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From the 4/1/2021 release of VAERS data:

Found 860,540 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 861

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VAERS ID: 207511 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Alabama  
Vaccinated:2003-07-28
Onset:2003-07-29
   Days after vaccination:1
Submitted: 2003-07-29
   Days after onset:0
Entered: 2003-08-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 21882C2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 482861 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0132N / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0761M / 1 LL / IM

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

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

Write-up: 8 x 5 in long.


VAERS ID: 207512 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Illinois  
Vaccinated:2003-07-30
Onset:2003-07-31
   Days after vaccination:1
Submitted: 2003-07-31
   Days after onset:0
Entered: 2003-08-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492818 / 4 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0190N / 1 LA / SC

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

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: 14 hrs post administration developed fever of 101 degrees and localized pain, redness and swelling in right arm.


VAERS ID: 207515 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Maryland  
Vaccinated:2003-07-18
Onset:2003-07-30
   Days after vaccination:12
Submitted: 2003-07-31
   Days after onset:1
Entered: 2003-08-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 5376A2 / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0626 / 3 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1181M / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0788M / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Rash macular, Rash papular
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Onset of rash, concentrated in/on trunk region. Rash is macular/papular and is wide spread. Rash onset 7/30.


VAERS ID: 207535 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Indiana  
Vaccinated:2003-07-31
Onset:2003-07-31
   Days after vaccination:0
Submitted: 2003-08-04
   Days after onset:4
Entered: 2003-08-06
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1038M / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 489479 / 2 - / -

Administered by: Private       Purchased by: Public
Symptoms: Eye oedema, Flushing, Rash
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: NONE
CDC Split Type:

Write-up: Mother states that patient had been playing around the house. She noticed that her daughter started turning red with a rash all over her body with swelling in both eyes.


VAERS ID: 207555 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2000-12-11
Onset:2001-05-01
   Days after vaccination:141
Submitted: 2003-07-31
   Days after onset:821
Entered: 2003-08-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1276K / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Abnormal behaviour, Autism, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (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: UNK
Allergies:
Diagnostic Lab Data: Hearing test normal; Speech rehab improved
CDC Split Type: WAES0307USA02676

Write-up: Information has been received from an occupational health registered nurse via the mother of a 3 year old male who in November 2000, when the patient was 11 months old, was vaccinated with MMR (second generation). In approximately June 2001, when the patient was approximately 18 months old, the mother reported she feels he now displays pre-autistic tendencies. The mother felt that pre-autistic tendencies was related to therapy with MMR (second generation). Unspecified medical attention was sought. Follow up information was received from the physician who reported that on 12/11/00, the patient was vaccinated with MMR (second generation) (lot # 636400/1276K). This was the only vaccination the child received on that date. The child was well at the time of the visit, and did not have any history of any allergies. In approximately 5/01, at 17-18 months of age, it was noted that the child was not as vocal has he should be at this age, and the child''s behavior was noted to be uncooperative. At 2 years of age he was referred for hearing tests and the results were reported as normal. Also, at 2 years of age, the child was referred to the intermediate unit for speech therapy and intervention, it was reported that the child continued to be uncooperative during appointments. His speech had improved, with speech therapy he could now say short sentences. At the age of 2 years 7 months, another specialist saw the child and diagnosed the patient with Pervasive Developmental Delay. The physician reported that the child is currently 3 and one-half years old, speaks in small sentences, and continues to have uncooperative behavior. The physician reported that the patient has a sibling who is 18 months of age and has not been immunized with MMR (second generation). Upon internal review, pre-autistic tendencies and pervasive developmental delay were considered to be an other important medical event (OMIC). Additional information has been requested. A 15-day follow up report received 10/24/2003 adds: Follow up info was received from the physician who reported that the parent of the pt "wanted to cancel the report of their child''s condition, as he is progressing to improve". Upon internal review, pre-autistic tendencies and pervasive developmental delay were considered to be an other important medical events. Additional info has been requested.


VAERS ID: 207563 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Oregon  
Vaccinated:2002-12-10
Onset:2002-12-19
   Days after vaccination:9
Submitted: 2003-07-02
   Days after onset:194
Entered: 2003-08-07
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0027M / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0207M / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: OR200327

Write-up: 12/19-12/20/02 Fever. 12/21-12/14/02 Rash. Rash did not have fluid in it and did not break open and scab over.


VAERS ID: 207568 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Maine  
Vaccinated:2003-07-28
Onset:2003-07-31
   Days after vaccination:3
Submitted: 2003-07-31
   Days after onset:0
Entered: 2003-08-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U08568A / 4 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1170M / 4 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Swelling of leg, slight warmth (left leg).


VAERS ID: 207614 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Illinois  
Vaccinated:2003-07-16
Onset:2003-07-20
   Days after vaccination:4
Submitted: 2003-08-07
   Days after onset:18
Entered: 2003-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1083M / 1 RA / IM
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 019SN / 1 LA / IM

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

Life Threatening? 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: Congenital Muscular Torticollis, reflux, otitis media
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 102 appeared four days after vaccine was administered. Fever lasted for 4 days, lingering around 100 - 101 degrees. Red rash appeared 9 days after the vaccine was given. Rash appeared on nape of the neck, and quickly spread to the back and stomach. Rash on the nape was extremely itchy. Low grade fever of 99-100 reappeared 12 days after the vaccine for two more days.


VAERS ID: 207617 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Florida  
Vaccinated:2001-03-15
Onset:2001-03-20
   Days after vaccination:5
Submitted: 2003-08-07
   Days after onset:869
Entered: 2003-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 1667K / 2 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Diarrhoea, Laboratory test abnormal, Lymphadenopathy
SMQs:, 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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: no allergies. Eczema
Allergies:
Diagnostic Lab Data: 4/10/01 2/13/02 5/15/03 Alkaline Phosphatease 366 U/L 291 U/L 282 U/L Absolute Monocytes 1514 c/mcl normal na Absolute Eosinophils 757 c/mcl normal na White Blood Count 17.6 normal na All values listed are above the normal range.
CDC Split Type:

Write-up: 1. Sever Lymphadenopathy immediately after vaccine and still enlarged lymph glands 2.5 post vaccine. 2. Diarrhea, loose stools, undigested food beginning after vaccination and lasting for 1.5 years. 3.Abnormal liver function tests immediately after vaccine. 4/10/01 2/13/02 5/15/03 Alkaline Phosphatease 366 U/L 291 U/L 282 U/L Absolute Monocytes 1514 c/mcl normal na Absolute Eosinophils 757 c/mcl normal na White Blood Count 17.6 normal na


VAERS ID: 207587 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Georgia  
Vaccinated:2003-07-31
Onset:2003-07-31
   Days after vaccination:0
Submitted: 2003-08-01
   Days after onset:1
Entered: 2003-08-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1101M / 4 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W0703 / 3 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1000M / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0325N / 1 RL / SC

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

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: After receiving MMR and Varivax in RAT approx 3-4 minutes later immediate redness and swollen.


VAERS ID: 207589 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: California  
Vaccinated:2003-07-29
Onset:2003-07-29
   Days after vaccination:0
Submitted: 2003-07-31
   Days after onset:2
Entered: 2003-08-08
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 592B9 / 4 RL / -
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UA821AA / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0131N / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492929 / 4 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0197N / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Right anterior thigh with 3 puncture sites. Erythema extending from most inferior and medial injection site. No induration, nontender to palpate.


VAERS ID: 207591 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Ohio  
Vaccinated:2003-06-10
Onset:2003-07-23
   Days after vaccination:43
Submitted: 2003-07-24
   Days after onset:1
Entered: 2003-08-08
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W0704 / 3 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0423M / 1 RL / -

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

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

Write-up: A per type rash present on 7/23/03. No signs of illness.


VAERS ID: 207594 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Ohio  
Vaccinated:2003-07-25
Onset:2003-07-27
   Days after vaccination:2
Submitted: 2003-08-01
   Days after onset:5
Entered: 2003-08-08
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W0906 / 2 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0945M / 1 RL / -

Administered by: Private       Purchased by: Other
Symptoms: Rash papular
SMQs:, 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: ~Measles + Mumps + Rubella (MMR II)~1~1.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low grade temp approx 48 hours after administration of MMR, then "measly" rash all over his body. These are small papules on face, trunk, extremities and diaper areas, buttocks. Feeling OK, behaving normally today.


VAERS ID: 207599 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Colorado  
Vaccinated:2003-07-23
Onset:2003-07-23
   Days after vaccination:0
Submitted: 2003-07-23
   Days after onset:0
Entered: 2003-08-08
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 601A2 / 4 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0144N / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1011M / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492850 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0210N / 1 RA / SC

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, 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? 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: Following administration of Varivax and MMR, developed a hive at site of administration. Pt was given the above vaccines in opposing arms. And had the local red reaction in each arm. Given Benadryl po.


VAERS ID: 207611 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Wisconsin  
Vaccinated:2003-07-23
Onset:0000-00-00
Submitted: 2003-08-07
Entered: 2003-08-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 598A2 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0105N / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492857 / 3 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up:


VAERS ID: 207612 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2003-08-07
Entered: 2003-08-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Rash macular, Rash papular
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Maculopapular rash starting on face and progressing to trunk. No treatment needed c/w measles vaccine associated rash.


VAERS ID: 207620 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Maryland  
Vaccinated:2003-06-10
Onset:0000-00-00
Submitted: 2003-08-08
Entered: 2003-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPIPV: DTP + IPV (NO BRAND NAME) / SANOFI PASTEUR U08520A / 4 LL / IM

Administered by: Military       Purchased by: Military
Symptoms: Injection site erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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: Septra
Current Illness: Trauma to L fingernail
Preexisting Conditions: Recurrent OM
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Child received DPaP IPV in L thigh on 6/10/03 Seen 6/12/03 and had 10x6cm swollen erythematous area L thigh. Puncture seen in upper part of swollen area. No apparent pain, moved leg normally, erythema fading.


VAERS ID: 207679 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: California  
Vaccinated:2003-08-05
Onset:2003-08-05
   Days after vaccination:0
Submitted: 2003-08-08
   Days after onset:3
Entered: 2003-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA853AA / 4 LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491186 / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: normal CBC with WBC 8.0 and normal UA with negative blood and urine culture (as of this date)
CDC Split Type:

Write-up: Patient received PPD, HIB#4, and Pneumo#4 in the morning and in the middle of that night development high fever 104-105.8.


VAERS ID: 207634 (history)  
Form: Version 1.0  
Age: 1.17  
Sex: Female  
Location: West Virginia  
Vaccinated:2003-07-29
Onset:2003-08-04
   Days after vaccination:6
Submitted: 2003-08-08
   Days after onset:4
Entered: 2003-08-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA774AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0773M / UNK LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Atelectasis, Bacterial infection, Insomnia, Pneumonia, Pyrexia, Rash, Retching, Stevens-Johnson syndrome, Vomiting
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: After vaccine was given: Amoxicillin
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Fever started 8/1/03, gagging, vomited, not eating or sleeping well. Taking to emergency room on 8/4/03 at 7:51 AM. Returned to emergency room 8/4/03, temp 100.4, rash. Diagnose with Steven-Johnson Syndrome. Hospital discharge summary states pneumonia, atelectasis and bacteremia.


VAERS ID: 207637 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: California  
Vaccinated:2003-07-23
Onset:2003-07-24
   Days after vaccination:1
Submitted: 2003-07-25
   Days after onset:1
Entered: 2003-08-11
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1383AA / 4 LA / -

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

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

Write-up: Arm at site swollen tense, hot and red with pale area (nickel sized) at exact site.


VAERS ID: 207660 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Missouri  
Vaccinated:2003-07-30
Onset:2003-08-07
   Days after vaccination:8
Submitted: 2003-08-08
   Days after onset:1
Entered: 2003-08-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA832AA / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0102N / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492818 / 3 RL / -

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

Life Threatening? 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: Premature birth
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Started with fever 08/04/2003 AM- 104 08/07/2003. 08/08/2003 AM started with rash and gradually spread over entire body.


VAERS ID: 207664 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Texas  
Vaccinated:2003-07-29
Onset:2003-07-29
   Days after vaccination:0
Submitted: 2003-08-01
   Days after onset:3
Entered: 2003-08-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 586E9 / 4 LA / -

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Irritability, Pyrexia
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 (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: 07/29/2003~DTaP (no brand name)~4~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC & M/D
CDC Split Type:

Write-up: Patients left arm was red with central paleness on deltoid area. Patient came in with 100.9F fever which has lasted four days with fussiness and irritability.


VAERS ID: 207672 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Arizona  
Vaccinated:2003-07-29
Onset:2003-07-30
   Days after vaccination:1
Submitted: 2003-08-07
   Days after onset:8
Entered: 2003-08-11
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 586A9 / 4 RL / -
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UA822AB / 4 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492819 / 4 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis, Injection site reaction, Injection site swelling, Rash erythematous
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: On the Prevnar leg on left lateral thigh raised blanching erythematous rash which localized, spreading distally to left lower leg. Benadryl.


VAERS ID: 207687 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Ohio  
Vaccinated:2003-07-25
Onset:2003-07-26
   Days after vaccination:1
Submitted: 2003-07-31
   Days after onset:5
Entered: 2003-08-11
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA765AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0334 / 3 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492821 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1058M / 1 LA / SC

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

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

Write-up: Started with a temperature on Sautrday 7-26-03. Was as high as 101 degrees. Fever broke on Monday 7-28-03. Rash apperared on 7-30-03 on neck and chest that is described as tiny red dots and remains the same today 7-31-03. chid is active today and tolerating fluids and food, but is having loose stools. Mom is treating symptoms with Tylenol and Motrin.


VAERS ID: 207688 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: New York  
Vaccinated:2003-08-07
Onset:2003-08-07
   Days after vaccination:0
Submitted: 2003-08-11
   Days after onset:4
Entered: 2003-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 596A2 / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0021N / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0906 / 3 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492395 / 3 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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: Moderate swelling, 3" x 3" area of induration and erythema, mild to moderate pain on site of injection of right thigh; 102 fever, on day of vaccines administration. Treated with acetaminophen and warm compresses. Erythema subsided on day #3 post-immunization, patient continues with a 3" x 3" induration on right thigh, and 2" x 2" induration on left thigh. No more fever, no pain on affected areas.


VAERS ID: 207689 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Ohio  
Vaccinated:2002-02-18
Onset:2002-02-26
   Days after vaccination:8
Submitted: 2003-08-11
   Days after onset:530
Entered: 2003-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 5209A9 / 3 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 480698 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1082L / 1 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Autism, 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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autism~Measles + Mumps + Rubella (MMR II)~1~1.30~In Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 10 days of MMR vaccine patient had fever of 103.0 and a rash all over his body. Patient was developing normally until the shot and within days of receiving the vaccine developed Autistic like symptoms. We are currently in the process of receiving an Autistic diagnoses.


VAERS ID: 207690 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Wisconsin  
Vaccinated:2003-08-09
Onset:2003-08-09
   Days after vaccination:0
Submitted: 2003-08-11
   Days after onset:2
Entered: 2003-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0851CA / 4 LA / IM

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

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: RED,WARM,SWOLLEN AREA AT INJECTIN SITE - SIZE OF AN EGG,TEMP 101.4


VAERS ID: 207709 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Michigan  
Vaccinated:2003-07-25
Onset:2003-08-01
   Days after vaccination:7
Submitted: 2003-08-04
   Days after onset:3
Entered: 2003-08-12
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0855M / 2 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1127M / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491785 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1058M / 1 - / SC

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

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

Write-up: 8/1/03 mother noticed a pimple like raised red spot on right leg. On 8/4/03 there were 3 distinct and raised areas. No fever or other signs/symptoms.


VAERS ID: 207716 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Louisiana  
Vaccinated:1997-04-29
Onset:1997-04-29
   Days after vaccination:0
Submitted: 2003-08-11
   Days after onset:2295
Entered: 2003-08-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81441 / 4 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH M005PP / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1006D / 2 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Autism
SMQs:

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:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Autism Spectrum Disorder


VAERS ID: 207717 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Wisconsin  
Vaccinated:2000-04-06
Onset:2000-05-31
   Days after vaccination:55
Submitted: 2003-05-31
   Days after onset:1095
Entered: 2003-08-12
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0050K / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 16583 / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 1 RL / -

Administered by: Private       Purchased by: Other
Symptoms: Anorexia, Antisocial behaviour, Autism, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow)

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:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EEG; HEG shows ? seizures, elevation in organic ?, abnormal high measles titer.
CDC Split Type:

Write-up: 5/31/00 month after vaccination, child shows first definite signs of regression; very unhappy, crying at night no appetite. His health deteriorated after MMR shot. Gradually, he loses eye contact, speech, receptive language. At age 2.5, he was diagnosed with autism. We follow up with ABA therapy. Medical record confirms the diagnosis of autism.


VAERS ID: 207720 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: West Virginia  
Vaccinated:2003-07-21
Onset:2003-07-31
   Days after vaccination:10
Submitted: 2003-08-05
   Days after onset:5
Entered: 2003-08-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 5272A2 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0016L / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491193 / 2 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0074N / 1 LL / IM

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

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

Write-up: Fever, rash at face, arms, legs and trunk for 4 days. Tx Tylenol. Fine 2 mm pinhead vesicular rash with centripetal distribution.


VAERS ID: 207735 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Texas  
Vaccinated:2003-07-17
Onset:2003-07-27
   Days after vaccination:10
Submitted: 2003-07-29
   Days after onset:2
Entered: 2003-08-12
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA850AA / 4 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0907 / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0099N / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Conjunctivitis, Cough, Laboratory test abnormal, Pyrexia, Rash macular, Rash papular
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conjunctival disorders (narrow), Ocular infections (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: CBC c/w viral illness, Rubeola titers IgM-320, IgG-2.23;
CDC Split Type:

Write-up: 07/27/2003: Fever to 102F, fine erythematous macular/papular rash starting at ears, scalp face, proceeding gradually. No eating, drinking well. 07/28/2003: Fever continues, rash on face to conjunctivitis (+) A/P nasal DC, cough, sick, looking like "measly" looking.


VAERS ID: 207741 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Massachusetts  
Vaccinated:2003-07-30
Onset:2003-08-01
   Days after vaccination:2
Submitted: 2003-08-05
   Days after onset:4
Entered: 2003-08-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0853DA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0704 / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492588 / 4 LL / IM

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

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

Write-up: DTAP/IPV/PREVNAR given on 07/30/2003. Seen on 08/01/2003 has grapefruit size redness and swelling on right thigh around DTAP site. TEMPERATURE: 96F.


VAERS ID: 207742 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:2003-07-21
Onset:2003-07-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2003-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 576A2 / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0133N / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Irritability, Pyrexia, Rash, Rash morbilliform
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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fever, irritable~Pneumo (no brand name)~3~0.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Previously reported high fever after Prevnar #3 10/15/2002 and Comvax #3.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Began having fever, high fussiness on 07/30/2003. Seen in urgent care advised bilateral OM and heat rash. Started on Zithromax. No improvement. Continued fevers to 103F, difficult to control with Tylenol/Advil. High irritability. Seen here 08/01/03 with fever 105, morbiliform rash difficult to console but otherwise normal exam.


VAERS ID: 207745 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Ohio  
Vaccinated:2003-07-30
Onset:2003-07-31
   Days after vaccination:1
Submitted: 2003-08-05
   Days after onset:5
Entered: 2003-08-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492404 / UNK RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Injection site oedema, Injection site rash, Pruritus
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Red, puffy rash 7 cm circle at injection site. Itching, and felt hard to touch. Diagnosis: cellulitis right thigh. Prescribed Augmentin 600/5 twice daily for 10 days.


VAERS ID: 207778 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Oregon  
Vaccinated:2003-07-28
Onset:2003-08-07
   Days after vaccination:10
Submitted: 2003-08-07
   Days after onset:0
Entered: 2003-08-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1385AA / 4 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1100M / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492814 / 4 RL / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, 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: Luride/Albuterol
Current Illness: NONE
Preexisting Conditions: Developmental delay, possible fetal alcohol syndrome
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pink to red rash, fever 38.1


VAERS ID: 207791 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Ohio  
Vaccinated:2003-05-06
Onset:2003-05-10
   Days after vaccination:4
Submitted: 2003-08-08
   Days after onset:90
Entered: 2003-08-13
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0472M / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Eye movement disorder
SMQs:, Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Right inguinal hernia repair 6/17/02
Allergies:
Diagnostic Lab Data: 7/21/03 MRI of brain-normal
CDC Split Type:

Write-up: 07/16/03: Mom reported per phone call 20 to 40 episodes daily of eyes rolling back, falling backward then usually getting right back up-started "a few days" after well child care 5/6/03. Seen in office 7/16/03 and referred to neurology.


VAERS ID: 207795 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2003-07-24
Onset:2003-08-03
   Days after vaccination:10
Submitted: 2003-08-04
   Days after onset:1
Entered: 2003-08-13
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W06262 / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0879M / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0424M / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Decreased appetite, Irritability, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Rash developed 08/03/2003 over neck, shoulders and trunk. Fever of 101F, low appetite, fussy.


VAERS ID: 207796 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2003-07-21
Onset:2003-07-21
   Days after vaccination:0
Submitted: 2003-08-08
   Days after onset:18
Entered: 2003-08-13
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491577 / 4 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0206N / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Rash, Skin ulcer
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Fever: 102F, annular hives-like rash from knee to upper thigh with central clearing. On right leg initially then on left leg with clearing on right. Also 14 days later 5 pox-like lesions on head and trunk.


VAERS ID: 207798 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2003-06-16
Onset:2003-06-27
   Days after vaccination:11
Submitted: 2003-07-23
   Days after onset:26
Entered: 2003-08-13
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229M / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1058M / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? 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: Red papular rash, legs, trunk, back, not vessicular non pruritic. Fever 102F-rash/fever started yesterday. 06/16/2003: MMR/VARIVAX administered; 06/26/2003: Right OM/sinusitis-Augmentin started; 06/27/2003: Rash/fever;


VAERS ID: 207804 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Iowa  
Vaccinated:2003-07-17
Onset:2003-07-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2003-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U0853CA / 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 490900 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0969M / 1 RL / SC

Administered by: Public       Purchased by: Other
Symptoms: Anorexia, Flushing, Pyrexia, Rash, Staring, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: NONE
Current Illness: NONE
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data: CBC, STREP culture at ER 08/01/2003
CDC Split Type:

Write-up: 07/19/2003: Pale, gray complexion, current-Staring and shakes, loss of appetite, mild rash, pale complexion 07/26/2003: Fever of 101F, vomiting, loss of appetite, still pale; 07/26/2003: Current-poor appetite; 07/28/2003: Current rash 08/01/2003: Vomiting, fever 103F; 08/01-08/03/2003: Fever 103F, no appetitie;


VAERS ID: 207808 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Washington  
Vaccinated:2003-07-08
Onset:2003-07-15
   Days after vaccination:7
Submitted: 2003-08-12
   Days after onset:28
Entered: 2003-08-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1385AA / 4 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA809AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0856M / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0018N / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Cellulitis, Cough, Decreased appetite, Laboratory test abnormal, Pyrexia, Rash, Rash macular, Rash papular
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil infant drops administered prior to immunizations
Current Illness: NONE
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data: Right ear culture, many stap aureus, many beta strep ctrp b
CDC Split Type:

Write-up: Fever 101.2F, wet cough, low appetite, rash on face, right jaw, lungs clear, maculopapular rash on trunk-viral exam, cellulitis right ear.


VAERS ID: 207819 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: North Carolina  
Vaccinated:2003-07-23
Onset:2003-07-24
   Days after vaccination:1
Submitted: 2003-07-31
   Days after onset:7
Entered: 2003-08-13
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0857AB / 5 LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492405 / 5 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Feeling hot, 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of itching type rash
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NC03095

Write-up: 7/24 woke up with rash on legs and abdomen. Only had a few areas, but each day thereafter increased. On 7/26 felt hot but did not take temp. On 7/30 rash was on face to face looked puffy. Went to ER 7/30. They said could be vaccine or something else and gave po Benadryl. In clinic 7/31, not reported better. 7/31 still had red raised whelps on body to face.


VAERS ID: 207835 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Montana  
Vaccinated:2003-07-29
Onset:2003-08-02
   Days after vaccination:4
Submitted: 2003-08-11
   Days after onset:9
Entered: 2003-08-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1230M / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491577 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1148M / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Cyanosis, Eye movement disorder, Loss of consciousness, Muscle twitching
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: On the morning of 8/2/03, patient became blue, fell over onto floor with her arms and legs twitching, became unconscious and eyes rolled back into head. Fell asleep for a few hours. At 5PM that evening, the same scenario occurred and patient taken to ER where she was observed overnight without further incidences. The discharge summary states new onset seizures.


VAERS ID: 207839 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2003-03-05
Onset:2003-08-05
   Days after vaccination:153
Submitted: 2003-08-12
   Days after onset:7
Entered: 2003-08-14
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0549M / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Infection
SMQs:

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

Write-up: Pt to office for ear check. Note to have varicella skin lesions (about 50). Pt known to have received vaccine at previous provider on 3/5/03. Otherwise asymptomatic.


VAERS ID: 207851 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Florida  
Vaccinated:2003-06-30
Onset:2003-06-30
   Days after vaccination:0
Submitted: 2003-07-10
   Days after onset:10
Entered: 2003-08-14
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1129M / 3 - / IM

Administered by: Military       Purchased by: Military
Symptoms: Irritability, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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: NONE
Current Illness: Right otitis media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash, irritability. Fever s/p 1 day 101.8 stated, 99.3 actual. S/p 2 day 105.3 R actual. S/p 3 day 103.7 actual.


VAERS ID: 207865 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Colorado  
Vaccinated:2002-11-04
Onset:2002-11-06
   Days after vaccination:2
Submitted: 2003-07-01
   Days after onset:236
Entered: 2003-08-15
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0584AA / 4 - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0883AA / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Grand mal convulsion, Insomnia, Oral intake reduced, Screaming
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~DTaP (no brand name)~1~0.50~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EEG; MRI''s, etc.
CDC Split Type:

Write-up: The night after our son started waking up at 2:00am screaming hysterically and unable to go back to sleep until 5am. This pattern continued. He started not eating well and unable to nap. A month later he had a grand mal seizure. Three months later he had another and then another.


VAERS ID: 207896 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Florida  
Vaccinated:2003-07-02
Onset:2003-07-15
   Days after vaccination:13
Submitted: 2003-07-16
   Days after onset:1
Entered: 2003-08-15
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0102N / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1062M / 1 LA / SC

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

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

Write-up: Immunization 07/02/2003. Rash 07/15/2003- chest and back - spreading to mid legs and face. No fever. Happy


VAERS ID: 207907 (history)  
Form: Version 1.0  
Age: 1.75  
Sex: Male  
Location: Colorado  
Vaccinated:2003-07-22
Onset:2003-07-22
   Days after vaccination:0
Submitted: 2003-07-24
   Days after onset:2
Entered: 2003-08-15
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0856AA / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0924M / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Crying, Injection site erythema, Injection site oedema, Injection site warmth, Screaming
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (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: CO030025

Write-up: Pt was given 2 immunizations on 7/22/03. These were #2 MMR and #4 DTaP to right arm. Mom states that evening he was crying up until 11:00 PM. Today his arm is red, hot and swollen. Area involved measures 40mm x 40mm.


VAERS ID: 207920 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Ohio  
Vaccinated:2003-04-15
Onset:2003-05-19
   Days after vaccination:34
Submitted: 2003-08-06
   Days after onset:79
Entered: 2003-08-15
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA752 AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0632M / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0868M / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Abasia, Arthralgia, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Arthritis (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: Pt is a twin, other twin received same same immunizations with no problem
Allergies:
Diagnostic Lab Data: CDC, right leg xray, ESR all normal except for tibia bowing on xray
CDC Split Type:

Write-up: Mother reported that several weeks after 4/15/03 immunizations, the infant began limping on right leg and then crawling on hands and knees to avoid walking. No fever or other sx. She saw pediatrician on 5/20/03. Dx: arthralgia. Motrin ordered. Symptoms resolved. Mother stated that the pediatrician thought it was related to the MMR vaccine and that it would resolve on its own.


VAERS ID: 207976 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Texas  
Vaccinated:2003-05-28
Onset:2003-05-28
   Days after vaccination:0
Submitted: 2003-08-15
   Days after onset:79
Entered: 2003-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / 3 LL / IM

Administered by: Military       Purchased by: Military
Symptoms: Convulsion, Dermatitis bullous, Pyrexia, Speech disorder
SMQs:, Severe cutaneous adverse reactions (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: broke out with measles~Measles + Mumps + Rubella (no brand name)~2~1.10~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: allergy to milk,eggs,soy,wheat
Allergies:
Diagnostic Lab Data: Patient was diagnosed as Autistic in June of 2003 after he started showing behaviour that I thought was strange after the seizure.
CDC Split Type:

Write-up: Patient was given the MMR. We knew he was allergic to it because of his previous reactions to immunizations. We refused to immunize him, eventually after 12 months of fighting the system, we were forced to do it. Patient got a low grade fever, broke out with the measles on the first day, this lasted for 3 days. On the 4th day he broke out with mumps, this lasted for 2 days, on the 6th day he broke out with the measles again and had a petite mal seizure. He is autistic now and has severe speech delay as a result of this vaccination. He was treated only with cortisone creams, benadryl, zyrtec, and the dr''s apology.


VAERS ID: 207927 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2003-07-11
Onset:2003-07-17
   Days after vaccination:6
Submitted: 2003-08-01
   Days after onset:15
Entered: 2003-08-18
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0144N / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0121N / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492400 / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0204N / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Pyrexia, Rash, Rash vesicular
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: NONE
Current Illness: Hoarseness
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 6 days after MMR, Varivax, Hib and Prevnar had temp of 104.8 and 8 days after these vaccines had a fine red rash on trunk and vesicular rash over body. No Tx needed and everything resolves without any difficulty. Gave only fever reducers. No apparent complications.


VAERS ID: 207931 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Georgia  
Vaccinated:2000-09-12
Onset:2003-07-23
   Days after vaccination:1044
Submitted: 2003-07-23
   Days after onset:0
Entered: 2003-08-18
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 8100N2 / 2 GM / -

Administered by: Private       Purchased by: Private
Symptoms: Blister, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (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: Scattered vesicles and dry skin with ulceration. Symptomatic Tx. Chicken pox.


VAERS ID: 207952 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Utah  
Vaccinated:2003-07-01
Onset:2003-07-09
   Days after vaccination:8
Submitted: 2003-07-10
   Days after onset:1
Entered: 2003-08-18
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0582AA / 4 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0740M / UNK RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W063 / 3 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0186M / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 490366 / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0597M / 1 LL / SC

Administered by: Public       Purchased by: Private
Symptoms: Convulsion, Otitis media, 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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT Scan; EEG scheduled; CBC; CXR; Electrolytes
CDC Split Type:

Write-up: Seizure at home; immediately taken to the hospital. Seizure lasted after arrival to hospital; unknown duration, temp 102 degrees F. Had low temperature mom stated since immunization. Treated with IV''s, KT, Rocephin given at hospital. 60 day follow up on 11/04/2003: "Unknown if vaccine recipient did ever recover from adverse events. Still having seizures, was seen by neurologist. He says will out grow. Doing much better." Discharge Summary received on 10/17/2003 states otitis media.


VAERS ID: 207964 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Florida  
Vaccinated:1998-01-13
Onset:2003-07-31
   Days after vaccination:2025
Submitted: 2003-08-07
   Days after onset:7
Entered: 2003-08-18
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0688E / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Infection
SMQs:

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

Write-up: Mild case of varicella 8/4/03.


VAERS ID: 207980 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Ohio  
Vaccinated:2002-07-23
Onset:2002-07-23
   Days after vaccination:0
Submitted: 2003-08-18
   Days after onset:391
Entered: 2003-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 567A2 / 3 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 0760 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (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: Father states that patient was healthy prior to vaccination.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Parents brought patient to our clinic today for a physical. State that after her shots last July she developed intractable crying and fever. Was in the ER all night. Father states that the doctor said the fever and crying was related to the shots. No other vaccines given since that time. Family not certain if a VAERS report was filed. This is all the information that I have! Today I gave patient an MMR-the father refused to repeat any of the previous vaccines and insists that we only give one vaccine at a time!


VAERS ID: 207993 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2002-12-10
Onset:2002-12-18
   Days after vaccination:8
Submitted: 2003-08-13
   Days after onset:237
Entered: 2003-08-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 5254C9 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0925M / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 485987 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0789M / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Dehydration, Joint swelling, Pyrexia, Rash maculo-papular, Red blood cell sedimentation rate increased, Rheumatoid arthritis, Tachycardia, Thrombocythaemia, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (narrow)

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? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lactulose; Mylanta; Prilosec
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Elevated sedimentation rate, thrombocytosis.
CDC Split Type:

Write-up: 8 days after vaccination developed maculopapular rash, fever joint swelling (multiple), tachycardia. Symptoms prolonged requiring hospitalization. Final diagnosis systemic onset juvenile rheumatoid arthritis. Still with JRA symptoms. 60 day follow up on 11/05/2003: "Vaccine recipient did not recover from the adverse events. Still having acute flare of juvenile rheumatoid arthritis (systemic) requiring methotrexate and oral steroids." The discharge summary received on 1/12/04 confirms diagnosis of juvenile rheumatoid arthritis. Also add joint pain, dehydration and weight loss.


VAERS ID: 208018 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Virginia  
Vaccinated:2003-08-12
Onset:2003-08-14
   Days after vaccination:2
Submitted: 2003-08-15
   Days after onset:1
Entered: 2003-08-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 594A2 / 4 LA / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UA857AA / 4 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492851 / 1 RA / IM

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

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: About 2" x 3" area of erythema with mild swelling and warmth to left deltoid at DTaP site.


VAERS ID: 208074 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Maryland  
Vaccinated:2003-08-08
Onset:2003-08-15
   Days after vaccination:7
Submitted: 2003-08-19
   Days after onset:4
Entered: 2003-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LL / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Fatigue, Irritability, Pyrexia, Rash maculo-papular, 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), 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: slight fever, rash~Measles + Mumps + Rubella (no brand name)~~1.10~In Sibling
Other Medications:
Current Illness:
Preexisting Conditions: eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue and crankiness, as well as little pink spots on chest, 6 days after vaccination. Loss of appetitite on morning of 7th day. After his nap on 7th day, woke up at 4:00pm with a fever of 103.3 (taken under arm). He vomited profusely and I called the doctor. I went in to the pediatric center at 6:25pm. I told the nurse his symptoms and that he had had his vaccinations a week before. The doctor came in, and despite the fact that I mentioned the vaccinations, determined that my son had probably gotten a virus. Two days later, on Sunday, my son developed little pink spots on his face and torso. It is now Tuesday and he is still tired and weak. He wants to be carried around all the time as if he is too tired to get around by himself. This is a dramatic change. Before the shots, he was fiercely independent and energetic. I can''t say if this will result in a permanent disability, because I''ve since read that some of the effects from an MMR shot can take months to develop.


VAERS ID: 208060 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: California  
Vaccinated:2003-08-04
Onset:2003-08-14
   Days after vaccination:10
Submitted: 2003-08-14
   Days after onset:0
Entered: 2003-08-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UA852AA / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1237M / 2 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0799M / 2 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Feeling hot, 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Vaccine given 8/4/03. On 8/14/03 developed vesicular rash which looked like mild case of varicella. On 8/13/03 child felt "warm" to touch.


VAERS ID: 208066 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Georgia  
Vaccinated:1999-09-28
Onset:2003-08-08
   Days after vaccination:1410
Submitted: 2003-08-12
   Days after onset:4
Entered: 2003-08-20
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 09295 / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 07185 / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Infection
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: chicken pox~Varicella (Varivax)~1~4.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chicken pox after vaccine.


VAERS ID: 208067 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: Massachusetts  
Vaccinated:2003-07-30
Onset:2003-08-11
   Days after vaccination:12
Submitted: 2003-08-13
   Days after onset:2
Entered: 2003-08-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1037M / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0204N / 1 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Pyrexia, Rash macular
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? 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: Temp 100.9. Pink blanching macular rash started on face and spread to chest. + occipital nodes 11 days post MMR/Varivax vaccines.


VAERS ID: 208070 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Georgia  
Vaccinated:2003-08-11
Onset:2003-08-13
   Days after vaccination:2
Submitted: 2003-08-13
   Days after onset:0
Entered: 2003-08-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0856DA / 4 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0020N / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492813 / 3 LL / -

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

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

Write-up: Possible allergic reaction with DTaP. Swelling right thigh 10 x 8cm. Right thigh 35cm left thigh 33.5cm. Zyrtec 3/4 tsp QHS. Pediapred 1 tsp BID for 5 days.


VAERS ID: 208078 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2003-07-31
Onset:2003-08-10
   Days after vaccination:10
Submitted: 2003-08-11
   Days after onset:1
Entered: 2003-08-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 21881F9 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100M / UNK - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1154M / 1 LL / SC

Administered by: Military       Purchased by: Military
Symptoms: Skin ulcer
SMQs:, 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: About 10 raised papules, few with vesicles on chest/abd. $g10 similar lesions on back. 3 lesions right arm. 2 lesions left arm. 4 lesions neck. 1 lesion face (right cheek). 4 lesions on left thigh. 1 lesion crusted over on left thigh at point of inoculation. Lesions began on check 8/10 and on left thigh, spread to back, neck, arms today.


VAERS ID: 208091 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: California  
Vaccinated:2003-08-08
Onset:2003-08-09
   Days after vaccination:1
Submitted: 2003-08-11
   Days after onset:2
Entered: 2003-08-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 600A2 / 4 RL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UA789AA / 4 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491165 / 4 LL / IM

Administered by: Other       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? 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: Parent reports pt developed urticarial rash on 8/9/03, was evaluated at hospital ER. Dx urticaria, possibly secondary to DT. Was prescribed Benadryl with resolution of rash.


VAERS ID: 208102 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Alabama  
Vaccinated:2003-08-01
Onset:2003-08-07
   Days after vaccination:6
Submitted: 2003-08-12
   Days after onset:5
Entered: 2003-08-20
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA781BA / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1376L / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492846 / 4 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0547M / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Infection, Skin ulcer
SMQs:, 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: Augmentin, ES 600 (finished 2 days before onset)
Current Illness: OM
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 7 days after MMR given, the child developed a test book case of rubella-quite extensive and nearly as bad as I would expect from a wild type infection. No significant fever, corta, or koplicks spots developed. Probably 200 lesions. The mother has photo''s on disk.


VAERS ID: 208111 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Wisconsin  
Vaccinated:2003-07-28
Onset:2003-07-28
   Days after vaccination:0
Submitted: 2003-08-11
   Days after onset:14
Entered: 2003-08-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 598B2 / 4 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1129M / 4 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491580 / 4 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Difficulty in walking, Injection site erythema, Injection site mass, Injection site nodule
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (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: Elidil cream, keflex 250mg
Current Illness: skin infection at elbow
Preexisting Conditions: ALLERGY TO LATEX
Allergies:
Diagnostic Lab Data: Still with 1 cm size nodule
CDC Split Type:

Write-up: Mom reports 25cent size lump with redness top of right leg approximately 2-3 hours after injection. Appointment was at 3:30pm. 25 cent size was largest presented to office 08/11/2003 AM with concerns poor walking for 1 week. That is better but 1cm size nodule remains right anterior thigh.


VAERS ID: 208118 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New York  
Vaccinated:2001-07-10
Onset:2003-08-08
   Days after vaccination:759
Submitted: 2003-08-12
   Days after onset:4
Entered: 2003-08-20
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179K / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472553 / 4 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Rash, Skin ulcer
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:
CDC Split Type:

Write-up: 08/08/03 started with rash on neck and trunk - on Benadryl. On 8/11/03 a few new lesions on arm and legs - still on Benadryl, baking soda or corn starch baths.


VAERS ID: 208120 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Louisiana  
Vaccinated:2003-08-04
Onset:2003-08-04
   Days after vaccination:0
Submitted: 2003-08-11
   Days after onset:7
Entered: 2003-08-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492857 / 4 RL / IM

Administered by: Private       Purchased by: Private
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: NONE
Current Illness: NONE
Preexisting Conditions: Ventricular septal defect repaired surgically
Allergies:
Diagnostic Lab Data: CT done in ER (I believe)
CDC Split Type:

Write-up: Prevnar given 8/4/03 mid-morning, temp of 102 degrees that night along with Tues AM. Seizure occurred Monday night and Tuesday AM. Pt taken to ER on Monday PM.


VAERS ID: 208121 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: California  
Vaccinated:2002-10-29
Onset:2003-06-18
   Days after vaccination:232
Submitted: 2003-08-01
   Days after onset:44
Entered: 2003-08-20
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Development of shingles


VAERS ID: 208125 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2003-07-10
Onset:2003-08-15
   Days after vaccination:36
Submitted: 2003-08-18
   Days after onset:3
Entered: 2003-08-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Platelet count increased, 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? 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: Shots 7/10/03. 8/11/03 Dx ITP platelets 13.000. 8/15/03 Varicella rash worse on left leg (not sure if site of immunization or not. Platelets up to 218,000.


VAERS ID: 208127 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Utah  
Vaccinated:2003-08-18
Onset:2003-08-18
   Days after vaccination:0
Submitted: 2003-08-19
   Days after onset:1
Entered: 2003-08-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1229M / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0593M / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Eye swelling, Nasal oedema, Rash
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: ECZEMA
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Woke up with a rash (afternoon nap), mom describes seen burn looking rash on face and neck and upper back, it appeared that his eyes and nose were also puffy. She was instructed to give him Benadryl and he appears fine this AM-no more symptoms.


VAERS ID: 208129 (history)  
Form: Version 1.0  
Age: 1.05  
Sex: Male  
Location: Nevada  
Vaccinated:2003-07-22
Onset:2003-08-04
   Days after vaccination:13
Submitted: 2003-08-19
   Days after onset:15
Entered: 2003-08-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA844AA / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0059N / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH W0962 / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0205N / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Eye disorder
SMQs:, Corneal disorders (broad), Retinal disorders (broad)

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

Write-up: Thinks having problems since MMR- right eye smaller now uses right hand instead of left hand.


VAERS ID: 208152 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: California  
Vaccinated:2003-08-18
Onset:2003-08-19
   Days after vaccination:1
Submitted: 2003-08-20
   Days after onset:1
Entered: 2003-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 58A2 / 4 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA756AA / 4 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Lumbar puncture normal
CDC Split Type:

Write-up: Febrile seizure the day following the vaccine administration.


VAERS ID: 208154 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: D.C.  
Vaccinated:2003-08-13
Onset:2003-08-17
   Days after vaccination:4
Submitted: 2003-08-20
   Days after onset:3
Entered: 2003-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK LL / IM
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none (minor heart murmur in both kids)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s brother, age 4, came down with chicken pox 4 days after patient received the vaccine. Pt had $g103.5 fever 9 hours after the shots and was lethargic for 24 hours. The fever was resolved about 8 hours after it peaked. The brother broke out in chicken pox 4 days later. He had two crops of 15 spots, one on chest, the other on his left arm, on successive days, no fever but malaise and runny nose for 3 days (so far). We expect another couple days of same symptoms. He takes systemic Benadryl every six hours. I recognize this may be independent of pt''s vaccination but I thought I''d report it anyway. He was innoculated for varicella at age 3. I don''t remember if he was innoculated against it before that. The doctor''s office said he was vaccinated on 9/1/02. He also received vaccinations the day pt did - DTaP, MMR & IPV.


VAERS ID: 208161 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: North Carolina  
Vaccinated:2003-08-18
Onset:2003-08-18
   Days after vaccination:0
Submitted: 2003-08-21
   Days after onset:3
Entered: 2003-08-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0857AB / 4 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 490536 / 4 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0200N / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Urinary tract infection
Allergies:
Diagnostic Lab Data: Negative blood culture. Elevated CBC.
CDC Split Type:

Write-up: Febrile seizure x 2 approx. 9 hrs after immunization given. The medical records state fever and congestion.


VAERS ID: 208180 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Oregon  
Vaccinated:1999-11-29
Onset:2002-07-11
   Days after vaccination:955
Submitted: 2003-08-18
   Days after onset:403
Entered: 2003-08-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Autism, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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:
Preexisting Conditions: Conjunctivitis, fever, lethargy, diarrhea, ear infection
Allergies:
Diagnostic Lab Data: Body height measurement (04/02): 99.0 cm. Body weight measurement (04/02): 15.2 kg. Head circumference (04/02): 50.5 cm.
CDC Split Type: WAES0308USA01278

Write-up: Information has been received from a mother concerning her 46 month old son with no prior medical history and no allergies who on 11/29/99 was vaccinated with a dose of MMR (second generation). There was no concomitant medication. On 7/11/02 the patient was diagnosed with autism. Medical attention was sought. No diagnostic labs were performed and no treatment was required. The patient''s autism persisted. The reporter felt that autism was disabling because the patient had to have speech therapy. Autism was considered disabling. Additional information has been requested. Follow up on 09/30/2003: "Initial and follow up information has been received from a physician, a nurse, and a mother concerning her 46 month old son with no prior medical history and no allergies who on 11/29/1999 was vaccinated in the right leg with a first dose of MMRII (Lot # 632457/1084J). There was no concomitant medication and no illness noted that the time of vaccination. On 07/11/2002 the patient was diagnosed with autism. Medical attention was sought. No diagnostic labs were performed and no treatment was required. The patients autism persisted. The patient''s mother felt that autism was disabling because the patient had to have speech therapy. The physician noted that the patient''s felt the diagnosis of autism was related to the MMRII. Autism was considered to be disabling. Additional information is not exptected." A 15-day follow up report received 10/20/2003 adds: The pt was born following an uneventful pregnancy at term via cesarean section due to failure to progress (also noted as elective cesarean section due to a number of procedures for endometriosis). It was noted that at delivery, the pt had the cord around his neck. Apgars of 8 and 9. There was no prenatal infections or complications. the pt did have a conjunctivitis which was negative for Chlamydia on culture. The pt had no known drug allergies. On 09/26/1998, at the age of one month, the pt was seen in the ER for fever, lethargy and diarrhea. There were no hospitalizations, operations, medications, or specifically identified allergies. Immunizations were up-to-date and were well-tolerated. He was negative for convulsions or [[name]] injuries, or loss of consciousness, cardiac conditions, pulmonary problems, maldigestion, or abnormal bowel movements, urinary difficulties, orthopedic problems, or skin conditions. He does bruise easily. There was a family history of autism, apparently severe, in the child of a paternal second cousin. There was also a speech delay in a different paternal second cousin. There were no major concerns during the pt''s infancy and he walked at approximately one year of age. However, language did not develop very well and by 18 months his parents were concerned, especially about language delay. At 18 months of age, he seemed to go off on a pathway of his own. His language became jargon, or even a foreign language. On 05/17/2001, at the age of 2.5 years, the pt was seen for a hearing assessment due to concerns with speech and language development. Sound field responses to speech and pure tones were obtained within normal range, using visual reinforcement audiometry. Results of tympanometry showed tympanic compliance and middle ear pressure for each ear. On 05/30/2001, at the age of 2.5 years, the pt was seen for a hearing assessment due to concerns with speech and language development. Sound field reponses to speech and pure tones were obtained within normal range, using visual reinforcement audiometry. Results of tympanometry showed normal tympanic compliance and middle ear pressure for each ear. On 05/30/2001, at the age of 2 years 9 months, the pt was seen for a speech/language pathology evaluation. The Preschool Language Scale-3 was attempted. He was unable to sit and attend to any aspect of the test for more than approx 30 seconds. He was able to complete the test items as he climbed about the room however he became quite upset if physically assisted to sit down. Results of the auditory comprehension portion of the PLS-3 reveal a standard score of 65 and an age equivalent of 1 year 3 months. It was possible for that he would have been able to score higher had he been willing to attend longer, although his lack of attention may be due to the lack of understanding. For the expressive communication portion of the PLS-3, he achieved a standard score of 61 and an age equivalent of 1 year. He was observed to communicate through the use of grunts, whining and grabbing. His vocalizations contained no consonants. Weekly speech and language therapy was strongly recommended. It was to assist the pt with his understanding and use of language, it will improve his attention and behavior as well. In September 2001, at the age of 3 years 8 months, the pt was seen by a developmental pediatrician for evaluation of delayed speech, body tremors, and difficult behaviors. The pt had made some [[name]] progress with early intervention with behaviors and socialization, as well as in his expressive language. The pt hated changes. He got easily frustrated and will throw temper tantrums. He does do some mandatory organizing, that was compulsions. They must follow the same routine or he gets upset. He squints and rubs his eyes a lot. He had an intermittent tremor of the hands, and sometimes of the legs. He runs well, but shortly he gets uncoordinated and stumbles. He was [[name]]strong and stubborn. He was a visual learner. They described that he had always been affectionate and was appropriately protective of his younger brother. He did not like to be touched at the [[name]]. He had great difficulties with water, such as bathing, but this had improved over time. Whenever they drove on curvy or uneven roads, he would get carsick. For example, he had emesis 3 times while on the way for this appointment. He can drink from a cup as well as from a straw, though he demanded to drink from his baby bottle. The parents clarified that they have just not been structured about discontinuing the baby bottle. He was not toilet-trained. He cannot pedal a tricycle, though he can sit at an appropriate position, he was just not coordinated enough for pedaling. He scribbed mainly with his left hand, though he can hold a pen very nicely. He preferred food items that dissolve easily. On physical exam, his weight was 15.2kg (50th percentile), height 99.0cm (50th percentile) and [[name]] circumference 50.5cm (75th percentile). Physical findings were all within normal limits. The physician indicated that the pt had a significant expressive language disorder with difficulty in articulation and intelligibility. He demonstrated poor socialization and mild sensory intolerances. The pt was diagnosed with either dyspraxia or mild autism spectrum disorder or perhaps even a combination of the two. On 07/11/2002, at the age of 3 years 10 months, the pt was seen by a developmental pediatrician for concerns with severe speech delay, occasional tremoring especially of the hands and upper extremities, socialization issues, resistant to change from routines, and fixations on certain activities. He had been weaned from the bottle and will now drink from a cup and eat more solid foods. He would have tremors of his hands and upper extremities when he was trying to do a fine motor activity and at night when he was in bed. He has not had any obvious seizures and no known [[name]] injuries. He had a number of ear infections when he was younger, but these have slacked off and he hears very well. His clumsiness had improved. The pt''s hearing was assessed by pediatric audiology, but no results were mentioned. The pt was also seen by a occupational therapist who felt that he demonstrated symptoms that were consistent with a diagnosis of an autism spectrum disorder. He had delayed language skills, intense areas of interest, and delayed social skills and decreased engagement and interaction. He also demonstrated delays in his fine motor skills. It was difficult to get him to do things on direct request. He was also very perseverative in his play. The therapist did not observe many tremors during the examination. The pt was also seen by a speech and language pathologist who administered the Preschool Language Scale, Fourth Edition. On this, his comprehension was 67, expressive score 80 (100 is average). The age equivalent for comprehension was 2 years 3 months, for expressive was 2 years 8 months. The therapist noted that it was difficult to keep him on task. It was noted that based on the parental report, observations, and formal language testing, that the pt''s receptive and expressive language were disordered. He also demonstrated an articulation disorder. The diagnoses included: developmental delay, expressive/receptive language disorder, articulation disorder, and autism spectrum disorder. A psychologist also evaluted the pt with the Bayley scale and estimated developmental index at 64 for age equivalent of 35 months. The psychologist agreed that he was somewhat difficult to engage. When he was frustrated, he hit himself. His seemingly imaginative play was actually very "scripted". He did seek the parents for play so there were some interactive skills. In summary, the team felt that he did demonstrated mild features on the autism spectrum, although he does show some interactive skills and empathy. On the other hand, he was perseverative, from his language description, and it was difficult to get him to interact on request. Recommendations were as follows: DNA test for fragile X. Admittedly, theh yield was not very high on this testing but important to rule out. The pt did have somewhat prominent ears. The main thrust of the recommendation was to continue with early childhood special education. Follow-up info was received on 10/06/2003 which pertained to events that occurred 2 years following the administration of MMR II on 11/29/1999. This info contained the following adverse experience: squint and rub eyes ([[name]] 2002). Autism was considered to be disabling. Upon internal review, body tremors and dyspraxia were determined to be other important medical events. Additional info is not expected. Medical records are attached as further documentation of the pt''s experience.


VAERS ID: 208184 (history)  
Form: Version 1.0  
Age: 1.28  
Sex: Male  
Location: New Jersey  
Vaccinated:2003-05-19
Onset:0000-00-00
Submitted: 2003-08-18
Entered: 2003-08-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1000M / 1 RA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0967M / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Milk allergy
Allergies:
Diagnostic Lab Data: Blood tests done: unknown details normal per mother.
CDC Split Type:

Write-up: 8 days after vaccine, patient developed high fever ($g 104) for four days as well as vomiting. he was seen in ED and recovered completely without treatment.


VAERS ID: 208190 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: Tennessee  
Vaccinated:2003-06-16
Onset:2003-06-17
   Days after vaccination:1
Submitted: 2003-06-19
   Days after onset:2
Entered: 2003-08-22
   Days after submission:64
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1383AA / 4 RA / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1051M / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0102N / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0323M / 1 RA / SC

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

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: History of eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN03049

Write-up: Home call mother states right arm red and swollen, scratching and fever. Took child to MD 06/17/03 where Motrin and Benadryl was given. Reported to clinic by phone 6/18/03 1:15 PM.


VAERS ID: 208191 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: New York  
Vaccinated:2003-08-08
Onset:2003-08-10
   Days after vaccination:2
Submitted: 2003-08-18
   Days after onset:8
Entered: 2003-08-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 587A2 / 4 RL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0914M / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492815 / 4 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0328N / 1 LL / -

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

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

Write-up: Mom took child to ER 8/10/03 with complaint of redness to left inner thigh since vaccine administered on 8/8/03. No treatment was indicated. Seen here on 8/11/03. Again, no treatment necessary-mild erythema to left leg.


VAERS ID: 208192 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Unknown  
Location: Oregon  
Vaccinated:2003-08-04
Onset:2003-08-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2003-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0848AA / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1101M / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1011M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492815 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0500M / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N:ONE
Current Illness: NONE
Preexisting Conditions: Known allergies milk, eggs, beans
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OR200331

Write-up: Generalized hives within 2 hours of receiving vaccinations. Swelling around eyes following morning. Treated with po Benadryl. Evaluated by family MD following day. On 8/7 still has a few hives on back.


VAERS ID: 208196 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Alabama  
Vaccinated:2003-08-01
Onset:2003-08-01
   Days after vaccination:0
Submitted: 2003-08-15
   Days after onset:14
Entered: 2003-08-22
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0131N / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0013N / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Rash papular
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? 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: Ataxia 1 hour after vaccine, persisted intermittently for 2 weeks. Brief papular rash, intermittent, 1-2 weeks following vaccine.


VAERS ID: 208212 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Ohio  
Vaccinated:2002-08-06
Onset:2002-08-12
   Days after vaccination:6
Submitted: 2003-08-21
   Days after onset:374
Entered: 2003-08-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0060N / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492814 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0599M / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Irritability, Pyrexia, Rash maculo-papular
SMQs:, 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? 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: Maculopapular rash at site of injection Fever and irritability for 3 days that occurred 9 days after immunizations


VAERS ID: 208271 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Alabama  
Vaccinated:2003-08-22
Onset:2003-08-22
   Days after vaccination:0
Submitted: 2003-08-23
   Days after onset:1
Entered: 2003-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER DO NOT KNOW / 2 RA / ID

Administered by: Public       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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient broke out into hives 1 hour after treatment. Hives were relieved completely after 12 hours.


VAERS ID: 208227 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2003-07-21
Onset:2003-08-10
   Days after vaccination:20
Submitted: 2003-08-13
   Days after onset:3
Entered: 2003-08-25
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 08338M / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0974M / 1 LA / SC

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

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

Write-up: Pt developed vesicular pruritic rash (on 8/10) with varicella vaccine on 07/21/03. Seen on 8/12 with topical lesions.


VAERS ID: 208231 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Maine  
Vaccinated:2003-08-06
Onset:2003-08-13
   Days after vaccination:7
Submitted: 2003-08-19
   Days after onset:6
Entered: 2003-08-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1015M / UNK LA / SC

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

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: Recurrent bronchiolitis suggestive of asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever T max 103.8 on D7 after MMR vaccination.


VAERS ID: 208239 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2002-11-23
Onset:2003-01-01
   Days after vaccination:39
Submitted: 2003-08-15
   Days after onset:225
Entered: 2003-08-25
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UA708AA / 4 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR U0348 / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0126M / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 489750 / 2 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Alopecia
SMQs:

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

Write-up: Pt received MMR, PCV, IPV and Hib vaccines on 11/23/2002. Hair started falling out in patches in January 2003. Completely bald by March 2003.


VAERS ID: 208242 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Ohio  
Vaccinated:2003-08-11
Onset:2003-08-12
   Days after vaccination:1
Submitted: 2003-08-18
   Days after onset:6
Entered: 2003-08-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1385AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W1002 / 3 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492818 / 4 RL / IM

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

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

Write-up: Urticaria, Temperature 99-100 day after receiving immunizations, continued on day 2 treated with per mouth benadryl.


VAERS ID: 208247 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2003-08-01
Onset:2003-08-13
   Days after vaccination:12
Submitted: 2003-08-18
   Days after onset:5
Entered: 2003-08-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0996DA / 4 RA / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0962M / 3 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0907 / 3 RA / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491189 / 4 LA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1158M / 1 LL / -

Administered by: Private       Purchased by: Private
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? 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: Had 5 shots on 08/01/2003: DTAP, IPV, Prevnar, Comvax, Varivax. Came back to office on 08/13/2003 with a rash (vesicular lesions) around neck and body (very mild) maybe 8-10 bumps.


VAERS ID: 208254 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Kansas  
Vaccinated:2003-08-18
Onset:2003-08-18
   Days after vaccination:0
Submitted: 2003-08-22
   Days after onset:4
Entered: 2003-08-25
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 21882C2 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0255N / 2 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1015M / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol-PRN
Current Illness: NONE
Preexisting Conditions: (+) skin test to eggs; history of allergies and asthma.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Hives present on face-not at injection site. No redness or induration at injection site. Eating, drinking and playing fine. No scratching. Given orapred, Benadryl and Tylenol.


VAERS ID: 208257 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:2003-07-14
Onset:2003-07-15
   Days after vaccination:1
Submitted: 2003-07-16
   Days after onset:1
Entered: 2003-08-25
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Eczema, Injection site erythema, Injection site induration, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NONE
CDC Split Type:

Write-up: Indurated erythematous, eczymotic, rash at site of injection, painful.


VAERS ID: 208258 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:2003-07-14
Onset:2003-07-15
   Days after vaccination:1
Submitted: 2003-07-16
   Days after onset:1
Entered: 2003-08-25
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Injection site erythema, Injection site haemorrhage, Injection site induration
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? 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: 10 cm x 10 cm erythematous indurated reaction at site of injection (thigh) with eccymotic center.


VAERS ID: 208290 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2003-05-13
Onset:2003-08-24
   Days after vaccination:103
Submitted: 2003-08-25
   Days after onset:1
Entered: 2003-08-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W0625 / 3 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0878M / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1146M / 1 LA / SC

Administered by: Public       Purchased by: Public
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? 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: Received varicella vaccine on 5/13/03. Varicella rash appeared on 8/24/03, checked in office 8/25/03 and diagnosed with varicella.


VAERS ID: 208295 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: California  
Vaccinated:2003-06-12
Onset:2003-06-13
   Days after vaccination:1
Submitted: 2003-06-13
   Days after onset:0
Entered: 2003-08-26
   Days after submission:74
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 594A2 / 4 LA / -

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

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: Conjunctivitis
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA030096

Write-up: 5 cm redness, warmth, swelling left arm where DTaP vaccine given. 5 times bigger about 6 hours after shot.


VAERS ID: 208309 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Tennessee  
Vaccinated:2003-08-21
Onset:2003-08-21
   Days after vaccination:0
Submitted: 2003-08-25
   Days after onset:4
Entered: 2003-08-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1387AA / 4 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0169N / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492853 / 4 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Rash, Rash erythematous, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (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: Recurrent diarrhea, URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 1 hour after administration of injections, Mom presents back to clinic with child covered with red rash, small raised bumps and wheezing. Gave 01.cc 1/1000 epi SQ.


VAERS ID: 208321 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2003-07-28
Onset:2003-08-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2003-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA73AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W06252 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0013N / 1 LL / SC

Administered by: Private       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? 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: 9 days after varicella developed 3 x 3.5cm indurated erythematous skin reaction at site of immunization.


VAERS ID: 208325 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2003-08-06
Onset:2003-08-07
   Days after vaccination:1
Submitted: 2003-08-21
   Days after onset:14
Entered: 2003-08-26
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0179N / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 489468 / 1 LL / -

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

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

Write-up: Single, red vesicular lesions over left scapula which developed within 48 hours after administration of varivax. Consistent with varicella lesions. (approximately 10 total).


VAERS ID: 208348 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Massachusetts  
Vaccinated:2003-08-07
Onset:2003-08-18
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2003-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA805AB / 4 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0879M / 1 RA / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492588 / 4 LA / -

Administered by: Private       Purchased by: Unknown
Symptoms: Cyanosis, Erythema multiforme, Pyrexia, Rash, Rash papular
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad), 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? 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: Febrile illness on 8/14-resolved that day rash 8/18: multiple target lesions, some coalescing, some papular, many with central duskiness; no mucous membrane involvement: rash c/w erythema multimorme.


VAERS ID: 208351 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2000-06-29
Onset:2003-08-16
   Days after vaccination:1143
Submitted: 2003-08-19
   Days after onset:3
Entered: 2003-08-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 18035 / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Blister, Infection, Skin ulcer
SMQs:, Severe cutaneous adverse reactions (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: Otitis media
Preexisting Conditions: Febrile seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Varicella disease with lesions over body and extremities. Scabbed and vesicles.


VAERS ID: 208353 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Connecticut  
Vaccinated:2003-08-15
Onset:2003-08-17
   Days after vaccination:2
Submitted: 2003-08-19
   Days after onset:2
Entered: 2003-08-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 598A2 / 4 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0024N / 3 RL / IM

Administered by: Private       Purchased by: Other
Symptoms: Cellulitis, 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? 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 for 2 days with large area of redness on right thigh. Diagnosed as cellulitis. Treated with antibiotics, Augmentin ES.


VAERS ID: 208370 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: New York  
Vaccinated:2003-07-30
Onset:2003-08-08
   Days after vaccination:9
Submitted: 2003-08-26
   Days after onset:18
Entered: 2003-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0060N / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492819 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0196N / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Rash pruritic, Thrombocytopenic purpura
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: 7-10 days after vaccination patient developed multiple small purpuric lesions, concnentrated mostly on scalp and forehead but also scattered throughout body; no petechiae, no bleeding; referred to Hospital ER on 8/10/03 - CBC revealed plt count of 3K, normal smear; diagnosed with ITP (ideopathic thrombocytopenic purpura), given infusion of anti-D antibody(Rho-gam); repeat CBC 12 hrs later plts 23K, 5 days later (8/15) plts 173K


VAERS ID: 208431 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Arizona  
Vaccinated:2003-08-20
Onset:2003-08-22
   Days after vaccination:2
Submitted: 2003-08-26
   Days after onset:4
Entered: 2003-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 21895A2 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0030N / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 489479 / 3 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0550M / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Red, swollen arm~DTaP (Tripedia)~5~4.90~In Sibling|Red, swollen arm~Polio Virus, Inact. (Ipol)~4~4.90~In Sibling
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm, deltoid area, red, swollen and painful over about 50mmX60mm area. Mom reports more swelling yesterday, but decreasing in size today.


VAERS ID: 208399 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Vermont  
Vaccinated:2003-08-01
Onset:2003-08-15
   Days after vaccination:14
Submitted: 2003-08-20
   Days after onset:5
Entered: 2003-08-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0099N / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0198N / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Blister, Injection site abscess, Pruritus, Pyrexia, Rash macular, Rash papular, Skin ulcer, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), 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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: MMR #1 and Varicella #1 vaccines given 08/01/2003; 7 days later developed fever to 103.5, intermittently for 3 days which may have been associated with an otitis media. About 2 weeks after vaccines, vaccine site developed progressive welt which appeared pruritic, had some serosanguinons drainage and crusted. About 16 days after vaccines developed diffuse, predominantly maculopapular non-pruritic rash on trunk, arms, face with a few vessicles and crusted lesions.


VAERS ID: 208416 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Washington  
Vaccinated:2003-07-29
Onset:2003-08-10
   Days after vaccination:12
Submitted: 2003-08-15
   Days after onset:5
Entered: 2003-08-27
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA807AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0857M / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0502N / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Petechiae, Rash maculo-papular
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Amox
Current Illness: URI, OM
Preexisting Conditions: Hemoglobin C Trait
Allergies:
Diagnostic Lab Data: Normal CBC, Viral screen negative
CDC Split Type:

Write-up: Generalized macular-papular eruption beginning 08/10/2003. Petechiae on face beginning 08/10/2003


VAERS ID: 208417 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: California  
Vaccinated:2003-08-18
Onset:2003-08-19
   Days after vaccination:1
Submitted: 2003-08-19
   Days after onset:0
Entered: 2003-08-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1386AA / 4 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0740M / 3 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492585 / 4 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Feeling hot, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Redness, warmth, swelling approximately 18 hour post vaccine


VAERS ID: 208418 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Michigan  
Vaccinated:2003-05-15
Onset:2003-08-16
   Days after vaccination:93
Submitted: 2003-08-20
   Days after onset:4
Entered: 2003-08-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1180M / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492409 / 4 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1158M / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Herpes zoster, Infection
SMQs:, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Came in for 15 months check ups yesterday and had classic shingles in distribution on left side. No history of chicken pox disease or even similar rash. Had Varivax at age 1 year and 1 year.


VAERS ID: 208421 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Florida  
Vaccinated:2003-08-13
Onset:2003-08-13
   Days after vaccination:0
Submitted: 2003-08-14
   Days after onset:1
Entered: 2003-08-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0857DA / 4 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492851 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Feeling hot, Oedema, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling to right arm- shoulder to elbow,tender, red, hot to touch.


VAERS ID: 208423 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:2003-08-05
Onset:2003-08-06
   Days after vaccination:1
Submitted: 2003-08-07
   Days after onset:1
Entered: 2003-08-27
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1386AA / 4 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UA856AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W1156 / 3 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site induration, Pyrexia, Skin ulcer
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt presented with erythema about 5 hours after DTaP injection over left thigh. Lesion extended to 10 x 5cm, warmth indurated. Also with fever 102. Tx with IM/PO clindamycin for 48 hours.


VAERS ID: 208424 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2003-08-11
Onset:2003-08-19
   Days after vaccination:8
Submitted: 2003-08-20
   Days after onset:1
Entered: 2003-08-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1062M / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492513 / 4 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1083M / 1 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Appears to have varicella $g100 lesions (vesicles). Asymptomatic. No superinfection.


VAERS ID: 208434 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2003-08-11
Onset:2003-08-20
   Days after vaccination:9
Submitted: 2003-08-21
   Days after onset:1
Entered: 2003-08-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 592B9 / 4 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA839AA / 4 - / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0010 / 3 - / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0771M / 5 - / SC

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

Life Threatening? 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: UNK
Preexisting Conditions: Questionable developmental delay
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Fever 8/20 to 101F; then rash (diffuse, discrete, exanthem) on 8/21.


VAERS ID: 208441 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Indiana  
Vaccinated:2003-08-01
Onset:2003-08-08
   Days after vaccination:7
Submitted: 2003-08-21
   Days after onset:13
Entered: 2003-08-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1385AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1230M / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0762M / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Coordination abnormal, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Papules-bug bites
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Rash and fever onset 8 days after vaccines 08/01/2003. Macular rash on trunk. "Off balance"-ataxia at this time 08/10-resolved by 08/13. Fever resolved by the 14th.


VAERS ID: 208517 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Wisconsin  
Vaccinated:2003-08-26
Onset:2003-08-27
   Days after vaccination:1
Submitted: 2003-08-27
   Days after onset:0
Entered: 2003-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0996BA / 4 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: RED,WARM,HARD,SWOLLEN AT INJECTION SITE


VAERS ID: 208475 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: Georgia  
Vaccinated:2003-07-07
Onset:2003-07-07
   Days after vaccination:0
Submitted: 2003-07-15
   Days after onset:8
Entered: 2003-08-28
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491182 / 3 - / IM

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Crying, Feeling hot, Injection site erythema, Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? 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: GA03082

Write-up: Mom states child very ill that first night with higher temperature, crying, very irritable. Left leg at immunization site very red, warm to touch. Next AM mom called Dr, advised clinic visit. Dr gave antibiotics/warm soaks for leg but told mom "the shot was given in fat not muscle." 3 days later child seen in clinic here without any symptoms.


VAERS ID: 208476 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Georgia  
Vaccinated:2003-06-30
Onset:2003-07-04
   Days after vaccination:4
Submitted: 2003-07-17
   Days after onset:13
Entered: 2003-08-28
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W0703 / 3 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 490900 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0190N / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA03083

Write-up: 06/30/03 received injections; 07/04/03 small area of rash right ankle which resolved 07/06/03; 07/16/03 small area of raised red rash right buttock, mom relates no complaints from infant.


VAERS ID: 208496 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:2003-08-12
Onset:2003-08-13
   Days after vaccination:1
Submitted: 2003-08-22
   Days after onset:9
Entered: 2003-08-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 600A2 / 4 LL / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0069N / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492585 / 2 RL / -

Administered by: Private       Purchased by: Other
Symptoms: 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? No
Previous Vaccinations:
Other Medications:
Current Illness: Gastroenteritis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Cellulitis B thighs-recommended warm compresses-Keflex antibiotics.


VAERS ID: 208506 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: California  
Vaccinated:2003-08-14
Onset:2003-08-15
   Days after vaccination:1
Submitted: 2003-08-26
   Days after onset:11
Entered: 2003-08-28
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA835AA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0526M / 1 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492585 / 3 RA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0866M / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site oedema, Rash erythematous
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Local~Varicella (no brand name)~1~1.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Raised reddened area at injection site, observed 12 days after injection given. 08/26/03: .5 x .5 pink area-mom reports prior raised swollen.


VAERS ID: 208561 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Michigan  
Vaccinated:2003-08-26
Onset:2003-08-26
   Days after vaccination:0
Submitted: 2003-08-28
   Days after onset:2
Entered: 2003-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 RL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Difficulty in walking, Erythema, Feeling hot, Gait disturbance, Oedema, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? 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 had a fever of 101.2 He had trouble putting weight and walking on his right leg. His thigh was red and warm to the touch and very swollen(he was swollen from his upper thigh down to his knee)Called the Dr''s treatment was Motrin and cold washcloth.(8/26/03) Patient still has some redness and a lump in his upper right thigh.(8/28/03)


VAERS ID: 208529 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Connecticut  
Vaccinated:2003-08-26
Onset:2003-08-27
   Days after vaccination:1
Submitted: 2003-08-27
   Days after onset:0
Entered: 2003-08-29
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1001M / 2 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0325M / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? 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: Hives on face, neck, arms and legs. AM after vaccination. Recommended over the counter hydrocortisone cream and benadryl.


VAERS ID: 208531 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2003-08-15
Onset:2003-08-15
   Days after vaccination:0
Submitted: 2003-08-15
   Days after onset:0
Entered: 2003-08-29
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0969M / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492814 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0333N / 1 LL / SC

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

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: NC03103

Write-up: 6cm area of erythema and swelling approximately 5 cm at site of varicella. Benadryl/cool compreses, Tylenol prn.


VAERS ID: 208541 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Female  
Location: California  
Vaccinated:2003-08-20
Onset:2003-08-21
   Days after vaccination:1
Submitted: 2003-08-22
   Days after onset:1
Entered: 2003-08-29
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1245AA / 4 LL / IM

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

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

Write-up: About 24 hours after vaccine Mom noted swelling, more sore vax day, no fever. Pt reacts femoral hot, induration area lat. No streak.


VAERS ID: 208544 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Utah  
Vaccinated:1996-06-07
Onset:2003-08-22
   Days after vaccination:2632
Submitted: 2003-08-25
   Days after onset:3
Entered: 2003-08-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0102D / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1659B / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Infection
SMQs:

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

Write-up: Chicken pox rash confirmed.


VAERS ID: 208545 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Utah  
Vaccinated:1998-08-04
Onset:2003-08-22
   Days after vaccination:1844
Submitted: 2003-08-25
   Days after onset:3
Entered: 2003-08-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0625H / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0651H / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Infection
SMQs:

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

Write-up: Chicken pox rash confirmed.


VAERS ID: 208546 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Iowa  
Vaccinated:2003-08-08
Onset:2003-08-23
   Days after vaccination:15
Submitted: 2003-08-25
   Days after onset:2
Entered: 2003-08-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0366N / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492852 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0210N / 1 RL / SC

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

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: Pediacare, Tylenol
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt had fever for 2 days after vaccination (about 100 degrees). Then on 8/23/03 developed papule at Varivax vaccine site, itchy. Gradually increased in size. Now 1.3cm redness with central raised non-vesicular papule. Non-fluctuant.


VAERS ID: 208549 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: Indiana  
Vaccinated:2003-08-14
Onset:2003-08-24
   Days after vaccination:10
Submitted: 2003-08-25
   Days after onset:1
Entered: 2003-08-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0178N / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0336N / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Rash morbilliform
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? Yes
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: 10 days after MMR given, pt developed morbilliform rash over entire body. No fever, no other symptoms. (Rash has the appearance of measles).


VAERS ID: 208625 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Utah  
Vaccinated:2003-08-25
Onset:2003-08-28
   Days after vaccination:3
Submitted: 2003-08-29
   Days after onset:1
Entered: 2003-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (DITANRIX) / GLAXOSMITHKLINE BIOLOGICALS 596A2 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0270N / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0344N / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Oedema genital, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMOXICILLIN
Current Illness: EAR INFECTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: PHYSICAL EXAM
CDC Split Type:

Write-up: VARICELLA VAC. GIVEN 8-25-03. PT RETURNED 8-28-03 WITH RASH COVERING MOST OF HIS BODY,SWOLLEN TESTICLES AND "MARKED ERYTHEMA AT THE SITE. NO FEVER OR OTHER C/O NOTED. TREATMENT WITH ZITHROMAX 5MG. AND FLUIDS.


VAERS ID: 208596 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Georgia  
Vaccinated:2003-08-11
Onset:2003-08-20
   Days after vaccination:9
Submitted: 2003-08-25
   Days after onset:5
Entered: 2003-09-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0098N / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492852 / 4 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0335N / 1 LL / -

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

Life Threatening? 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: Polyvisol after Fc
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Fever and rash 9 days after immunization.


VAERS ID: 208601 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: California  
Vaccinated:2003-08-07
Onset:2003-08-15
   Days after vaccination:8
Submitted: 2003-08-21
   Days after onset:6
Entered: 2003-09-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA888AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0907 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0098N / 1 RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Face oedema, Oedema peripheral, Periorbital oedema, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Patient started getting a rash on face and ears that spread over entire body over a couple of days. His neck, eyes, between eyes, lips all swelled up on day 2 & 3 of reaction then legs and feet swelled up and legs turned purple.


VAERS ID: 208604 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: New Jersey  
Vaccinated:2003-08-13
Onset:2003-08-23
   Days after vaccination:10
Submitted: 2003-08-25
   Days after onset:2
Entered: 2003-09-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0286N / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1108M / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0974M / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Febrile convulsion, Laboratory test abnormal, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal tap, blood culture, urine culture
CDC Split Type:

Write-up: Patient had fever 1 week after vaccines. Patient then developed febrile seizure. Patient worked up for possible sepsis, sepsis exam normal except for elevated white count, blood, urine and CSF cultures were negative.


VAERS ID: 208615 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: New Jersey  
Vaccinated:2003-08-27
Onset:2003-08-27
   Days after vaccination:0
Submitted: 2003-08-29
   Days after onset:2
Entered: 2003-09-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1526AA / 4 LA / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284N / 3 RA / IM

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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fever, rash~Measles + Mumps + Rubella (no brand name)~1~1.00~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: DTaP given 8/27/03. Fever 101 degrees for 2 days starting several hours after administration. Positive erythema left deltoid at site of administration.


VAERS ID: 208616 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: California  
Vaccinated:2003-08-25
Onset:2003-08-27
   Days after vaccination:2
Submitted: 2003-08-29
   Days after onset:2
Entered: 2003-09-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U09997CA / 4 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0255N / 4 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0201M / 1 LL / -

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

Life Threatening? 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: Rash, fever


VAERS ID: 208747 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: New York  
Vaccinated:2003-08-26
Onset:2003-08-29
   Days after vaccination:3
Submitted: 2003-09-02
   Days after onset:4
Entered: 2003-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH UNKNOWN / 2 UN / SC
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER UNKNOWN / 1 UN / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Aphasia, Coma, Dyspnoea, Heart rate increased, Hypotonia, Pallor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (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: same as this report~Pneumo (Prevnar)~1~0.80~In Patient|''~Hep B (no brand name)~~0.80~In Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: benign heart murmur
Allergies:
Diagnostic Lab Data: Bloodwork, urine test; EEG is scheduled for 09/09/03, if that is inconclusive, our peds. want her to wear a holter monitor
CDC Split Type:

Write-up: 08/29/03 Three days after 2nd Prevnar and first Chicken Pox vaccination (08/26/03), child awoke in a dazed state and remained that way for 5 1/2 hours, her eyes were open, but she was unresponsive to any stimulus; she did not make any vocalization in those hours( very unusual for our baby), she was listless and her body was limp with a rapid heart beat, labored breathing and pallor of the skin- this same reaction happened at 9 mos. after first dose of prevnar- our doctors have dismissed the coincidence and have ordered further testing assuming that she had sustained a seizure- bloodwork and urine came back fine- no infections, no fever. She bounced back by the evening. When we initially called our Ped. 1 1/2 hours into the episode, right off the idea that this was vaccine related was dismissed as it did not occur in the normal 24-48 hours.


VAERS ID: 208654 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Texas  
Vaccinated:2003-07-24
Onset:2003-07-25
   Days after vaccination:1
Submitted: 2003-08-05
   Days after onset:11
Entered: 2003-09-03
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UA854AA / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1002M / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492389 / 3 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0593M / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia, Rash papular
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Papular skin rash with fever after immunized with MMR, Varivax, Hib for 1 year of age.


VAERS ID: 208666 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Texas  
Vaccinated:2003-07-25
Onset:2003-08-18
   Days after vaccination:24
Submitted: 2003-08-19
   Days after onset:1
Entered: 2003-09-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0987AA / 3 - / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 5384A2 / 3 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA830AB / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1001M / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1147M / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX03100

Write-up: Broke out with varicella disease.


VAERS ID: 208671 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Texas  
Vaccinated:2003-08-06
Onset:2003-08-13
   Days after vaccination:7
Submitted: 2003-08-18
   Days after onset:5
Entered: 2003-09-03
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0609M / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1150M / 1 RA / SC

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

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

Write-up: Extreme irritability low grade fever beginning about 7 days after MMR administered progressing to rash and worsening irritability and arthralgia. ER visit 08/17 dose due to irritibilaty both ne.


VAERS ID: 208681 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Missouri  
Vaccinated:2003-08-19
Onset:2003-08-26
   Days after vaccination:7
Submitted: 2003-08-29
   Days after onset:3
Entered: 2003-09-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0045N / 4 LL / -
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0030N / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 4 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0451M / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Infection
SMQs:

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

Write-up: Has varicella about 10 vesicles to each arm about 3 vesicles to face (rash began 7 days after receiving varivax).


VAERS ID: 208683 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: California  
Vaccinated:2003-08-25
Onset:2003-08-27
   Days after vaccination:2
Submitted: 2003-08-28
   Days after onset:1
Entered: 2003-09-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UB168AA / UNK LA / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W1233 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0134N / UNK RA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1154M / UNK RA / -

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

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

Write-up: The patient was vaccinated on 08/25/2003. 2 days after he presents rash on trunk and extremities. He received Benadryl 08/27/2003 and hydrocortisione cream.


VAERS ID: 208697 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Georgia  
Vaccinated:2003-08-11
Onset:2003-08-15
   Days after vaccination:4
Submitted: 2003-08-22
   Days after onset:7
Entered: 2003-09-03
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0325N / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? 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 upper left thigh, fever.


VAERS ID: 208704 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Texas  
Vaccinated:2001-06-08
Onset:2001-06-08
   Days after vaccination:0
Submitted: 2003-08-27
   Days after onset:810
Entered: 2003-09-03
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0311DA / 4 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 622363A / 4 RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T0485 / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0014L / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1139K / 1 LL / -

Administered by: Public       Purchased by: Other
Symptoms: Pruritus, 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:
CDC Split Type:

Write-up: 1 1/2 hours after vaccine given he got a rash all over body, itching, fever. Went to ER and was given liquid to drink and antibiotic to take at home. Once he received liquid, rash and fever went away gradually. Then no problems.


VAERS ID: 208707 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1999-04-13
Onset:2003-03-28
   Days after vaccination:1445
Submitted: 2003-08-26
   Days after onset:150
Entered: 2003-09-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1842H / 1 - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Meningitis aseptic, Mental impairment, Myasthenic syndrome, Pruritus, Rash papular
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Malignancy related conditions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF picture consistent with aseptic meningitis
CDC Split Type:

Write-up: 3/28/03 10 itchy papules that scabbed, associated altered mental status and seizures, varicella encephalitits and questionnable myasthenia gravis syndrome. CSF picture consistent with aseptic meningitis.


VAERS ID: 208711 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Missouri  
Vaccinated:2003-08-26
Onset:2003-08-27
   Days after vaccination:1
Submitted: 2003-09-02
   Days after onset:6
Entered: 2003-09-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1386AA / 4 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0367M / 3 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Left upper arm warm to touch with slight induration in center approximately 3cm wide. Diagnosed with cellulitis and prescribed Duricef 250/5 1 teaspoon BID for 7 days.


VAERS ID: 208714 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Missouri  
Vaccinated:2003-08-26
Onset:2003-08-27
   Days after vaccination:1
Submitted: 2003-09-02
   Days after onset:6
Entered: 2003-09-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 21895A2 / 1 LA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA803AA / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0030N / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0325N / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Jaundice, Pyrexia
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (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: On 8/26/03, patient received Pediarix, HIB, MMR, and Varicella at approximately 10 AM. The next morning he woke up with fever of 194 rectally. Had fever that day and was given Tylenol and Pedialyte. Fever broke that night. On 8/29/03 patient started turning yellow and is still jaundiced today.


VAERS ID: 208728 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Massachusetts  
Vaccinated:2003-07-16
Onset:2003-07-16
   Days after vaccination:0
Submitted: 2003-07-23
   Days after onset:7
Entered: 2003-09-03
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 489750 / 4 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Dysphagia, Face oedema, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: RAST testing done today.
CDC Split Type:

Write-up: 2-3 hours after PCV 7 vaccine, pt had swelling of lips, rash on face, apparent difficulty swallowing. No respiratory compromise. This event was immediately preceded by eating peanut butter. Treated with prednisolane and Benadryl.


VAERS ID: 208730 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Indiana  
Vaccinated:2003-04-30
Onset:2003-05-07
   Days after vaccination:7
Submitted: 2003-07-23
   Days after onset:77
Entered: 2003-09-03
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0878M / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0797M / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Lethargy, Pyrexia, Rash, Roseola
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 week after MMR and Varicella pt got roseola rash covered entire body. Fever was 103 degrees. Mother reports child was better in 3-5 days. Did not appear to be in any discomfort from the rash. She was lethargic from fever.


VAERS ID: 208740 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Male  
Location: Maine  
Vaccinated:2003-08-26
Onset:2003-08-28
   Days after vaccination:2
Submitted: 2003-09-01
   Days after onset:4
Entered: 2003-09-03
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0857DA / 4 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492854 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0224M / 1 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Muscle rigidity, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Umbilical hernia
Allergies:
Diagnostic Lab Data: CRP: 1.5; NORMAL ELECTROLYTES, CBC: NORMAL
CDC Split Type:

Write-up: Shaking and had clenching, muscular rigidity of extremities, looking "out of it" for 30 min.


VAERS ID: 208749 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Idaho  
Vaccinated:2003-08-18
Onset:2003-08-28
   Days after vaccination:10
Submitted: 2003-09-02
   Days after onset:5
Entered: 2003-09-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0237N / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0204N / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Rash papular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: resolving mild gastroenteritis
Preexisting Conditions: NKDA, routine colds and illness but no medical conditions, no recent illness except as in question 18
Allergies:
Diagnostic Lab Data: I considered culturing the papule for varicella but could find nothing to de-roof.
CDC Split Type:

Write-up: 10 days from vaccine administration pt developed small papule with surrounding erythema at site of vaccine administration. Papule is dark, ~7mm in diameter, raised ~ 3mm rough, non-tender, non-fluctuant, ? mildly vescicular (but no clear areas noted for de-roofing, etc.), surrounded by silver-dollar sized area of normal temperature erythema and induration mildly tender to touch and non-fluctuant. I took pictures with a digital camera.


VAERS ID: 208846 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Illinois  
Vaccinated:2003-08-07
Onset:2003-08-09
   Days after vaccination:2
Submitted: 2003-09-03
   Days after onset:25
Entered: 2003-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 574A2 / 4 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA825AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0625 / 3 RL / IM

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

Write-up: Mother noted hives on trunk of body (chest, abd., back) when child awoke on August 9th. A few hives were noted on the neck and face. The doctor felt the child did not need an appt. for an examination. Resolving hives noted by writer on August 11th. Denies changes in food or laundry soaps or environment.


VAERS ID: 208757 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Maine  
Vaccinated:2003-08-12
Onset:2003-08-23
   Days after vaccination:11
Submitted: 2003-08-28
   Days after onset:5
Entered: 2003-09-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1080M / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0198N / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Laboratory test abnormal, 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC 6,000 H/H 12.6/37.5 Ptts 252, Na 133 K 4.2 CiId Co221 Glucose Bun 20 Cr 0.4 Ca 4.6 Ma 2.6 Phosh 4.7 U/A neg
CDC Split Type:

Write-up: Brief seizures x 2 associated with fever on 08/23/2003. Observed overnight in hospital. No complications associated with febrile seizures.


VAERS ID: 208768 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Alabama  
Vaccinated:2003-09-03
Onset:2003-09-03
   Days after vaccination:0
Submitted: 2003-09-03
   Days after onset:0
Entered: 2003-09-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W0907 / 4 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0434M / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1066M / 1 RA / SC

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: redness~Measles + Mumps (MM-Vax)~1~1.00~In Patient
Other Medications: PPD-Parkdale-00242P, left forearm
Current Illness: NONE
Preexisting Conditions: 30 week premature twins
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm: 4x4cm red circle area, white 2x2 cm, whelped area in center. Right arm: 2cm red area at injection site.


VAERS ID: 208769 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Alabama  
Vaccinated:2003-09-03
Onset:2003-09-03
   Days after vaccination:0
Submitted: 2003-09-03
   Days after onset:0
Entered: 2003-09-04
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W0907 / 4 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0434M / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1066M / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~Measles + Mumps (MM-Vax)~1~1.00~In Sibling
Other Medications: PPD-Parkdale-00242P-left forearm
Current Illness: NONE
Preexisting Conditions: 30 week premature twins
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm: 5x5cm red circle with whelp 2 cm x 4cm center. Right arm 2x2cm red circle area with 1cm knot middle.


VAERS ID: 208775 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Illinois  
Vaccinated:2003-08-23
Onset:2003-08-23
   Days after vaccination:0
Submitted: 2003-08-27
   Days after onset:4
Entered: 2003-09-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491582 / 4 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0329N / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Flushing, Heart rate increased, Respiratory rate increased, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: Tricuspid atresia, hypoplastic right ventricle, VSD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Approx 15 minutes after administration, pt returned to office. Child crying, flushed, urticaria all over body, increased heart rate and respiratory rate, no wheezing. Benadryl 0.4ml (20mg) administered deep IM. Urticaria then improved, child alert, not crying, playing. No SOB or wheezing. Symptoms to watch for discussed with mother.


VAERS ID: 208780 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Illinois  
Vaccinated:2003-06-19
Onset:2003-06-21
   Days after vaccination:2
Submitted: 2003-08-07
   Days after onset:47
Entered: 2003-09-04
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492395 / 1 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Erythema, 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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Erythematous, blanching papular rash along dermatone left arm; non-pruritic.


VAERS ID: 208783 (history)  
Form: Version 1.0  
Age: 1.49  
Sex: Female  
Location: Unknown  
Vaccinated:2003-08-14
Onset:2003-08-20
   Days after vaccination:6
Submitted: 2003-08-26
   Days after onset:6
Entered: 2003-09-04
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 592B9 / 4 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0340N / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1201M / 1 RL / SC

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

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

Write-up: 8/20/03 Mom noticed rash beginning on abdomen, fever 100.4 noted then and has continued. Rash spread to chest, neck, face and extremities. Mom given Tylenol every 4 hours. on 8/25 at 2AM, mom report baby crying out - irritable. Mom questioned ear infection.


VAERS ID: 208789 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Ohio  
Vaccinated:2003-08-27
Onset:2003-08-28
   Days after vaccination:1
Submitted: 2003-08-29
   Days after onset:1
Entered: 2003-09-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0857DA / 4 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA834AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0101N / UNK LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492815 / 3 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Gait disturbance, Pyrexia, Skin discolouration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever for 4 days, swelling discoloration of left thigh. Gait favoring left leg.


VAERS ID: 208790 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: New York  
Vaccinated:2003-08-20
Onset:2003-08-27
   Days after vaccination:7
Submitted: 2003-08-27
   Days after onset:0
Entered: 2003-09-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR U1006BA / 4 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0202N / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Rash papular
SMQs:, Lack of efficacy/effect (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: NONE
CDC Split Type:

Write-up: Varivax 8/20/03. 8/27/03 Presented with 3 papules on forehead and 2 on posterior right calf.


VAERS ID: 208796 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Michigan  
Vaccinated:2003-06-05
Onset:2003-07-05
   Days after vaccination:30
Submitted: 2003-08-26
   Days after onset:52
Entered: 2003-09-04
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 565A9 / 4 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491186 / 3 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Muscle atrophy
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: Lat atrophy at site of injection into right thigh expanding steadily 2 months post immunization.


VAERS ID: 208803 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: Illinois  
Vaccinated:2003-08-08
Onset:2003-08-10
   Days after vaccination:2
Submitted: 2003-08-23
   Days after onset:13
Entered: 2003-09-04
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1039M / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: CBC WNL; CXR WNL
CDC Split Type:

Write-up: Fever


VAERS ID: 208815 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: California  
Vaccinated:2003-08-22
Onset:2003-08-22
   Days after vaccination:0
Submitted: 2003-08-28
   Days after onset:6
Entered: 2003-09-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA858AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0206M / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Rash erythematous, Rash maculo-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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Papular Aerodermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Awaiting allergy testing to egg protein.
CDC Split Type:

Write-up: Patient''s mother described the appearance of welts on his back, chest, and legs within two hours of his vaccination. Evaluated him in my office approximately 8 hours after vaicination. He had discrete, fading erythematous macules on his trunk at the time. They had spontaneously resolved within 24 hours.


VAERS ID: 208816 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: California  
Vaccinated:2003-08-22
Onset:2003-08-22
   Days after vaccination:0
Submitted: 2003-08-28
   Days after onset:6
Entered: 2003-09-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1232M / 1 LA / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492822 / 4 RA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0866M / 1 RA / -

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Erythema and induration after MMR injection immediately. Relieved by Benadryl.


VAERS ID: 208821 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Texas  
Vaccinated:2003-08-25
Onset:2003-08-26
   Days after vaccination:1
Submitted: 2003-08-27
   Days after onset:1
Entered: 2003-09-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0876M / 3 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493260 / 2 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Feeling hot, 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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Erythema and induration left thigh, 3 x 3, minimal tenderness. Fussy, warm to touch. Tylenol and Motrin given. Started within 24 hours after shots (PCV and MMR). Still having symptoms as of 8/27/03.


VAERS ID: 208825 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Ohio  
Vaccinated:2003-08-26
Onset:2003-08-27
   Days after vaccination:1
Submitted: 2003-08-27
   Days after onset:0
Entered: 2003-09-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0849CA / 4 RL / -
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UA765AA / 3 LL / -

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

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: Right upper thigh area about 4cm diameter edematous, red reaction warm to touch. Tx: Benadryl and ice and observe.


VAERS ID: 208831 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Washington  
Vaccinated:2003-08-25
Onset:2003-08-26
   Days after vaccination:1
Submitted: 2003-08-27
   Days after onset:1
Entered: 2003-09-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 594A2 / UNK LL / IM

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

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

Write-up: Localized redness, swelling and warmth around area where vaccine administered. One day after vaccine given.


VAERS ID: 208885 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Delaware  
Vaccinated:2001-06-13
Onset:2002-08-31
   Days after vaccination:444
Submitted: 2003-09-04
   Days after onset:369
Entered: 2003-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO371AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA563AC / 1 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Antisocial behaviour, Autism, Difficulty in walking, Speech disorder
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow), 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: Preliminary examination by Dr., suggest 50 times the EPA limits on mercury were administered through DTAP & Hib vaccinations administered to Arpit in 2001 (ref: Physician''s Desk Reference).
CDC Split Type:

Write-up: Behavioral problems resembling Autism spectrum, namely repetitive activities, lack of social skills, speech delay, toe walking, hand flapping. Problems persisting despite speech & occupational therapies (some improvement in speech noticed). Currently, planning to treat through dietary intervention & chelation.


VAERS ID: 208863 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Maryland  
Vaccinated:2003-08-26
Onset:2003-08-27
   Days after vaccination:1
Submitted: 2003-09-02
   Days after onset:6
Entered: 2003-09-05
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1387AA / 4 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0330N / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Feeling hot, Injection site erythema, Injection site haemorrhage, Injection site induration, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Protopic
Current Illness: Eczema
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Pt developed fever 100.7 at home (despite antipyretics) and about 8 x 7cm erythematous to ecchymotic warm, tender, indurated area around injection site.


VAERS ID: 208873 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Texas  
Vaccinated:2003-09-02
Onset:2003-09-02
   Days after vaccination:0
Submitted: 2003-09-03
   Days after onset:1
Entered: 2003-09-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0760M / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Application site reaction
SMQs:

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

Write-up: Local reaction to injection sites with whelps 2-3 minutes after injection given.


VAERS ID: 208880 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Connecticut  
Vaccinated:2003-08-29
Onset:2003-08-30
   Days after vaccination:1
Submitted: 2003-09-05
   Days after onset:6
Entered: 2003-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 616A2 / 4 LA / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W1002 / 3 RA / -

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

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: Reddness, pain and swelling of left arm. Elbow-shoulder hot to touch. 6-8 cm in diameter. (I) (^) warm soaks, augmentin 600/5 1/2 tsp three times a day for 10 days.


VAERS ID: 208925 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: California  
Vaccinated:2003-09-02
Onset:2003-09-03
   Days after vaccination:1
Submitted: 2003-09-05
   Days after onset:2
Entered: 2003-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0327N / 1 RA / SC

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

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

Write-up: left upper extremity with diffuse erythema and swelling (approximately 6x6 cm), no induration, non-tender, no vesicles/pustules/mass


VAERS ID: 208932 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: Texas  
Vaccinated:2003-09-03
Onset:2003-09-03
   Days after vaccination:0
Submitted: 2003-09-05
   Days after onset:2
Entered: 2003-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0997CA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR W1002 / 3 RL / SC

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

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

Write-up: 4 by 4 erythema on left upper thigh


VAERS ID: 208934 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Texas  
Vaccinated:2003-08-12
Onset:2003-08-18
   Days after vaccination:6
Submitted: 2003-09-06
   Days after onset:19
Entered: 2003-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0283N / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1178M / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1147M / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Seven days after patient received VZV, Comvax, and MMR vaccines, patient developed 20-30 lesions on the abdomen consistent with varicella lesions. Patient did not require hospitalization. She did require a doctor visit and supportive therapy.


VAERS ID: 208909 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Iowa  
Vaccinated:2003-08-18
Onset:2003-08-20
   Days after vaccination:2
Submitted: 2003-08-20
   Days after onset:0
Entered: 2003-09-08
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0012N / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0945M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491567 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0204W / 1 LL / SC

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

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
Current Illness: Teething
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left thigh, area approx size of 50 cent piece, slightly swollen and red. No pain noted. Appeared 2nd day after injections. Instructed mother to contact family physician. 8/29/03 TC to mother, red area almost gone the next day (8/21/03). Did see Dr and no treatment.


VAERS ID: 208911 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: California  
Vaccinated:2003-08-19
Onset:2003-08-20
   Days after vaccination:1
Submitted: 2003-08-21
   Days after onset:1
Entered: 2003-09-08
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1008M / UNK RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492397 / UNK LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0019N / UNK RL / -

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? 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: NONE
CDC Split Type:

Write-up: Received vaccines 8/19. 8/20 Mom noted redness. 8/21 Seen by MD with 5 x 7 erythema, induration LAT.


VAERS ID: 208920 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:2003-09-03
Onset:2003-09-04
   Days after vaccination:1
Submitted: 2003-09-05
   Days after onset:1
Entered: 2003-09-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492822 / 3 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Injection site induration, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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: Redness, swelling and induration


VAERS ID: 208945 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2003-08-29
Onset:2003-09-02
   Days after vaccination:4
Submitted: 2003-09-03
   Days after onset:1
Entered: 2003-09-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 1127M / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1068M / 1 LL / SC

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

Write-up: Fever 102-103, urticaria rash.


VAERS ID: 208962 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Colorado  
Vaccinated:2003-08-29
Onset:2003-08-30
   Days after vaccination:1
Submitted: 2003-09-02
   Days after onset:3
Entered: 2003-09-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1387AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W1156 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0393N / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493274 / 3 LL / IM

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

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

Write-up: Pt was administered on R th IM upper-DTaP .5cc, lower-IPV IM .5cc on 8/29/03. Was seen at urgent care for redness, 3 in diameter on R upper th- called our office for f/u on 9/2/03. Site is cleared up. Immunization reaction.


VAERS ID: 208965 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Female  
Location: Indiana  
Vaccinated:2003-08-21
Onset:2003-09-02
   Days after vaccination:12
Submitted: 2003-09-03
   Days after onset:1
Entered: 2003-09-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR UA775AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0179N / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493244 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0202N / 1 RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Dermatitis bullous, Rash maculo-papular
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Seen for insect bites
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 year old female, got MMR, varicella vaccine, Hib, PCV on 8/21/03. One week later developed generalized maculo papular-vesicular rash (varicella like) and fever; tx Benadryl and observation.


VAERS ID: 208981 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Michigan  
Vaccinated:2003-07-15
Onset:2003-07-15
   Days after vaccination:0
Submitted: 2003-07-15
   Days after onset:0
Entered: 2003-09-09
   Days after submission:56
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U0852CA / 3 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0722M / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W06262 / 3 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0876M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491785 / 3 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Crying, Erythema, Urticaria
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: DTAP, HIB, IPV, PCV7 Given at other sites
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI2003039

Write-up: Approximately 15 minutes post immunization, wheal approximately 2.5 cm just above MMR injection site with erythema extending 10 cm around area. Ice applied .25ml Benadryl given IM above site. Wheal subsided in 15 min post Benadryl. Erythema diminished also evaluated by EMT. Mom refused transport child doing well when left clinic. Crying throughout. No respiratory distress.


VAERS ID: 208985 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2003-04-09
Onset:2003-07-20
   Days after vaccination:102
Submitted: 2003-09-02
   Days after onset:44
Entered: 2003-09-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0599M / UNK - / SC

Administered by: Public       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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: PCR-Vaccine strain VZV CDC
CDC Split Type:

Write-up: Rash C4-C8 deimatomes vesicular patch g 1-3 inches.


VAERS ID: 208992 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2003-08-23
Onset:2003-08-31
   Days after vaccination:8
Submitted: 2003-09-08
   Days after onset:8
Entered: 2003-09-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0271N / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0472N / 1 LA / SC

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

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

Write-up: Localized rash at injection site starting on 08/31/2003. 10mm x 5mm. Temperature 102 degrees on 08/31/2003. Afebrile since.


VAERS ID: 208996 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2003-09-03
Onset:2003-09-04
   Days after vaccination:1
Submitted: 2003-09-08
   Days after onset:4
Entered: 2003-09-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492847 / 4 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1065M / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Parents had GI viral illness
Preexisting Conditions: Loud innocent, heart murmur, allergic colitis, on milk and soy based formula.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Temperature 101.0 (rectal); Vomiting and diarrhea; Spotty rash on torso, cheek; decreased appetite.


VAERS ID: 209108 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Virginia  
Vaccinated:2003-08-26
Onset:2003-08-26
   Days after vaccination:0
Submitted: 2003-09-09
   Days after onset:14
Entered: 2003-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH UNKNOWN / 2 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Cough, Epistaxis, Irritability, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none, our doctor did not take this seriously
CDC Split Type:

Write-up: Vaccine was administered before lunch. By late that afternoon pt had a fever of 102.5 and a bloody nose. That turned into a runny nose that lasted for 12 days. He also had a congested cough that was presnt primarily when he slept, and is still present. He was very fussy, irritable, clingy, NOT like himself, for 2 weeks following the vaccine. He also lost his appetite and ate very little, prefering instead to nurse.


VAERS ID: 209019 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: Ohio  
Vaccinated:2002-08-21
Onset:2002-08-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2003-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR U11428 / 3 - / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1484L / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CAT head; LP serologic tests for ECHO were negative.
CDC Split Type:

Write-up: Received IPV, MMR on 8/21/02 and had seizure 8/28/02. Was not initially aware of vaccination but should have reported this earlier. Had 1 day hospitalized and all work ups were negative. Fever of 102 deg-103 deg noted at time of seizure.


VAERS ID: 209022 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Georgia  
Vaccinated:2003-08-06
Onset:2003-08-16
   Days after vaccination:10
Submitted: 2003-08-28
   Days after onset:12
Entered: 2003-09-10
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0585M / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0816 / 3 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130N / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492854 / 2 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Otitis media, Petechiae, Pyrexia, Sepsis, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Left otitis media; URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/18/03 Office visit for fever 101-103, petechiae on legs and arms for 2 days. BOM persistent from 8/6/03 and diagnosed with thrombocytopenia (cath UA, CX, CBC/Blood CX, LP and CX. Rocephin 1gm IM). Admitted to hospital. Office recheck from hospital discharge on 8/21/03. Diagnosis - sepsis, OM, thrombocytopenia. Prescribed Omnicef. Office recheck 8/28/03 ITP 2 hours to MMR. 60-day follow up on 11/21/2003: "Vaccine recipient did recover from adverse events that were reported for this vaccination. Seen 09/04/2003 follow up: ITP resolving. Seen 09/10/2003 Diagnosis with upper respiratory and doing well." The hospital d/c records received on 1/23/04 confirms diagnosis of fever and thrombocytopenia.


VAERS ID: 209028 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Georgia  
Vaccinated:2003-08-26
Onset:2003-08-26
   Days after vaccination:0
Submitted: 2003-08-28
   Days after onset:2
Entered: 2003-09-10
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1237M / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 492854 / 3 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195N / 1 RL / -

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

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: Allergic rhinitis, eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed elevated temperature-fever. Received vaccines about 11:15 AM 08/26/03. Temperature elevated to approx. 99 degrees F upon awakening from nap about 10:30 PM and increased to 101+ by 3:00 AM, 8/27/03. T max 102.6 ax. Seen 8/27/03 hospital in AM and in office in PM. Treated with Children''s Tylenol and Motrin, topical cool compresses only. Fever decreasing by exam.


VAERS ID: 209029 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2003-08-25
Onset:2003-09-04
   Days after vaccination:10
Submitted: 2003-09-05
   Days after onset:1
Entered: 2003-09-10
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0138N / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0074N / 1 RL / IM

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

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

Write-up: 2 weeks after MMR developed erythematous blanching 2-3cm circular to red rash all over face, neck, spread to chest, arm/back/legs. Associated with itch, does not look like hives, raised papular, all lesions look the same (were not like chickenpox). No fever, no conjunctivitus. Benadyrl PM.


VAERS ID: 209058 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Male  
Location: Florida  
Vaccinated:2003-08-21
Onset:2003-08-29
   Days after vaccination:8
Submitted: 2003-09-02
   Days after onset:4
Entered: 2003-09-10
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 61092 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0488M / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), 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: RAD, seasonal allergies, premature at 25 wks
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, swelling to R thigh began 8/29/03 (1 1/2cm x 4cm) fever (101-102 deg F) began 8/29/03; relieved by Tylenol.


VAERS ID: 209074 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Female  
Location: Ohio  
Vaccinated:2003-08-25
Onset:2003-08-29
   Days after vaccination:4
Submitted: 2003-09-03
   Days after onset:5
Entered: 2003-09-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1281AA / 4 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA839AA / 4 LL / IM

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? 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: Mom called 8/29/03, reported that pt had red areas on her thighs. R leg approx 2 1/2", L leg approx 1". Pt had temp 99 deg.


VAERS ID: 209076 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Washington  
Vaccinated:2002-09-03
Onset:2002-09-03
   Days after vaccination:0
Submitted: 2003-09-04
   Days after onset:366
Entered: 2003-09-10
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 594A2 / 4 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, 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? 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: Redness and swelling at ihnjection site with rash.


VA