: N/A
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: FEVER FOR 4 DAYS, 5 DAYS POST VACCINATION ASSOCIATED WITH REDNESS SLIGHT INDURATION ON SITE OF INJECTION, LEFT THIGH. FOLLOWED BY MACULOPAPULAR ERUPTION ON FACE TRUNK WHEN FEVER ABATED.


VAERS ID: 303057 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Male  
Location: California  
Vaccinated:2006-05-05
Onset:2006-05-15
   Days after vaccination:10
Submitted: 2008-01-20
   Days after onset:615
Entered: 2008-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1057R / 1 LL / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Developmental delay, Irritability, Pyrexia, Rash generalised, Speech disorder developmental
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 10 days after the vaccine was administered, the child got a red splotchy rash all over his body, mostly concentrated on the trunk (stomach and back). Child was extremely fussy, and had a fever. Child subsequently displayed developmental delays in speech and behavior, unsure if there is a correlation.


VAERS ID: 303097 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Male  
Location: Massachusetts  
Vaccinated:1999-02-26
Onset:2008-01-20
   Days after vaccination:3250
Submitted: 2008-01-21
   Days after onset:1
Entered: 2008-01-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1059H / 1 RL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Rash, Skin lesion, 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? 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: Typical varicella exanthem, 750 lesions mostly on trunk, some scattered on extremities & face.


VAERS ID: 303197 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Virginia  
Vaccinated:2008-01-14
Onset:2008-01-14
   Days after vaccination:0
Submitted: 2008-01-22
   Days after onset:8
Entered: 2008-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK LL / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK RL / -

Administered by: Military       Purchased by: Military
Symptoms: Inappropriate schedule of drug administration, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Medication errors (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: local reaction~Tdap (no brand name)~~1.00~Patient
Other Medications:
Current Illness: none
Preexisting Conditions: egg allergy; hx of eczema
Allergies:
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: Child received Prevnar in right thigh on 1/14/08 and Pediarix left thigh at about 1000. At 1800 mother noted hives from head to toe. Gave child Benadryl. Hives were gone by am. On 1/15/08 left thigh was red and warm. On 1/16/08 thigh was red, warm, swollen and hard. Evaluated on 1/17/08. Mother had been giving the child Motrin without improvement. 1/17/08 8cm diameter of swelling, erythema and induration noted left thigh. Allergist gave mother Keflex. On 1/18/08 Mom stated redness and swelling were improved. On 1/22/08 all symptoms were resolved. Mother never gave the pt Keflex.


VAERS ID: 303198 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2008-01-14
Onset:2008-01-15
   Days after vaccination:1
Submitted: 2008-01-22
   Days after onset:7
Entered: 2008-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2477BA / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425U / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 870145C / 4 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1470U / 1 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site cellulitis
SMQs:

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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 1/23/08-records received-WBC 24.5, segmented neutrophil increased 52, lymphocytes decreased 35, eosinophils increased 6, absolute neutrophils increased 13.2, absolute eosinophils increased 1.5, absolute monocytes increased 1.2.
CDC Split Type:

Write-up: Cellulitus at site left upper arm; Prevnar flu given 1/4/08; Admitted 1-15-08 -$g 1-18-08 1/23/08-records received for DOS 1/15/08-ED report presented with C/O fever since night before. Temp 103.8. Left upper arm with tender induration 2cm in diameter on lateral aspect, no fluctutation. Right upper arm lateral aspect with needle mark and mild swelling, no redness no tenderness. Impression Arm abscess. 3/27/08-DC Summary received for DOS 1/15-1/18/08 DC DX: left arm cellulitis. leukocytosis. Fever.


VAERS ID: 303212 (history)  
Form: Version 1.0  
Age: 1.33  
Sex: Male  
Location: Colorado  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-01-22
Entered: 2008-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0279U / UNK - / IM

Administered by: Unknown       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? 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: Patient''s provider called County Health and Human Services to report that patient came in 10 days after receiving MMR, and had a rash along with a low grade fever. MMR administered was Merck Lot number 0279U.


VAERS ID: 303213 (history)  
Form: Version 1.0  
Age: 1.16  
Sex: Female  
Location: Ohio  
Vaccinated:2008-01-08
Onset:2008-01-19
   Days after vaccination:11
Submitted: 2008-01-22
   Days after onset:3
Entered: 2008-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF120AA / 4 UN / SC
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0774U / 1 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016H / 4 UN / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Body temperature increased, Fatigue, Irritability, Nasal congestion, Rash, Rhinorrhoea, Viral rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ALLERGIC DERMATITIS
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had vaccines administered 01-08-08. Became congested with runny nose approx 1 week later. On 01-19-08 pt became more fussy and tired and developed a rash over bilateral upper extremities and across trunk. Pt taken to Stat Care 01-20-08 and was diagnosed with "Viral Exanthem." Family was instructed to keep pt out of child care for up to 1 week while rash still visible. Also instructed to administer infant Tylenol or Motrin as needed. Pt developed low-grade temperature of 100.0F on 01-21-08. Rash still present at this time.


VAERS ID: 303226 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: California  
Vaccinated:2008-01-10
Onset:2008-01-17
   Days after vaccination:7
Submitted: 2008-01-22
   Days after onset:5
Entered: 2008-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1470F / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568U / 1 RL / SC

Administered by: Private       Purchased by: Private
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: (L)om, Conjunctivitis
Preexisting Conditions: 34wk Preemie
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient seen in clinic 1-20-08. Right Thigh with oval Area of inflammation at injection site.


VAERS ID: 303227 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Nebraska  
Vaccinated:2008-01-11
Onset:2008-01-12
   Days after vaccination:1
Submitted: 2008-01-16
   Days after onset:4
Entered: 2008-01-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133BA / 1 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1259U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF217AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087028 / 4 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Body temperature increased, Computerised tomogram, Convulsion, Crying
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? 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: CT scan
CDC Split Type:

Write-up: On 1/12/08 patient presented to the ER with seizure lasting 45 min. Fever at the time before seizure started was 103.5 rectally. CT scan was negative. Chest x-ray was negative. From the time of discharge 1/12/08 - 1/16/08 baby cried/screamed almost all the time.


VAERS ID: 303232 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Ohio  
Vaccinated:2008-01-04
Onset:2008-01-04
   Days after vaccination:0
Submitted: 2008-01-15
   Days after onset:11
Entered: 2008-01-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0617U / 1 LL / UN

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

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

Write-up: Leg - red and blotchy - gave Benadryl, no resp difficulty.


VAERS ID: 303237 (history)  
Form: Version 1.0  
Age: 1.54  
Sex: Female  
Location: Texas  
Vaccinated:2007-12-17
Onset:2007-12-17
   Days after vaccination:0
Submitted: 2007-12-31
   Days after onset:14
Entered: 2008-01-22
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2456EA / 1 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB213AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF208AA / 2 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1028F / 1 LA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300K / 2 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1107U / 1 RA / UN

Administered by: Public       Purchased by: Public
Symptoms: Auricular swelling, Erythema, Eye swelling, Lip swelling, Pharyngeal oedema, Rash generalised
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Given immunizations on 12/17/07, parent states child''s lips, eye, ears, and throat began to swell approximately 4 hrs after immun. She sates red rash on body and face. Take to ER, was given a steroid shot and Benadryl. Stayed for 4 hrs before being released once swelling and rash started to subside.


VAERS ID: 303246 (history)  
Form: Version 1.0  
Age: 1.06  
Sex: Female  
Location: North Carolina  
Vaccinated:2008-01-16
Onset:0000-00-00
Submitted: 2008-01-17
Entered: 2008-01-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2289AA / 4 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB217AA / 1 LL / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B97283A / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1462U / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vuslon ointment; Locoid Lipocream
Current Illness: None
Preexisting Conditions: NKDA, GER, WARI
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type: NC08015

Write-up: 12 month old received a Gardasil vaccine that is not indicated for this age group. No adverse reaction noted, seen in office 1/17/08 for recheck.


VAERS ID: 303249 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Kansas  
Vaccinated:2007-08-29
Onset:2007-10-02
   Days after vaccination:34
Submitted: 2008-01-12
   Days after onset:102
Entered: 2008-01-22
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 07870 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26C10F / 4 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Culture negative, Injection site abscess sterile
SMQs:

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: abscess~Vaccine not specified (no brand name)~UN~0.60~In Patient
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Culture-sterile
CDC Split Type:

Write-up: Sterile abscess 1 month post vaccination L thigh.


VAERS ID: 303251 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Unknown  
Vaccinated:2008-01-11
Onset:2008-01-14
   Days after vaccination:3
Submitted: 2008-01-17
   Days after onset:3
Entered: 2008-01-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0185U / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H716 / 1 LL / IM

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

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

Write-up: Rash Hives on 1/14/08


VAERS ID: 303257 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2008-01-10
Onset:2008-01-19
   Days after vaccination:9
Submitted: 2008-01-21
   Days after onset:2
Entered: 2008-01-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2526AA / 2 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1259U / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1121U / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (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: GER, R OME
Preexisting Conditions: GER
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cranky x2 days. Red area of induration L upper outer thigh.


VAERS ID: 303287 (history)  
Form: Version 1.0  
Age: 1.56  
Sex: Male  
Location: New York  
Vaccinated:2008-01-21
Onset:2008-01-21
   Days after vaccination:0
Submitted: 2008-01-23
   Days after onset:2
Entered: 2008-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1857CA / 4 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2459PA / 2 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB206CA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 4 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? 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: Painful left thigh swelling to approximately twice normal diameter. No impairment of walking and no signs of infection, improving at time of office visit 1/23/08 at 9:30am.


VAERS ID: 303301 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-01-22
Entered: 2008-01-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Allergy test positive, Blood immunoglobulin E, Diagnostic procedure, Hypersensitivity, Intensive care, Pruritus, 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? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations: rash urticaria-like~Varicella (Varivax)~UN~0.00~In Patient
Other Medications: fluticasone furoate 44 microgm; vitamins (unspecified)
Current Illness: Hypersensitivity
Preexisting Conditions: Eczema; Asthma; Vaccination adverse reaction
Allergies:
Diagnostic Lab Data: allergy test see narrative; dose titration see narrative
CDC Split Type: WAES0801USA03205

Write-up: Information was received from a literature article, titled as stated above, concerning a 15-month-old adopted male with a history of eczema, asthma, and a prior adverse reaction to Varivax was referred for further allergic evaluation. Upon initial allergic evaluation, the infant was able to tolerate eggs, milk, wheat, fish, and pork. No medication allergy was documented. His medications included fluticasone 44 mcg 2 puffs daily in the morning for asthma maintenance, and multivitamins. Skin prick testing was positive for Varivax (Oka/Merck) and histamine and negative for egg and MMR II, gelatin, and normal saline solution. The patient''s mother described a previous allergic reaction to Varivax (Oka/Merck) as a rash, suggestive of generalized urticaria, for which the patient was prescribed oral prednisone for two days. Intradermal testing revealed a positive reaction to the MMR II as well as histamine, but not to saline. Subsequently the patient received diphenhydramine topical cream to control the itching. When the patient was 18 months old he was admitted to the pediatric intensive care unit for an MMR II graded challenge. The dosing protocol included an initial dose of MMR II of 0.5 ml with a 1:100 dilution, followed at 5 minutes with 0.05 ml with a 1:10 dilution. At 30 minutes 0.5 ml of MMR II was administered at full strength, followed by 0.10 ml full strength at 45 minutes, 0.15 ml full strength at 60 minutes and a final dose of 0.20 ml full strength at 75 minutes. The patient tolerated the procedure without any adverse reaction. It was also noted that the patient had tolerated subsequent vaccinations (unspecified) well. Research suggests that immediate and some non-immediate type reactions to Varivax are caused by anti-gelatin IgG or IgE immune reactions. Most individuals with IgE antibodies to gelatin and type I hypersensitivity to gelatin containing vaccines have not reported allergic reactions to gelatin prior to vaccination. Sensitization to gelatin during infancy may be attributed to prior ingestion of precooked infant food for administration of gelatin containing vaccines. The patient''s history suggested the presence of serum IgE antibodies to gelatin. Hypersensitivity after vaccination warrants consideration of gelatin allergy as a potential cause. In the opinion of the reporters hypersensitivity to gelatin, a stabilizing vaccine constituent is associated with anaphylaxis to MMR and varicella vaccines. Adverse reactions to these vaccines are commonly related to gelatin allergy. Individuals with prior hypersensitivity to gelatin-containing vaccines are more likely to experience future adverse reaction to vaccines, and therefore may benefit from a safe and rapid approach, such as a graded-dose protocol. This is one of two reports received from the same source. A copy of this published article is attached as further documentation of the patient''s experienced.


VAERS ID: 303302 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2008-01-22
Entered: 2008-01-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Adenosine deaminase deficiency, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, CD4 lymphocytes decreased, CD8 lymphocytes, Laboratory test abnormal, Lymphocyte count decreased, Pyrexia, Rash papular, Rash vesicular, Respiratory tract infection, Scab, Selective IgA immunodeficiency, T-lymphocyte count decreased, Transfusion, Varicella
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), 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? Yes, 0 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Failure to thrive; body height abnormal; weight abnormal
Allergies:
Diagnostic Lab Data: diagnostic laboratory - CD3+CD56+NKT cells (6/mm3); diagnostic laboratory - CD3+CD56+NK (150/mm3); blood transfusion; diagnostic laboratory - deoxyadenosine nucleotides (0.056 umol/mL, normal <0.002); lymphocyte count 57 mm3; serum immunoglobulin G 152 mg/d; serum immunoglobulin M 25 mg/d; serum immunoglobulin A 10 mg/d; blood CD3 count 27.4%; blood CD4 count 14.7%; lymphocyte count 560 mm3; serum adenosine 16.8 nmol; blood CD8 count 10.3%; blood CD19 count 6.3%; blood CD16 count 32.5%; blood CD3 count 55 mm3; blood CD4 count 51 mm3; blood CD8 count 7 mm3; blood CD19 count 0 mm3
CDC Split Type: WAES0801USA03090

Write-up: It was reported in a published article, title as stated above that: "Rational" Immunodeficiency should be considered in children with severe failure-to-thrive prior to administration of live vaccines. Methods: A 17 month old male with failure-to-thrive presented to the allergy consult service 14 days after a presentation to the ED with prolonged fever (Tmax 103F) and erythematous papules on his face. A respiratory infection had been diagnosed in the ED and treated with amoxicillin. Fevers persisted, and the rash evolved into grouped papules, vesicles, and crusting lesions over the face and abdomen. Past medical history revealed a growth curve below the 3rd percentile for height and weight, but no prior hospitalization or serious infection. The live attenuated varicella vaccine had been given approximately 14 days before the ED presentation. Results: Varicella infection was confirmed by direct immunofluorescence assay, and a Tzank stain showed multinucleated giant cells. Severe lymphopenia was evident, with 1% lymphocytes (57/mm3), along with decreased immunoglobulins (152 (IgG), 25 (IgM) and 10 (IgA) mg/dL) and T, B and NK cells (CD3: 27.4%, CD4: 14.7% (6/mm3), CD8: 10.3% (4/mm3), CD19 6.3%, CD16: 32.5%). The patient was transferred to a hospital after initiation of acyclovir and IVIG. Expanded lymphocyte enumeration confirmed markedly decreased T (CD3 (55/mm3), CD4 (51/mm3), CD8 (7/mm3)), B (CD19 0/mm3), and CD3+CD56+ NKT cells (6/mm3), and slightly decreased CD3-CD56+ NK cells (150/mm3). SCID was diagnosed. After RBC transfusion, lab tests revealed low levels of adenosine deaminase (ADA) (16.8 nmol/h/mg, normal 63) and increased levels of deoxyadenosine nucleotides (0.056 imol/mL, normal <0.002) in the hemosylate. Lymphocyte proliferation to PHA was decreased but present (21,377 CPM, background 189; Control 188.330, background 126). Pegylated-ADA was started at 187.5 IU IM twice weekly. Levels of ADA, lymphocyte subsets and IgG are being monitored, and after two weeks of therapy the lymphocyte count increased to 560/mm3. Conclusion: This case demonstrates the consequence following administration of a live vaccine to a child with severe failure-to-thrive who had undiagnosed SCID. To the author''s knowledge, this is the first published report of disseminated cutaneous varicella infection after vaccination as the presenting symptoms of SCID-ADA deficiency, and shows the need to consider immunodeficiency in such patient''s." A copy of the published article is attached as further documentation of the patient''s experience.


VAERS ID: 303313 (history)  
Form: Version 1.0  
Age: 1.23  
Sex: Male  
Location: Indiana  
Vaccinated:2008-01-15
Onset:2008-01-18
   Days after vaccination:3
Submitted: 2008-01-23
   Days after onset:5
Entered: 2008-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB225CA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1313U / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981A / 4 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site rash, Rash, Rash erythematous
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: ARM SWELLING~Varicella (Varivax)~0~1.00~Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Mother noted small red bumpy rash on both legs and few days after vaccinations.


VAERS ID: 303329 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: North Carolina  
Vaccinated:2008-01-04
Onset:2008-01-07
   Days after vaccination:3
Submitted: 2008-01-11
   Days after onset:4
Entered: 2008-01-23
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UE93AA / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: NC08014

Write-up: Throwing up 6 x in 24 hrs and then 2 x next day-1 x next 3 days-low fever and diarrhea. She did not play the first day and then some after that. She was completely better after 1 week.


VAERS ID: 303330 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Florida  
Vaccinated:2007-12-18
Onset:2008-01-10
   Days after vaccination:23
Submitted: 2008-01-21
   Days after onset:11
Entered: 2008-01-23
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B1256B / 1 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2460AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0184U / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016A / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1559U / 1 LA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Facial palsy
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? 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: sent to ENT LABS: rapid strep (-).
CDC Split Type:

Write-up: Bell''s palsy 2 1/2 wks after immunizations persisting. Sx''s started 1/10/08 approx. 1/25/08 Reviewed pcp medical records which reveal patient seen 1/21/08. Had cold s/s w/fever 1-2 wks prior. Developed right eye ptosis, right facial droop, neg facial/labial fold x approx 10 days prior to office visit. Referred to ENT who saw patient 1/21/08 who dx w/left Bell''s palsy & tx w/antiviral med. DX: Bell''s palsy. 1/25/08 Received vax record w/flu info. Fluzone, SP, UT2460AA6, left thigh.


VAERS ID: 303340 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Female  
Location: Montana  
Vaccinated:2007-12-03
Onset:2007-12-04
   Days after vaccination:1
Submitted: 2008-01-23
   Days after onset:50
Entered: 2008-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1081U / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Irritability, Malaise, Pyrexia, Wrong drug administered
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Medication errors (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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type: MT0801

Write-up: Fever, malaise, fussy. Patient inadvertently given Zostavax instead of Varivax.


VAERS ID: 303345 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: California  
Vaccinated:2008-01-08
Onset:2008-01-09
   Days after vaccination:1
Submitted: 2008-01-23
   Days after onset:14
Entered: 2008-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2475BAA / 1 UN / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 09867 / 1 UN / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1246U / 1 UN / SC

Administered by: Private       Purchased by: Public
Symptoms: Ataxia, C-reactive protein, Computerised tomogram normal, Fall, Liver function test, Nuclear magnetic resonance imaging normal
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Mild cold
Preexisting Conditions: Atopic dermatitis or eczema PMH: URI 1 wk prior to admit. Eczema. Sibling w/URI at present.
Allergies:
Diagnostic Lab Data: CT, no acute abnormality; MRI, within normal limit; CBC, BMP, LFT''s, CRP, CK 228 LABS: CT of head WNL. CBC & chemistry WNL. CK 228 (H). Plts 449 (H). Blood c/s neg.
CDC Split Type:

Write-up: Approx a day after vaccination (or <24 hrs) pt. falls forward or occasionally feel down after walking (ataxia), unusual as per mom. Started walking 4-5 wks ago. 2/19/08 Reviewed hospital medical records which reveal patient experienced difficulty walking x 1 day, falling backwards whenever standing up. Also emesis x 2. Admitted 1/10-1/11/08. FINAL DX: Ataxia, post viral vs post vaccination.


VAERS ID: 303348 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Arizona  
Vaccinated:2008-01-23
Onset:2008-01-23
   Days after vaccination:0
Submitted: 2008-01-23
   Days after onset:0
Entered: 2008-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U2289BA / 4 RA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2525AA / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB218BA / 2 LA / UN

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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic rhinitis; allergic rhinitis, bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Urticaria within 10 min of shot


VAERS ID: 303364 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: California  
Vaccinated:2008-01-15
Onset:2008-01-16
   Days after vaccination:1
Submitted: 2008-01-18
   Days after onset:2
Entered: 2008-01-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 1 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB171AA / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0282U / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013H / UNK LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1509U / 1 RL / UN

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

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: Tylenol; Flouride
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 cm x 5 cm redness and swelling lt thigh


VAERS ID: 303365 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Michigan  
Vaccinated:2008-01-15
Onset:2008-01-15
   Days after vaccination:0
Submitted: 2008-01-18
   Days after onset:3
Entered: 2008-01-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB20BA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1307U / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1559U / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Rash papular, 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: Mild rhinorrhea. Vomited the morning she received the vaccines (before appt).
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: She developed a papular hive-like eruption 6-8 hours after receiving her vaccines. These were red welt-like raised areas most prominent on thighs and extending into the diaper area.


VAERS ID: 303372 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Texas  
Vaccinated:2008-01-17
Onset:2008-01-17
   Days after vaccination:0
Submitted: 2008-01-23
   Days after onset:6
Entered: 2008-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2156CA / 4 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF209AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1026F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1104U / UNK RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Erythema, Local reaction, Localised infection, 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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Varicella vaccine administered subqu in R leg on 1-17-08 at 0930. Reaction noted after 10 min. Area red around injection site with 0.5cm raised area noted. Most likely localized infection. Advised Dr. Instructed mother it was best pt did not have Varicella vaccine again v.o. Dr./LVN. Allergy noted in pts chart. After 2 days area was normal.


VAERS ID: 303379 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: North Carolina  
Vaccinated:2008-01-14
Onset:2008-01-15
   Days after vaccination:1
Submitted: 2008-01-17
   Days after onset:2
Entered: 2008-01-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2289CA / 4 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2508AA / 2 RA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS B217BA / 2 LA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B97283A / 4 RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Induration
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? 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: 10x6 cm area of redness, mild induration.


VAERS ID: 303387 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2008-01-07
Onset:2008-01-07
   Days after vaccination:0
Submitted: 2008-01-08
   Days after onset:1
Entered: 2008-01-23
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2459NA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0527U / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702K / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1248U / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site urticaria, Radioallergosorbent test negative
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: Albuterol, Zantac
Current Illness: Vomiting
Preexisting Conditions: Cow milk allergy
Allergies:
Diagnostic Lab Data: Negative RAST tests to gelatin and egg
CDC Split Type:

Write-up: Local hives at the site of subcutaneous injection of VZV developed within minutes of immunization


VAERS ID: 303488 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Virginia  
Vaccinated:2007-07-19
Onset:2008-01-23
   Days after vaccination:188
Submitted: 2008-01-24
   Days after onset:1
Entered: 2008-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVBL199AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 00780 / 3 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0541U / 1 RL / SC

Administered by: Other       Purchased by: Public
Symptoms: Erythema, Rash vesicular
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: none~ ()~~0.00~In Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spontaneous eruption erythematous raised lesions with 5 cent vesicular centers - Appearing in crops and increasing (-) other symptoms


VAERS ID: 303490 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Florida  
Vaccinated:2005-05-13
Onset:2008-01-16
   Days after vaccination:978
Submitted: 2008-01-18
   Days after onset:2
Entered: 2008-01-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0469P / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0767P / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: 10-20 Lesions


VAERS ID: 303492 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Massachusetts  
Vaccinated:2007-12-05
Onset:0000-00-00
Submitted: 2007-12-18
Entered: 2008-01-24
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U22908A / 4 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF144AA / 4 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B47442E / 4 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Inappropriate schedule of drug administration, Injection site induration, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: DTaP and PCV 7 given on 12/5/07 Both in Rt thigh (HIB in Lt Leg)- Developed swelling/induration at site-favoring leg-appears painful to touch- no known fevers- parents used heat and cold-pt. seen 12/14- no longer favoring leg-still with some 1cm by 1 cm induration


VAERS ID: 303528 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: California  
Vaccinated:2008-01-08
Onset:0000-00-00
Submitted: 2008-01-16
Entered: 2008-01-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 5 LL / UN
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0495U / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 4 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007C / 4 LL / UN

Administered by: Other       Purchased by: Public
Symptoms: Wrong drug 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse seen, but pt was given IPV and Hep B by mistake.


VAERS ID: 303587 (history)  
Form: Version 1.0  
Age: 1.51  
Sex: Female  
Location: Iowa  
Vaccinated:2008-01-15
Onset:0000-00-00
Submitted: 2008-01-25
Entered: 2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0910U / 1 RL / SC

Administered by: Unknown       Purchased by: Unknown
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:
Current Illness: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None reported or noted.


VAERS ID: 303595 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2008-01-14
Onset:2008-01-23
   Days after vaccination:9
Submitted: 2008-01-25
   Days after onset:2
Entered: 2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAB225B3 / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425U / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1073U / 1 LL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pallor, Pyrexia, Rash generalised, Rash papular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received shots on 1/14/08. Fever started on 1/23/08 and rash occured on 1/24/08. Tylenol for fever. Diffuse blanching papular rash over entire body.


VAERS ID: 303596 (history)  
Form: Version 1.0  
Age: 1.34  
Sex: Male  
Location: Michigan  
Vaccinated:2008-01-22
Onset:2008-01-24
   Days after vaccination:2
Submitted: 2008-01-25
   Days after onset:1
Entered: 2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR U2156CB, UF184A / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1326F / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54014D / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1656U / 1 LL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood test, 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:
Allergies:
Diagnostic Lab Data: Blood work done at Emergency Department, Tylenol suppository given, Rocephin injection given then patient sent home on amoxicillin.
CDC Split Type:

Write-up: Had a fever of 101, went to sleep and had a seizure about 20 minutes later. All happened about 52 to 56 hours after immunizations were given.


VAERS ID: 303615 (history)  
Form: Version 1.0  
Age: 1.71  
Sex: Male  
Location: Massachusetts  
Vaccinated:2007-12-10
Onset:2008-01-04
   Days after vaccination:25
Submitted: 2008-01-14
   Days after onset:10
Entered: 2008-01-25
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0185U / UNK LL / UN

Administered by: Private       Purchased by: Private
Symptoms: Basophil count normal, Convulsion, Eosinophil count normal, Haematocrit decreased, Haemoglobin decreased, Lymphocyte count decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Monocyte count decreased, Neutrophil count, Platelet count decreased, Polymerase chain reaction, Pyrexia, Red blood cell count decreased, Red blood cell microcytes, Red cell distribution width increased, White blood cell count normal
SMQs:, Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), 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:
Current Illness: cold (runny nose)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 10.9 (6.0-17.5) (th/cmm); HCT 25.2 L (33.0-39.0) (%); HGB 8.7 L (10.5-13.5) (gm/dl); RBC 3.53 L (3.70-5.30) (mil/cmm); PLT 25 L (150-450) (th/cumm); MCV 72 (70-86) (fl); MCH 24.7 (23.0-31.0) (pg/rbc); MCHC 34.5 (30.0-36.0) (g/dl); RDW 17.6 H (11.5-16.0) (%); Poly 36 (25-49) (%); Lymph 58 L (60-67) (%); Monos 3 L (4-11) (%); EOS 2 (0-8) (%); Basos 1 (0-3) (%); Absolute Neuts 3.93 (1.5-8.5) (th/cmm); Absolute Lymphs 6.27 (4.0-10.50) (th/cmm); Absolute Monos 0.36 (0.3-0.9) (th/cmm); Absolute EOS 0.26 (0.2-0.5) (th/cmm); Absolute Basos 0.05 (0.0-0.03) (th/cmm); Aniso 1+ H (None); Hypo None; Macrocytes None; Microcytes 3+;
CDC Split Type:

Write-up: Fever 12/18/07, seizure 12/18/07, ITP onset 1/3/08. Platelet count < 5,000 1/4/08-1/6/08. Anti-D given 1/4/08. As of 1/11/08, platelet count up to 356,000.


VAERS ID: 303624 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2008-01-22
Onset:2008-01-24
   Days after vaccination:2
Submitted: 2008-01-25
   Days after onset:1
Entered: 2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB215AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF009AA / 4 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C212993 / 4 LL / UN

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

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: 5 cm by 3 cm swollen redness upper left thigh


VAERS ID: 303625 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New York  
Vaccinated:2008-01-23
Onset:2008-01-23
   Days after vaccination:0
Submitted: 2008-01-25
   Days after onset:2
Entered: 2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354BA / 4 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB207BA / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1305U / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015H / 3 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1592U / 1 LL / UN

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site papule, Injection site rash, 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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. developed red, papular, urticarial-like lesions to L thigh. Benadryl administered and pt. monitored for 20 mins. - no other adverse effects noted. Left office in NAD.


VAERS ID: 303626 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New York  
Vaccinated:2008-01-08
Onset:2008-01-15
   Days after vaccination:7
Submitted: 2008-01-18
   Days after onset:3
Entered: 2008-01-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF22499 / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 897283C / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357U / 1 RL / SC

Administered by: Public       Purchased by: Private
Symptoms: Erythema, Full blood count, Skin nodule
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 115g/ml .8 mL BID; MVI with flouride 0.25 day
Current Illness: runny nose
Preexisting Conditions: NKDA, No birth defects
Allergies:
Diagnostic Lab Data: CBC Sent
CDC Split Type:

Write-up: 7 days after injection - red tender nodule at right thigh; No F/c - possible infection - no fructame, no d/c - will Rx with Aox to be safe


VAERS ID: 303657